USA > Tennessee > Shelby County > Memphis > A history of the yellow fever : the yellow fever epidemic of 1878, in Memphis, Tenn., embracing a complete list of the dead, the names of the doctors and nurses employed, names of all who contributed money or means, and the names and history of the Howards, together with other data, and lists of the dead elsewhere > Part 7
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Dr. Laski, a German physician, who, according to his own statement, had some experience in Asia with the black plague, and in Africa with the cholera, before settling in Memphis, where he has practiced for years, and where he had three experiences of epidemie yellow fever -- in 1867, 1873 and 1878-treated his patients very successfully. He gave them castor-oil in simple doses so long as the discharges from the bowels were hard and dark; camomile tea to keep up perspiration ; washing the hody under the clothes with a wash com- posed of water tempered by alcohol, ammonia, camphor and common salt. To tone up the patient, he gave good cognac or the best whisky.
Dr. Luke P. Blackburn, of Kentucky, a noted yellow fever expert-whose experience is equal to that of any living physician, extending. as it does, not only over this continent, bat to the Bermudas and the West India Islands, his latest experience being at Hickman, Ky., in 1878-gives his treatment as fol- lows: "The patient should be placed in bed in a horizontal position : should not under any circumstances be allowed to arise from that bed ; should be well cov- ered with blankets; a foot-tub of hot water without mustard should be intro- duced under the blankets; the patient lying upon his back, should flex his lower limbs and place his feet in the tub; the covering should be tucked well around him, close up to his neck ; he should be given hot tea. composed of balm, sage, elder blossom. boneset, eorn-shock, or orange- or lemon-leaf. At the same time he should be permitted to drink ice-water or to take crushed ice in suffi- cient quantities to allay his thirst. Free and continuous perspiration should be kept up. After the foot-tub has been removed, if the action of the skin shoukl cease and the forehead become dry, the feet should be at once replaced in the tub and the ptisan, or hot tea, should be used as before. The fever will continue
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A HISTORY OF THE YELLOW FEVER.
from twenty to ninety hours. When it has passed off the blankets should be gradually withdrawn from the patient; stimulants, such as ale, porter, pure rum, and French brandy should be freely given. I prefer Cook's Imperial St. Louis native wine to any stimulant I have ever used. Nourishment, such as rice-water, or corn-meal gruel, or chicken-water should be given cautiously and sparingly. Should there be a spontaneous movement of the bowels, as will occur in many cases from the irritation of the mucous coat of the stomach and bowels, that tissue which is first assaulted by this disease, give no opium, no preparation of opium, nor any thing to check that action. It is the crisis of the disease as it is in measles. The fever will pass off in five hours, and the patient will recover rapidly without fear of a relapse. Should the perspiration have a glutinous, gummy touch, you may expect your patient to recover with watchful and careful nursing. But should the perspiration have a sensation like that of pure water, showing that there is no vicarious action by the skin, which gives relief to the liver and kidneys, you may know that your patient is in great danger. You will find upon an examination the tongue red and trem- ulous, covered with a short white fur, with great gastric fetor of the breath. It is then all important to apply the cups or leeches to the pit of the stomach in order to prevent that degree of inflammation which destroys the coat of the stomach. If neither cups, leeches, nor blisters be applied, the patient will com- plain of the sensation of a ball in his stomach in thirty-six hours. And in twelve hours thereafter he will throw off blood that is exuded into the stomach. known as black vomit, which has the appearance of coffee-grounds floating in an amber-colored finid. If there be any doubt as to the character of the matter ejected from the stomach, you can at once decide upon its character by dipping a white handkerchief or linen cloth into the matter ejected from the stomach, and exposing it to the sun for a few moments. If it be the romito, or genuine black vomit of yellow fever, it will impart a sanguine or bloody tinge to the cloth or handkerchief. If it be bile, which never occurs in yellow fever, it will impart a yellow tinge."
