1240 



YELLOW FEVER 



to, the pit of the stomach, and haemorrhages in general should be 

 met with doses of calcium chloride or hypodermic injections of 

 adrenalin or ergotin. 



In these bad cases it is advised by some authors to rub olive oil 

 into the skin in quantity, with a view of ladening the endothelial 

 cells of the blood capillaries with fatty particles, and so protecting 

 them against the action of the toxins. 



Anuria requires treatment by hot fomentations to the loins, or 

 cupping and hot-air bathS; and Carroll recommends the injection of 

 15 grains of urea, either hypodermically or by the rectum, with a view 

 to stimulating renal activity, on the ground that in these bad cases 

 the production of urea by the liver is not sufficient for that purpose. 



Cardiac failure requires hypodermic injections of strychnine, 

 camphor dissolved in ether or oil, or simply ether. 



Diet. — ^No food should be given for two or three days, but only 

 the alkaline drinks, and champagne if necessary, the idea being to 

 relieve the stomach and prevent the accumulation of waste products 

 in the system, and so to save the kidney from too much work. 



After this time, or if the temperature is below 102° F., milk and 

 lime-water, toast-water, and barley-water may be given. With 

 a view to saving tissue waste and getting fat into the circulation, 

 pure frozen cream, cold white wine-jelly or lemon-jelly, should 

 be given, or olive oil administered by the mouth or rubbed into the 

 skin, as indicated above. 



After the temperature has been normal for some three days, 

 chicken-broth, custard-pudding, blanc-mange, etc., can be tried, 

 and a few days later the diet can be gradually increased. 



Strong beef extracts and strong alcohohc stimulants should be 

 avoided, the best stimulant being iced champagne in tablespoonful 

 doses. 



Prophylaxis. — ^Yellow fever is generally conveyed from one 

 place to another by ships, but in order to produce an epidemic 

 several factors are necessary — ^viz., cases of the disease from which 

 Stegomyia calopus may become infected, together with conditions 

 of temperature, moisture, etc., suitable for the development of 

 the germ in the mosquito, and also for the propagation of the 

 mosquito itself, together with the presence of non-immune people 

 for the mosquito to infect. It is also necessary to bear in mind 

 that the incubation period is usually from three to six days, and 

 therefore quarantine must be of at least five days, or, to be on the 

 safe side, of six or seven days' duration. In order that the mos- 

 quito may become infected it must bite a patient during the first 

 three days of the illness, and another fourteen days must elapse 

 before it is able to infect non-immunes. Therefore an infected 

 ship must be anchored at least a quarter of a mile from the shore 

 and from other ships. The sick must be placed in mosquito-proof 

 rooms, the crew quarantined for at least six to seven days, and the 

 whole ship disinfected by a Clayton's disinfector, preferably be- 

 tween 9 a.m. and 3 p.m., while the mosquitoes are quiescent. 



