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fever and the initial headache, all the others may be wanting, though the 

 pain in the loins and limbs are seldom absent. Neither will their mildness 

 or intensity, except in extreme cases, enable us to decide beforehand in 

 which of the three types a given attack will finally have to be classed. 



The first distinctive symptom usually makes its appearance in the 

 course of the second, third or fourth day, when albumen may be detected 

 in the urine, and the case is thereby excluded from the category of 

 "acclimation fever", which will now be described. 



Acclimation Fever -U. — Some authors include under that head even 

 ephemeral attacks and fevers of two or three days' duration, which no 

 clinical foundation beyond the fact that they occur in susceptible subjects 

 during the prevalence of yellow fever. Such a position is defended on 

 the plea that immunity has not unfrequently been acquired after such 

 mild fevers, and even wthout any morbid phenomena whatever, by persons 

 who have subsequently resided many years in an endemic focus. Prom a 

 clinical point of view, however, it seems preferable to restrict the name of 

 "acclimation fever" to cases that present certain features by which they 

 can be positively diagnosed aud their analogies with regular yellow fever 

 recognised. I have included in the present category all such cases, pro- 

 vided that no signs of albumen were discovered throughout the attack, by 

 boiling the urine before and after acidulation, even, though more delicate 

 tests should on certain days indicate a doubtfull trace of it. 



The fever, as already stated, generally reaches its acme within the 

 first forty-eight hours, after which it continues at lower figures, and with 

 more or less marked diurnal oscillations, until the fifth, sixth, seventh 

 or eighth day, without falling to 37° C. ; but on the third or fourth day a 

 remission is usually observed, if carefully looked for, in so much that the 

 temperature either falls lower or rises less high than on the preceding or 

 the following day, at the same hours. During this remission the headache 

 and the other pains disappear or are much relieved, and the patient feels 

 and looks better. It may last only a few hours, or it may continue during 

 a whole day or more. The second paroxysm then commences, being some- 

 times limited to a slight increase in the temperature, followed by a gradual 

 defervescence. In other cases the second paroxysm is attended with tempe- 

 ratures nearly as high as those of the first; the headache and general 

 pains may return, the patient becoming restless. Insomnia is a frequent 

 symptom; the stomach may become irritable, with nausea or vomiting of 

 the medicines and drinks ; nervous symptoms of an hysterical character may 

 occur, and a slight sub-icteric tint is often seen in the conjunctive. Oozing 



3) It seems unnecessary to explain that the term "acclimation" is here 

 exclusively used in reference to the yellow fever infection, and independently of other 

 climatic modifications. Our "acclimation fever" does not apear to differ from the 

 "fiévre bilieuse inflamatoire" of the French West Indies and French Guyana, as 

 described by Béranger-Féraund and Burot. 



