5 i6 
THOMPSON YATES LABORATORIES REPORT 
absorption and distribution of toxic products causing the symptoms of the second 
period of the fever. It may be remarked that many writers (Finlay and others) 
have laid stress on the difference between the onset and the second stage, and have 
variously suggested that the latter stage is due to some different cause from the first. 
Although symptoms of a severe character might arise from the elaboration of the 
specific toxic products in and about the gut as a consequence of a localization from a 
generalized infection it would not follow that an original infection could be 
established by way of the gut (compare experimental feeding and injection of many 
bacteria). 
Prolonged cases, such for example as No. XI (Synoptic Table), and others less 
prolonged are perhaps due to multiple infections during the period of the illness. 
Treatment 
According to the figures (Para Medico, January, 1901, p. 70), five hundred 
and fourteen patients were treated at the isolation hospital for yellow fever or 
Hospital Domingos Freire, of these one hundred and ninety-three or 37-5 died. 
This apparently is a high mortality rate, moreover the figures cannot be 
judged directly for two considerations : first, a large proportion of the patients are 
only sent to the hospital late in the disease, and not infrequently in an almost moribund 
condition (a few have arrived at the hospital actually as corpses), so that the mortality 
rate is no satisfactory guide ; and secondly, the five hundred and fourteen patients 
include all admissions to the institution, so that the death-rate of the yellow fever 
cases is still higher, especially from the bed cards in which cases of slight mild 
yellow fever are recorded as gastric or perspiration or malarial fever, as well as those 
indubitable cases of malaria in which we found the malarial parasite. 
Theoretically, the treatment is a ' hydrotherapie ; ' water to drink (plain, or Vichy 
or Apollinaris), copious enemata of normal saline, and, if bad symptoms ensued, 
hypodermic or intravenous infusion. Practically, a number of drugs were given over 
and above an initial purge of castor oil and calomel ; aconite, digitalis, and belladonna 
were favourites at the early stage, and lactate of strontium later, this was supposed to 
be 'good for albuminuria,' but it did not appear to have any effect. Cold baths or 
packs, too, were much used, and were regarded by us as heralds of a possible autopsy. 
In the uraemic condition hypodermic injections of trinitrine, strychnine, etc., were 
administered ; it need hardly be said that they gave no highly favourable result. 
Judging from results one has seen, and without any personal care of cases, it 
would seem that the most important thing in treatment is to keep the patients in 
bed, and not allow them to leave it any more than one would in a typhoid case. 
Next, if the patient became infected in the house in which he is laid up, he should be 
removed from it at once, so that he may not receive a constantly increasing supply of 
the infecting agent ; it is only reasonable to suppose that what otherwise might be a 
