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 8
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A HISTORY OF THE YELLOW FEVER.
patient is perspiring moderately, he should be left alone. But if there is a dry skin and thirst, he should have warm teas : orange-leat is perhaps the best, but flax-seed is good, sage is good, and even China tea. This should be taken as freely as patient wants, but should not be forced upon him. Feet should also be put in hot mustard bath, and kept in a sufficient length of time to cause per- spiration, and then returned to bed and free from draft, which I think is bad at any and all stages of the disease. If patient gets too warm or sweats too pro- fusely, the cover should be partially moved, and if there is pain in the head, the temporal arteries beating, cold cloths should be freely applied, with either nitre or muriate of ammonia in the water, or ice, if deemed necessary; but these should be used with caution, and, when once begun, must be continued. I use them but seldom, preferring plain cistern water, which may be discon- tinued or renewed at the desire of the patient. If patient vomits, no emetics should be used; no hot tens, especially if there be specks of blood in the vomit. Mustard plasters should be put to stomach at once, and ice pounded like snow used if patient desires it, instead of teas. If the vomiting continues or the stomach becomes sore, then patient should be cupped at once and freely. This being done, then for the doctor's prescription. When the fever appears to run high, and the pain in the back and head is great, I give the following:
" R : Hyd. ch. mitis ; Quinæ sulphatis; Opii et ipecac pulvis: (F. charts, No. 4:) ãā grs. xij. Sig .-- One every three hours.
"This is repeated as long as the fever lasts, lessening the dose or increasing the length of the intervals, from three to six hours, according to circumstances. All tending to congestions is carefully guarded against, and remedies directed to the point ; all local paius are at once subdued. These are generally done by mus- tard plasters, cups, and blisters. If skin is still hot I give tincture of aconite, in ten-drop doses, every two or three hours, sometimes using sweet spirits of nitre with aconite. This treatment is continued until the fever subsides and the stage of calm comes on, which would be in thirty-six or fifty-six hours after the fever rises. If patient is much exhausted and pulse feeble I give brandy toddy, as much as patient wants, but will not force it on him; if there is restlessness I give valerianate of zinc, in from five- to ten-grain doses, as often as necessary. This is better than morphine; but I have used morphine with good results, if patient can not sleep. If there is retching or vomiting at this stage, I have used, with the best results, the following :
"R : Brandy, Siv ; Creosote, 3j ; Morphine, gra. iv : M. Sig .- Give tablespoonful every three hours, or ac- cording to circumstances, in a little water.
" I generally put a blister over the stomach, which is generally swollen, sore and tender to the touch at this stage of the disease. Blister is closely watched and cuticle kept on if possible, dressed with glycerine and covered with oil-silk,
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for they are apt to bleed, and will mortify if they are not well attended to. Should black vomit come in spite of all our efforts to keep it back, I continue the brandy and creosote mixture, and alternate with tincture chloride iron, in five to thirty drops every two hours, between the brandy or the solution of perchloride of iron or tannin. The latter does not corrode. By this treatment twenty-three cases of black vomit recovered under my charge, in 1867. I never give quinine in this stage of calm, or while the fever is off, to a patient with yellow fever: jusi the reverse of intermittent fever. It chills the patient, makes the skin very cold, and causes a cold and clammy sweat, very weakening to the patient. I allow my patients lemonade, as they want, throughout the disease; and this must be closely watched or it will produce serious ptyalism, which should be avoided. When only partial it is a good, favorable sign; but if severe, will often prove fatal by producing sloughs and hemorrhages. Where the kidneys do not act I use freely sweet spirits of nitre, tincture of buchu, or spirits of turpentine, in the usual doses. If a stimulant is necessary in this con- dition I use gin instead of brandy. Patient should be allowed food whenever called for, which should be light and nutritious, such as beef-tea, tea and coffee, to suit patient's taste. Black meats, as pigeons, ducks, Guinea chickens, venison, etc., in moderation. Patient must be gently fed when fever goes off, if there is no bad symptoms, or he will sink and the stomach prey on its own membrane, and nausea and vomiting will follow. There is no disease that requires as close watching as yellow fever, and none in which judiciously administered medicines will do more good. Patient should be watched from the stage of calm, or after the fever leaves, until complete reaction is restored, and should not be allowed to get out of bed, if possible, using bed-pan on all occasions. They will faint easily, and to faint is very dangerous at this stage, as the blood is so fibrinated that clots will form in the heart and arteries and patient die from embolism. Patient must take no unusual exercise for six weeks, or be exposed to damp or wet; must carefully avoid all sudden changes, all mental excitement as well as physical. Relapses do not often occur from very trifling causes, and a relapse is much worse than the original disease, and must be combated with the same remedies, but as a general thing will have to be used in much smaller doses, or the patient will sink. I have thus given the plan with which I have treated over two thousand cases, with about twenty-five per cent. loss, in hospital, taking all the cases as they come, and in private practice about ten. In children about five per cent. In 1867 I treated fifty-nine cases from the time they took their bed until their final recovery, in the hospital (all grown persons-sailors and employés), and only lost three-my assistant surgeon, laundress, and one sailor from a revenue cutter. In 1867 I treated forty-two children, and did not lose a single case ( I mean children under twelve years). Three had black vomit."
