Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair.
- Blair, Daniel.
- Date:
- [1856]
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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![practitioner than any other drug he has to deal with. lu the i^reseut epidemic, the most salutary effects were observed from its use iu the begin- ning; but a number of cases occurred in which it was so manifestly detrimental, that its use was about being relinquished again. In some of these cases in which it was injurious, its first effects for some hours seemed favourable; and for a considerable time, no criterion was known for its administration. Various conjectures arose, at the same time, as to the mode of injurious action both of morphinism and hypercinchonism. Fol- lowing the cue of Frerich's theory, it was supposed that the drugs supplied some element to some other casual element in the blood, as emulsine and synaptase converts harmless amygdaline into poisonous hydrocyanic acid, or a diastase quickens starch. As quinine and morphine are alkaloids, and contain nitrogen, and are very complicated in their constitution, and possess high combining powers, the hypothesis was for a moment feasible. But I suspect that the injury frequently arising from the use of morjihine is chiefly due to its action on the seci-etions of the kidneys. It impairs that function; and where the march of symptoms is already verging on that of urinary suppression, although the tranquillizing effects of the drug may be j)leasant for the time and well marked, it indirectly induces head symptoms, and adds to the ursemic poisoning. The rule therefore would be, not to give it whm there ve suppressio7i or tendency to sujypi'ession. Of course, if the restlessness or sleeplessness or suffering is extreme, it becomes a question for deliberation, whether, even in suppression or tendency to it, the relief which is sure immediately to follow the dose of morphine will compensate for the jeopardy of bfe. The necessity must be extreme indeed that would justify, for present ease, the surrender of the smallest chance in favour of ultimate recovery. Its beneficial effects are most visible and unqualified in those cases wherein the disease has been imperfectly aborted, and which, after a few doses of the aq. acet. amraon. and camphor water, will induce a good night's rest, out of which the patient awakes free from disease. Morphine is perfectly safe while the urine is non-albuminous. The effect of yellow fever on the system is to make it sensitive to narcotics. Cases of delirium tremens with a taint of the epidemic will not bear that liberal use of opiates of which it is normally so tolerant; and a dose such as that which the anodyne draught contains, is too much for yellow fever, though never found so for iutevmittents. After many observations, I have come to the conclusion that, for an adult, eight drops of the solution of the acetate (one-fourth of a grain) should be the maximum dose, and should rarely be repeated within twenty-four hours. The smouldering form of yellow fever is best treated by rest, the recumbent position, cool drinks, and abstinence from any but the lightest food. The patient, however, should be closely watched, although inter- ference is seldom required, the curative and conservative i)owcr of nature being adequate to the perfect restoration of health in almost all these cases^ Inflammatory complications were treated on general principles; and in pneumonia, the tartrate of antimony wivs borne well. Before concluding, it may be instructive to notice the results of a few unsuccessful ex]ierimenta, undertaken during the course of the epidemic. The chief of these was the trial of the use of belladonna as a prophy-](https://iiif.wellcomecollection.org/image/b22283614_0088.jp2/full/800%2C/0/default.jpg)
