Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair.

  • Blair, Daniel.
Date:
[1856]
Catalogue details

Licence: Public Domain Mark

Credit: Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    fever dietary. Dilute alcoholic drinks were given freely, and with good effect. Unfortunately, the quality of the hock wine to be obtained was much inferior to that used in the former epidemic; and from its acidity, frequently disagreed with the stomach, and fell into disuse. Where brandy could be obtained pin-e (tolerably free from acidity and fusel oil), and was well diluted with water, that spirit answered every indication. Sometimes the effervescing wines were relished and retained, but they are very liable to the objections of containing foreign matters, and the products of mis- managed fermentation. Dui-ing the course of the disease, auxiliary treatment was required to meet contingent symptoms. This was embraced chiefly in the use of local and general blood-letting, croton oil, morphine, ether, vesicatories, hydro- cyanic acid, and the creosote before referred to. Cujjping, leeching, and blistering were found useful in relieving the primary head symptoms and irritability of stomach, when applied respectively to the nape of neck or epigastrium. Tenderness over the liver seemed also benefited by these applications; but I cannot say I have ever seen any benefit resulting from their application over the kidneys, with the view of relieving that con- gestion of which albuminosity of the urine and suppression are the indices. In only one instance have I seen stranguiy follow the application of blisters in this malady, and in that case it seemed to exercise no injurious effect. Seeing that herpes labialis was a favourable indication, and arguing that their vesications might be beneficial from their situation at the termination of the mucous sui'f'aces, we created on several occasions an artificial herpes, by brushing the lips and parts around the mouth with the acetic ether-infusion of cantharides. This operation, however, was without results. When the primary reaction was violent, and the face was turgid, and the head symptoms severe, arteriotomy was performed, and with benefit. In a few such cases, and when the patient was young, strong, and full-blooded, and where the dynamic congestions were so violent that the ves.sels yielded to the turgesceuce and impulse, and blood- corpuscles without tube-casts, or even but a haze of albumen, was present in the urine, the arm was opened, and free bleeding relieved the tension of the vascular system. In such cases, convalescence was slow and unsa- tisfactory, but the immediate results had been beneficial. In general, the bowels responded easily to the action of mild purgatives; but a cluster of cases occun-ed about fifteen months after the commencement of the epidemic, in which a-oton oil was required to foUow the resolvent dose. Hydrocyanic acid was supposed beneficial in a few cases in abating the primary irritability of the stomach; and being easily taken, may be borne in mind by the practitionei^, as a variety of such resources are at tiuies required. Ether was frequently attended with marked advantage in removing or abating the distressing symptom, hiccup; but we used it also a.s a diffusible stimulant, and where acceptable to the patient, is fully equal to brandy for that purposes. Of all the auxiliaries which must be occasionally impressed into the service of the patient, by far the most important is inorphine. I am inchned to think that the type of the present epidemic tolerates that drug more easily than the last; but there is no doubt that its management is better understood now than then. Its administration, however, still mvolves more knowledge, discernment, and judgment on the part of the