=Definition.=—An acute, infectious disease, characterized by a febrile
paroxysm followed by short remission and then relapse, jaundice,
toxemia, suppression of the urine, and gastric hemorrhage.
=Osteopathic Etiology= and =Pathology=.—While a specific germ is the
cause of yellow fever, it has not as yet been isolated. Extended
tests by United States Army surgeons in Cuba show conclusively that
the infection is alone carried by the _stegomyia fasciata_, but “It
remains somewhat uncertain whether the mosquito is the sole means
of transmission.” (Anders). Season is the chief predisposing cause
as the outbreak is usually in summer and a frost ends its spread.
Immunity is generally conferred by one attack. Tucker[58] noted that
all cases examined had liver lesions and that most of the patients
were of the malarial or bilious type. Spinal lesions were not marked
in some cases, but when present were in the liver and renal areas.
Tete[59] believes it to be a virus secreted in the human organism under
certain atmospheric and other conditions in certain types, i. e. people
subject to hepatic and renal disturbances. He also says the vagus is an
important factor.
=Pathologically=, there is more or less jaundice and hemorrhagic
extravasations under the skin. The blood serum is red-tinted, owing
to the destruction of the red cells. The liver is pale and presents
extensive fatty degeneration, with necrotic masses in and between the
cells. The gastro-intestinal mucous membrane is swollen, congested and
presents numerous minute hemorrhages. The kidneys show parenchymatous
inflammation. The spleen is not enlarged. The heart sometimes shows
fatty degeneration. The stomach contains more or less of the “black
vomit,” which is a mixture of transuded serum and transformed blood
pigment.
=Symptoms.=—The incubation period varies from one to five days. The
attack generally begins with a chill, fever, 102 to 105 degrees,
headache and pains in the loins and legs. The pulse is accelerated,
the face is flushed, the tongue is coated, the throat sore, the bowels
constipated and the urine scanty and albuminous. Recent observers state
that bile is present in most cases before the albumin is noted. Nausea
and vomiting may be present at the onset, but become more severe about
the second or third day when the black vomit appears. The =febrile
stage= or stage of invasion, lasts from a few hours to several days
and is followed by a decline in the fever when the severity of the
other symptoms abates. This is called the =stage of remission= and in
favorable cases convalescence sets in or the patient may pass into the
second febrile paroxysm. The temperature rises again, jaundice appears
rapidly, nausea and vomiting return. The tongue becomes dry and coated.
The stools are black and offensive, the urine is albuminous, scanty and
may be suppressed; there may also be hematuria. Death may occur from
exhaustion or from uremia. Recovery may follow the gravest symptoms,
even when there has been black vomit. The duration of the entire attack
covers about one week. Relapses sometimes occur.
Price says there is a point in differential diagnosis in yellow fever
and it is a symptom not met with in any other febrile affection. It
is the progressive fall of the pulse-rate during the congestive stage
of the first sixty or seventy hours, i. e., a variation of from five
to ten beats less each morning and evening. He adds, “As long as the
kidneys are active there is but little to fear.”
=Diagnosis.=—=Remittent fever= has not the deep jaundice, the clear
mind, the black vomit, or the albuminuria of yellow fever. The enlarged
spleen and the presence of the organism of Laveran in the blood in
remittent fever will decide the diagnosis. =Dengue= is sometimes
confused with yellow fever.
=Prognosis.=—This is always a grave disease, and in its severe forms
very fatal. Recovery, however, may occur after the severest symptoms
have been manifested. Black vomit is not always a fatal sign. Enough
cases have been treated osteopathically to state that osteopathy is
particularly effective. Improved sanitation is doing much to reduce
mortality.
=Treatment.=—Prophylactic treatment should be carefully carried out.
All patients should be quarantined and carefully screened so they
cannot be bitten by the mosquito and the disease spread further. People
that are not acclimated should keep away from infected districts. All
pools, cisterns and other places which can breed mosquitoes should be
drained or screened. A systematic warfare should be waged against them.
The patient must be put to bed at once and plentifully supplied with
fresh air. Everything must be scrupulously clean—body and bed linen.
Use a tube for nourishment and a bed-pan for excretions as the patient
must not make the slightest exertion.
Spinal lesions may or may not be found. They have been observed in the
cervical, eighth dorsal and second lumbar.
The treatment on the whole is symptomatic. The chills and fever of
the first stage should be controlled by thorough work at the upper
cervical, upper dorsal, lower dorsal and lower lumbar regions.
Treatment at these points controls the superficial and deep vascular
areas of the body through the vasomotor nerves. The irritable stomach,
delirium and severe neuralgic pains of the head, back, epigastrium
and limbs are to be treated according to the conditions and severity
of the symptoms. The kidneys and bowels should be watched carefully,
and at the onset should be freely opened and control of the kidneys
never lost. Let the patient drink freely of water, which will aid.
Hydrotherapeutic measures, as a cold bath or sponging, may be employed
to aid in controlling the fever, the nervous symptoms, and the
eliminative power of the excretory organs. Discontinue the use of
hydrotherapy when a spontaneous fall of temperature occurs.
At the beginning of the first stage and during the stage of remission
are the periods that the osteopath should do very effectual work
by paying particular attention to the four large vascular areas of
the body, viz.: head, lungs, abdomen and legs. Treat the vasomotor
nerves to these regions, thoroughly, as given in the treatment of the
first stage. During the third stage everything should be done that is
possible to support the system. Ice slowly dissolved in the mouth will
be of aid to an irritable stomach. Hemorrhages and the various symptoms
are to be treated as they arise.
Good nursing, dieting, ventilation and keeping the skin, kidneys and
bowels active are the primary points to consider. During the period of
depression, the heart must be closely watched. The diet should be a
light, liquid one, of the nature of peptonized milk or light broths.
No food is recommended by some at the onset nor until the crisis is
passed. Others feed during the stage of remission and give stimulants.
During the last stage rectal feeding is suggested if gastric
irritability is pronounced.