The Home Medical Library Volume I Part 19

To children may be given a daily amount of quinine equal to one grain for each year of their age. In the severe forms of remittent and pernicious types of malaria it may be necessary for the patient to take as much as thirty grains of quinine every three days or so to cut short the attack. But, unfortunately, the digestion may be so poor that absorption of the drug does not occur, and in such an event the use of quinine in the form of the bisulphate in thirty-grain doses, with five grains of tartaric acid, will in some cases prove effective.

Chronic malaria is best treated with small doses of quinine, together with a.r.s.enic and iron. A capsule containing two grains of quinine sulphate, one-thirtieth grain of a.r.s.enious acid, and two grains of reduced iron should be taken three times daily for several weeks.

=YELLOW FEVER.=--This is a disease of tropical and subtropical countries characterized by fever, jaundice, and vomiting (in severe cases vomiting of blood), caused by a special germ or parasite which is communicated to man solely through the agency of the bites of a special mosquito, _Stegomyia fasciata_.

=Distribution.=--Yellow fever has always been present in Havana, Rio, Vera Cruz, and other Spanish-American seaports; also on the west coast of Africa. It is frequently epidemic in the tropical ports of the Atlantic in America and Africa, and there have been numerous epidemics in the southern and occasional ones in the northern seacoast cities of the United States. The last epidemic occurred in the South in 1899.

Rarely has the disease been introduced into Europe, and it has never spread there except in Spanish ports. The disease is one requiring warm weather, for a temperature under 75 F. is unsuitable to the growth of the special mosquito harboring the yellow-fever parasite. It spreads in the crowded and unsanitary parts of seacoast cities, to which it is brought on vessels by contaminated mosquitoes or yellow-fever patients from the tropics. Havana has heretofore been the source of infection for the United States, but since the disease has been eradicated by the American army of occupation, that danger has been removed. Yellow fever is not at all contagious in the sense that a healthy person can contract the disease by contact with a yellow-fever patient, or with his discharges from the stomach, bowels, or elsewhere, and is probably only communicated to man by the bite of a particular kind of mosquito harboring the yellow-fever organism in its body. Both these facts have been incontestably proved,[12] in part by brave volunteers from the United States Army who submitted to sleep for twenty-one days on clothes soiled with discharges from patients dying of yellow fever, and escaped the disease; and by others living in uncontaminated surroundings who permitted themselves to be bitten by infected mosquitoes and promptly developed yellow fever.

=Development.=--After a person has been bitten by an infected mosquito, from fourteen hours to five days and seventeen hours elapse before the development of the first symptoms--usually this period lasts from three to four days. With the appearance of a single case in a region, a period of two weeks must elapse before the development of another case arising from the first one. This follows because a mosquito, after biting a patient, cannot communicate the germ to another person for twelve days, and two days more must elapse before the disease appears in the latter.