Dr. Warren Stone, in his Bellevue Hospital lecture, diagnoses the disease and prescribes his treatment of the disease as follows: " In the well-marked cases there was rigor, pains in the head, back, and limbs, and sometimes a peculiar capillary engorgement, particularly in the eye. If the patient is placed in bed at onec, with a little assistance he breaks into a sweat. as in common intermit- tent fever ; this gives some relief, but not much. The pains continue; but if
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A HISTORY OF THE YELLOW FEVER.
the case is favorable, it will go on until the sweating and heat subside together at the end of three days. The patient must be kept perfectly quiet; and if he is then nourished, he will have no return of the suffering. He must not even be allowed to raise his head. If he gets up, a faintness comes over him, and the whole process is often renewed, with the addition of nausea and loathing of food. In this case he almost certainly dies. This is the history of favorable cases. Purgatives are not essential, and many do much harm. A mild dose of oil may be given if there is any thing in the stomach likely to ferment and prove irritating. A simple injection may prove useful. If patients were seen in the beginning. I gave them, as soon as perspiration began, a full dose of quinine. There is no doubt of its good effect in quieting pains and promoting perspiration. Sometimes a second dose would be advisable the following morn- ing. This was all that could be done, beyond regulating the drink and nourish- ment. There was nothing more to do. There was no organic disease. Nothing was revealed by dissection. The poison caused a peculiar condition of the blood, which afterwards showed itself in the skin. There were many little points in the treatment which, in the aggregate, were of vast importance. In regard to the application of ice to relieve the pains in the head, it was common, but not advisable, and afforded only temporary relief. The reaction from it was dangerous. Cup- to the head, stomach, and back were much used at one time ; but only in cases of plethora were they of service. Simple applications of mustard were generally sufficient to relieve the pain in the back. Absolute rest and nourishment were of the highest possible importance. Any form of stimulant may be given that the patient prefers; but malt liquors are the best. Brandy may often be given, even with the fever. Beef-tea is necessary, and if the stomach can not retain it, it must be given by injection. Where there is acidity of the stomach, small doses of bicarbonate of soda, combined with the one-thirty-second part of a grain of morphia, had often an excellent effect. Sponging the patient is grateful and appropriate, but on no occasion must he be disturbed by the treatment. There is much in anticipating certain symp- toms. If there is a disposition to delirium and wandering, it may be guarded against by mild anodynes and stimulants. If this delirium is allowed to con- tinue, the patient becomes comatose, and dies. It must be remembered that yellow fever patients are wholly irresponsible, and though they may talk rea- sonably, they do not appreciate their own condition. It was exceedingly difficult to keep patients quiet in bed; yet it was the most essential part of the treatment. I once saved an intelligent sea captain, during one of the epi- demics, by threatening to cut his throat if he dared to stir from a given posi- tion in the interval- of my visits. The treatment of yellow fever is simple. In old times, people thought because it was a mighty disease it needed mighty remedies; and, when I first went to New Orleans, it was customary to give sixty-grain doses of calomel, and even more than that; and yet some patients even then got well. With rational treatment. a large proportion will recover. The chief difficulty lies in preventing the patient from committing fatal acts of indiscretion in the absence of his physician. It should be remembered that every thing depends on rest and nutrition, and that nothing can be gained by
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A HISTORY OF THE YELLOW FEVER.
depletion. It is even better to allow the bowels to remain unmoved for five or six days than to run the risk of giving active purgatives."
