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NOTES 
 
 TAKEN FROM A LECTURE BY 
 
 / 
 DR. MANUEL DAGNINO, 
 
 At the Medical University of Caracas, Capital of Venezuela, 
 
 ON THE 
 
 TREATMENT OF YELLOW FEVER. 
 
 TRANSLATED INTO ENGLISH BY 
 
 DR. ANTONIO DE TEJADA, 
 
 Of Cartagena, U. S. of Colombia, and now of New York. 
 
 The public are respectfully informed that during the prevalence of Yellow 
 Fever in the South, one-third of the net proceeds of this pamphlet will be 
 devoted entirely to the relief of the sufferers^ and forwarded accordingly. 
 
 Price, 25 Cents. 
 
 This pamphlet is sold in this city at IIUDNUT'S PHARMACY, Herald 
 Building; GEORGE SHIELDS', Apothecary and Chemist, 896 Broadway; and 
 at Ford's Department at CASWELL, HAZARD & CO.'S, comer Broadway and 
 24th Street; and also by all Medical Booksellers. 
 
 u 
 
 Copyright 
 National Printing Company, 16, 18, 20 and 22 Chambers Street. 
 
 
<lf 
 
 & 
 
 *v 
 
Treatment of Yellow Fever. 
 
 I divide the Fever into Light and Malignant. 
 The malignant can be divided into the fulminating 
 and regular, following its ordinary course. Practice 
 has taught me that the Climatorial or Yellow Fever 
 can be divided, as far as symptoms are concerned, as 
 follows : First, Inflammatory ; second, Bilious ; third, 
 Ataxic; fourth, Adinamic ; fifth, Catarrh. The pro- 
 per distinction of these different varieties occurring 
 in the Yellow Fever has assisted me greatly in its 
 treatment. I now divide the Yellow Fever into three 
 stages, according to its duration. For the benign 
 and fulminating there is only one stage. In the 
 Fever which lasts five days, as it has done gene- 
 rally in the cases coming under my observation, 
 there are two stages. When the Fever extends to 
 seven, nine, or eleven days, it should be, in my opinion, 
 divided into three stages, not mentioning very rare 
 cases in which I have seen the Fever last twenty days, 
 nor the more frequent cases where it is complicated 
 with inflammatory diseases, such as pneumonia, dysen- 
 
2 TREATMENT OF YELLOW FEVER. 
 
 tery, &c, when it becomes the duty of the practical 
 physician to properly determine the course of the 
 disease. 
 
 SYMPTOMS OF THE BENIGN FEVER. 
 
 The Yellow Fever presents itself frequently under 
 unalarming circumstances, the patient complaining 
 simply of a slight indisposition not sufficient to keep 
 him from his daily avocations. Of such cases I have 
 seen many, notably where a sea-captain came on 
 shore for business purposes, and on passing my 
 house consulted me as to what I thought ailed him 
 slightly, ignoring altogether that he had the Yel- 
 low Fever. The symptoms usually complained of 
 by the patients are languor, lumbago, slight headache, 
 heavy feeling about the head, sometimes slight ver- 
 tigo, loss of appetite, more or less thirst, also occasion- 
 ally a sense of weight at the stomach. The physician 
 will perceive the pulse to be slightly accelerated, there 
 being seventy to ninety beats a minute, together with 
 a slight rise' in temperature. The eyes are injected, 
 the tongue coated, heavy breathing, urine high 
 colored and ammoniacal. On closer examination he 
 will find that the patient is restless and wakeful, and 
 is troubled much by disagreeable dreams. His 
 

 
 TREA TMENT OE YELLO W EE VER. 3 
 
 spirits will be found slightly depressed, although I 
 have met cases in which I have seen the greatest 
 tranquillity, the patient attributing all the above 
 symptoms to a slight cold. 
 
 The physician who meets with cases in which the 
 described symptoms occur should at once take every 
 precautionary measure against Yellow Fever, but must 
 be careful not to arouse suspicions on the part of his 
 patient, or to dispel his pleasant illusions too hastily. In 
 this state of the disease the patient generally feels bet- 
 ter in the morning, worse during the afternoon and 
 night, which condition usually lasts three days, at the 
 end of which period there will be a jaundiced appear- 
 ance of the esclerotic membrane of the eyes, There 
 will be sedimentary deposits in the urine, together with 
 bile therein, abundant perspiration, and the patient 
 finds himself soon so well again that he cannot believe 
 himself to have been ill. 
 
