Calomel.—We have spoken of calomel, the action of which, so different according to the dose, is here formally indicated, either as a purgative, or as an alterative, or as a derivative. We have seen, that emetics were counter-indicated with persons too robust and disposed to cerebral congestion. It is in these cases, that calomel should be employed, at least, when there are no symptoms of local irritation or inflammation of the stomach. But if the tongue is loaded, humid, large and saburral, without redness of its borders, if the region of the liver is painful, the indication for calomel is more precise.
For a purgative dose there will be given every half hour from three to six grains, until the patient has taken eighteen. If, after having obtained the purgative action, it is necessary to continue the medicine for a certain time in smaller doses, as a derivative, it is given in doses of two grains every hour, until the characteristic greenish stools are obtained.
Calomel is still applicable, when constipation persists, despite the employment of sulphate of magnesia. Administered then, every hour, in grain doses up to twelve, it works marvellous effects. I have seen convulsive symptoms disappear after the administration of this remedy. One of its inconveniences is ptyalism, but this is obviated with the aid of Seidlitz powder. Very often when it has been given after the emetic and sulphate of magnesia, calomel is sufficient to produce a remission, when there has been none.
Sudorifics.—When the remedies, of which we have spoken heretofore, do not bring on a remission of the symptoms, it is well to look to sudorifics, which, facilitating the peripheric circulation, produce a general relaxation, and with this an abatement of the pulse. Among the sudorifics, I commonly select Dover’s powder, and the liquid acetate of ammonia or spirit of mindererus.
The latter administered in doses of twenty drops, in four ounces of flower of elder, acts as an antiseptic and sudorific. It is indicated, when the skin is dry, with the sharp heat so common in yellow fever of the continued acute type, without remission. I have often seen individuals stubborn to sweat, despite the purgative, transpire abundantly after some doses of this medicine.
Dover’s powder suits, when the patient has dry skin, is restless, and turns over in his bed uttering deep sighs. I give for the dose, every two hours, from three to four grains in two or three spoonfuls of infusion of tilia, warm or hot. After the second or third dose, the patient becomes more calm, sleeps, and wakes covered with sweat. The effect of sudorifics will always be assisted by a mustard foot-bath.
Some medical men have considered the transpiration so useful, that they have made it the basis of their treatment. In the outset, they prescribe a steam bath. I have tried this but without advantageous results.
When transpiration is determined, the pulse remains full and strong, diuretics are indicated, and among these powder of digitalis associated with nitre.
Sulphate of Quinine.—Sulphate of quinine is one of the most powerful and most useful remedies in the treatment of this disease; but it must be well indicated, well administered, and in a suitable dose. What are the indications of sulphate of quinine in yellow fever? There must be at least remission, if there is not complete intermission of the fever. Its application is then excluded from the continued type. When the fever has yielded, by the use of the medicines of which we have spoken, or when, with sweat or moisture of the skin, the pulse has sensibly lowered, the employment of quinine is always good. Its effect will be shown, for the strongest reason, in the intermittent type. In this last case, it acts with the same precision and the same success, as in simple intermittent fever.
As sulphate of quinine has a prompt and durable action, the mucous membrane of the stomach ought to be in the best possible condition for absorption. It must, therefore, be empty. An emetic and a purgative, at least the latter, should precede the administration of sulphate of quinine. I know that there are medical men, who administer quinine in the height of the fever, regardless of the state of the stomach and of the mucous membrane. If they have found this treatment beneficial, it is by chance; for it is illogical, and its effects are commonly deplorable.