568 TIIE TREATMENT OF DISEASES. 



duration. A yellow tinge makes its appearance on the forehead, and rapidly 

 spreads downwards over the face,- back, and chest, and then involves the whole body. 

 After a few hours the black vomit returns, the pain at the pit of the stomach 

 is aggravated, the patient refuses all medicine and food, complains of excruciating 

 pain in the calves of the legs, and finally becomes delirious. 



The usual duration of the fever is from three days to a week, although in some 

 cases death may ensue in a few hours. When the sixth day elapses without the 

 occurrence of black vomit, or suppression of the urine, there is great hope of recovery, 

 but even if all the other symptoms be absent, and only one of these two present, 

 the indications are unfavourable. In many epidemics the mortality is as high as 

 one in three. 



In so serious a disease as this, the attendance of a doctor is of course essential, 

 but considering the frequency with which it occurs in places where medical aid is 

 not obtainable, we will briefly indicate the line of treatment to be adopted. 



The disease cannot be cured, and all we can hope to do is to guide the patient 

 safely through it. There is little to be done, except to treat the most urgent 

 symptoms as they arise. Quinine, which does so much good in ague, is here useless. 

 Removal from the infected locality is often followed by a marked amelioration of 

 the symptoms. Nothing so quickly and so effectually arrests yellow fever on board 

 ship as running into a cold latitude. The greatest attention should be paid to 

 cleanliness, and during the whole of his illness the patient should be in a large, well- 

 ventilated room. As the bowels are generally confined, a calomel purge (Pr. 61) 

 may be given at the onset of the disease. Drop doses of ipecacuanha, given 

 frequently, will usually check the vomiting, but should this fail, recourse must be 

 had to chloroform, given internally, or to milk and lime-water. 



ULCERS. (See SORES OR ULCERS, p. 516.) 



ULCER OF THE STOMACH. 



Ulcer of the stomach probably occurs far more frequently than ic usually 

 supposed. It so frequently heals spontaneously, and the patient recovers so quickly, 

 that the true nature of the illness is not even suspected. In post-mortem 

 examinations scars of old ulcers are frequently met with on the inner wall of the 

 stomach. The disease occurs more frequently in. women than in men. The 

 majority of cases occur between the ages of twenty and thirty, but the liability to 

 the disease increases as age advances. These statements may at first sight appear to 

 be contradictory, but they are in reality not so, for it must be remembered that 

 there are far fewer people living between the ages of say sixty and seventy, than 

 between twenty and thirty. Allowing for the number of persons living at different 

 ages the preponderance of the disease in the later periods of life is very considerable. 

 The disease is more common among the poorer classes of society, and it occurs most 

 frequently in servant-girls, and pale, aneemic, half-starved, needlewomen. It has 

 been supposed that there is a connection between ulcer of the stomach and arrest of 



