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of blood from the gums, hawking up of bloody mucus or pure blood, 

 epistaxis, anticipated or over-abundant menstruation in women, are some- 

 times observed between the fourth and the seventh day. Defervescence 

 mostly takes place (below 37° C.) before the eighth day, and convalescence 

 follows, at times attended with dyspeptic or malarial symptoms, but not as 

 a general rule. All the cases of the non-albuminurie type terminate 

 favourably. 



Plain Albuminuric Yellow Fever. — When yellow fever is suspected, 

 the urine should be tested each day for albumen, however mild the symtoms 

 may apear. For the sake of an early diagnosis, this should be done at first 

 with Esbaeh's acets-picric solution, followed by the application 

 of heat if any precipitate is thereby produced. By this means a trace of 

 albumen is sometimes detected before any opalescence can be produced by 

 simply boiling the acidulated urine. For clinical purposes, however, I deem 

 it preferable to consider as distinctly "albuminuric" only the cases in 

 which the albumen becomes evident by the "boiling" test, properly con- 

 trolled. This sign may occur as early as within the first twenty-four hours, 

 or not till the end of the third or fourth day. The moment of its first 

 appearance is important, inasmuch as an unusually early date generally be- 

 tokens a severe infection. The quantity of albumen is also significant for 

 the prognosis, but less so than might be expected, — some cases with very 

 moderate fever and marked albuminuria from the second till the ninth day 

 running a general course in other respects as mild as one of the simple 

 acclimation fever. Even then, however, the presence of albuminuria renders 

 a repetition of such attacks highly improbable, even on severe exposure. 



As a rule, the "almuminuric cases" are attended with more marked 

 symptoms than the "non-albuminurie". The fever runs higher, the pains 

 are more characteristic and more apt to persist after the remission; the 

 second parozysm is stronger and oftener attended with an irritable con- 

 dition of the stomach ; nausea, vomiting of glairy mucus, of bile, or simply 

 of the drinks and medicines, and more rarely, obstinate hiccough, may 

 occur. The urine is liable to become very scanty or entirely suppressed 

 during periods of twelve hours or more, when uraemic symptoms may set 

 in, with delirium or with irregular breathing, and if the secretion be not 

 soon re-established death becomes inevitable. The haemorrhagic tendency 

 is more marked ; the gums, the buccal mucous membrane, that of the nose 

 or of the female genitals and raw surfaces on the skin are apt to bleed, 

 sometimes to an alarming and even fatal extent. 



The yellow tinge of the conjuntivae and skin is more noticeable, some- 

 times amounting to decided jaundice, which may continue after convales- 

 cence, and, in fatal cases, becomes more marked after death. But, as al- 

 ready premised, every ease attended with gastric or intestinal haemorrhage 

 or black vomit must be considered apart from the "plain albuminuric type". 

 Except in unusually severe epidemics, the great majority of the cases of this 



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