Report on the etiology and prevention of yellow fever / by George M. Sternberg.

  • Sternberg, George Miller, 1838-1915.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Report on the etiology and prevention of yellow fever / by George M. Sternberg. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    iimst be reuiciubered that tlieso lists related to the poj)ulatiou generally, and included a very large proportion of the colored race, who remained in the infected citj^ while a large share of the white i^opulation left it upon the outbreak of the epidemic. Now, the mortality from this disease among negroes is always small, and is estimated by Dr. Mitchell not to have been over 2 per cent, in the Jacksonville epidemic. Yet the general mortality, as shown by the daily reports published in the newspapers, was in the vicinity of 10 per cent. Dr. Mitchell estimates the mortality among the white population, considered separately, as from 22 to 25 per cent., but has not yet been able to give me the exact figures. This estimate includes both sexes and all ages, and if adult males were considered separately it would no doubt be considerably more than this. With two or three exceptions the 79 whites included in Dr. Mitch- ell's list were adults; one only was a child of 8 years; 10 were between 1.5 and 20 years ; 25 from 20 to 30 ; 29 from 30 to 40; 11 from 40 to 50, and 3 from 50 to 60. The cases are classified by Dr. Mitchell as to severity as follows: Mild, 46; severe, 19; very severe, 14. It must be remembered that the treatment was commenced at the outset, and the mildness of the attack in those cases classified as mild may have been due to some extent to the favorable influence of the medicine administered. Indeed, the general result indicates that such was the fact. It is well known to those physicians who have had an extended experience in the treatment of yellow fever that many cases which appear to be mild at the outset in the end ter- minate fatally, and especially so in adult males, among whom the tendency to sup- pression of urine seems greater than in tlaecase of females and childi'en. One of the principal objects which I had in view in prescribing full doses of bicar- bonate of sotlium at regular intervals was to neutralize the very acid condition of the urine, in the hope that it might be secreted more abundantly and with less injury to the renal parenchyma. The results attained seem to indicate that such Is the case, and that the favorable action of the medicine is largely due to this fact. Dr. Weiss, in transmitting the clinical notes of twelve successive cases treated in the Garcini Hospital, in Havana, in 1838, without a death, says: •■'The urine has always been abundant. In some cases the density was lowered, but was compensated by a large quantity of urine. Albumen did not appeai* in some of the cases, in others the amount was small, and in others it reached 2 grammes to the litre. The albumen has always disappeared on the second or third day, and then the fever ceased. Dr. Conyngton, of Decatur, remarks: One point of special note was that patients on this treatment in my hands never had any symptoms of suppression of urine, but rather the quantity was increased; while, on the other hand, in patients treated by the expectant plan, with diuretics, the urine was scanty, and those that died (3 in number) died of suppression. Dr. Sollace Mitchell, in a letter dated February 1, speaks of the marked effect of the treatment in diminishing the albumen and preventing in a great measure su^i- pression of urine. Dr. A. J. Wakefield, of Jacksonville, has given me a list of 89 cases treated by himself during the recent epidemic in that city. Of these cases 75 were white and 14 colored. Five deaths occurred among the whites—a mortality of 6.6 per cent. Thirty-nine of the white cases were males and 36 females ; 41 of the cases are classed as severe and 48 as mild. One of the fatal cases is said to haVe been a consumptive; 1 to have been convalescent and to have died from imprudence; in another the re- mark is made bad nursing and imprudence; another, unfavorable surroundings. BESULTS OF TREATMENT AT KIO DE .TAXEIRO. My friend Dr. Cleary, an American physician practicing at Rio de Janeiro, in a letter dated December 13, 1888, gives me an account of 4 cases treated by this method ; 3 made a good recovery and 1 died. The fatal case assumed a severe form from the out- set, and was attended with hemorrhage from the vagina. Black vomit and suppression