« السابقةمتابعة »
Mild cases most dangerous from
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.
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
Don't wait for begun by a death or black vomiting. It is true that a
black vomit be
fore announcing, walking case introduced the disease into a village last year
where the earmarks of yellow fever were shown the best,
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 com. munications 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 carofal 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 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 sigus 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.
sometimes faintly purplish. Sweating will diminish these
Of course there is anorexia from the beginning; usually Anorexia. *omiting of the last food taken; bile will be vomited early if the early nausea is not checked; no bile will be vomited =fter about thirty-six hours if the patient has had proper Totowel actions. After vomiting of last food taken and a little bile theo. " vomit will usually be white, and will remain so until blood oozes into the duodenum or stomach. As to black vomiting, do not be hypercritical, the chances are vastly in favor of yellow fever. Please notice the hiccough and retching, and listen to the black fluid regurgitating through the pylorus into the stomach. But this is rather late for diagnosis of a first case, and is not applicable in mild cases. Mild cases demand examination of the feces. Always consider the chances of infection to and from your patient.
Yellow fever is like a language; you should know some- . Differentiation thing of others. Differentially considered, dengue has a ** demonstrable rash in the fauces always, between the shoulder blades, generally, and often over the big joints and on the trunk. The pains of dengue are in the bones and joints. A dengue patient is in pain and can not lie still— he don't want to get up. Yellow fever pains, except the head, are in the muscles, and the patient after four or five days is comfortable in bed, but wants to get up and do a lot of work. He gets up only to faint and return to bed. The dengue patient gets up, but keeps on growling about his pains. This is a late distinction, but it is valuable.
Malaria is usually prodromed for some days by malaise, From malaria. loss of appetite, discontent, and a general tired feeling. It nearly always attacks in the daytime or when the victim is at his work, and is ushered in with a positive chill. Constipation is the rule, but not so marked a feature as in yellow fever. The malarial tongue is full—swelled—too big for the mouth—tooth marked and heavy coated, with white edge and yellow or dirty top area. A yellow-fever tongue is rarely indented—if it is, there is malaria in the patient; it
... soon shrinks and gets a red edge and red tip; the red tip
is diamond-shaped, the front of the diamond being made by
Malarial vomiting is attended with more bile than is
the statement is true. Malarial attacks generally permit
Examination of The service has arranged to have samples of suspected
blood examined by the new agglutinative test by Dr. Archi.