Dr. Marvin Huse, Physician of the Yellow Fever Hospital, of Louisville, where nearly two hundred cases were treated, "found that there were two classes of cases : one in which the temperature ranged from 100° to 106°, with a hot dry skin ; and a second, where the temperature ranged between 97º and 100°, with a cold, clammy, and much yellower skin. The latter variety was more fatal. The symptoms were, in the main, like those of former epidemie-, but a number of interesting characteristics were noted. The pulse was always so irregular as to be of help in the diagnosis. It ranged from thirty-five to one hundred and forty beats a minute. It bore no relation to the temperature. The fever was a continued one. It had remissione, but not intermissions. The fauces were red and swollen: the tongue, eventually, dry and cracked, unlike the flabby and enlarged tongue of malarial fever. From the skin there exhaled the peculiar rotten-hay odor always noticed. Herpetic eruptions about the mouth and nose were frequent. The urine had at first a high specific gravity, falling as the disease progressed. It was small in amount at first, also, and suppression with uræmia was always to be looked out for. It generally contained bile, and
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always albumen, the amount, however, varying very much. There were also granular casts. The amount of albumen and casts was in proportion to the- severity of the disease, and furnished a valuable aid in prognosis. Vibrios and bacteria were found in the breath and the blood. The proportion of white- blood-corpuseles was increased. Black vomit occurred in half the cases, and did not prove so very unfavorable a symptom, as a third of those thus affected got well. There were melnic stools, as usual. A hemorrhagic tendency was constant, but was casily controlled by a spray of Monsel's solution. The blood oozed from the mouth, eyes, nose, cars, etc. Just before death, the tempera- ture generally fell to 97º. After death it gradually rose, sometimes to 1061.º in the axilla, the body remaining warm for twelve hours. The average dura- tion of the disease was four days. Very careful post-mortem examinations were made, the kidneys and liver giving the most uniform lesions. The stomach showed no erosions, congestion, or catarrh. The hemorrhages from it were passive ones. The liver was enlarged, and generally of some shade of yellow. The microscope showed more or less fatty infiltration and fatty de- generation, with occasionally increase of connective tissue. The kidneys always showed, under the microscope, the tubules choked with finely granular dibris and epithelium, or in other places empty and denuded of epithelium. There were no important changes in the other organs. The treatment consisted in at once exerting the emunctories to action, especially the skin and kidneys. The patient was then kept cinchonized, and the various symptoms com- bated as they arose. The cases brought to the hospital were uniformly bad ones, the discase generally being in the second stage when they were received. The patients had previously suffered from neglect and exposure, and the mortality therefore of thirty-one is not considered high. None of the physicians, attendants, or visitors at the hospital caught the disease, although no especial pains were taken in the way of protection and disinfec- tion."
Dr. Chopin, President of the New Orleans Board of Health, in his instruc- tions to the people of that city, at the outbreak of the late epidemic, says of the yellow fever, that its "onset is more apt to be sudden and violent than that of the other fevers which prevail here, and more apt to occur at night. Frequently, but not invariably, a chill precedes the fever. There is violent pain in the forehead at the beginning, soon followed by severe pain in the. lower part of the back. The eyes are red and glistening. Any individual affected as above described, should immediately go home, go to bed, and send for a physician without delay. Without waiting for his arrival, a hot foot- bath should be taken, and perspiration encouraged by warm drinks and a moderate cover in bed. If there should be any delay in the arrival of the- physician, a simple purgative should be taken; and, if the attack comes on soon after eating, an emetic of ipecac or mustard would be advisable. Prompt treatment is of the utmost importance in this disease; and it should be under- stood that persons ought not to walk about after falling sick, nor get up at all after once going to bed, until the attack is over."
Dr. William H. Fall, of Cincinnati, gives his method of treatment as fol-
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A HISTORY OF THE YELLOW FEVER.
