Hematuria is combatted with weak sulphuric lemonade.
It is during the period of hemorrhages, that the parotids become swollen—a frequent indication of amelioration of the general condition. When pain or swelling appears, I apply tincture of iodine three times a day externally, loco dolenti. During the epidemic of 1862, I had twenty-nine cases of inflammation of one parotid, and seven of both parotids, and lost but one patient. I attribute this success to iodine. When suppuration does not invade the whole gland, premature incisions must be avoided. They would produce the serious inconvenience of retarding the cure, of making the patient suffer uselessly, and of occasioning hemorrhages difficult to arrest.
The tumors which show themselves on different parts of the body ought to be treated with topical tonics. Compresses soaked in wine of cinchona, facilitate resolution. It is not necessary to open these tumors; this would expose them to hemorrhage.
During the first period, slightly acidulated drinks are prescribed, warmed to promote diaphoresis; in the second, the patient takes cool beverages; in the third, tonics are preferable.
During the whole course of the disease, absolute diet is essential. There must be no indulgence on this point. Often a little broth, given before the period of remission, is enough to bring on indigestion, then reäction, and finally death. In the second period, there is sometimes a sensation of false hunger, which deceives the patient; but the least compliance on the part of the physician might be fatal.
To be more exact, we now proceed to examine singly each one of the recognized therapeutic remedies against yellow fever:
Bleeding.—I consider general bleeding injurious, except with individuals of apoplectic temperament, presenting symptoms of inflammatory fever. I repeat that cupping is preferable to leeches. I have already so insisted on this mode of application, that it is useless to allude to it again. I will say only, that it is necessary to employ the spring scarificator, and never the lancet or bistoury.
Pediluvia.—Foot-baths are perfectly associated with cuppings, to diminish local congestions. They ought to be given in the manner following: The patient lying on the back, draws his thighs upon the stomach, the legs upon the thighs. In this position the feet and legs are placed in a vessel filled with warm water, the temperature of which is gradually increased, until it becomes unendurable. The bath ought to last from fifteen to twenty minutes. Its effect will be increased by the addition of powdered mustard. When taken from the water, the feet should be carefully dried, and mustard plasters applied to the thighs and allowed to remain as long as the patient can bear them, when they will be removed, and placed on the calves of the legs.
Emetics.—Emesis is one of the most important remedies in the first, but becomes injurious in the second period. Black vomit often comes soon after the administration of an ill-judged emetic. The principle indication are these—the tongue humid, saburral, charged with whitish mucous deposits, nausea, disposition to vomit, bad taste in the mouth, the temperament bilious, constitution lymphatic, atmosphere damp, etc. Administered under these circumstances in the first period of the invasion, the emetic is a heroic remedy. I prescribe thirty grains of ipecac, dissolved in six ounces of distilled water, taken in one draught. Nausea soon occurs, and as soon as the patient begins to vomit, the effect of the medicine is assisted by drinks of warm water. The food contents of the stomach are first ejected, then bile. The drinks of warm water should be continued, until the liquid ejected is as clear as the water that is swallowed. After the vomiting, the patient takes one or two cups of tilia. Ordinarily, the congestive symptoms of the brain increase, by reason of these efforts, but after a short repose and a little sleep, the skin becomes covered with sweat, and on awaking, the pain in the head is sensibly diminished.
I prefer ipecac to tartar emetic, because the action of the former is more gentle and more constant, and because tartar emetic irritates the mucous membrane of the stomach. After ipecac, the patient remains calm, whilst after tartar emetic, the nausea continues, and is very often followed by diarrhœa. I insist strongly on patiently awaiting the effect of the ipecac before giving warm water, because prematurely swallowed, this embarrasses instead of promoting the effect of the medicine.