Treatment for Yellow Fever Orleans Parish Submitted by: Raye Ann Gaskin Source: Official Report of the Deaths from Yellow Fever, as reported by the New Orleans Board of Health Louisiana Section, Main Branch, New Orleans Public Library Date: March 2000 ********************************************** Copyright. All rights reserved. http://usgwarchives.net/copyright.htm http://usgwarchives.net/la/lafiles.htm ********************************************** TREATMENT FOR YELLOW FEVER. BY LASSALINIERE CHEROT, M.D., OF LAFOURCHE. ------------ FROM THE FRENCH NOTES OF THE REV. CHARLES M. MENARD. ------------ Translated by Clay Knoblock,. Esq., of Thibodaux, La. ------------ Our task would have been incomplete had we not thought it both advisable as well as all-important in a work of this kind, to append, for the benefit of the many who have no knowledge whatever in the management of yellow fever, the following almost infallible treatment of the disease from its incipiency to its abatement, as pursued by Dr. Chérot, of Thibodaux, during the terrible scourge that afflicted the good people of that town during the summer of 1853. Dr. Lasalinière Chérot was a native of the Island of Guadalupe, one of the French Antilles, and received his education partly in France, but graduated at St. Mary's College, Maryland. He was a regular licentiate of the Medical University of Louisiana, receiving his diploma from Professors Stone, Mercier, Faget, Labatut and Bertrand. History informs up that yellow fever first originated in, and is a native of tropical countries, particularly the West India Islands, and is known to have existed there from 1690 to the present time. The physicians of those countries, more than any other, should be thoroughly familiar with the diagnosis and proper treatment of the disease. Hence, Dr. Chérot's great success over others who practice, many of them, theoretically. He removed to the United States in 1849, and settled in Lafourche a short time before the breaking out of the epidemic of 1853. His success in battling with the disease, when almost every house was filled with the sick and dying, was wonderful, seldom losing a single case when called upon in [t]ime to administer his remedies. The treatment a[s] now presented is taken from a revised copy, as lately published in the Thibodaux Sentinel, furnished by the Rev. Charles M. Ménard, in French, and translated into English by Clay Koblock, Esq., Attorney-at-Law, Thibodaux. It may not be inappropriate or out of place; to further the merits of this treatment, to give place to the following views of Mr. Jona C. White, now of this city, to the editors of the New Orleans Times, in its favor, when it was published in that paper on the 22d of August last; though not exactly in its present shape, but from a slip of the Thibodaux Sentinel of October, 1875: "NEW ORLEANS, August 22, 1878. "Editors Times:---When disease and death are in the land, and terror reigns supreme in city, village and hamlet, it is a common duty we owe to humanity to contribute all within us lies to alleviate the sufferings of our fellow mortals. With this object in view I submit the following mode of treatment for the cure of yellow fever, which was pursued by the late Dr. Chérot, of Thibodaux, Parish of Lafourche, during the fearful epidemic which visited that place in August and September, 1853, carrying to the bourne from which no traveler returns over two hundred and forty persons out of a population of not over eight hundred souls. "Having been at that time a resident of Thibodaux, and familiar with the progress of the disease from its incipiency to its final subsidence, I can bear witness to the appropriateness of the treatment, and the almost universal success that attended it when followed out to the letter. I had four cases in my own family - three children and one servant - all of whom recovered. 'Being a native and to the manner born,' and having great experience in nursing, administering, and attending to yellow fever cases in '47, 53, '58 and '67, I can in all consciousness, as well as in confidence, recommend Dr. Chérot's mode of treatment as the most successful that has come under my observation; in truth, it is next to infallible if rigidly observed. I have no hesitation in saying that this treatment, if generally adopted, will save many a life, more especially in the country where the physician has no practical experience in the treatment of the treacherous malady. "The communication is a translation from notes in French, taken at the time by Rev. C. M. Mènard, Curate of the Catholic Church of St. Joseph, Thibodaux, a gentleman