Chapter 13 - Diseases of the General System and Miscellaneous Diseases
Introduction to Diseases of the General System and Miscellaneous Diseases
Blood Aneamia
Typhoid Fever
Prevention of Typhoid
Bilious Remittent Fever
Congestive Fever
Fever and Ague
Yellow Fever
Purple Disease
Bubonic Plague

13.21 Bubonic Plague

Yellow Fever

Yellow Fever (known as Yellow Jack, Bronze John).
A highly infectious but not contagious disease occurring in the warm climates and always characterized by high fever, jaundiced skin, black vomit in some cases, and usually appearing with sudden onset. In the seventeenth century this disease was noted in Southern climates. Since then all warmer portions of North and South America have contributed to its death rate. The white race seems to be far often greater affected than the colored, though the black race is more or less susceptible. People who have lived in the warmer climates do not catch the disease as quickly neither are they as sick as newcomers to the country. Elderly persons and children ordinarily are safer from attack than the middle aged, but like similar fever diseases one severe attack, should the patient survive, will be a guarantee against the disease in the future. Havana, which is the hotbed of yellow fever, has been long recognized as the point from which it spread, and until the Spanish War, when the United States was compelled for the safety of the soldiers as well as to prevent extermination of the Northern visitors, to take hold of the question, and began the precautionary measures for the wiping out of this disease, the death rate was something frightful.

Causes. It has been now so conclusively proved that the mosquito is the carrier of the infection and the cause of the disease that all history previous to the Spanish War may well be omitted. At that time a commission was appointed by the United States to investigate the disease and was given unlimited powers in the warfare. The conclusions of this commission carry the whole story so thoroughly that they may be well quoted at this point. The Mosquito serves as the carrier of the parasite of yellow fever and yellow fever is carried to an individual not immune to the disease by means of the bite of a Mosquito that has previously fed on the blood of one who was sick of the disease. An interval of about twelve days appears to be necessary before the disease can be carried from a person lately affected to one who is well. The bite of the Mosquito less than twelve days after contamination does not appear to protect the patient against any further attack. Yellow fever may be also produced by direct attack of the blood of a patient with a person who is well. But an attack of yellow fever even produced by the bite of a Mosquito secured immunity against further attack by experiment. Disinfection of clothing, bedding or merchandise even if it has been in contact with those sick with the disease is unnecessary, it being pre supposed that Mosquitoes will not have access to such articles, and the spread of yellow fever may be completely controlled if the Mosquitoes are destroyed and the sick are protected against the bite of these insects. Although it is known at this time how yellow fever can be contracted as well as prevented, yet the direct cause of the disease has not yet been discovered. The extermination of the disease has now resolved itself as will be seen by the above paragraph to the destruction of the Mosquito and the protection of houses by suitable screens from the inroads of all Mosquitoes as, of course, one is unable to learn which insect has had access to a patient sick with the disease, and further the treatment by covering the surfaces of all breeding places for Mosquitoes s with petroleum, such as marshes, old wells and stagnant water, has been found efficient in destroying the eggs before they have launched into live insects.

Symptoms. In addition to the rapidity with which the disease manifests itself by the striking chill and high fever with an almost para, doxical pulse, many times a patient with a temperature of one hundred and three to one hundred and five having practically a normal pulse which would be unusual in any other disease, and the headache, possible sore throat, great weakness and. vomiting with beginning jaundice around the eyes and upper part of the body is an expression described by Guiteras as characteristic. He describes the eyes as staring, moist and generally contracted. The cheeks and conjunctiva are congested and there is a general anxious expression. The tongue appears to be swollen and the gums are engorged. After two or three days, all of the above symptoms appear to subside and the pulse may be lowered to one half its former rate, in which case should the disease have been a light attack, or the patient especially resistant to its poison, recovery may occur without any more serious results than slight involvement of the kidneys and a more or less irregular fever lasting for some weeks. This secondary fever in the severe cases lasts from two to three days, and by the third day has markedly abated. It is at this period when the jaundice becomes most marked and the patient is then a true example of yellow fever. Should the disease be of the severe type or the former serious symptoms occur again in a much intensified form, the yellowness increases deeply, hemorrhages of the skin occur about the body, hiccough, great weakness and exhaustion together with increased complications of the kidneys, causing intense anxiety as to the outcome. Although recovery may occur with this recurrence of severe symptoms, the chances are poor and death is usually common at this period. One remarkable feature in the diagnosis of the &ease that appeals to physicians is that the relative loss of red blood corpuscles is not as great as would be expected in a disease accompanied by the hemorrhages that occur in yellow fever.
This is probably more apparent than real for the actual loss of red cells must be in direct ratio to the amount of blood that is lost. Two or three diseases have similar symptoms to yellow fever in the early stages. One known as dengue or breakbone fever might be mistaken at first, but practically no one dies from uncomplicated dengue. The joint symptoms, while common to most diseases at first, are most pronounced of all in dengue, and the notable difference between the pulse and temperature as in yellow fever is absent in breakbone fever. In the severe types of malaria, especially the irregular and mixed forms of this disease, yellow fever may easily be suspected but all of the symptoms that are noticed at the onset of yellow fever occur, if at all, late in the progress of malaria and in a much less severe form. The mortality of yellow fever varies at different times, seasons and epidemics between twelve per cent and seventy five per cent. Its greater ratio noted in hospital practice is probably accounted for by the severe cases being sent to the hospitals as well as during severe epidemics, when field hospitals are usually established. The average mortality, as stated by one observer, is about thirty five per cent.

Treatment. The treatment of this disease, as in most of the other ones, which as yet we have no specific for, is largely one of stimulating the patient and prohibiting any exhausting causes which might turn the scale. Systematic treatment for the hiccough, such as carbonated waters, very hot water, brandy and ice or a mild solution of cocaine, are usually necessary from the first, and tincture of digitalis in doses of five drops, strychnine in doses of one fortieth of a grain are the most important to keep the heart at work and counteract any tendency to collapse on the part of the patient. Of course, in the more serious types of the disease, very strong heart remedies such as hypodermic injections of the medicines above mentioned together with ether and alcoholic stimulation may be necessary to overcome momentary collapse. The kidneys are affected to a greater or less extent and diuretics and cathartics to remove the poison from the body are in almost constant demand. Nothing is better than the citrate or acetate of potassium in twenty grain doses three or four times a day to keep the kidneys at work, and last, but by no means least important, and probably of more importance than any medicine is the care taken in the nourishing of the patient; for at least the time when the fever is at its height nothing but liquid foods in concentrated type such as rich chicken and beef broth with milk and eggs should be taken. The patient should remain in bed long after the fever has subsided and until every possibility has passed that the heart or kidneys would be weakened by exercise.

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