I. Hygienic.—The patient should take to bed immediately on the appearance of the first symptoms. The room should have means for free ventilation, and the temperature in it should be between 60° to 70° F. The air of the room may be cooled by a block of ice. The room should be kept clean, and there must not be in it any curtain, carpet or hangings. The floor and bedsteads should be daily washed with a disinfectant solution. A position of absolute rest in bed is to be maintained throughout the illness.

Bedpan and urinal should be always used. Bedclothes should be light and warm. Wearing apparel if saturated with perspiration should be changed. It is best to have two beds side by side so as to be able to move the patient easily from one to another for cleansing purposes. Mattresses should be suitably protected from penetration by the discharges. The air of the sickroom can be made antiseptic by placing pieces of blotting paper saturated with eucalyptus oil or phenol on plates about the apartment or by pouring carbolic acid on hot water in a plate. The doorways should be curtained by a sheet wet with disinfectant solution. Great cleanliness of the body of the patient should be enforced by cold sponging with an antiseptic solution. Skilful nursing is essentially necessary. The motions should be disinfected by strong antiseptics such as quicklime, carbolic acid, &c., as soon as they are passed.

II. Dietetic.—From the commencement of the disease the diet should be liquid and nourishing. Milk is best. The quantity for adults should not be less than three or four pints in the twenty-four hours. It must be given in small quantities at short intervals. Soda, potash or plain carbonated water may be mixed with it. Barley water and thin sago water may also be given. If the patient’s vital powers are low, the milk may be peptonised by using Fairchild’s powders or by adding a little of Benger’s Liquor Pancreatices. In cases when milk cannot be taken in sufficient amount, animal food may be given in the form of plain meat broth. Egg-flip with or without brandy may also be given. It is useless to give strong meat essences when the digestive powers are seriously impaired, and excess of zeal in this direction does a great deal of harm. These accumulate in the intestinal canal and form a fermenting mixture in which poisonous ptomaines form. Throughout the attack the patient’s strength should be husbanded as carefully as possible. When there is thirst, water, or iced water, or iced beer or stout, or ice-cream, or fruit sherbat should be given. During convalescence great care should be taken of diet, for then the vital powers are at a very low ebb.

III. External.—In order to lower the temperature rubbing of the skin with oil from the commencement of the disease has been recommended, but this procedure is, I think, of no use. I suggest, however, that when temperature is high 15 drops of Creosote may be rubbed near the axilla. During height of fever, the body may be lightly sponged all over, twice or thrice a day, with the following solution:—

Mustard plasters to limbs and over the heart should be given when there are signs of failing heart and circulation, and over the epigastrium when there is vomiting or hiccough. Smelling salts and strong ammonia should be applied to the nostrils for their restorative action. Blister over the nape of the neck is useful when cerebral symptoms are present. Ice caps over the head is very useful and should be applied continuously. The enlarged glands may be fomented with hot water or spongio-piline wrung out of hot antiseptic solution. When they are much painful, poppy or belladonna may be added to the water. Belladonna with glycerine should be applied in the beginning and iodine afterwards. Hot corrosive sublimate fomentations are also useful. If the glands suppurate, they should be opened aseptically and dressed with antiseptics. Proper drainage should be provided.

IV. Internal.—Knowing as we do that the plague is due to the toxic products metabolized by a pathogenic bacillus, the question comes—would an antiseptic treatment be of any use? Can we by any means induce an antiseptic action on the blood, or have we any drug which can act as antitoxin? It must be at once stated that no drug that has been tried yet fulfils the above conditions. The claims of quinine, however, should be taken into account. This drug in small repeated doses acts as a general antiseptic. I would, therefore, advocate its use especially in the early stages. Plague is a disease in which collapse sets in early and cardiac asthenia is a very early complication. There is, therefore, great urgency for early stimulation. Alcohol may be given freely, but at the same time it must be remembered that if the organs of elimination are not acting properly, alcohol may do harm. For their stimulant effects whiskey or iced champagne may be given. Carbonate of ammonia or spirit ammonia aromatic are held to be very useful stimulants in plague cases. They may be given in combination with cinchona, digitalis and ether. A prescription like the following may be useful:—