well known to us for nearly forty years, and to whose charaacter for veracity, christian virtues and truthfulness the entire population of Lafourche parishes can bear testimony. I should be pleased to have it appear in your columns. Respectfully, "JONA C. WHITE, "Ex-Editor Thibodaux Minerva." [From the Thibodaux Sentinel.] In 1853, yellow fever appeared in Thibodaux. The first case was on the 17th of August. Soon after that date, the disease spread throughout the town and suburbs. Seven or eight days after the appearance of the disease, I became convinced that the course of treatment followed by Dr. Chérot, (a venerable gentleman recently arrived from Martrinique, was the most efficacious. I had occasion, every day, to see the sick who were visited by Dr. Chérot, and I can affirm, by personal observations and by memoranda taken at the time, that Dr. Chérot attended 414 cases. Of these, 27 died, 14 of them having been attended by other physicians previous to being seen by Dr. Chérot; the remaining 13 died for the want of proper nursing, changing the course of treatment, or of relapse brought on by imprudence. At one time, all the physicians (Dr.Chérot among the number) were sick. The people treated each other after Dr. Chérot's method, and I myself was in a manner forced to attend to 54 cases -- 7 of them with black vomit. I followed Dr. Chérot's treatment to the letter, and saved 54 cases. SYMPTOMS OF YELLOW FEVER. 1st. A violent headache; 2d. Severe pains in the back; 3d. Weakness in the lower limbs; 4th. Sickness of the stomach; 5th. Excessive heat about the nape of the neck; 6th. A sense of general uneasiness; 7th. The tongue rose tinged and encircled on the edges and tips by a red girt, which, however, only encircles the tongue completely at the end of a few hours - it often occurs, also, that at the outset a spot, sometimes white sometimes black, appears upon centre of tongue and becomes very distinct in a few hours; 8th. Frequently the eyes are blood-shot at the outset, and this symptom develops with the disease. N. B. When symptoms 7 and 8 are well defined on first taking sick, it is a sure sign that the case will be a serious one, as often occurs to persons corpulent, strong, bilious, or given to late hours or hard work. I. FIRST TREATMENT. Put the patient in bed; cover him well up to the neck; keep apartment closed; without any delay, give the patient a hot foot bath, with mustard, and leave feet in bath from 8 to 10 minutes. Be particular not to let fresh air come in contact with the patient; give two or three cups of elder leaf tea, to produce perspiration; if convenient, place hot bricks or bottles of hot water around the patient's legs. Apply mustard to the feet for about one quarter of an hour. Be very particular and not let the patient uncover - this is all important. As soon as possible, give the patient lemonade every twenty minutes. The lemonade is made as followed: Two sour oranges, (lemons will answer); peal, remove outer skin as much as possible, remove seeds, and boil 6 to 10 minutes in about two bottlesful of water; let cool; sweeten if desired, and administer. It is important to give the lemonade, one glassfull every twenty minutes for the first six hours, and then every 30 or 40 minutes until the fever has subsided. II. DURING PERSPIRATION. One hour after the patient has taken to bed, give clysters every three hours, followed by a foot bath without mustard. The clysters are prepared of mauve or gombo leaves, or of flax seed in small quantity. This treatment is kept up until the fever has subsided. Always be careful that the patient is not exposed to air while perspiring. The patient must be made to perspire from four to five hours-not less than four hours. His clothes must be changed three times. Warm the clothes well before changing; and while effecting the change, do not let fresh air strike the patient. III. AFTER PERSPIRATION. When the patient shall have well perspired from four to five hours, according to circumstances, remove covers, leaving only one sheet on the patient if weather is warm - keeping the feet, however, well covered with quilt or blanket. Be particular, however, to maintain a very moist skin as long as the fever lasts - this is all important. While giving clysters and foot baths keep the apartment closed. If the weather is not cold or damp, you may now open apartment so as to let a little fresh air circulate; being careful that the patient is not in a current of air. The fever lasts from twenty to forty hours, usually; sometimes, though rarely, from sixty to eighty hours. The pulse gives 100 to 120, sometimes 