 MALIGNANT OR INSIDIOUS FULMINATING FEVER. 
 
 The above designation is applied to this class of the 
 Yellow Fever in consequence of its extreme malignity, 
 differing from the other branches of the Fever inas- 
 much as it skips over the normal stages and terminates 
 
4 TREA TMENT OF YELLO W FE VER. 
 
 always in death ; hence it may well be termed perni- 
 cious. 
 
 However this may be, the cases which I have ob- 
 served of this Fever, and which I term Fulminating, 
 have presented to me the following symptoms and 
 signs : The patient, following his usual daily avocation, 
 is seized suddenly and falls to the ground, as if struck 
 by lightning, without time to call upon friends and 
 warn them that he feels sick. 
 
 A. — There are cases in which the patient has no time 
 to call a doctor ; when he arrives the patient is found 
 either dying or dead. I have noticed that those ex- 
 posed to the sun — such as soldiers and sailors — are 
 mostly subject to such sudden attacks. The bystand- 
 ers inform the physician that the patient fell as if 
 knocked down by a severe blow, and on examination 
 he is found to be slightly swollen, with stertorous 
 breathing, coma, and heightened temperature. I may 
 here note in this connection that a soldier who had 
 succumbed in this manner, for four hours after re- 
 tained such bodily heat that considerable doubt and 
 apprehension existed as to his being dead previous 
 to making his autopsy. 
 
 B. — In other cases there is time to take the first pre- 
 
TREA TMENT 0F f YELLO W FE VER. 5 
 
 cautionary measures, but all of a sudden, before the 
 termination of the first stage, and when least ex- 
 pected, the patient takes to his bed and succumbs to 
 the disease in a few hours, to the surprise of his at- 
 tendants, altogether presenting the symptoms de- 
 scribed under A, and in addition accompanied by 
 black vomit, together with a highly jaundiced condi- 
 tion of the skin. 
 
 The cases referred to have been of robust and san- 
 guineous Europeans. After the first twenty-four or 
 thirty-six hours, everything progressed well. Cups 
 were applied to the neck, and leeches in the region of 
 the temples, symptoms of cerebal congestion predomi- 
 nating. The patient, although ultimately dying, seem- 
 ed to respond to the treatment, nothing occurring to 
 make-me apprehensive. I believe that bleeding, freely 
 used, was required in these cases. 
 
 In a more extended translation of Dr. Dagnino's 
 lecture, which may possibly hereafter appear, it would 
 be proper to notice his description of the Regular 
 Fever, the prodromes or prelude to the Fever, symp- 
 toms of invasion, and description of each of the three 
 stages, but all of which, for want of space in a limited 
 pamphlet of this nature, I leave out, and pass on to 
 
6 TEE A TMENT OF YELLO W FE FEE. 
 
 TREATMENT. 
 
 When we suspect an acclimated person is seized with 
 Yellow Fever, we proceed in a practical manner, con- 
 sulting especially our own experience, to quiet the ap- 
 prehensions of the patient, then to place him in the 
 proper hygienic condition both for himself and others ; 
 and lastly, to discover as far as possible what may have 
 given rise to the disease and any former sicknesses he 
 may have had, in order to be able to commence treat- 
 ment without embarrassment. 
 
 In many cases the patient commences to feel sick 
 after a meal, with nausea, weight and pain at the 
 stomach, bad taste in the mouth, together with all the 
 symptoms of indigestion. In such cases it is well to 
 commence treatment with an emetic of Ipecac. If in 
 place of these symptoms of indigestion there should 
 only be constipation for a few days, treatment can be 
 commenced by a dose of castor oil, or it might be 
 proper to unite calomel with the oil. 
 
 If the indication should be purging, both from rec- 
 tum and mouth, the following prescription may be used : 
 
 Saline mixture, 13 ozs. 
 
 Epsom Salts, 2 ozs. 
 
