YELLOW FEVER EXPEDITION 
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mild case may become extremely grave if further and repeated infection has been 
allowed to occur. But if removal is to be carried out it should be done at once, and 
if the patient has been ill for say four days, he should not be exposed to the risks of 
disturbance by removal. In a well-ordered town which it is desired to free from the 
malady, there can be no question that all cases should be isolated, and that isolation 
should be effected promptly if it is to be of any use as well as non-injurious to the 
patient. 
It does not appear that drugs are of much value ; for cases treated in this wise 
from the first are not saved from a fatal result, and it seems wiser to withhold from 
them altogether, with the exception of laxatives. It seems of importance to induce, 
or at any rate not to interfere with sweating, as by chilling the skin, cold bathing, 
and the like ; I think that care should be taken to supply blankets and other means 
to avoid chilling, and especially application of vapour baths or warmth. Except 
agonal sweats, the fact that a patient is sweating greatly increases the favourableness 
of the prognosis. The administration of plenty of water, in the form of saline 
enemata, or, if necessary, directly into the system, seems good ; whether the former 
should be given cold, as I have seen it employed, is perhaps a matter for grave 
doubt. The temperature was rarely a source of anxiety as such in the cases seen ; 
if it can be reduced by inducing sweating without drugs so much the better. 
There can be no doubt that the patient ought to be protected from mosquito 
bites, for by those of already infected insects he may have added quantities of the 
infecting agent, and also he may contaminate otherwise uninfected insects and cause 
danger to his neighbours. 
Just as malaria has been stamped or rather died out in England without the 
disappearance of the Anopheles, or of any very direct attack against them, so yellow 
fever has been stamped out in places without dealing with the mosquitoes ; thus, 
yellow fever does not appear in the British Guiana reports, and has practically been 
absent in Jamaica since 1897 ; again, instances are to be found in the southern part 
of the United States and Porto Rico. At the same time, it must be admitted that 
the method adopted in Havana by the Americans for yellow fever, and at present being 
conducted on the West Coast of Africa by our own countrymen for malaria, is by 
far the most reasonable method of clearing a neighbourhood of a gnat-borne pest, 
especially a town disease like yellow fever. 
No prophylactic inoculation has as yet been discovered for yellow fever, though 
many have been vaunted. It is clearly too risky to make use of artificial gnat 
infections. The only scheme which suggests itself as practicable is on the lines of 
the useful modes employed in some diseases of animals (as rinderpest), in which a 
dose of infective material is given with a dose of serum of an immune animal {i.e., 
blood of early yellow fever patient mixed with serum of a convalescent). 
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