YELLOW FEVER.
No drug possessing a specific action on this disease has been yet dis covered. Remarkable advances have been made in the prevention of the malady, though its exact pathology is still to be cleared up unless the discovery of an intracorpuscular parasite by Seidelin proves to be the final solution of the mystery.
Prophylaxis.--The disease being communicated from the affected to the healthy by the bite of a mosquito (Slegomyia calopits), the problem of prevention is allied to that of the extermination of malaria. The breeding-grounds of the insect have been attacked, and the disease has thus been stamped out completely in districts in which it has remained endemic for many years.
As soon as a patient becomes infected, he must be surrounded with fine mosquito netting to prevent the admission of the insects, which other wise would spread the disease to the healthy in the immediate neigh bourhood.
It must, however, he remembered that the mosquito may remain infective for 57 days after sticking the blood of a yellow fever patient, and the next brood of young mosquitoes may be tainted through the virus in the eggs laid by their infected mother. Therefore no possible means should be omitted to prevent the bites of the insect by those living in an endemic zone.
The treatment of the established disease.is to be conducted on sympto matic lines as in typhoid and other continuous fevers. The patient is to be ordered immediately to bed and fed by small spoonfuls of liquid nourish ment supplemented by rectal alimentation, or preferably he should be entirely fed by the rectum for the first three days or permitted to abstain from all food.
Fever is to be reduced by cold sponging-, baths or cold packs; vomiting by iced Champagne or effervescing drinks and Morphia hypodermically; cephalalgia by the icecap; and hcemorrhage by Calcium Chloride. Alco hol will be indicated in a considerable number of cases, such as in alcoholic patients and in adynamic cases; it should not he administered as a routine.
The most successful routine is to administer at first a lar:je dose of Calomel, and after the thorough evacuation of the bowel to commence with large rectal injections of Normal Saline administered slowly at a, temperature not exceeding 70° F.; these entirely meet all the needs of the system for the first three days without administering food in any form.
Sternberg's method of treatment has met with most acceptance, and in his own hands has reduced the mortality amongst Europeans to about 7 per cent., whilst in negroes the death-rate fell to almost nil. It consists in the administration of an alkali with minute doses of Perchloride of Mercury, the formula being gr. Hyd. Perchlor., 6 grs. Bicarbonate of Soda in 12 drachms of iced water administered every hour. The object aimed at is to keep the urine alkaline and abundant in quantity. Mitchell doubles the strength of the mixture and reports favourably of the results.
Larger doses of alkali combined with Theobromine, Caffeine or Nitro glycerin will he necessary should the amount of urine continue to decrease, and when these fail Normal Saline solution must be administered by the skin or veins as well as by the rectum, and dry cupping and poultices applied to the loins.
Black Vomit is an indication for the suspension of all food by the mouth and for the administration of 3o-min. doses of Adrenalin Chloride solution. Some authorities adhere to a routine consisting of Quinine administered hypodermically.
Strychnine should be given hypodermically as soon as any symptom of heart failure shows itself, and this may be necessary during the pro longed weakness occurring during the-convalescing period, when absolute rest in the horizontal position should be maintained, and the strength kept up by concentrated soups and alcoholic stimulants.