TREA TMENT OF YELLO W FE VER. 7 
 
 Tartar Emetic, 2 £ grs. 
 
 Syrup, 2 ozs. 
 
 M. and take two tablespoonfuls every half hour. 
 
 Should there occur no marked indication of purging 
 as here mentioned, perspiration should be freely en- 
 couraged, for which the footbath may be used for a 
 more or less prolonged time, and charged with pul- 
 verized mustard, &c, according to the degree of 
 headache and other circumstances which the practi- 
 tioner will recognize. Immediately after the footbath 
 it is advantageous to make use of warm frictions with 
 mixed olive oil and alcohol, made after the style 
 of Masage, especially over the back, to alleviate the 
 pain which there torments the patient so much. Gen- 
 erally the first twenty-four hours of the disease should 
 be employed applying the applications here named, 
 besides mustard plasters in the proper places, warm 
 or lukewarm lemonades, and the Potion de Riviero 
 with liquor acetate of ammonia, in order to open the 
 pores. Generally I have made my patients take from 
 three to five drachms of this diffusive medicine every 
 twenty-four hours. 
 
 The following is the formula in which the Potion de 
 Riverio is prepared : — 
 
TREATMENT OF YELLOW FEVER. 
 POTION DE RIVERIO. 
 
 Take 
 
 Bicarbonate of Potash, \ drachm. 
 
 Water, 14 drachms. 
 
 Simple Syrup, 4 " 
 
 M. and mark "Alkaline Solution, No. 1." 
 
 Take 
 
 Citric Acid, i drachm. 
 
 Lemon Syrup, 4 drachms. 
 
 Water, 14 
 
 M. and mark " Acid Solution, No. 2." 
 
 If in this first stage the pulse and congestion should 
 be such as to require bleeding, wet cups and leeches 
 can be had recourse -to. The sedatives to the forehead, 
 such as ice-water, vinegar, ascetic ether, all seem to 
 have a good effect, and are called for. In this period 
 the patient may be allowed some orange to eat, but no 
 solid alimentation. There are cases in which the pain 
 in the back causes much suffering. Then the physician 
 will commence by applications of poultices of mustard, 
 which, if not sufficient, cupping may be had recourse 
 to, which, in some cases, has afforded immediate re- 
 lief. 
 
TREA TMENT OE YELLO W EE VER. 9 
 
 After all this has been done, we proceed to make 
 use of the Sulphate of Quinine. I have rarely employed 
 it alone, but generally use it in combination with Calo- 
 mel and Rhubarb in the following proportions : — 
 
 Take 
 
 
 Sulphate of Quinine, 
 
 30 grs, 
 
 Calomel, 
 
 25 " 
 
 Rhubarb, 
 
 15 " 
 
 Mix and divide into 20 pills. 
 
 Of these we make the patient take two every three 
 hours, or one every two hours ; sometimes we alter- 
 nate doses of the Calomel and Rhubarb, according to 
 circumstances, viz.: — 
 
 If the bowels are open, diminish the doses, or they 
 can be increased if there is a tendency to constipation ; 
 and there are cases in which they are discontinued 
 after having been used, or where I avoid the Calomel 
 from the commencement, which I have done in rare 
 cases, such as with women enceinte. Conjointly with 
 these pills I continue the use of cold acid drinks, such 
 as the Potion de Riviero, orangeades, and lemonades, 
 taking care not to overcrowd the stomach, bearing in 
 mind that the great thirst of the patient will not be 
 quenched by taking large quantities of fluid at one 
 
i o TREA TMENT OF YELL OW FE VER. 
 
