TREATMENT 



1259 



Treatment. — ^There is no specific remedy known for yellow fever. 

 The usual treatment, if the patient is seen on the first or second 

 day, is to give repeated small doses of calomel until 3-5 grains 

 have been administered, and then a draught of magnesium sulphate 

 and sodium sulphate. Then employ Sternberg's mixture, which is : — 



Sodium bicarbonate .. .,. . .. 150 grains. 



Perchloride of mercury . . . . . . J grain. 



Water . . . . . . ... ... 60 ounces. 



This is given in three tablespoonful doses every hour. 

 Genercil TY&oitmmt. — 'As the cause of the disease is unknown, the 

 treatment must aim at the prevention of the spread of the infection, 

 the rapid elimination of the toxins, and the alleviation of the 

 symptoms. To prevent the spread of the disease, the patient's bed- 

 room must be rendered gnat -proof. The excretion of the toxins 

 must take place by the bowels, skin, and kidneys, and therefore 

 it is necessary to encourage the action of all three. The action of 

 the bowels can be maintained by enemata of i tablespoonful of 

 sodium sulphate dissolved in a pint of warm water, and given 

 morning and night. 



When there is severe headache, a hot mustard foot-bath may be 

 given, which should relieve the head. After this the patient is 

 warmly wrapped up in blankets, care being taken that he is not 

 oppressed by the clothing, for only those who have been seriously 

 i|l can appreciate how embarrassing the weight of heavy blankets 

 is to the heart. It is hoped that by these means the action of the 

 skin will be stimulated. 



In order to dilute the toxins, and at the same time to stimulate 

 the action of the kidneys, an alkaline treatment, with plenty of 

 fluid, is required. This can be effected by administermg 2 to 

 4 quarts of iced Celestin variety of Vichy water in the twenty- 

 four hours, or the same quantity of any alkaline mineral water, 

 to each pint of which 30 grains of sodium bicarbonate have been 

 added; or by Sternberg's mixture as recommended above; or an 

 effervescing drink can be made up of sodium bicarbonate and fresh 

 lime-juice, but care should be taken that this is mixed in such 

 quantities as to be neutral, and it may, if necessary, be combined 

 with sodium sulphate. If this alkaline treatment cannot be given 

 by the mouth, then the bicarbonate of soda must be administered 

 as warm enemata. 



Symptomatic Treatment. — ^As regards symptoms, if there is great 

 pain, this can be relieved by a small dose of phenacetin, while 

 severe lumbar pain may be relieved by hot fomentations; but if no 

 urine is passing, the warm mustard bath will be better. 



Vomiting is treated by sips of iced Vichy, iced champagne, a 

 blister to the pit of the stomach, a dose of a mixture containing 

 chloroform, or a hypodermic injection of morphia. If there is 

 much fever, this must be treated by cool sponging and cool applica- 

 tions to the head. 

 Black vomit should be treated by the application of the ice-bag 



