248 



As a common drink the patient is given a 2 per 1000 solution of sodie 

 bicarbonate in boiled water, of which some two litres may be consumed 

 in the twenty-four hours. Enemata of boiled water are at the same time 

 prescribed to be administered every six hours by means of the irrigation 

 bag hung at a moderate height. Nausea or vomiting should be allayed by 

 small draughts of effervescent mixtures, cold mint infusion, pieces of ice 

 kept in the mouth, or counter-irritation to the epigastrium. Some means 

 should be taken to form an approximate estimate of the quantity of 

 urine that is passed between the visits, and to have the last portion that has 

 been discharged kept apart in order to test it for albumen. When less than 

 five or six ounces are passed in the space of six hours, diuretine (in 1 

 gramme or i/ó gramme doses) should be given, or else, if the heart action be 

 weak, caffeine may be ordered instead. For the insomnia, 1 or 2 grammes 

 of chloral hydrate may be added to the enema at night. For the nervous 

 excitement valerianate of ammonia is often useful. When the fever runs 

 high, sponging with aromatic vinegar is recommended. Should uraemic 

 symptoms appear, the enemata must be more frequently administered, and 

 also the theobromine or caffeine. When delirium declares itself, and the 

 head feels hot to the touch, ice applications or cold compresses to the head, 

 and the tepid bath, are sometimes beneficial. If the haemorrhages from the 

 nose, mouth or female genitals are excessive, some styptic applications may 

 be employed, and when the black vomit or blood is discharged in large 

 quantities, fluid extract of ergot may be injected under the skin, — some- 

 times with very good results, — provided the respiration remains free. 

 Ulood-letting, which was formerly much and rather indiscriminately 

 employed, has now been entirely discarded; yet in the robust and 

 plethoric, when the congestive symptoms are intense, leeches applied behind 

 the ears, on the first or second day, sometimes afford very marked 

 relief. 



No food of any kind is allowed during the first four or five days. 

 This is a rule very generally observed in Cuba, and from which no bad 

 results have even been cited ; whereas premature attemps to feed the 

 patient are believed to hasten the development of melanic symptoms. The 

 patients themselves do not generally express any desire for food before the 

 fifth day, or, if they do, will not relish it when granted. 



The patient should be kept as quiet as possible, both in mind and body, 

 in a well-ventilated room, all hygienic precautions being taken both for 

 the sake of the patient and for others. 



The employment of intestinal disinfectants have given very satisfacto- 

 ry results, not only in my hands, but also in those of several colleagues 

 who prescribe them pretty much as I do though many differ from me in 

 considering the gastro-intestinal tract as the probable seat of the primary 

 yellow fever infection. It is difficult, however, to judge upon statistical 

 data the efficacy of any plan of treatment, inasmuch as, in different sets 