 time. It is necessary to see that the attentions of the 
 attendants do not excite vomiting which has not yet 
 existed, but which may be superinduced by the least 
 imprudence on their part. With this treatment, more 
 or less modified, we arrive at the end of the third day 
 and to the commencement of the second sta^e of 
 the disease. The patient will have taken by this 
 time from three to five grams of the sulphate of 
 quinine, and from twelve to fifteen grams of the liquid 
 acetate of ammonia, when synconism will generally 
 have been produced. Now we have to take into 
 consideration the strength of the patient, and we 
 make use of mineral acids, of the bitters, together 
 with generous wines in small quantities. The anti- 
 spasmodics will, if indicated, be used, selecting those 
 most suitable to the palate of the patient, with a view 
 to obviate nausea and vomiting. The patient may be 
 allowed the use of various kinds of teas, and cold drinks 
 may be continued. With this treatment we may arrive 
 to the fifth day and enter into the period of convales- 
 cence. Many cases will present themselves in which 
 there will be no necessity for recourse to other meas- 
 ures than here stated, but unfortunately this does not 
 always happen ; when the physician, despairing, puts in 
 practice all the therapeutic remedies against the symp- 
 toms of this terrible disease. 
 
TREA TMENT OF YELL O W FE VER. 1 1 
 
 The advice here given is throughout from my own 
 experience, and not from any preconceived ideas culled 
 from the writings of other practitioners, however 
 worthy. I now proceed to enumerate the remedies 
 which I have found efficacious : First, for pain in the 
 epigastrium, viz., mustard poultices ; the abstraction of 
 blood in accordance with the state and strength of 
 patient ; applications of flying blisters ; sometimes 
 stimulating liniments. Second, Vomit. For this cold 
 acid drinks ; pieces of orange ; solution of cream of 
 tartar, &c, &c. ; if not counter indicated by carbonate 
 of soda or magnesia, with a little opium ; sometimes in 
 the bilious form an emetic has seemed to do good and 
 afterwards stay the vomiting. If there be constipation, 
 a dose of calomel or rhubarb may do good service. 
 
 BLACK VOMIT. 
 
 For this, small repeated doses of lime-water should 
 be given, associated with a few drops of laudanum oft 
 repeated. Small doses of chlorate of potash and bi- 
 carbonate of soda seem to do good. Vegetable and 
 mineral acids are often useful. 
 
 HEMORRHAGES. 
 
 If epistasis occurs, it will be treated in the usual way. 
 
1 2 TEE A TMENT OE YELL O W FE FEE. 
 
 I have never been obliged to tampone the posterior 
 narris. For hemorrhages from the stomach, cold drinks 
 and mineral acids are used ; other hemorrhages may be 
 treated in the usual manner. 
 
 DELIRIUM. 
 
 This symptom or complication is of grave import- 
 ance and urgent. Apply cold to the head, revulsives 
 to the extremities, depletion of blood from behind the 
 ears, opium, and antispasmodics. Everything should 
 be put in practice that may be deemed suitable, whether 
 there is albumen or not in the urine. 
 
 TREATMENT ACCORDING TO THE DIFFERENT FORMS. 
 
 In accordance with what we have already said of the 
 forms of the Fever, I believe that we should pay them 
 attention in the consideration of treatment. In the 
 form adenamic, sustain the strength by means of the 
 mineral acids and bitter tonics employed with prudence. 
 Quinine may be also used ; also any form of mercu- 
 rials, with caution. The prudent practitioner will be 
 careful to bear in mind the form adenamic in order to 
 avoid the antiphlogistics, which not only predispose 
 the patient to adenemia, but also indirectly precipitates 
 it. In this particular it should be noted that the Yel- 
 
TREA TMENT OF YELLO W FE VER. i 3 
 
 low Fever goes hand in hand with Typhoid, and the 
 practical man must not forget the fact. 
 
 ATAXIC OR NERVOUS FORM. 
 
 When certain nervous symptoms predominate, the 
 physician will presume that the ataxic form has super- 
 vened. This is very important for the treatment. 
 Blood extraction should be used with great discretion, 
 and every endeavor should be made to help nature as 
 far as it is possible. Small doses of opium may be ad- 
 ministered to quiet the symptoms. Light antispas- 
 modics will be prescribed (chloral may be here used). 
 Cold applications to the head will be continued, and 
 leeches to the base of the cranium will not be left to the 
 last resource. Unfortunately, I have seen in my prac- 
 tice that all is useless when the ataxic form reaches the 
 form of continuous delirium, with convulsions and al- 
 bumen in the urine. Even without these circumstances 
 I have lost various cases after employing all the means 
 indicated, and, in addition, musk, camphor, castor, etc. 
 
 BILIOUS FORM. 
 