Samuel B. Washburne, late a captain of the volunteer navy of the United States, furnishes the following method of treatment. He says: " My first knowledge of the pestilence was in New Orleans, at the time it prevailed so frightfully in 1847. I think that was the year. I was then the first mate of the ship Herculcan, Captain Isaiah Chase. We went to New Orleans in the month of August, to take in a cargo of cotton for Liverpool, and were in port for weeks when the fever was at its beight, and expecting every day to be stricken down. During this time I watched the progress and treatment of the disease; and Captain Chase and myself determined on the treatment we would pursue in case either of us or any of our crew should be attacked. Having, after great delay, got our cargo on board, with much difficulty we shipped a crew. The shipping-agent delivered the men on board one evening, and we were immediately taken in tow, and on the next morning we were in the
Balize. Early in the day symptoms of the fever were developed among the
crew. Without losing a moment, Captain Chase and myself applied the remedies we had agreed upon. The patient was covered all over with thick woolen blankets, and his feet put into a tub of very hot water, well charged with mustard. After half an hour, and when in a full perspiration, two men with coarse, dry towels gave him a thorough rubbing down, until the whole body was in a glow, and the circulation in a good state. He was then put to bed and covered with blankets. In another half-hour an immense dose of castor-oil was administered. The patient was not permitted to leave his bed, but was kept very quiet, and limited to a very light and careful diet. No other medicine was given except an occasional dose of oil. We had four cases, and all recovered. In July, 1850, I found myself at Para, under the equator, in command of the ship Edward Henry. The yellow fever was then raging there with a malignity and fatality almost without a parallel. All business was suspended for more than two months, and the death rate was fearful, particularly among the shipping. There were many vessels in port that lost every man on board, officers und crew. Every single man on my ship was attacked. I was fully prepared, and had determined to apply the same treat- ment as on the Hereuleun. The American consul advised me, in the event of the fever breaking out, to send my men to the hospital on shore; but I declined, preferring to treat them myself. It was well I did so, for scareely a sailor who went to the hospital ever came out alive. As soon as a man showed the least symptoms of the fever, I put him through the same course of treatment as I have stated, and every man recovered. As for myself, I happily escaped the fever both in New Orleans and Para, buit had an attack of it at Brashear City, Louisiana, in the summer of 1863, when in command of the United States iron-clad steamer Nyanza. My attack was a light one, and yielded readily to the remedies I had so successfully applied to others."
Two contrasting cases are those offered by Dr. George W. Moore, of the Hernando Road, near Memphis, and Dr. E. J. Pitts, of Shreveport, La. The latter gives his personal experience of the ice treatment. He says: "In
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A HISTORY OF THE YELLOW FEVER.
Navisota, Texas, in the fall of 1867, I was attacked about midnight, but did not call a physician (Dr. Jones) until next morning, and he pronounced it yellow fever of the most malignant type, as did all other physicians whom he con- sulted. I was given a most active purgative, of which I think the principal ingredient was calomel, and took quinine during the day in great quantities; but my fever did not abate in the least, but rather grew worse. The next day I was so reckless of life that I resolved to try an experiment to kill or cure; my main object was to relieve myself of pain. So I hired the waiter to bring a tub of cold water in my room and put sufficient ice in it to make it almost in the freezing state. I drank often of ice-water, though little at a time, and swallowed pounded ice in lumps almost as large as my thumb; this threw the heat on the outward surface. I then wet my head and neck, and gradually got in the tub of ice-water and bathed my whole body freely for five or ten minutes, until I felt unpleasantly cold, and then immediately got in bed and wrapped up warmly, and soon got in a profuse perspiration, and fell into a pleasant slumber which lasted four or five hours. When I awoke I was entirely free from fever and from all pain, and was entirely well in a few days."