130 pulsations a minute. Do not be alarmed; keep patient in good spirits; keep him diverted but do not fatigue him. Diversion contributes to a speedy cure. Seven or eight hours after taking the fever, the patient's tongue is spotted white, oftentimes black on the center, and is always encircled by a well defined red girt. IV. WHEN THE FEVER CEASES. As soon as the fever has subsided, and the pulse indicates sixty or seventy or eighty pulsations a minute-which happens at the end of about 20 hours-the patient must hasten to take one of the following remedies, 1st. manna and senna; 2d. magnesia; 3rd. peruvian bark and epsom salts; the first for ordinary cases; the second for weak patients, and the third for serious cases. These remedies are prepared and taken as follows: 1st.-Manna and Senna: for an adult, three ounces of manna well stirred in a cup of hot milk or water (the milk is preferable); add an infusion of senna leaves; mix the whole together, strain, cool a little and administer at a single dose, or in two doses. For a child, give one to one and a half ounce of manna and but little of the senna infusion. 2d.---Henry's Calcinated Magnesia: three tea spoonsful stirred in a small cup of tepid milk. Give in one dose. 3rd.---The most efficacious medicine of all: one ounce of pulverized peruvian bark (red) well stirred in a cupful of boiling hot water-stir and make a paste. In another cup full of boiling hot water, dissolve one half ounce of espom salts. Pour contents of both cups in an ordinary wine bottle and fill the bottle three quarters full of hot water. Shake well and long, until the elbow tires. Let cool and settle and give one table spoonful every quarter of an hour. When the patient begins to purge, give two table spoonsful every half hour until the patient has had say three operations, then stop for fear you may purge the patient too much. This said Dr. Chérot, is la medecine par excellence. If medicine No. 1 (manna and senna) does not operate in two hours, give medicine No. 2 (magnesia). Be quick, for fear that the fever will return or vomiting will occur. When these medicines are being taken, clysters followed by foot baths are discontinued. As soon as the patient has taken above remedies, give him orange leave tea, or if that does not suit his palate, continue to give him the lemonade. When the patient has had two operations, give him a little soup made of sour sorrel, the yolk of an egg, a little butter (preferable to lard), use very little salt, and soak in soup a thin slice of bread. This soup strengthens and does not interfere with taking of medicines. After four or five operations, begin with quinine, (the French if it can be had) twenty to twenty-five grains given in five grain doses every hour. For a child twelve to fifteen grains in three grain doses every hour. As soon as the patient has taken the twenty to twenty-five grains of quinine you must, using a great deal of prudence, endeavor to strengthen the patient with light broths, a very little claret in water-all in small quantities at a time. No pure wine, no ice, nor cold water pure. You must encourage him to sit up, and get up a little while, and to take nourishment by degrees. Do not keep the patient in a current of air or allow him to go out in the sun or dampness, for ten days after convalescence has set in. If a slight fever should recur and pass give 10 grains of quinine in two doses. During the whole course of treatment or for the first three or four days of convalescence do not allow the patient to drink natural water. If the patient suffers too much from pain in the pit of the stomach, give him gummed water-that is gum arabic dissolved in hot water. Give cold, one tea spoonful every now and then. One of the most critical stages of the disease is when the pain the pit of the stomach increases. You must encourage the patient; make him drink often. The disease apparently becomes more violent, the patient weakens rapidly, but he is unconsciously getting better. During convalescence give barley water or other similar beverage. If during convalescence the patient has pain in the stomach that keeps him from resting well give him at night, in a cupful of orange leaf tea, 10 drops of laudanum or 15 drops of paregoric. The above is the treatment in ordinary cases. V. SUPPRESSION OF URINE. Too much care cannot be paid on this point. Press questions: if the patient feels pain in lower part of abdomen, (a sure premonitory symptom of suppression), friction the part every quarter of an hour with camphorated oil. If after premonitory symptoms suppression should actually occur, you will, in