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The Great Fever
Toward an Understanding of Yellow Fever

Hospital with yellow fever patients, 1898 Marine Hospital Report, 1898 -- Treatment

In 1898 the United States Marine Hospital Service issued a report on yellow fever. In Section B, Surgeon R.D. Murray speculates that yellow fever is a disease of the duodenum, before cataloguing treatments for the disease. The general sense of impotence in his descriptions is palpable, as the methods he describe constantly remind doctors not to let patients know how sick they are and what they are suffering from.


Treatment of Yellow Fever
By Surg. R.D. Murray.

I have seen yellow fever in twenty-one summers (including 1870) and in every month except February. The elimination of yellow fever from our nomenclature will follow when there is a proper conception of the influence of clothing, bedding, and unclean bedrooms as transmitters. The disease is air borne for some distance; the infection is stronger at times and places than at others; whether it is intensity or quantity I do no know; it may be diluted, and is transmitted by clothing, bedding, and related articles. Hair from the dead has transmitted it; corn sacks; blankets and old newspapers have carried it; mountains of filth will not produce it; they may give it a new nidus or garden from which it goes out "seeking whom it may devour." The cleanest town in the South may have a severe prevalence if the people insist on disobeying the advice of the health officials.

In 1875 as a result of several post-mortems and an attack of the disease, I came to the conclusion that yellow fever was an inflammation of the duodenum, primarily, and wanted to call it epidemic duodenitis. Many post-mortem examinations, as well as bed side experience, have shown me that the death-dealing process was not the "inflammation" that I was taught thirty years ago to understand as inflammation, i.e., there is no proliferation of cells or tissue and no new growth.

There is a primary involvement of the duodenum and the symptoms of the disease follow generally in regular order. The mildest cases have a tender duodenum (if you know how to press) and a little back ache; note how close to the spinal column the duodenum lies. If the stools could be all and carefully examined sometimes a mass of white mucus with a black or brownish middle will be found. Maybe there will be a stool of black mucus once only. It is fair to say that there is always a clay or bismuth stool with the mucus clot stained with black. The "bloody sweat" from the duodenum, and in bad cases from upper intestines and stomach, starts in the duodenum.

Sometimes the symptoms come in such quick succession that we think the attack is necessarily fatal. Many times in such cases we have no chance to ask the patient how matters fared with him twenty-four or thirty-six hours before, when he was sick, but would not admit the fact. Walking cases are common in this as in the other bed diseases. I have known a man, suffering with headache for three days on duty, to vomit black on the stairs on the way to his deathbed. I have given immune certificates to persons who never went to bed.

In ordinary, the patient should like the medical attendant. If the physician is distrusted, he should be called off or feign illness, so that a favored one can be called in. Consultations over the patient are injurious. I would have the doctor do his share in keeping up courage, hope, and life-purpose in his patient; to minimize the aches, distress, and fears, and to carry his patient's mind away from the now with its dreads to to-morrow, with its reward or revenges. Several people are living now because, in their desire to take vengeance on me for what they thought was my indifference, they forgot themselves and their conditions.

NOT EVERY CASE NEEDS TREATMENT.

It is fair to say that of one hundred cases seventy-five need only to be let alone by the extra-attentive nurse or friend or heroic physician. They will get well under any plan of treatment and under miserable local conditions; notably so with infants, who, if they die, are generally sacrificed by curds or some acrid medication.

These seventy-five are "cases" and should be recorded, but only for sake of good records and to establish their immunity. They should receive only what occasion demands and be watched for untoward incidents.

Of the twenty-five some will need formal attention and careful procedure; others will die in spite of all reasonable aid. Some vicious habit or chronic disease will add to the trouble, and in some cases uncontrollable fear will insure a fatal result.

My oldest patient to get well was 109 years of age; the youngest was 52 hours old when she threw up black vomit. One of my children had black vomiting five days after she was born. I know of the recovery of a chronic Bright's disease sufferer; of a morphiomaniac's recovery, and last summer gave a diabetic doctor such a cheerful council that he had a severe attack without fatal result, and has been in better health since than before. I cite these cases to show the triviality of the disease if "taken right and in time." I have often said "Yellow fever is the most honest, most trivial, and cheapest to treat of all diseases that kill." It is "honest" because it comes with definite signs and leaves no trace, always insuring the afflicted on that he is hereafter immune; it kills, if at all, in a few days and is merciful in the killing, as the doomed one is usually conscious to the last and does not linger as a consumptive or one afflicted with cancer; "trivial" because 50 per cent of those who suffer with it are scarcely aware of serious illness, and have no sequels to make them miserable the remainder of their lives; also, because it rarely takes off children, and they, by reason of the attack, gain the privilege of living in its habitat; "cheapest to treat" because it is so; the delicacies, liquors, etc., sometimes provided are generally consumed by the disbursers and attendants and are not fairly chargeable to the sick; the medicine actually needed cost very little.

TREATMENT OF YELLOW FEVER.

When called to a man (most of my work has been with men) who has had a chill some time during the previous night, has a pulse of 100 to 112, with temperature of 101.5 degrees to 103 degrees, headache (cutting across the forehead), backache running down into the thighs, sore muscles, skin hot if you hold your hand on it a while (hands and wrist not hot to gentle touch), anorexia, white tongue (may be a yellow center far back -- the red edges and red diamond on tip will not show at once), suffused eyes, and notably or faintly purpled cheek bones with semipuffed upper lip, the hundred chances are you have a case of the yellow fever.

Give three or four compound cathartic pills at once and as soon as possible give a hot foot bath (an all-over bath is better, but is not always possible), with or without mustard and salt. Mustard at this time is really a nonessential, but sometimes the patient thinks it is the proper thing; so with the table salt. As to the cathartic: calomel at first is too slow and usually must be sent for, the pills contain enough of it and are in your vest pocket. Every yellow fever doctor should carry first doses of compound cathartic pills, compound acetanilide tablets, and such other pocket remedies as may be needed on emergency. A parade of a small medicine chest is not advised. Do not begin to make a reputation for wonderful medical skill now. Dwell on the dengue symptoms and the signs of malaria, and without great formality convince the patient that "it is not yellow," but do not say so. Keep back information about the actual temperature all the way through, but tell them about the height of the fever. No patient should ever hear that his fever went about 102 degrees until after he gets well. (I saved a doctor once by hiding his thermometer and using my French scale, which he could not translate.)

Give as soon as convenient, or, if fever is above 102 degrees, at once, any coal-tar derivative in 7 1/2 grain doses, with some bicarbonate of soda and caffeine. The antikamnia compound is a good one. If powders or tablets are objectionable to the patient, give antipyrine. I nearly always use acetanilide with soda and caffeine. I have no objection to any, except that I like cheapness and simplicity. After the bath and a good sweating, under blankets, for from four to six hours, rub dry and cover with two blankets. (the clothing should have been hung outside of the house or dumped into a tub of water; dispose of the wet sheets and blankets in like manner. When washed they are ready for use again; this hint in regard to prevention of infection.)

If a person likes blankets next to skin, so much the better for prevention of skin shock. Quilts and counterpanes are objectionable because of the nasty odors they retain.

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