Dr. Moore's treatment is of another extreme, and is thoroughly heroic. He says : "I may premise by stating that I have a long experience in a disease known to the profession as 'malarial hematuria' or 'swamp fever.' It has prevailed extensively in the Mississippi swamps. The treatment which I pur- sue has been successful in every case, no matter how malignant. Now, as I consider malarial hæmaturia nothing more than a bastard form, or rather the twin-sister of yellow fever, I have adopted the same course of treatment in the present epidemic; and I am happy to add, that in every case, no matter how malignant, my cases have got well when called before the death symptoms (of black vomit or suppression of urine) have supervened. Now for a slight synopsis of the treatment I pursue. If called early in the disease, I give calomel ten grains, with one-half grain of ipecac; in four to six hours I scour out the bowels with oil and terpentine; on the first decline of fever I give from three to five grains of quinine every two hours until twenty or thirty grains are taken: sometimes combine a small portion of Dover's powders to allay nerv- ousness and restlessness. From the beginning I order hot foot-baths, with plenty of mustard, also large mush and mustard poultices over the bowels. I also use a saturated solution of the chloral of potassa all through the disease to act on the secretions. As a nourishment I use beef-tea or chicken-water."
Two other and equally remarkable contrasts in treatment are furnished, the one by Mrs. Jane G. Swisshelm -who recommends hot water compresses and packs, with homeopathie medicines for internal treatment-the other Dr. S. Ales- ander, of Clinton, Miss., which is almost as heroic as Dr. Moore's, though with different (root) remedies. He says: " The treatment should be varied accord- ing to present indications, but always cleansing, stimulating, and sustaining. If you find your patient in the first stage with the chill upon him, give him strong, stimulating teas, as good composition or bayberry, African and wild ginger, equal parts: or ginger and bayberry in sage tea; or sage, or catnip, bayberry and cayenne; or bayberry, boneset, and ginger. If a free use of any
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A HISTORY OF THE YELLOW FEVER.
of the preceding teas should have a tendency to produce vomiting, give a tea- spoonful or more of lobelia-powder in a cup of the tea, to make him to do it well and thoroughly, and prevent that congestion which makes him vomit too inuch. Nine cases out of ten should be vomited at once to cleanse the stomach. Much attention should be paid to the surface. It should be thoroughly cleansed either by the vapor bath, the warm bath, or warm water and soap (the first is the best), and if hot, dashed with cool alkaline water after it; if cool, rubbed with a liniment made of a tablespoonful of cayenne in half a pint of good cider vinegar. While chill or fever is on, the thirst can be allayed by acidu- lated drinks, as with vinegar, lemonade, sumachberries, simple grape-juice, apple-water, etc. Good tonic bitters should be freely given after the system is thoroughly cleansed and the fever is off-not before. If the bowels are inactive, give enemas of a tea of equal parts of cayenne, lobelia, and slippery elm. If they are too loose give one of these, and follow its action with one of bayberry (or some other good astringent) and ginger and cayenne. Remember to bring the action to the surface as soon as you can. and maintain it there in a gentle softness of the skin, not profuse perspiration, which would prostrate, but just a comfortable freedom from heat and dryness. As soon as the stomach is cleansed and the action of the surface is restored. give enough of the following to move the liver and the bowels gently: say, one grain of the extract of man- drake, two grains of the extract of black root, and five grains of rhubarb. Should this dose fail to act in from six to eight hours, use the best Alexandria senna, in small doses, until the object is accomplished. Before and after the action of the medicine give a wine-glass of Virginia snake-root tea, with sage or pepper tea as a sudorific. The stomach cleansed, the action of the surface being restored, the liver and bowels being relieved, all that is wanting to com- plete the cure is good nursing, close attention, a judicious repetition of the same means as the exigencies of the case may demand. Convalescence of this dis- ease requires to be watched with peculiar care."
Dr. Masderville, physician to Charles IV, published in New Orleans, in a work dedicated to the Governor Baron de Carondelet, in 1796, the following as a safe treatment: "An antimonial mixture, in viper water; five ounces of emetic wine; one ounce of cream of tartar; a teaspoonful for a dose. After the fifth day give an electuary of salt of wormwood, tartar emetic, and Peru- vian bark, in divided doses." The third and last remedy ( lavement), called the blessed laxative, was composed of antimonial wine-water, honey, and oil. He rejected cordials, blisters, and blood-letting. He considered life as residing in the blood. as derlared by Moses ( Leviticus xvii, 14), and denounces venesee- tion as dangerous for that reason, as life and health depend upon it. He main- tains that his method is a true specific against all the fevers of Spain and America, as he knew from an experience of twenty years. His most Catholic Majesty commanded the Spanish physicians to follow his prescription and to prescribe nothing else. He blamed the physicians of Havana for not having adopted this " blessed" method of treatment.