=Symptoms.=--During the night or morning the patient has a chill (or feels chilly) and experiences discomfort in the stomach, with sometimes nausea and vomiting. There is pain through the forehead and eyes, in the back and thighs, and often in the calves. The face is flushed and slightly swollen--particularly the upper lip--and the eyes are bloodshot, and gradually, in the course of thirty-six hours, the whites become yellowish. This is one of the most distinguis.h.i.+ng features of the fever, but is often absent in children. The tongue is coated, there are loss of appet.i.te, la.s.situde, sore throat, and constipation. In the beginning the temperature ranges from 101 to 103 F., or in severe cases as high as 105 or 106 F., and the pulse from 110 to 120 beats a minute. The fever continues for several days--except in mild cases--but the pulse usually falls before the temperature does. For example, the temperature may rise a degree during the third day to 103 F., while the pulse falls ten or more beats at the same time and may not be over 70 or 80, while the temperature is still elevated. This is another peculiar feature of the disease. Vomiting often increases on the second or third day, and the dreaded "black vomit" may then occur. This presents the appearance of coffee grounds or tarry matter and, while a dangerous symptom, does not by any means presage a fatal ending. The black color is due to altered blood from the stomach, and bleeding sometimes takes place from the nose, throat, gums, and bowels, with black discharges from the latter. The action of the kidneys is usually interfered with, causing diminution in the amount of urine. It is extremely important to pay regard to this feature, because failure of the patient to pa.s.s a proper amount of urine calls for prompt action to avert fatal poisoning from retained waste matters in the blood. The normal amount of urine pa.s.sed in twenty-four hours in health is over three pints, and while not more than two-thirds of this amount could be expected to be pa.s.sed by a fever patient, yet in yellow fever the pa.s.sage of urine may be almost or wholly suppressed. The course of the disease varies greatly. In children--especially of the Creoles--it is frequently so mild as to pa.s.s unnoticed. In adults the fever may only last a few hours, or two or three days, with gradual recovery from the various symptoms, and yellowness of the skin lasting for some time. This is not seen readily during the stage of fever when the surface is reddened, but at that time may be detected by pressure on the skin for a minute, when the skin will present a yellow hue on removing the finger before the blood returns to the pressure spot. With fall of fever, and abatement of symptoms after two or three days, the patient, instead of going on to recovery may, after a few hours or a day or two, again become very feverish and have vomiting--perhaps of blood or black vomit--yellow skin, feeble pulse, failure of kidney action with suppression of urine, delirium, convulsions, stupor, and death; or may begin to again recover after a few days. Mild fever, slight jaundice, and absence of bleeding are favorable signs; black vomit, high fever, and pa.s.sage of little urine are unfavorable signs. The death rate is very variable in different epidemics and among different cla.s.ses; anywhere from fifteen to eighty-five per cent. Among the better cla.s.ses it is often not greater than ten per cent in private practice.

Heavy drinkers and those living in unfavorable surroundings are apt to succ.u.mb.

=Prevention.=--Yellow fever, like malaria, is a preventable disease, and will one day be only a matter of historic interest. Dr. W. C.

Gorgas, U. S. A., during 1901, by ridding Havana of the mosquito carrying the yellow-fever organism through screening barrels and receptacles holding water, and by treating drains, cesspools, etc., with kerosene, succeeded in also eradicating yellow fever from that city, so that in the following year there was not one death from this disease; whereas, before this time, the average yearly mortality had been 751 deaths in Havana. Spread of the disease is controlled by preventing access of mosquitoes to the bodies of living or dead yellow-fever patients; while personal freedom from yellow fever may be secured by avoiding mosquito bites, through protection by screens indoors, and covering exposed parts of the face, hands, and ankles with oil of pennyroyal or spirit of camphor, while outdoors.

=Treatment.=--There is unfortunately no special cure known for yellow fever such as we possess in malaria. The patient should be well covered and surrounded with hot-water bags during chill. It is advisable to give a couple of compound cathartic pills or a tablespoonful of castor oil at the start. Two, or at most three, ten-grain doses of phenacetin at three hours intervals will relieve the pain during the early stage. Cracked ice given frequently by the mouth and the application of a mustard paper or paste (one part mustard, three parts flour, mixed with warm water and applied between two layers of thin cotton) over the stomach will serve to allay vomiting. Cold sponging (see Typhoid Fever, p. 232) is the best treatment for fever. The black vomit may be arrested by one-quarter teaspoonful doses of tincture of the chloride of iron, given in four tablespoonfuls of water, every hour after vomiting. The bowels should be moved daily by injection of warm soapsuds. The patient should not rise from his bed, but should use a bedpan or other receptacle. In addition, a pint of warm water, containing one-half teaspoonful of salt, should be injected into the bowel night and morning and, if possible, retained by the patient. The object of the latter is by its absorption to stimulate the action of the kidneys. The diet should consist of milk, diluted with an equal amount of water, broths, gruels, etc., and only soft food should be given for ten days after recovery. Iced champagne in tablespoonful doses at frequent intervals, or two teaspoonful doses of whisky in a little ice water, given every half hour, relieves vomiting and supports the strength.

FOOTNOTES:

[11] See Volume V, p. 76, for detailed methods.--EDITOR.

[12] See Frontispiece, Vol. V.