Report on the etiology and prevention of yellow fever / by George M. Sternberg.

  • Sternberg, George Miller, 1838-1915.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Report on the etiology and prevention of yellow fever / by George M. Sternberg. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    98/286 (page 92)
    The idea that the specific iufectious ageut of yellow fever may, as in cholera, have its habitat iu the aliiueutary caual, has bceu forced upon the writer by his failure to find, it iu the blood and tissues of those suffering from the disease. Dr. Gibior has been led to a similar iufereuce, and has even claimed the discovery of a bacillus which, as we think upou insuf3Qcieut evidence, he supposes to be the specific infec- tious ageut in question. The treatment proposed by him is based upon this idea, and consists in the free administration of ijurgatives for the purpose of clearing the pathogenic microbes out of the intestine, and of bichloride of mercury in large doses for its geruiicide eifect. So far as the j)wi'g«itiou is concerned, experienced physicians iuthe yellow-fever zone generally agree that it is important to clear out the bowels with a brisk purge at the outset of the attack; but it is also established by expe- rience that active medication of this kind after the first aud second day of an attack is likely to do more harm than good, and, in fact, is a dangerous procedure. I quote from the paper of Dr. de la Guardia, published in the Cronica Medico- Quirnrgica, of Havana, as follows : We have been constant in giving the patients the series of purges recommended; tbe first day a saline cathartic, 45 grammes of sulphate of sodium ; the second day, 45 grammes of castor oil in emulsion, with an equal quantity of sirup ; and, finally, on the third day, I gramme of calomel, to which we added 1 gramme of jalap to make it more active, given in two doses at an interval of one hour. The saline purge was frequently rejected by vomiting, and this also happened sometimes with the castor oil; not so with the calomel, which is generally tolerated. During the period of large evacuations we invariably made use of the mercurial medication ; using a draft composed of 5 centigrammes of bichloride of mercury, 30 granmies of brandy, and 120 grammes of sweetened water. Some patients rejected this by vomiting immediately after taking it. The patients were made to take this until the seventh, or, in some cases, the eighth day ; at this time the favorable or unfavorable result was decided. During his illness the patient was given a large quantity of liquid iu the form of chlorhydric lemonade (2 to 1,000) iced. This was well retained by the stomach. Milk was the only food allowed, generally iced. In some of the most severe cases the purgatives were again commenced. Certain symptoms were treated by special measures, in accordance with general principles. Vomiting, for example, was treated by the application of a blister to the epigastrium, and the patient was allowed to swallow small pieces of ice, Eivier's draft, etc. Hemorrhage was treated with ergot, and adynamia by tonics. The bichloride of mercury has rarely given rise to stomatitis, and when this has hap]Dened it has been mild in character, and has been rapidly cured with simple emollient washes or with chlorate of potassium. Thirty-seven cases were submitted to the mercurial treatment, all of them typical cases of yellow fever, in St. Margaret's ward of the civil hospital. Of these, 22 recov- ered and 15 died. Tliis gives a mortality of 40 per cent., which is about the average mortality from this disease in Havana; a little more or less, but rather more. It will be seen that the result of our scrupulous investigation up to the present time has been, if not disadvantageous, at least without any advantage to the patients treated. In a letter from Dr. Sollace Mitchell, from which I have already quoted, he says : Dr. Gibier claims to have suggested the use of bichloride internally some weeks prior to yourself. He says that he suggested one-tenth grain every hour. But as I experimented with doses from one-twentieth to one-sixtieth, and found that in 6 cases when one-twentieth was used severe cramps and diarrhea followed in from 6 to 18 hours, I doubt very much if a patient could bear one-tenth grain with advantage to himself. Dr. Mitchell has given me a list of 40 cases treated by the bichloride alone; 32 of these were whites and 8 colored; 9 of the whites died, a mortality of 28 per cent.; whereas the mortality among the same class of patients treated by the alkaline and bichloride method was only 6.3 per cent.