Volume 2

The Internal secretions and the principles of medicine / by Charles E. de M. Sajous.

  • Charles E. de M. Sajous
Date:
1903-1907
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: The Internal secretions and the principles of medicine / by Charles E. de M. Sajous. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    1133/1138 page 1873
    Yellow Fever. An acute infectious disease due to the toxin of some as yet unidentified niicrooiganism which depresses, or paralyzes in severe cases, the sympa- tlietic center. The pathogenic toxin, iiowever, simultaneously provokes a violent reaction of the test-organ and therefore accumulation in the blood of a corresponding excess of auto- antitoxin and thyroidase. As all tis- sues are thus flooded through tlieir diluted arterioles with blood whose proteolytic or digestive power is very marked, hivmolysis and autolysis oc- cur. To the passive congestion are due: the flushed face, the swollen eyelids, tne conjunctival and faucial congestion, the intense headache, the muscular pains, and the want of cor- respondence between tlie temperature and the pulse-rate, the central con- trol of the arterioles (which through tlieir changes of caliber and their propulsive activity govern these phenomena) having ceased. To tlie stasis in the STiperficial capillaries of the skin and conjunctiva, caused by the slowing of the blood-stream, is due the yellow coloration of the skin :iu<l eyes, the tinfje being due to oxidation of what adrenal ])nnciple is left in the skin after disintegration of the liDemoglobin molecule. To the exces- sive proteolytic activity of the blood are due the fatty degeneration and necrosis of the hepatic tissue; the cloudy swelling of the kidneys; the active hsemolysis; the capillary ero- sions which cause hipmorrhage in variotis tissues including the gastric mucosa, the source of the black vomit. Treatment: If the case is seen early the aim should be to check if possible the increase of the toxin in the blood by destroying its source: the unidentified pathogenic organism. The inercuric bichloride Voo grain and sodium, bicarbonate TVa grains every hour (Sternberg), not only forestail the pathogenic poison by stimulating the adrenal center, thus provoking tlie appearance of an excess of auto- antitoxin and thyroidase (opsonin) in the blood, but the sodium salt in- creases the alkalinity of the latter and enhances its bactericidal proper- ties. If the morbid process persists unchecked, however, the first twenty- four hours, the mercury should be replaced by saline solution intraven- ously to increase the fluidity of the blood and thus reduce its depressing action on the sympathetic center, which is thus rendered more amenable to agents which stimulate it, viz.. ontijjijrin or acetanilid in hourly doses until the dilated arterioles re- sume their normal caliber, as shown by the diminution of the facial red- ness and the improved cardiac ac- tion. To cause further depletion of the capillary system Of the entire or- ganism, potassiinn bromide or ye)-a- tnim viride, which depress the vaso- motor, may also be used, the blood be- ing thus caused to accumulate in the large central arteries. i\one of these compromise the de- fensive properties of the blood, the really harmful feature of the disease being the dilation of the arterioles and the admission of an excess of blood rich in aut«-antitoxin into the capillaries. Cold applications, spong- iufi, are of great value to facilitate the dissipation of heat. Zona. See Neuritis. 2—fiS
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