170 SOME MINUTE ANIMAL PARASITES 



increasing with it. Then the pulse slows consider- 

 ably. The first definite sign is the occurrence of 

 vomiting, the vomit being speckled with dark or 

 black patches. This gradually assumes the charac- 

 teristic form known as black vomit, when the ejected 

 substance is said to be like coffee grounds. The 

 kidneys are intensely affected, and much albumin at 

 first appears in the urine ; then the latter diminishes 

 and may be entirely suppressed. Yellow coloration 

 of the eyes and skin appears, though this may be late 

 in the disease. 



After an acute stage an improvement occurs, and 

 the patient feels well, and wants to get up and to take 

 food. Both are fatal. A relapse follows rapidly, and 

 insensibility gives place to death. The period of 

 "feeling well" is absolutely the most dangerous of 

 all, and needs most attention. With regard to 

 remedies or treatment, everything depends on good 

 nursing. There must be absolute rest of every part 

 of the body, no food should be taken, but as much 

 alkaline water (e.g., Vichy water) as the patient cares 

 for must be given. If the water cannot be taken, 

 saline injections are necessary. No sitting up of any 

 sort or for any purpose must be allowed. The heart's 

 action can be stimulated with drugs such as digitalis, 

 strychnia, or alcohol. Small quantities only should 

 be given, and champagne is the best form of alcohol 

 to use. In addition, the patient must be most care- 

 fully screened from all mosquito-bites. This is as 

 much for the benefit of others as for himself, as the 

 virus is infective in the patient for the first three days. 

 If, moreover, the Stegomyia obtains blood during these 



