j
) GUIDE TO SHiPMASTERS
VISITING THE CAPE FEA~
At\D OTHER ~VERS.
PRESENTED BY THE
NORTH CAROLINA BOARD OF HEALTH.
Copies may be had Cree of Charge on application at the office oC the
SECRETARY OF THE NORTH CAROLINA BOARD OF HEALTH,
WILMI GTON, . C.
RALEIGH:
NEWS AND OBSERVER, State Printers.
1881.
ADVICE TO SHIPMASTERS
FOR THE
Prevention of River Fever.
• •
THE FEVER THERMOMETER-ITS USES.
The use of the thermometer to indicate the existence of
fever is now established beyond doubt. It has been shown
by thousauds of ob!lervations that the heat of the body in
any part of the world--:in the tropics or the arctic circle­varies
very little from 98.4° Fahr., in a grown person, in
health. Upon this settled observation is based an estimate
of the amount (If fever in any given case.
The fever thermometer differs from the ordinary instru·
ment in being seH·registering. In the figure a thermometer
is shown with the index just below 95°. This index
is a slender line of mercury separated from that in the bulb
by a slight space, and ill a good thermoffitlter the index
does not fall back and unite with the mercury in the bulb.
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COOMAN • SHURTLE'F.
BOSTON.
To Read the Tbermometer.-The instrument must be
examined lind the index must be below the arrow seen at
98.4°. If it is above it can be shaken down, either by hold·
ing it firmly between the finger and thumb and shaking
forcibly as in flirting the ink out of a pen; or, by taking
the instrument at its upper tip, the end opposite the bulb,
4
elevating the band as high as tbe head, lind, by a smart im­pulse
downwards, thus shake the index below the arrow.
The instrument is put under the tongue, or betweeu the
teeth and the cheek, the lips closed upon it,aud it is allowed
to remain at least a minute by the watch.
On removing the instrument, au examination of the iu­dex
will show the temperature, which is indicated at tbe
upper tip of the index, that is, the end of the index the
farthest from the bulb.
What a Rise in Temperature Means.-For the pur­poses
of the instruction intended to be conveyed, it is safe
to assume that every degree of heat be)'ond the arrow is a
degree of fever.
The following table will show tbe relation between the
pulse and the temperature of the body:
An increase of temperatU1'e of One Degree above 98° Fah­renheit,
corresponds with an increase of Ten beats of the
pulse per minute. (Aitken.)
Temperature 98°-Pulse 60.
" 99°_.. 70.
" 100°-" 80.
" 101°-" 90.
" 102°- " 100.
" 103°- .. 110.
" 104°- " 120.
" 105°- " 130.
" 106°- " 140.
The rule above is subject to some variation, but is a fairly
good guide.
It is well known that 101° before 11 A. M., indicates an
approaching fever, and that the same after 5 o'clock, a de­clining
fever; and so ou with every degree above it. 103.5°
is about the average of the malarial fever of the rivers.
Many severe cases reach 104.5° and 105.5°. Even 106° is
not surely fatal, but beyond this, in the most favorable con-
5
ditions, the danger is very great. 108° to 110° is most
surely fatal.
Wit.h these introductory remarks we will call the atten­tion
of Shipmasters to certain precautions which long ex­perience
in this latitude hilS shown neeessary to be observed.
The fever occurring amongst the seamen who visit this
and other Southern rivers is malarial. It is due to the ex­posure
of sleeping on board vessels, and keeping late hours
at night.
The Nature and Oourse of River Malarial Fever.­It
commences sometimes with a chill. The chill i!:' either a
shaking ague, or sometimes merely coldness of the fingers,
bl ue nails, cold nose, and ears and toes. Both forms may be au
essential part of !;imilar fevers. A chill may last from half
an hour to two or three hours, and is always followed by
fevH. Chill is only a cold stage of fever, and the ther­mometer
will most always show from 101° to 102° even when
the chill is highest. The fever comes on, the coldness of
the skin gradually going off, and the heat of fever follow­ing,
thtl temperature rising gradually to 103.5 to 105°.
For instance, if the chill comes on before 11 o'clock A. M.,
as it often does, the fever will reach its height usually by 5
o'cloc·k P. M., and then gradually decline, either by copious
sweating or an abundant discharge of urine. If the fever
goes entirely off it is intermittent. If it merely declines it is
remittent. In either case a person seized with fever may
look for a return on the succeeding day, or the day after.
These are forms of the same fever and have all been named.
Thus we have them coming on daily, twice daily, every other
day, evel'Y third day, aud so on; but the fevers are essentially
the same, being practically cured by the same treatment.
The way to avoid River Fever.-Live temperately,
and do not sleep in the river on board vessel during the
months of August, September and October. The air of the
town is perfectly harmless to most persQus, aud especially
those who go to bed early, and are not intemperate.
6
Sleeping on board during the months named does not
al ways cause sickness, but it does nearly al ways. Sometimes
fever does not develop until a vessel gets to sea, and then all
hands mllY be taken down at the same time. Such cases
are known.