 The Bilious form from the commencement requires 
 the use of adequate emetics. I have seen cases in 
 which the administration of an emetic on the fourth 
 
i 4 TREATMENT OF YELLOW FEVER. 
 
 day has very much alleviated the sickness, producing 
 bilious vomit of a dark character, abundant diaphoresis, 
 disappearance of the cephalalgia, clearing of the head, 
 and bringing on rapid convalescence. 
 
 INFLAMMATORY FORM. 
 
 The Inflammatory form calls for the use of anti- 
 phlogistics, but it should be recollected that in the 
 Yellow Fever from one moment to the other in the best 
 constituted and robust person there can come in with 
 the typhoid symptoms a surprising condition of adene- 
 mia, on which account we should not imitate those 
 practitioners who are too sanguine as to the results of 
 bleeding. 
 
 CATARRHAL FORM. 
 
 There is very little to be said with respect to this 
 form, which is very rare. Warm drinks and sudorifics 
 can be employed. 
 
 COMBINATIONS. 
 
 As these forms present themselves combined in 
 practice, after having given an account of the princi- 
 ples of treatment used, the variations will be met by 
 
TEE A TMENT OF YELL OW FE FEE. 1 5 
 
 the practitioner, consulting always the state, strength 
 of the patient, and the character of the fever present 
 at the time. 
 
 COMPLICATIONS. 
 
 Complications will be treated as they present them- 
 selves, having always in view the nature of the prin- 
 cipal disease. 
 
 With this method of treatment, which for the most 
 part is a rational treatment, I have obtained in my prac- 
 tice very favorable results. In it there figures only a 
 systematic use of the sulphate of quinine, associated 
 only with calomel and rhubarb. I ought here to men- 
 tion why I have so much faith in these agents, whatever 
 may be the form or intensity of the disease. From 
 the year 1856 to i860, during which time I practiced 
 in the hospitals, I saw put in execution by various 
 physicians, and some of them very distinguished, 
 divers curative methods, without being able to assign 
 to any one of them a position of preference in the 
 therapeutics of Yellow Fever. None of these es- 
 teemed physicians had any set method or treatment 
 from conviction for the Yellow Fever, as it happened 
 with other diseases which reigned in the country, such 
 as typhoid, dysentery, etc. Alternately I saw put in 
 
1 6 TREA TMENT OF YELL OW FE VER. 
 
 practice the extraction of blood, the acetate of am- 
 monia, the purges, emetics, expectant treatment, and 
 mercurials. The sick succumbed in the greater part. 
 The autopsies proved nothing particular except a pe- 
 culiar state of the liver, which was revealed by dis- 
 coloration. As to the rest, the signs were of little 
 importance, such as dark contents in the stomach and 
 small intestines, coagulated blood in the stomach, red- 
 dening of the gastric mucous membrane, which some- 
 times was more or less softened, and so forth. It re- 
 sults therefore that in the year i860, when I received 
 my degree in the Medical University of Caracas, al- 
 though I had seen and assisted many cases of Yellow 
 Fever, I had no convictions of my own with respect 
 to treatment. 
 
 Finding myself therefore frequently before people 
 suffering with this disease, and not having as yet suffi- 
 cient confidence in my own judgment to separate my- 
 self from the classics or the teachers of medicine, I 
 continued to put in practice the various methods of 
 which I was cognizant, but always with an equal result. 
 At the end of two years of this conduct, and led by the 
 idea which the Amphitheatre suggested, that the liver 
 was the organ or apparatus which most suffered in this 
 disease, and led by clinical induction to think that 
 Yellow Fever developed itself amongst us by miasma, 
 
THE A TMENT OF YELL OW FE VER. 1 7 
 
 I endeavored invariably to put in practice the system 
 I have propounded. By means of the sulphate of 
 quinine I endeavored to operate on the miasma; by 
 the calomel and rhubarb, on the liver. Having frequent 
 occasion to put in practice my ideas, I was enabled to 
 obtain satisfactory results, and if before I saw that the 
 sick died at the rate of 60 or 70 per cent, I was at 
 last able to persuade myself that with this method 
 almost all were saved, that is to say, 00 per cent 
 

 

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