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last cases were of a malarial remittent type, and were kept in a separate
ward. Bacteriological evidence confirmed the diagnosis, and both ended
fatally.
A reference to the table will show the fallacy of depending on the
appearance of so-called characteristic buboes in this disease and the use of
the term "Bubonic Fever" to be a misnomer. All cases without buboes
-other than primary pneumonias-were shown by examination post
mortem, or by bacteriological test to be Plague, wherever an opportunity to
do so could be got. The majority of buboes left to take a natural course
subsided without suppurating. In only 7 per cent. of acute bubonic
cases, in which no irritant application had been used, and to which
sedative liniments or ointments had been applied, did suppuration
ensue, whilst, as was generally the case when such irritants had been
used, suppuration was the rule. Patients liked to busy themselves with
treatment of the local expression of the disease, and poultices, marking
nut, iodine, or nitrate of silver were very constantly used.
Many observers think that the vis medicatrix natur in plague is by
suppuration of the inflamed gland; but nature's trend in this disease is
to place the patient on the burning ghat. It is overlooked that at
least 60 per cent. of plague patients died before there has been time for
suppuration, and how many died before reaching hospital, struck down
suddenly, no one can estimate. No doubt, if the patient survives long
enough, suppuration may occur, especially when poultices or irritants
have been used. It would appear that such conclusions as that sup-
puration is beneficial, result from a study of virtually selected cases;
and the safer and juster conclusion is that, because the patient has
survived long enough, his bubo has suppurated, and not that because
of the suppuration he has recovered.
In some instances patients with buboes were sent into hospital who were
proved by bacteriological methods not to have Plague. Two instances
of sympathetic buboes due to ulcer of the leg were of such a nature, and
one case of syphilis; none of which on puncture and cultivation of the
contents of the inflamed glands gave any characteristic growth.
As regards treatment of buboes, an emollient sedative application,
such as glycerine and belladona, is generally useful. Poulticing and
incisions were not practised, but in patients received from other hospitals
ample opportunity was afforded for studying the results of such modes
of treatment as seemed to delay convalescence considerably and lead
to anmia and debility. Excision of the bubo was entertained, but not
considered prudent. To promote absorption equal parts of creosote and
glycerine seemed the best application.
This was rubbed in on alternate days, in one drachm at a time in
some cases, and generally with good effect. Iodine was of no use in
procuring absorption. An ointment of oleate of mercury (10 per cent.)
gave satisfactory results in hastening the absorption of the buboes.