lows: "In the case of the sponge and vapor baths, the results were of un- doubted benefit. The patients always expressed themselves as feeling much better after their use, and frequently requested that they might have them more often. I did not resort to hot or tepid-water baths, as I found the sponge and vapor baths to answer all purposes. I highly approve of their use in this disease, provided the patient is strong enough to bear them; but where there is much prostration, they are objectionable. Absolute rest of mind and body is of the greatest importance, and whatever occurs to mar it is injurious to the patient. Vapor and sponge baths may be given to the patient while in bed, and therefore can not produce any injurious results, while on the other hand they may be of decided benefit. They may be used in any stage of the disease. Every thing necessary for their use is to be found in every bouschold, while portable bath tubs are frequently absent. In reference to the use of the cold bath in this disease, I can not speak from experience, as I did not resort to it. It can not, however, be made u-e of, except in the first stage of the disease, and even then I doubt the propriety of its use. Ice-pellets and crushed ice were given freely to each patient, and were taken with relish. Lime-water was successful in allaying the irritability and acidity of the stomach, even after black vomit had occurred, and I regard it as one of the best agents we can employ. Iced champagne was made use of in cases Nos. 3, 4. and 5, aud was very refreshing to the patient, agreeable to the taste, and arrested irrita- bility of the stomach. Lemonade was given in two cases, but in each dis- agreed with the stomach, and was vomited. I do not approve of its use because of its excessive acidity. The salicylate of soda was given in three cases, and good results were obtained from its use. In the case of Smith, who recovered, no urine was passed for twenty-four hours, but after com- meneing the acid, the flow was recstablished. I think if it had not been resorted to, combined with the use of the bath, he would most certainly have died of uremie poisoning. . Cases 4 and 5 did well under its use until Tues- day night, when the sudden change of temperature produced such a change for the worse in their condition, that they did not rally from it. It has been remarked that northern breezes are killing to yellow-fever patients, and such was the result in these cases. I was forcibly struck with the effect the change of temperature produced upon them, and although every effort was made to shield them, it was unavailing. The salicylate of soda is a diuretic, diapho- retic, and antiseptic, and the symptoms and course of the disease clearly in- dicate it as a proper remedy in the treatment of yellow fever, and I think we are justified in giving it a further trial."
Mr. J. Livingston. of 52 Camp Street, New Orleans, who joined the Howard Association as far back as 1841, and has passed through every epidemic in that city, in a pamphlet published after the epidemic of 1878, offers to the public the ammonia cure, which, if the results he gives are well established, would seem to be advanced beyond the domain of theory and into that of fact. He says: " During last summer I talked much about iny treatment. Physicians would not listen. and non-professional persons had their doctors, who, in their opinion, could give yellow fever the fits. Occasionally some of the unlearned
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A HISTORY OF THE YELLOW FEVER.
thought they would, if occasion required, use the remedy suggested. One old man, a stranger to me, was particular in writing my prescription. A few weeks after he sent me word that his child was saved by the application. Ile could get no physician, and so expended twenty-five cents for ammonia and camphor and applied it as directed. The second day the physician came and found the child out of danger, and that his services were not required. In riding in the cars one day I explained my theory to a lawyer. Not long since I met him and he thanked me for saving his two children; 'for,' said he, 'two days after my conversation with you two of my children were taken with the fever, and on applying the liquid it acted as described.' He employed a homeopathic physician and explained what he had done. There were other cases reported to me, but as I never saw any of them I can not assert positively that the remedy was effectual, relying upon statements to me as to the results. I will eite particularly one case under my own obser- vation. The patient, about forty-five, was in the early part of October taken with the fever. It was an aggravated case, with great heat. excruciating pains in the back and head, and with hemorrhage of the nose and gums, injected or congested eyes, tongue on the sides very sore, palate and roof of the mouth the same. It was a genuine case of hemorrhagic yellow fever. The hemor- rhage commenced with the attack, and I was fearful that there was internal hemorrhage, or that it would soon take place. Cases of this description are nearly always fatal, and terminate with black vomit. This was my experience. As soon as I could I applied aqua ammonia, with an equal portion of spirits of camphor, commencing at the head, rubbing it well, then the spinal column-in fact, all over the body. But two applications were made. In an hour or less time the temperature of the body was much reduced and the pains all gone. The patient seemed, after the second application, inclined to sleep. The heat and pains never returned. Hemorrhage from the gums and nose con- tinued for several days. On the arrival, in the evening, of an homeopathic physician, he found his patient free from fever and pains. On the third day he advised rubbing spirits of turpentine over the region of the kidneys, and gave a few drops of the spirits of sweet nitre, to be followed by watermelon tea. The urine which flowed after was not bloody, but of such a deep red color as to appear as if it was bloody. No nourishment was taken until the fifth day, and then in the shape of beef-tea. After this I gave chocolate, and eggs boiled very soft, stimulants in the way of weak brandy and water, a little krug, and English ale. I told the patient that all the internal organs were similar to the nose, gums, tongue and eyes, and that as soon as all the soreness and inflammation disappeared the inflammation of all the other organs would also be gone. From the externals I judge of the appearance and condition of the internals. On the tenth day the patient sat up and could take more nour- ishing food. Any indiscretion in eating. in this case, before the healing of the nose, gums, etc., had taken place, would have brought on a relapse. This was an undoubted case of very malignant yellow fever. The application used ter- minated the fever, arrested combustion. prevented internal hemorrhage, and rendered black vomit impossible. It is my conviction that no medical skill .