Dr. Mitchell, of New York, who was born in 1763, and died in 1831, Dow- ler says, learned alike in physic, physics, and politics, influential at home and
F
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abroad, exercised at the beginning of the present century an influence over the public mind rivaling that of Dr. Rush. This great New York professor and Member of Congress claimed to have discovered the demon of all epidemics, par- ticularly that of yellow fever, called by him Septon, that reigned by virtue of the principle of AAcidity in the earth, air, and water, causing corruption everywhere; whereupon, he inaugurated Alcalinity into power with a serub broom in one hand and a bucket of lime-water or soap-suds in the other, by which only " Grim Septon " could be conquered. Dr. Mitchell moved, in Congress, the ap- pointment of a committee with the view of reporting on the purification of ships by alkalies in order to destroy this pestilential Septon. The Secretary of the Navy adopted the theory, or at least the practice, which latter he ordered to be carried into effect. Books, pamphlets, and letters soon appeared against Septon and for Alcalies. The next year an article appeared in the Medical Re- pository, having the title following: " Dr. Chalmers on the Acidity of the At- mosphere of South Carolina." The fading of goods, the rusting of metals, and other effects of atmospheric acidity were gravely announced as indubitable proofs of this theory. Dr. Hosack and many others adopted Dr. Mitchell's theory of Septic acid as being the cause, and alkalies as the preventive of yel- low fever. Lime-water and the like were reckoned to be vastly important in neutralizing the Septic acid, which was considered very corrosive, particularly after black vomit appeared. Dr. Cathrall, of Philadelphia, read a paper before the American Philosophical Society on the analysis of black vomit, in which he asserted that there was an acid in this liquid which was inert to the taste and smell, and harmless when swallowed.
In their report to Congress, the Homeopathic Yellow Fever Commission of 1878 state that, in their treatment for yellow fever they did not have recourse to any of the allopathic remedies. Some acknowledged the occasional use of an anodyne to produce sleep in cases of extreme wakefulness or restlessness. Some gave a little carbonate of soda for sick stomach, or sulphurcarbolate of soda for black vomiting, or frictions or enemata of quinine in collapse. One supplied a blis- ter or two, a kind of coarse, external homeopathy! another gave watermelon- seed tea for suppression of urine. Foot-baths, sponging, enemas, warm and cold applications, frictions, stimulants, regulations of diet and of covering, of the temperature of the sick room, and ventilation of the same, were resorted to. "The great therapeutic question of the first stage," they say, "is how to re- duce the extreme high temperature, which, if long continued, will inevitably destroy the integrity of the blood and arrest the processes of nutrition in the molecules of every organ of the body. The homeopathie physician would take Aconite, the great homeopathic antiphlogistic, and giving it in very small doses frequently repeated, would equalize the circulation, quiet the nervous system, and reduce the temperature in a gradual and satisfactory manner, without the pos- sibility of doing the least harm. Leaving nature all her strength and her re- sources unimpaired, he would do the greatest amount of good practicable under the circumstances of each case. The whole secret consisted in selecting the remedy according to the homeopathic law, and in using it in very small doses frequently repeated. The last fact we can best illustrate by saying that water
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dropped, drop by drop, upon a stone, will make more impression upon it than a thousand times the quantity dashed against it at once. The homeopathic physician has more genuinely homeopathic remedies for the second stage than for the first, among them the giants arsenie, crotalus, and carbo vegetabilis. Here, too, he gives smaller doses, and with still better effect. He has more re- coveries after black vomit. He checks hemorrhages without the use of that relic of surgical barbarism, the actual cautery, which was actually used upon a little child in New Orleans last summer. He restores the secretion of urine without diuretics. He rouses his patient from a deeper collapse, and saves him from the most desperate condition. The action of homeopathie remedies in the second stage of yellow fever frequently reminds us of their similar efficiency in the collapsed stage of Asiatic cholera."
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