Let us, however, observe, that ipecac, if useful when clearly indicated, may produce deplorable consequences, if administered despite counter-indications. In my experience, it is counter-indicated, whenever the period of invasion is passed, and even during the period of invasion, when the patient has not been attacked immediately after a meal, when the disease has not commenced with chills, when the individual is plethoric and is subject to cerebral congestions, or when he complains of pains in the stomach, even when fasting.
The first twenty-four hours of the invasion passed, the emetic can have fatal effects. At this period, indeed, the stomach and abdominal organs suffer in a manner more direct, and the efforts of vomiting increasing, these local congestions may determine a condition as much more difficult to encounter, as the period of the disease is advanced. How often have I seen black vomit appear after an emetic improperly given! I have seen under the same circumstances epistaxis which could not be arrested, and such irritability of the stomach, that it could not bear anything.
Purgatives.—Purgatives are of as great importance as emetics in the treatment of yellow fever.
After the administration of the emetic and a repose of twelve to twenty-four hours, the purgative may be used to induce action by the intestines. It slightly excites the secretion of mucus, and facilitates the circulation and the passing of bile by the stools. Drastics should be absolutely excluded, their too violent action producing injurious irritation. Among the purgatives I recommend, above all, castor oil alone, or associated with oil of sweet almonds. When judged proper to be administered alone, two ounces at least should be given at once. When mixed with oil of sweet almonds, three ounces of the first, and two ounces of the second, adding some drops of lemon juice, unless it is preferred to give the patient a slice of lemon, after the potion, to prevent vomiting.
The action of castor oil is a little slow, but it should be assisted with injections of olive oil and warm water.
If the patient has an antipathy to castor oil, sulphate of magnesia is administered, in a dose of one ounce in a half tumbler of fresh water, with the addition of six grains of nitrate of potash. The mixture of these two remedies produces secretion of intestinal mucus, acts upon the kidneys, augments the secretion of urine, and at the same time excites diaphoresis.
This mixture ought to be given in small doses, every half hour, as the stomach will bear it better. Given in this way it is sometimes vomited in part, so that there should be no attempt to give the remainder. If its action is delayed, it should be assisted with injections slightly purgative, warm sea water, or sulphate of magnesia, mixed with olive oil. During the action of the purgatives, especially of sulphate of magnesia, the patient may drink as much fresh water as he wishes.
Obstinate constipation, indicating a congestive state of the brain, will be combatted with Seidlitz water. The different purgatives generally bring on a calm, and marked relief.
Other purgative substances are employed, among which I would cite rhubarb and Seidlitz powder, or Seidlitz water. They are particularly indicated in the jaundice of the second, and in the commencement of the third period.
The counter-indications of purgatives are colliquative diarrhœa, the third period of the disease, hemorrhages, especially those of the anus. Feeble and lymphatic temperaments do not endure them well. They should be given to women and children with caution, and in small doses frequently repeated.