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A Case of Yellow Fever.

Problems:

Art. VIII.—
—By Joseph J. Kendrick, M. D., Bryan, Texas.

A Mr. S., about thirty-two years of age; light hair, eyes and complexion; of good proportions, and about average vitality. He had carried an enlarged but not very tender spleen for several months. On Friday. in the first week of October, he was out in a very cool rain; took a chill and on the next day sent to me for medicine for diarrhoea and fever. On closely questioning the very intelligent gentleman who had brought the message of Mr. S., and had examined him, I found that his fever was high; severe pain in limbs, spine, head, and in the region of the spleen; eyes looked "as if they had been smoked"; tongue coated a yellowish white. The chill was reported as having had considerable duration, but not much sense of coldness, though with considerable difficulty of respiration. Had been constipated, and took two Podophyllin and Leptandrin pills on the night of his chill. With yellow fever then in our place, and knowing that Mr. S. had been visiting the town for two or three days previous to being attacked, these symptoms were sufficient to make me suspect his having the prevailing disease. His diarrhoea I knew to be the result of the irritation set up by the pills; and, on the reasoning before stated, I believed oppression of nervous centres the primary of all the lesions defined by his messenger's report; and I sent him, for the enteric irritation, Comp. Syrup of Rhubarb and Potassa, adding two and a half drachms Chloroform and ten drops Norwood's Veratrum; believing these latter agents as good as the best stimulants of innervation—especially sympathetic innervation. Dose of the mixture, a teaspoonful every two hours.

On the next day (Sunday) I went, at his bidding, to see him, and as I expected, found a moderately severe case of yellow fever. The nervous lesion, as might have been predicted, being felt more acutely in the region of the spleen so long diseased. Diarrhoea had ceased; skin was acting, the perspiration being a little more free than the normal; and, as is usual, the pulse had gone down to less than a hundred. Knowing that in this disease it is important to establish secretion from the liver as soon as possible, and that failure of the kidneys is best anticipated by the use of mild diuretics, I thought best not to trust wholly to stimulating nervous centres; I gave about half grain Leptandrin every three and four hours during that day and the succeeding night; and for a drink (thirst was persistent, but not intense) I gave a cold infusion of Galium; continuing the first prescription for the fever and irritated intestines. Over the left gastric region I used mustard friction and moist heat, relieving the pain and very much mitigating the occasional nausea. Continued the use of the above means and progressed finely; and on the third day of the fever, that is, from establishment of reaction from chill, the pulse went down to about sixty; skin still acting naturally; tongue cleaning; pain going and appetite returning; but there was still a little sighing respiration and some torpidity of the bowels. The former got Chloroform in small doses, the latter mild enemata; all the time tincturing the patient's drink with Galium. As soon as moist skin and tongue, soft, even pulse and quiet stomach allowed, I gave Quinine with Gelseminum; bringing up the too slow pulse and low temperature to the normal standard. Continuing a mild tonic and appetizer with occasional doses of Chloride of Sodium for pallid mucous membranes and torpid bowels, I left him in the hands of the cook; advising, for a few days, a "kitchen medicine" prepared of Irish moss. He made an excellent recovery; having passed from the beginning of the chill to established (but not confirmed) convalescence in seven days. Used no purges, no emetics, attempted no profuse diuresis or diaphoresis, and had secured all I aimed at without the mustard baths, orange leaf teas, lemon water, Calomel, Buchu, or Opium.

My brother (Julien C. Kendrick, M. D.) treated six cases on exactly the same plan, and had like results—not losing a case. Out of eight cases treated by us, one died; but the death of this one was mainly due to the fact that his friends were not fully convinced he had yellow fever, and he was not nursed with the necessary care. Several times escaping from his nurse at one side of his bed, he would tumble out on the opposite side, and with singular alacrity strip himself of all his clothes, checking the favorable action of his skin, and undoing all that his medicine had effected.

I do not give you the history and semiology of yellow fever in detail, because you can find them better told in special texts on this disease; besides, I can not find room in a letter to do justice to those particulars.


The Eclectic Medical Journal, Vol. XXXIV, 1874, was edited by John M. Scudder, M.D.



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