YELLOW FEVER 119 



suppression of urine, and vomiting ; the temperature 

 charts are not unlike in the two diseases/ as in both there 

 is a remission in the pyrexia between the primary and 

 secondary fever. Clinically there are important differ- 

 ences. Haematemesis may occur, but is very rare in 

 blackwater fever, and common in yellow fever. Haemo- 

 globinuria or methaemoglobinuria is invariable in black- 

 water fever and very rare in yellow fever, though there 

 may be haematuria. In neither disease are malarial 

 parasites found in the blood, during the attack, and in 

 yellow fever the increase in the relative number of the 

 large mononuclear leucocytes is not found. The intense 

 headache in the early stages of yellow fever is not present 

 in blackwater fever, and the repeated rigors so common 

 in blackwater fever are usually absent in yellow fever. 

 Icterus appears later in yellow fever than in blackwater 

 fever, and it is only in yellow fever that the pulse-rate 

 does not increase as the temperature rises. 



Treatment. A preliminary purge seems to be of great 

 importance, and calomel is frequently used for this 

 purpose. Many drugs have been employed, and a treat- 

 ment for which great success was claimed, by Blair, was 

 by large doses of calomel and quinine, 20 gr. of each 

 being given. All later work shows that quinine has no 

 effect on the disease. 



Carbolic acid, in drop doses every hour, and other 

 intestinal antiseptics have also enjoyed a great reputation. 

 There does not appear to be any drug with a specific 

 action. The present treatment is that introduced by 

 Sternberg, well diluted bichloride of mercury and car- 

 bonate of soda being given frequently in small doses. 

 It is on this treatment that Hearsey's treatment of black- 

 water fever is founded. Some hold that any adminis- 

 tration of food by the mouth in the early stages of the 

 disease is injurious and may lead to the conversion of an 

 attack of the mild type into one of the more severe. 

 When suppression of urine threatens, rectal injections of 

 salt and water or injections of fluid into the subcutaneous 

 areolar tissues are indicated as in blackwater fever. 



