PUBLIC RECORD OFFICE
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C.O.885
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21 PUBLIC RECORD OFFICE, LONDON
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If the diminution becomes more pronounced or suppression occurs, dry cupping is done and mustard or linseed poultices applied.
As a means of lowering the temperature, baths are used, cold spongings, washing with vinegar, or alcohol, &c.
In cases where there is much gastric pain or vomiting, ice bags are applied locally or ethyl chloride is sprayed over the epigastrium at intervals. This latter, however, must be done with care. When hemorrhages have come on, nothing seems to be of any avail. Adrenalin, Ergot, &c., have no effect.
If from appearances early on in the case (marked conges- tion of face, eyes, feet, &c.) it appears as if hæmorrhages may probably occur later, Adrenalin, if commenced at once, seems occasionally to be of some advantage.
The pulse must be very carefully watched in all patients suffering from this disease, so that the necessary steps may be taken to ward off symptoms of collapse. Should it begin to fail hypodermic injections of Caffeine are given at regular intervals. Brandy and champagne, especially the latter, are freely administered. Rubbing with vinegar is practised and hypodermic injections of oil of camphor are given, which, however, give rise to a great deal of pain.
No special treatment is adopted for "black vomit." In cases where the affection is complicated by malaria, no treatment is adopted for the latter until the patient has recovered from the yellow fever.
Murray (United States Service) however, recommends that in specially malarial districts a large single dose of a quinine salt be administered during the first 12-24 hours of the disease, if seen at that time.
As regards food, the stomach must have as complete rest as possible for several days. All must be absolutely stopped and the patient only allowed some iced alkaline water to drink, such as Vichy, which is invariably used in Brazil. He may, however, take as much of this, in not too large quantities at a time, as he feels disposed. Should, however, the vomit- ing be incessant, it is advisable to stop everything for a time and then recommence with very small quantities of fluid. This is continued for several days and very great care and judgment must be exercised in commencing food and making additions to the diet.
5. Remarks. In comparing the cases of fever which we meet with on the Coast with those which I saw in Brazil, the former, taking them as a whole, do not present the same aspects or combination of symptoms as the latter.
There is
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not associated with them the auxious facies, the quiet but alert look (as Touâtre says:" the yellow fever patient is, as a rule, mentally alert," "the malaria patient doesn't care what happens"), the marked conjunctival injection, the peculiar character of the tongue, the jaundice, the almost invariable presence of some degree of albuminuria, the com- paratively frequent partial or complete suppression of urine (the latter being, in my experience, extremely rare indeed if hæmoglobinuric fever be excluded), nor any hæmoglobinuria and the relation of pulse and temperature, as stated in "Faget's Law," is not a feature specially noticeable in our cases. I have seen a few instances of very slow pulse following an attack of fever which appeared to be malarial, but they are not common.
In looking back, however, I can specially call to mind two cases, the symptoms of which bore a striking resemblance to those I have just seen in patients suffering from yellow fever. At the time I noticed the difference between them and those associated with our usual cases, but was unable to interpret the significance of it. In all probability these, I now think, were instances of yellow fever.
In the public mortuary I have also seen cases in which the cause of death was not as plain as one would like, and in one or two instances I recollect the liver bore some resemblance to those I have now become acquainted with.
With regard to "bilious remittent" fever, which some seem to consider a special variety of malarial fever, the term has, I think, been very loosely used in the past. To my mind it is a confusing term which could with advantage be dropped. In some instances it certainly is a manifestation of malaria, but in others (if the presence of yellow fever on the Coast be granted) it is almost as certainly yellow fever..
Dr. Guiteras appears to hold the view that, at any rate in "bilious remittent" fever is really yellow fever,
most cases,
and, in conversation, stated that since yellow fever had been eradicated from Habana "bilious remittent" and the "coffee ground" fever of children had disappeared, although malaria still remained.
ANTI-YELLOW FEVER MEASures. Para.
6. In October, 1910, Dr. Oswaldo Cruz visited Para, bringing with him a large staff, and officially commenced anti-yellow fever work in the town. After remaining some