This disease prevails principally in warm climates and is peculiarly fatal where is attacks persons who are not acclimated, and who, coming from a colder region, seem to forget, that a change of climate would naturally indicate a change in habit, dress and diet. In a previous chapter we have spoken of the different amount of oxygen contained in a warm and moist climate, where the heat continues for months, and in the colder regions of the temperate and frigid zones, where the intense heat is of but few days or weeks' duration. The amount of food, both in kind and quantity, should be materially different in warm climates from that in regions at greater distance from the equator. In the rarefied air of the former, a less amount of oxygen is taken into the system, and therefore less solid nourishing food is required than in colder regions, where the air is more condensed, thus necessarily containing more oxygen. Food introduced into the system and not consumed, remains as a clog and irritant, encumbering the organs, cramping their operation, and sowing in the body the seeds of decay. Hence, in these warm climates great caution is necessary not only as it regards diet, but also clothing and exposure to the heat of the midday sun and the dampness of the night.

Causes

Animal and vegetable substances exposed to continued heat in a moist atmosphere soon decay, and fill the air with a poisonous miasmata. This miasm, may give rise to yellow fever, especially where it is produced by the decaying animal and vegetable substances found in close streets, the crowded and ill-ventilated rooms and cellars, and the necessarily confined air of the populous city or village. The chemist, perhaps, would hardly undertake to detect the subtile poison in the atmosphere, by which the life-springs of thousands are tainted, and yet he can laugh right merrily at the folly and absurdity of infinitesimal doses. Other prominent causes, are exposure to the heat of the sun, mental anxiety, want of cleanliness, dissipation, a fondness for stimulants, both in food and drink, in reality a greater love for the palate and stomach, than for life and health. This is one great cause, why the disease is more frequent and much more fatal among that class of residents who foolishly persist in indulging in the same variety of food, the same style of living, the same habits they were accustomed to in their colder home.

Diagnosis

This fearful pestilence is looked upon as almost as fatal as that terrific scourge, the Cholera. Sometimes the patient is taken down when at his daily avocations, without warning, and in a few hours is a corpse. In other cases the disease approaches more slowly, the premonitory symptoms being well marked. The severity of the disease, as we have before stated, depends much upon the constitution, habits and temperament of the patient.

The first symptoms are generally want of appetite, constipation, oppression of the stomach, giddiness and debility. Where the attack comes on with violence, there is cold, shuddering, headache, nausea and vomiting. This is followed by severe pain in the back, shivering along the spine, although the setting in of the attack is often preceded by great exhilaration of spirits, and tearing pain in the limbs, sometimes amounting to cramps. These sensations last for a few hours, and are followed by violent reaction. The breathing becomes difficult, the breath burning, the pulse hard, full and quick, the cheeks red and turgid, the conjunctiva injected, violent pain in the head and throughout the body, skin dry and hot, burning thirst, nausea and vomiting. The abdomen becomes hard and painful, and a sensation of great suffering is felt in the stomach. This period, lasting in severe cases from twelve to twenty-four hours, although sometimes it continues three or four days, is followed by what seems to the patient almost an entire remission. For a few hours the patient is comparatively comfortable, notwithstanding there may be some nausea and distress about the stomach, but this rest is speedily followed by a return of many of the old symptoms with increased violence. The skin and eyes acquire a yellow tinge. The tongue is parched and covered with a dark fur, the skin clammy, the head confused, the pulse sinks, delirium may set in, the retching increase in violence, the matter vomited presents a darker and thicker appearance, and the stomach is painful and sensitive.

This stage may last from twelve to forty-eight hours, sometimes with slight remissions towards the termination, when it is followed by the third stage, when the symptoms increase at a fearful rate. The strength fails rapidly, there is extreme prostration, the tongue and lips are parched and cracked, the gums soft and livid, exuding black blood; there is intense suffering in the stomach, great anxiety, hiccough, the dreaded black vomit, getting darker and darker, and more and more frequent, until death closes the painful scene. On the setting in of the third stage, the patient is generally beyond the power of earthly aid.

Treatment

The most important remedies are, - in the first stage, and sometimes in the second, Aconite, Ipecac., Belladonna, Bryonia, Pulsatilla and Nux-vom. In the second and third stage, Nux-vom., Mercurius-sol., Arsenicum, Argent.-nit., Digitalis, Phos.-ac., Rhus-tox., Verat., Canth., Carb.-veg. and when there are black dejections, Hellebore.

Ipecac

Is generally indicated in the first stage, where slight chills, general pains, uneasiness in the stomach, nausea and vomiting, together with a sensation of faintness are present.

Dose

A powder, or three globules dry on the tongue every two hours.

Aconite

Should the symptoms after a short time remain unabated, or change for the worse, other remedies are indicated, and the treatment should be of the most prompt and decided character. Aconite is indicated where there is violent febrile reaction; dry and hot skin, great thirst, full and rapid pulse, short and anxious respiration, restlessness and anguish; eyes red and sensitive, mouth dry, great internal heat; pain in the forehead and head, also in the back and limbs, heat and sensitiveness of the stomach; nausea, vomiting, and a general sense of prostration.

