[As I have never practiced farther South than Cincinnati, and have seen but few cases of this disease, my experience with it has not been sufficient to be relied upon as authority. Therefore, I shall give a brief description of the disease, with the proper and successful treatment, furnished me by A. H. Burrett, M. D., of New Orleans, who is not only a Physician of more than ordinary learning and skill in his profession generally, but is one who has spent his time in New Orleans among the sick of Yellow Fever, through three of the most fatal epidemics that ever scourged any city. He is a man for the times, a man of resources, who draws useful lessons from experience and observation. Hence he has been able to select such remedies as have enabled him to cope most successfully with the pestilence, saving nearly all his patients, while, under other treatment, a majority have died. I therefore, attach great value to his treatment, and recommend its adoption with the most implicit confidence.]
When this Fever prevails as an epidemic, as it usually does, in the southern part of the United States, it is a disease of the most malignant character. The proportion of fatal cases under the Allopathic course of treatment, has been equal to, and, in some places, as in New Orleans, and some Towns in Virginia, has exceeded that of Asiatic Cholera. It is almost entirely confined to Southern regions, and only prevails in hot weather, after the continuance of extreme heat for some weeks.
It usually begins with premonitory symptoms somewhat like those of ordinary fever, but with this difference: the patient, instead of losing his appetite, has often a morbidly increased desire for food. He complains of severe pains in the back, and more or less headache. Both the head and backache are of a peculiar character: the pains resembling rheumatic pains, the head feeling full and too large, the eyes early turn red, almost bloodshot and watery, a chill comes on, which may be distinct and quite severe, lasting for an hour or more, or, it may be slight, and hardly perceptible. The chill is followed by high fever, the pain in the head and back increasing, the eyes becoming more red and suffused, the forehead and face extremely red and hot, and the heat of the whole surface very great, the carotids beat violently, the pulse very frequent, and usually, at first, full and strong, though sometimes it is feeble from the beginning. However the pulse may be in the beginning, it very soon becomes small, but continues to be frequent. The tongue is at first covered with a white paste-like coating, which afterwards gives place to redness of the edges and tip, with a dark or yellow streak in the center. The stomach is very irritable, rejecting every kind of food, and all drinks, except, perhaps, a few drops of ice water. There is a peculiar distressed feeling in the stomach, often a burning sensation, so that, if suffered to do so, he would take large quantities of ice or water. One remarkable feature of the cases noticed in the epidemic, as it existed in New Orleans the past season, was, that the patients had a great desire for food, notwithstanding the nausea and distress at the stomach.
Sooner or later, varying from a few hours to several days, in the ordinary course of the disease, the fever subsides. From this time the patient may recover without any further symptoms, but this is, by no means, the usual result. If the subsidence of the fever is accompanied by natural pulse, a free, but not profuse or prostrating perspiration, a genial warmth of the surface, natural appearance of the countenance, eyes, and tongue, with little or no soreness on pressure over the stomach, we may safely look for a speedy recovery. But if, on the contrary, the eyes, face, and tongue, become yellow, or orange-colored, the epigastrium is tender to pressure, the urine has a yellow tinge, the pulse becomes unnaturally slow, with the least degree of mental stupor, we have reason to know, full well, that the lull of the fever is only the calm preceding a more destructive storm. The fever has subsided, only because exhausted nature could re-act no longer. It may be in a few hours, or not until twelve or twenty-four have elapsed, the pulse becomes quickened, even to the frequency of 120 to 140 in a minute, but very feeble, the extremities of the fingers and toes turn purple or dark, the tongue becomes brown and dry, or is clean, red, and cracked, sordes may be on the teeth, the stomach become more irritable, nausea and vomiting are extreme, the substances vomited being, at first, reddish, afterwards watery, containing floculæ, like soot, or coffee grounds; the breath becomes foul, and the whole surface emits a sickening odor. The pulse becomes very small, though the carotid and temporal arteries beat violently. The urine fails to be secreted, and later, blood is discharged from the mucous surfaces, involuntary discharges from the bowels, clammy sweats; and death follows.
The disease runs its course in from three to seven days, sometimes proves fatal in less than a day, and at others, assumes a typhoid form, and runs for weeks. Occasionally it sets in without any of the premonitory symptoms, the chill being first, the fever following, succeeded immediately by the black vomit, going through all the stages in a single day, or two days.
Again, it sometimes begins with the black vomit, the patient being immediately prostrated. In all cases, however it may begin, the peculiar head-ache and back-ache as described in the beginning, as well as the extreme heat of the head and face, redness of the eyes, the gnawing sensation at the stomach, and peculiar nausea are present. These seem to be characteristic symptoms that mark the Yellow Fever, and those which should guide in the search for the proper remedies.
TREATMENT.
The remedies that proved successful in arresting the disease during the early or forming stage, before the chill or fever had set in, while the symptoms were pain, fullness, and throbbing of the head, with more or less dizziness, rheumatic pains in the back, and redness of the eyes, were Aconite and Bell., at low attenuations, once in two to four hours, according to the violence of the symptoms. For the fullness of the head, pressing outwards, as though it would split, with pains of a rheumatic character, Macrotin 1st, given in one grain doses, every hour or two hours, proved specific.
These three remedies, Aconite, Bell. and Macrotin, would, in nearly all cases, arrest the disease in the forming stage, so that no chill or fever would occur, or, if fever did come on after this treatment, it was mild.