Treatment Of The First Period

The patient must be immediately put to bed and kept absolutely free from excitement. Rest in a recumbent position must be carefully enjoined, and the patient must not be allowed to even raise the head to drink. Medicine and fluids must be given through a tube or with a teaspoon. If the patient is seen promptly, and there is a probability of undigested food being present in the stomach, that organ should be unloaded by an emetic, and as little medicine as possible should be ordered. If constipation is present the bowels should be emptied by a purgative enema. It is generally considered that profuse perspiration is an advantage. This object can be accomplished by covering the patient with blankets and giving a hot lemonade or hot toddy, such as hot whisky and water.

As the vomiting becomes more and more severe, efforts may be made to relieve it, but if all measures fail, it will be best to let the stomach have absolute rest, which is secured by hypodermic injections of morphine, mustard paste over the epigastrium, and the use of the rectum for all medication. Among the various means at command for the relief of the vomiting are cracked ice, light acidulated and effervescing draughts, such as acid lemonade, Vichy, Seltzer, or carbonic water, strong coffee, plain lime water in frequent half-ounce doses given cold, besides dilute hydrocyanic acid, cerium oxalate, etc. Iced champagne, very dry Mumm or Pommery sec, or acid lemonade with bitartrate of potassium, will sometimes be retained. With the supervention of uraemic symptoms, or when there is suppression of urine, there is urgent need of getting more fluid into the body. The lumbar region should be cupped or poulticed or covered with a mustard paste. If aerated waters are not tolerated by the stomach, three or four pints of salt water should be injected into the rectum every two hours, or it is suggested that hypodermoclysis might prove of service after the manner employed in cholera (p. 455). While the fever lasts, or throughout the first period, it is usually best not to attempt to give food at all, for the stomach is almost certain to reject or fail to digest it.

Cochran dissents somewhat from the prevalent practice of allowing no food during this stage, and believes that an attempt should be made to supply a little nourishment per os, to fortify the system against the future drain upon it which is certain to follow. He says: "I have seen infants at the breast pass through attacks of yellow fever to prompt recovery, throwing up black vomit frequently and freely, and nursing as regularly and heartily as if there was nothing the matter with them".

Many cases of yellow fever occur among previously healthy people who can withstand the absence of food for a day or two without serious loss, provided exhausting symptoms can be held in check. In many instances, however, prostration and exhaustion occur with extraordinary rapidity, and in an hour the patient may be too feeble to articulate or move. Active stimulation by the rectum and hypodermically is then necessary. For this purpose whisky is best. It should be obtained pure and injected hypodermically with a sterilised syringe in quantities of one to three drachms. The injections may be made beneath the skin on the outer surface of the thigh and arms in four or five places. Two ounces of whisky diluted in an equal part of water may be injected per rectum.