Prophylactic.-The daily use of Quinine or the prepa-rations
of Peruvian Bark, will prevent fev~. It is a good
practice to give to crews of vessels a daily morning dose
equal to five grains of quimne. Some of the cheuper prepa­rations
of bark answer this purpose wery well. None of
them are equal to Qun'QUINIA, a preparation tested now
during several seasons, and found to be remarkably efficient.
It contains 15 per cent. of Quin'ia and 45 per cent. of other
valuable alkaloids of Peruvian Bark, which really gives it
an advantage over th~ Sulphate of Quinine usually sold.
It is recommended with great confidence.
What to do after the vessel gets to sea.-In every
case 01 complaining 011 the part of a seaman, the Captain
or an intelligent officer shol,ld take the man's temperature.
If it is more than 98.4° he will be wise to conclude that
there is a fever approaching. 100° or 101° is absolute evi­dence,
apart from any other condition of the man, that he
has fever, and it is tolerably certain that if it is not ehecked
he will have more the next dav.
What to do if the tempe~ture rises.-No amount of
fever should prevent the patient from taking quinine. or
some other preparation of bark in the proper doses. It is
always best t) commence Quinine early in the morning be·
cause the fever increases towards noon, and with the in­crease
of fever comes on many times such a sick stomach that
the patient cannot retain the much needed medicine. But
if the stomach does not reject it he ought to have his medi·
icine in proper quantities, notwithstanding the fever, for
every day of its continuance unaffected bv medicine lessens
the chance of recovery. .'
What Medicine to Give.-If the fever is detE-cted early,
7
medicine should be given at once. It is necessary usually
to give twenty grains of quinine every twenty-four hours. More
is needed sometimes, but it is not often that a less quantity
will succeed. It is best to direct* five grains of quinine in
pills every two Lours, commencing as early as four o'clock
in the morning, until twell ty grains are given. Should pain
in the bead and hot skin, ard unpleasant "singing".>r
" roaring" in the ears, trouble the patient, bromide* of potash
should be given in ten grain doses, dissolved in water,every two
or three bours. Usually a very hot and dry skin yields to
the action of the remedies above. Should they fail, fluid
extract of Jaborandi should be given, fifteen drops every
hour until 00pious sweating comes on.
Oonstipation is sometimes an accompanim~ntof this fever,
and should be relieved by *Calomel and Soda at night or
Epsom Salts and table salt in the morning.
Relapses are not uncommon, and although the thermome­ter
may not iudicate fever after a few days of treatment,
(and it is urged that the thermometer should be carefully
applied morning and evening.) it is never safe to withdraw
the Quinine the day following the one on which the patient
misses his fever. At least ten grains should be continued
/' daily for three or four days in succession.
RECAPITULATION.
1. The thermometer is a sure guide in the early detection
of River Fever.
2. Whenever a man shows any indisposition after a stay
on the river during the months of August, September, and
October, apply the fever thermometer, and if be has 100°
or over, you may look out for more fever the next day.
3. Quinine should be given daily in five grain doses until
twenty grains are given. No time should be lost.
4. Relapses can be prevented by continuing the medicine
four days in succession after the last indications of fever.
*See formulas on the last pages.
8
FORMULA 1.
QUININE PILLS.
Take of
Quinine, two scruples or forty grains,
Tartaric Acid, thirty grains,
Glycerine, twenty to thirty drops,
, Mix well,and make twelve pills. Roll in Magnesia before
putting in a box.
One pill every hour until six are taken a day.
QUININE SOLUTION.
Take of
Quinine, forty grains,
Tartaric Acid, Thirty grains,
Water, two ounces or four tablespoonsful,
Mix and make a solution.
A teaspoonful every hour until six doses are given each
day.
BROMIDE SoLUTION.
Take of
Bromide of Potassium, one ounce,
Sugar, two tablespoonsful.
Water, eight tablE:Spoonsful,
Dissolve the Bromide in the water and add the sugar
until all is dissolved.
The dose for headache, and for the excitement caused by
quinine, is a teaspoonful every two hours.
A little lemon juice or h)'drobromic acid makes the solu­tion
pleasanler to take.
Make as in the solution of quinine and in the same quan­ties.
Take of
Calomel, six grains,
Bicarbonate Soda, twenty grains,
Make a powder. and mix in a spoon with syrup.
To be taken
•
CALOMEL AND SODA.
PUl~Qative.
QUINQUINIA SOLI'TION FOR FEVER.
9
QUINQUINIA SOLUTION.
Prophylactic.
QUINQUINIA PILLS.
Make the same as quinine pills and in the same quanti­ties
and doses.
Take of
Quinquinia, one ounce,
Tartaric Acid, half an ounce,
Water, tbree pints.
Mix and make a solution.
Dose, a tablespoonful every morning.
EPSOM SALT~ AND TABLE SALT.
Pw·gative.
Take of
Epsom Salts, one-half to one ounce,
Table Salt, one teaspoonful,
Mix and make a solution in a cup of water.
before breakfast.