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A HISTORY OF THE YELLOW FEVER.
could have saved this patient. A continuance of the fever for twenty-four or forty-eight hours could not but have produced black vomit. The alkali neutral- ized the poison, and the fever disappeared. This and other cases impressed upon me the conviction that the right remedy had been applied at the right time. My next and coneInding article will suggest the course to be pursued in the treatment of this fever. I have never observed any benefit from the ad- ministration of drugs. My conchisions were these : the process of digestion be- gins in the mouth, where the food is cut, crushed and ground. As it is reduced to a pulp it is moistened by the saliva, a digestive fluid, which is secreted from the blood by three sets of glands called the parotid, submaxillary, and sublin- gual. As soon as the food is mixed with this saliva it enters the stomach, and it there is acted upon by the gastric juice which is secreted by the glands of the stomach, and is converted into what chemists call chyme. It then passes into the intestinal canal, is acted upon by the pancreatic juice, and by the bile from the liver. These change the chyme into chyle, and in that condition it is then, by innumerable absorbents, distributed to the various parts of the system, sup- plying such matter as these various parts need. After all the nutriment is ex- tracted, the chaff and husks, if I may so say, pass out of the system. In a healthy organization but very little goes out as excrementitious matter. This whole digestive apparatus, so very complicated, becomes inactive by the action of the poison, and all know that food can not be digested by a yellow fever patient. A piece of good beefsteak would be as fatal in the early stages of this fever as poison. Now, since the process of digestion is arrested, how is it pos- sible for drugs to be acted upon, and how, since every absorbent is inactive, could the drugs be distributed throughout the system? It is impossible, ac- cording to my view. Hence, no treatment is preferable to medicines. As soon as combustion ceases, which it does after the poison is neutralized, the whole in- ternal organism is left in an inflamed condition, just as the gums, nose and tongue were, in the case described, or I might say the whole was in a row con- dition. Medicine can not be applied to a raw surface. Mucilaginous drinks should first be given. They are emollients and soothe the irritated surface. They contain also some nourishment. I would give gum arabic water, flax- seed tea, mucilage of boiled okra or slippery-elm bark. At first the mildest emetic should be given, and then a purgative of some of the preparations of magnesia, or a cooling cathartic, and afterwards diuretics, if necessary. But in comparatively mild cases diuretics will not be needed, for if the mixture is applied soon after the fever appears, combustion ceases, the internal organi-m will in two or three days be restored to its normal condition. The profession have a mistaken idea that the yellow fever has a particular spite against the kidneys. They are in no worse condition than the other glands; but because there is no visible manifestation that the kidneys do secrete, ergo the conclusion has been that the kidney, are in the most disorganized state. Every gland is in the same condition as the kidneys. The system, after the poison is de- stroyed, must have time to heal, and food and medicines arrest the healing process. It is known to all that any indi-eretion in cating when the patient feels well, but before strength has been gained, is apt to produce a relapse,
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often terminating fatally. Keep the patient in bed as long as possible; a day or two more, even after he feels well, may prevent a relapse. Mucilaginous beverages, chocolate, eggs boiled very soft, and stimulants, the first few days will suffice. In conclusion I have demonstrated, I think-my theory-chat the fever is caused by an acid poison-that aqua ammonia, being an alkali. de- stroys the poison and ends the fever. I always add about equal parts of spirits of camphor, acting under the impression that camphor is a sedative, and slightly nareotie, and that it has the tendency to quiet the nervous system. My theory is a plain remedy, cheap and always at hand, and if it does not cure, it can not kill."