Dose

This remedy is particularly indicated in the first and sometimes in the second stage of the disease. It is often indicated in alternation with Belladonna, when it should be given two drops of the tincture, or six globules, dissolved in a tumbler of water, a table-spoonful every two hours. When given alone, it should be taken every two or three hours, according to the violence of symptoms.

Belladonna

Indicated mostly in the first stage of the disease, where there are sharp shooting pains or violent throbbing in the head; face bloated and red, eyes sparkling and red, or fixed, glistening and prominent, pulse variable, burning thirst and heat, tongue loaded with whitish yellow or brown coating; nausea or vomiting; aching and cramplike pains in the loins, back and legs; during the fever, great restlessness and anguish.

Dose

The same as Aconite.

Bryonia

Headache increased by movement, pains in the back, loins, and limbs; pulse rapid, full or weak; great thirst, tongue dry with white or yellow coating; yellow skin; eyes painful on motion, red, or dull and glassy, or sparkling and filled with tears. Pain and burning in the stomach, or fullness and oppression; vomiting or nausea, particularly after drinking; restlessness, anxiety and delirium.

Dose

The same as Aconite. Give every two or three hours. Sometimes the remedy can be alternated with Rhus.

Rhus

Dull, glazed, and sunken eyes; dry and black tongue, pulse quick and small; talkative delirium, or partial stupor; moaning and great restlessness, particularly at night. Violent pain and burning in the stomach; spasms in the abdomen; numbness or partial paralysis of the lower extremities; nausea and vomiting, colic, diarrhoea, and difficult deglutition.

Dose

Same as Bryonia. Nux-vom. - Eyes yellow or inflamed; yellow skin; pulse variable; tongue dry, cracked and brown, or coated with a white or yellow fur; vertigo; pains in the head; pressure, cramp-like or burning pain in the stomach; hiccough; bilious or acid vomiting; tremors of the limbs; great desire for stimulants; frequent movements of slimy, bloody, or bilious matter; coldness, cramps, and numbness in the lower extremities.

Dose

A powder or three globules every two hours.

Mercurius

Tongue moist and white, or dry and brown, pulse very changeable, now quick, strong and intermittent, and again weak and trembling; loss of strength and feeling of fatigue; vertigo or pain in the head; convulsive vomiting of bilious matter; extreme tenderness of the stomach; coldness and cramps in the arms and legs; constipation or loose mucous, bloody or bilious discharges. Dose. - Same as Nux.

Arsenic

Changeable expression of countenance, generally a yellowish, bluish, or deathly cast; sunken eyes, surrounded by a dark circle; lips and tongue brown or black; nose pointed; cold clammy sweat, pulse irregular, generally quick, weak, and small, or trembling, indicating great prostration; burning pains, especially in the region of the stomach and liver, sometimes with oppression of the stomach, and vomiting, particularly after drinking; diarrhoea sometimes with pain and tenesmus, though often involuntary; pain in the abdomen as from a weight; oppression of the chest, with rapid and anxious respiration. Delirium, low muttering, or talkative; loss of consciousness. This remedy is peculiarly applicable in the second and third stage, where there is a rapid sinking of the vital power.

Dose

Give a powder, or dissolve six globules in a tumbler of water, and give a tablespoonful every half hour or hour, as the symptoms may indicate.

Veratrum

This remedy is principally indicated in, the second and third stage, where there is a general coldness, particularly of the hands and feet, which may be covered with a cold perspiration; cramps in the upper and lower extremities, and in the stomach and abdomen; frequent loose evacuations; pain in the abdomen and stomach: vertigo; great thirst; severe vomiting, sometimes of bile and mucus, and again of black bile and blood. Loss of sense, stupor or violent delirium.

Dose

One drop or six globules in a tumbler of water, a table-spoonful every half hour, hour, or two hours, according to symptoms.

Phos.ac. - Stupidity; aversion to conversation; great prostration, stupid expression, with glassy hollow eyes; sleeplessness, restless, or sleepiness, or delirium, with picking the clothes. Cold perspiration, with anxiety and oppression of the chest.

Dose

Six globules in a glass of water, a tablespoonful every hour.

Besides the remedies we have already enumerated, Canth., Carb.-veg., Lach. and Sulph. may also be serviceable. For particular indications, see Materia Medica, at the close of the book.

Diet And Regimen

When the attack first comes on let the feet be placed in warm mustard water for a few moments, then put the patient in bed, cover him warmly, to induce perspiration and apply cold water to the head. If the patient is very thirsty, small lumps of ice may be held in the mouth, or a little cold water or toast-water given.

During convalescence particular care should be taken not to over-fatigue the system, to take nourishment in small quantities at a time, and to avoid mental excitement.