YELLOW FEVER, ITS NATURE, DIAGNOSIS, TREAT- The following articles and letter of transmittal were published and transmitted in book form to quarantine and health officers, and others: LETTER OF TRANSMITTAL. TREASURY DEPARTMENT, OFFICE OF THE SUPERVISING SURGEON-GENERAL, To the Honorable MARINE HOSPITAL SERVICE, The SECRETARY OF THE TREASURY. SIR: I transmit herewith, arranged for publication with your approval, a number of articles by officers of the Marine-Hospital Service relating to yellow fever. These articles have been prepared by my direction by the officers of the service, whose valuable work in connection with yellow-fever epidemics has made them particularly well qualified for conveying the information herein contained. No similar work has ever been published, and while it is to be hoped that with the advancement of scientific medicine a positive knowledge of the true nature of yellow fever will before long be acquired, and that the measures for its prevention will be more accurate and certain through this acquired knowledge, yet the information herein given is at the present time pertinent and necessary. It is proposed to transmit this volume not only to the medical officers of the Marine-Hospital Service, but to State and local quarantine officers and to others to whom a plain statement of the method of diag nosis of yellow fever, its treatment, and the measures for the preven tion of its introduction into the United States, and for its suppression when it has passed the boundaries of this country, will be of immediate value. I have the honor to remain, respectfully, yours, Approved: WALTER WYMAN, Supervising Surgeon General, Marine-Hospital Service. L. J. GAGE, Secretary. CIRCULAR LETTER ON DIAGNOSIS OF YELLOW FEVER ADDRESSED TO CERTAIN PHYSICIANS ON THE GULF COAST. By Surg. R. D. MURRAY. MOBILE, ALA., May 28, 1898. DEAR DOCTOR: I have prepared a short letter on the importance of early diagnosis of cases of yellow fever, which I have arranged to send to every physician on the coast. As you are associated with me officially I will repeat to you what I have written them and add some arguments to increase your usual interest and perhaps give you some extra aids in prompt diagnosis. DISCOVERY OF FIRST CASES ENABLES SUPPRESSION OF EPIDEMICS. ease can be pre It is well known that first cases can be prevented from Spread of dis conveying the disease. Every prevalence for years has vented. shown this, and the results of prompt and proper action at Perkinston, Miss., and Franklin, La., and in other towns during the past season should stimulate every physician to "catch on" to the first cases. A man is not a scoundrel because he suspects a case, nor a fiend because he finds a first case. But a doctor is culpable if he slurs over a case and hopes against his judgment in order to save his precious record with a vacillating public. I can not quite agree with Dr. Guiteras that we can inure our people to prompt announcements of suspicion and actual cases, but I know the people will fully trust us if our words and conduct are apparently in behalf of their final interest. It is easy to call every illness "yellow" a month after other towns have quarantined, but it is not easy to decide on an individual case when no warning has been given and no source of infection is read about every morning. 10918-19 False alarms not so bad as neglected cases. Mild cases most dangerous from point. DO NOT BE DILATORY IN REPORTING FIRST CASES. It will not do to advocate the notion that any place is free from the chance of infection, nor to insist that all the old-time symptoms must be present, with a death or two added, before one suffers with a twinge of honesty and risks his present prosperity by doing what should be done with a first case. Scares and false alarms are hurtful, but they do not usually kill. I would as little trust an alarmist as one who "would die before he would report a suspicious case." Duty to one's self, to one's family, and to all communities demand careful observation of every fever case, with proper action in case there is reason to suspect yellow fever. A lot of "rejected" cases have spread the infection. It is established that only yellow fever makes yellow fever, but it is not so well known that a mild case of yellow fever is as dangerous as a case that ends fatally in sixty hours. I think the mild case much more dangerous than a "genuine" one. "MILD CASES" ARE DANGEROUS DISEASE SPREADERS. Now, to quicken your senses, to increase your usefulness, sanitary stand- and to assist you in giving your best efforts to your people I presume to give you some hints as to discovery of first cases. I do not claim to be expert, but I have a long record of lucky decisions which warrant me in speaking freely to those who have been so fortunate as to have an abiding place or a place called "home." I am not infallible, but I am in earnest in my desire to do good to others and to save my people from the horrors of an epidemic and the provo cations of quarantine. Mild cases of yellow fever are the mildest cases of disease that can be seen. Walking cases, nursing cases, and transient cases are more common than doctors realize. Mild cases transmit infection as easily and effectually as bad cases, and thus make "genuine" cases in the proper persons. Mild cases are not so quickly apprehended as severe ones, but they can be isolated more easily and at less expense than bad ones. Mild cases are the cases to look out for. black vomit be It is not true that a prevalence of the disease must be Don't wait for begun by a death or black vomiting. It is true that a fore announcing. Walking case introduced the disease into a village last year where the earmarks of yellow fever were shown the best, and the results were worst in comparison with all other infected towns of which there is a record. Hibernation. I do not believe in recrudescence or hibernation of the fever in small towns or in the country, but many health officials do, and as there is a possibility that all is not known of past epidemics and that there is much to be learned yet of the yellow-fever pest, it behooves us to be watchful-first, for the sake of our professional probity, and second, in the interest of our people. I am reiterative in order to gain your attention. Pardon me if I seem to be prolix. POINTS TO BE CAREFULLY NOTED. First. As to the region lately beset by the Cuban plague, permit me to remind you of what the doctors think-i. e., that the disease recurs; this remark is to prepare you for rumors that there is yellow fever in your practice or community now! So be prepared to affirm or deny by the card. Note taking is a good thing for doctors! Second. If there is reported yellow fever within the communications of your place, suspect every case of febrile disease but say nothing! Get to thinking! Here is the chance for careful observation and some taking of notes. Keep careful Not long ago a physician blundered as to the date of his first visit! His memory of the pulse, temperature, and nausea was of same sort-his patient died. Third. If called to any person who sickened in the night or early morning and complains of headache and malaise or body and leg ache with some stomach distress, suspect notes. the case and make inquiry as to where he got it. A chill Initial chill. is called for in the books, but one sufficiently severe to be told of to you is rare; there will be a story of chilliness or waking up in discomfort. Distress in the early morning is a rule; a failure to eat a good breakfast is a bad omen, but hints at a mild case. Fever of 101 to 103 with pulse of 110 to 120; cutting pain through the forehead, with aching eyes; fullness of eyes with some pain and suffusion, generally with injection are probable signs. The back and thighs will be sore in a severe case; there is some soreness in the mildest cases. Severer cases will have pain in Duodenal back of neck and in calves. Ask few questions. Press firmly and deeply over where you think the gall bladder lies and you will generally elicit a squeak-don't mention it! The face will be full and less mobile than in health with a fullness of the upper lip rendering a smile less Swollen lip. gracious. These signs depend somewhat on an acquaintance with the person. The cheeks will be of a dusky red color-more or less-and depending on the patient's color; Passed Assistant Surgeon White reports that he made two diag noses with the swollen upper lip as the first noticeable symptom. pain. |