addition to frictions with camphorated oil, place warm emollient poultices on lower part of belly; and if the patient is not perspiring give him a warm hip bath, being particular that water does not quite reach up to navel. Also give Pumpkin seed tea; or take saltpetre, say the size of a pea, pulverize well and dissolve it in about 5 or 6 glassfull of flax seed tea. It is highly important to remove suppression. VI. VOMITING. The vomiting of bile, water, and glairs at the outset of the disease is a good sign. Give tepid water to favor but not enough to provoke vomiting. Other vomiting of substance bloody, and sometimes black, in cases of relapse, or when fever has lasted too long, or because treatment has not been followed properly. Take Peruvian bark pulverized (the red) one-half ounce, and put it in an ordinary wine bottle three-quarters full of cold water. Shake well and long; let settle as much as circumstances will permit, and give one table-spoonful every quarter of an hour, and even oftener. Seven or eight doses usually suffice to check vomiting. After this give the Peruvian bark prepared with epsom salts as mentioned above. [See 3d of No. IV.] VII. GANGRENE. A thick white and bloody coating of the inner mouth indicates the presence of gangrene. Administer the Peruvian bark prepared with cold water [see No. VI.] every quarter of an hour for half a day; then double the dose and give it at intervals of half an hour, and finally every two hours. Purge patient every twenty-four or thirty-six hours with the Peruvian bark and epsom salts: then you may continue to give the Peruvian bark with cold water, giving the doses further and further apart until the gangrene has disappeared. Give emolient clyster morning and night; administer the gummed water; give a little soup; a little wine in a great deal of water (no pure wine). The least imprudence can cause death. VII. SPECIAL OBSERVATIONS. Children-Must be forced to drink lemonade and take medicines. If necessary, stop up the nose and thus force them to drink. If threatened with attack of worms, give a little vermifuge. In other respects treat them like adults, only give remedies in smaller doses. Women.-If periodical complaints appear, that of itself is the best of remedies. In such a case encourage flow by application of warm poultices on large veins inside of thighs. Do not give lemonade and other remedies. If the patient is one in "delicate way," bolster head and stomach by means of pillows. No lemonade; orange leaf tea, but weak; foot baths, but not very warm; no clysters except in serious cases, and then not frequent; manna with not much senna, or simply magnesia: quinine; gum-water; use great precaution during convalescence. Use same and greater precautions for women recently delivered. IX. IMPORTANT REMARKS. 1st-If patient throw up medicine or quinine, repeart the dose at once. If patient be very sick of stomach, of swallow with difficulty, apply mustard on the pit of the stomach for a few minutes; or take a bandage, say one inch wide, dip in cold water and apply under the chin clear up to and under the ears. 2d.-If patient does not eject the first clyster at once, give a second with castile soap in it, and if that is not ejected, give a third, and then wait the next regular time for giving clyster-say three hours. 3d-Stools are black and highly offensive to smell; are more difficult with women; you must act accordingly. 4 th-Nursing must be attended to night and day, to see that patient is made to perspire well at the outset; to keep him covered; and to give him medicines punctually. 5th---Except in rare instances, the disease lasts three days. If disease has not been properly attended to, vomiting and other serious symptoms usually occur on the third or fourth day. 6th---Relapse is dangerous, and is occasioned, 1st, in exposing patient to air or current of air; 2d, in his eating too much or of things indigestible; 3d, in laying in bed too long; 4th, in fatiguing patient or allowing him to sit up late at night; 5th,in going out in the sun too soon. 7th---Convalescence is long and tedious, lasts from fifteen to twenty days. During convalescence, give barley water (eau d'orge pele.) Do not let patient fatigue; and do not allow him to go out into the sun for ten or twelve days. X. ESSENTIAL THINGS. 1st--To keep patient in good spirits. 2d---To make him perspire freely from four to five hours at the outset. 3d---To make him drink lemonade from the beginning. 4th-To guard against suppression of urine. 5th---Great activity in the treatment so as to control disease as speedily as possible in the earliest stage.