I2O TROPICAL MEDICINE AND HYGIENE 



Nursing. Careful nursing is of great importance. The 

 room must be kept very quiet and dark, as there is great 

 intolerance of light. Vomiting must be checked if pos- 

 sible, and opium is contra-indicated. All food, drinks, 

 and medicines must be given in small quantities at a 

 time, and well iced. 



Ice-bags or cold compresses to the abdomen give more 

 relief in most cases than hot applications. 



Protection from the bites of mosquitoes must be very 

 carefully attended to in order to prevent the spread of the 

 disease and the infection of the mosquitoes, and through 

 them of the occupants of the house. This is of the 

 greatest importance during the first stage of the disease. 

 The danger is present both day and night, as the freshly 

 emerged mosquitoes feed both during the day and night. 

 Mosquitoes which have once fed become feeders at night 

 only. The bed must be always screened off in a mosquito 

 net sufficiently large for the attendant also to be inside 

 it, and any mosquitoes that obtain entrance to the net 

 must be caught and killed, as otherwise they may become 

 infective in ten days. The netting must not be too 

 coarse, as the S. fasciata can pass through a mesh of 

 15 to the square inch. All the evidence is opposed to 

 the belief that any discharges from the patient are 

 infective. 



Mosquito larvae in the room should be destroyed, 

 and no breeding-places flower- vases, water-jugs, &c. 

 allowed to remain in the room. 



Pathology and Morbid Anatomy. The organism that 

 causes yellow fever has not been isolated. It is present 

 in the blood of the patient during the first three days of 

 the disease, and is so minute that blood serum of such 

 a patient retains its infectivity after passage through a 

 Berkefeld filter. This serum if injected into a non- 

 immune subject will cause an attack of the disease, not 

 merely a toxaemia, as the blood of this person is infective, 

 showing that he also harbours the parasite. The morbid 

 changes due to the action of this unknown organism 