Dr. Dowell, in his diagnosis and cure of yellow fever, says that " this disease usually comes on with slight chilly sensation, even preceded by a few hours or a few days of languor and general malaise. These chills or rigors last for a few minutes or a few hours, and terminate in a fever of not a very high grade : pulse about 100, respiration about 20, and heat about 36 centigrade, (102 F. ; acute pain in head. back, and loins, sometimes vomiting mucous and undigested substances, and when severe mixed with sperks of blood, which is a grave symptom in the first twenty-four hours of the fever. Patient very nervous, tremulouz, easily excited, startles at any noise. This is especially so in chil- dren; fever continues regularly for twenty-four to sixty-four hours. generally abating in thirty-six hours, when there is a cahn : this calm lasts for a few hours or a day, when it terminates in convalescence, or the fever will return. In four or five days, say about the fifth day, patient's eyes will become tinged with yellow, and finally the whole skin will become yellow, like the yellowness of slight bruise or contusion. The skin does not turn yellow in more than one case in six. and many die before there is the least yellowness even in the eyes; not more than one in three turn yellow that die of black vomit. When there is vomiting and sick stomach from the rise of the fever, the patient is liable, between or after the third day until final recovery, to vomit up specks of blood and mueous, which will become blacker, and finally a blackish brown-red, of the consistency of chocolate or coffee, but free from lumps. This is the pure vomito pristo, or black vomit, which is the only positive sign of the disease. and I believe it is unlike any thing seen in any other pathological condition. I have not seen any thing like it in my professional life. I have seen, in con- gestion of the stomach, black matter, sloughs of the mucous coat, and -pecks of blood. generally with some small green specks. This is common with mala- rial fevers with congestion of the stomach, and these symptoms may occur in yellow fever, but the brownish black semi-fluid effusion in yellow fever is very different. This effusion may be in small quantities, leaving specks on the hand- kerchief or on the bed, or it may come up involuntarily, or may be spit up, or there will be pint after pint for hours, or even for two or three days. Patient at this stage is very restless, sighs, hallows, screams. attempts to get up. tal's about, half-conscious, and can't tell why he can not lie still, nor can he give a reason why he cries out. Skin begins in this stage to become yellow, if pa- tient does not die in a few hours; first a bright jaundice yellow, then a livil yellow, almost a contused black. In spots over the body blood will ooze out,
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nose will bleed, blistered and cupped surfaces will bleed, and show no disposi- tion to heal. Urine is generally natural in this stage; will not stain the shirt, as it always does in jaundice. This fact is very important, for this yellowness occurs in hematuria miasmatica, and the species of delirium also occurs in that disease, but we seldom have hemorrhage from the kidneys in yellow fever. Most often there is a suppression of urine, and though it may be scant, it is rarely more yellow than natural. Black vomit is the last symptom, for the patient generally dies either in a few hours or a few days after throwing it up. The quantity thrown up does not indicate the fatality or hasten dissolution, for only a few mouthfuls seem to be as fatal as bowls full. This black stuff is often found in the bowels when not vomited up, and not more than one in three that die throw it up. Hence the great difficulty in diagnosing this fever. I summarize the following symptoms, to be specially noticed in the order I have put them down :
" 1st. Chill, rigors along the spine.
"2d. Pain in head, very severe in most cases.
"34 .. Fever not very high, tending to perspiration if kept free from a draft. " 4th. Stage of calm about third day. Fever lasts but twenty- four hours, at least in children, and may run on without interruption for at least five days.
"5th. No second chill unless patient has been subject to intermittent fever, when he will often have regular paroxysis each day, or every day for three days, when it will assume a typhoid type, with red edges to tongue, dark brown coat in center, and on the fifth and later there will be more or less dryness, and a disposition to crack and bleed. This will be especially the case if the patient is kept from hot water or made to drink hot teas." Dr. Dowell gives his treatment as follows: "No nurse should be put in charge of a case who will not follow directions of doctor or doctors in attendance. This is a great curse in this city, many taking upon themselves to change their medicines as well as openly violate the doctor's instructions; such should always be dis- charged-the doctor or nurse should be discharged at once. There must be no divisions of these persons, or the patient will most assuredly die. There are so many opinions as to how a patient should be nursed ; I will only give my own plan, and what I wish all nurses under my directions to follow; but one thing all should remember, to make no change from doctors' directions. Doors should not be opened that were ordered to be closed, nor windows. All drafts of a sudden character should be strictly avoided-what I think a nurse should do and might do without the instructions of a doctor -- and this is what I recommend : When chill comes on patient should be put to bed and comfortably covered. not too hot nor too cold. patient's feelings to be duly consulted in this. If patient has eaten only a few minutes before, an emetic of mustard or ipecac may be given, to remove all the undigested substances in the stomach. as well as make the patient sweat. and to stop the chill. If. however, he has eaten one or two hours before, a dose of castor-oil with a little brandy should be given, and repeated if it does not act, to remove all indigestible substances from the intestinal canal, which if left might irritate and cause serious gastric congestion, and finally prepare the way for the black vomit. If by this time the chill is over, the 5
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