TREATMENT. — The treatment of the disease is symptomatic. Quinine has been used as a prophylactic, but, accord ing to Osier, on insufficient grounds. Salines, refrigerants, and hydrotherapy (cold pack or bath) may be employed against the fever. The headache and arthritic pains may sometimes be relieved by local applications and the use of the salicylates, phenacetin, or acetanilid; more often opium in some form is re quired. Later, when convalescence is established and the arthritic pains per sist, great relief may follow the use of the iodides; quinine and other tonics are in dicated throughout the period of con valescence.
Beyond general hygienic measures, such as rest in bed, a fluid diet, mild aperients, etc., there appears to be but little in the treatment of dengue. Ex posure greatly increases the severity of the pains. All exertion, both physical and mental, is to be avoided.
Antipyrine relieves the headache in a remarkable manner, and also the other pains in a lesser degree. Antifebrin, phenacetin, and antikamnia act similarly, though more feebly. It is advisable to avoid large doses of antipyrine; for adults, 10 grains may be given whenever the symptoms are severe, but never more frequently than once in eight hours. The drug, however, should be avoided late on the fourth day, as if given shortly before the ci isis collapse might thereby be in creased. Sulphonal has seemed to act well as an hypnotic.
Morphine subcutaneously is at times demanded by the severity of the pains, but it is apt to be followed by an ex acerbation of the gastric symptoms.
For the retching and vomiting, which is so constant a symptom on the fourth and fifth days, nothing has been found effectual except emetics of warm water. The patient is directed to swallow rap idly a pint or more of warm water. This is immediately returned and the pro cedure repeated once or twice.
It is of the greatest importance to warn parents of the possibility of collapse, and to instruct them carefully in the manage ment of this condition before it arises. It almost always occurs at the same period of the disease, viz.: about the end of the fourth day or the beginning of the fifth. The child should then be con stantly watched, not being left for an in stant, and the proper remedial measures taken on the first suspicion of a change. Hot stimulants are to be given by the mouth if possible, otherwise by the rec tum, with beef-tea; external heat in all forms; mustard to the priecordia; hypo dermic injections of strychnine and ether have generally been used. Wet packs or the bath have been tried in the hyper pyrexia which follows, but without bene fit. F. E. Hare (Australasian Med. Gaz., Mar. 21, 'OS).
Mountain-fever. — Osler observes that several distinct diseases have been de scribed as mountain-fever: antemia, associated with anehylostoma, not yet met with in this country; certain cases of a fever occurring in mountainous regions of the Western States, which have been shown to be unmistakably typhoid fever, through the careful observations of Hoff, Smart, Woodruff, and Raymond. not only from the clinical features, but the Widal reaction as well. It would be
well, says Osler, for the use of the term mountain-fever to be discontinued.
Mountain-fever is merely an atypical form of typhoid fever. The disease is characterized by malaise, headache, chill, and pains in the muscles and back. The tongue is coated, there is loss of appetite, and constipation. The characteristic roseolar eruption is frequently present, and there is often gurgling in the right iliac fossa. The temperature is that characteristic of typhoid fever, but occa sionally there are irregularities during the convalescent stage. The pulse is usually rapid, dicrotic, and occasionally intermittent. Intestinal Inemorrhage is exceedingly rare. Stuver (Med. News, Nov. 4, '09).
Cavite fever, according to B. L. Wright (Phila. Med. Jour., Feb. 9, 1901), is an acute infectious disease, characterized by an abrupt onset, high temperature, severe muscular pain, and extremely tender and painful eyeballs. The predisposing causes are high tem peratures: low. damp localities; over crowding; and, possibly, the close prox imity of salt-water. The period of in cubation is two days to two weeks. The disease is of sudden onset, usually com mencing with a slight chill; in a few hours the temperature rises to 104° or 10,5° F., and may even reach 107° F.
The face is flushed: the eyes injected, extremely painful, and tender; the skin burning hot; the pulse full, strong, and rapid; the respiration accelerated, and the mind frequently delirious; the pa tient extremely prostrated.
Nausea and vomiting are usually pres ent, the bowels constipated, and the urine scanty and high colored. Head ache and muscular pain are severe; the latter usually located in the muscles of the back and legs, but occasionally in those of the arms and shoulders. The temperature usually continues high for from three to five days, when it falls by crisis; the muscular pain may or may not cease with the fall of temperature.
Relapses are not common; but sec ond, third, and even more attacks are not unusual.
This disease is most apt to be con founded with dengue; but the absence of an afebrile period, and the rash, fol lowed by a second febrile attack of defi nite duration, enable one to distinguish it from that disease. The absence of catarrhal symptoms separates it from catarrhus epidemicus.
The treatment should be as follows: Rest in bed, with a liquid diet. The bowels should be freely opened by a brisk saline purge, and kept regular by small and frequently repeated closes of calomel. Such drugs as antipyrine, phenacetin, or acetanilid, and small doses of quinine should be administered.
A good combination, which also in cludes the proper amount of calomel, is as follows: 1 Antipyrine, 3.S grammes.
Quinine sulphate. 1.2 grammes. Hydrarg. chlor. mit., 0.1 gramme. M. et ft. cap. No. xij.
Sig.: One capsule every two or three hours.
The high temperature should be con trolled by sponge-baths or by "tub bing," and an ice-cap should be applied to the head. For a week or ten days after recovery, tonics—such as iron, quinine, and strychnine — should be given.