YELLOW FKYKll. 



773 



Vi:i.I,< >W FKVKU. The prevalence of this 

 epidemic in tin.- Southwestern States, in 1867, 

 demand^ -nine notice. Tin- disease, like rhol- 

 ns marked and peculiar symptoms from 

 its nutlet. Commencing with :i feeling <>\' 

 chilliness, ft quick fever supervenes, accompa- 

 nied l>y pains in the head, hack, :md limbs. 

 The pain in tho head is frontal, und often ex- 

 ceedingly severe, attended with confusion of 

 thought and violent delirium. Tho stomach is 

 carh atVected, and vomiting ensues almost im- 

 mediately. The matter vomited consists of 

 the contents of the stomach, of bile, and thin 

 colored fluids. The patient complains of a 

 burning sensation in the stomach, the t'n-,- is 

 Hushed and swollen, the eyes red, suffused, 

 muddy, and sensitive to light. The breathing 

 is sometimes hurried and irregular, sometimes 

 slow and embarrassed. The skin is commonly 

 hot, dry, and harsh. The yellowness, from 

 which the disease derives its name, first tinges 

 the eye, then spreads to the forehead, neck, and 

 breast, and last to the extremities. The color 

 varies from an orange to a bronze, and some- 

 times, in the last stage, approaches a dark 

 mahogany. The tongue is at first generally 

 moist and white, then red. The pnlse leaps to 

 100, and is full and bounding. The patient is 

 very restless, constantly changing his position, 

 while the expression is gloomy and anxious, or 

 sometimes fierce and threatening. 



These are the first stages of the disease, the 

 average (furation of which is from 36 to 48 

 hours. The second stage is succeeded by an 

 abatement of all the unpleasant symptoms. 

 The skin becomes moister and cooler, the pain 

 in the head and limbs is relieved, the stomach 

 is irritable, the pulse calmer, the expression of 

 the countenance more natural. The yellowness 

 of the skin, however, becomes more marked and 

 deeper in tint. The stage of remission generally 

 lasts from 12 to IS hours, though it may be 

 prolonged to 24 or 36. The third stage is char- 

 acterized by prostration; the pulse becomes 

 more feeble and the skin darker; the tongue 

 may remain large and moist, or become dry 

 and brown, or smooth, red, fissured and bleed- 

 ing. The irritability of the stomach returns or 

 is increased. The vomiting is often incessant. 

 At first it may consist of a colorless, acrid 

 liquor; soon, in bad cases, it begins to contain 

 Hakes- <>f a dark color, increasing until the 

 matters vomited look like a mixture of soot, or 

 coffee-grounds and water; that is the black 

 vomit. The quantity thrown up is often very 

 great, and it conies up with little effort. 



Sometimes diarrhoea now supervenes, the 

 stools resembling the matter ejected from the 

 stomach. With tho appearance of these symp- 

 toms the patient becomes more and more 



prostrated; tin- skin is cold and clammy, tho 



puNc very feeble, frequent, or Intermittent; the 



breathing irreirular und labored; the tongue is 

 black and tremulous; there is low, muttering 

 delirium, and death closes the scene. Patholog- 

 ical anatomy has not hitherto ad l.-d much to 

 our knowledge of yellow fever. The most con- 

 >tant alteration is found in the conditions of the 

 blood. This is usually dark colored and fluid, 

 seeming sometimes to have entirely lost its co- 

 agulability. The surface of the body is usually 

 more or less yellow after death, even in cases 

 which did not present any trace of that color 

 during life. Tho liver presents a full yellow or 

 fawn color, and is more or less fatty; and tho 

 stomach is more or less reddened and its mu- 

 cous membrane generally softened. 



The causes of tho disease are much the same 

 as those of cholera. Filth, decayed vegetable 

 and animal matter, marsh rniasm, the exce i\v 

 use of tropical fruits, and excesses in eating and 

 drinking are the principal causes. The disease 

 is epidemic during the hot season, a succession 

 of heavy frosts checking and usually ending it 

 for the season. Opinions in regard to its con- 

 tagiousness are divided, a small majority of 

 professional men favoring the idea of contagion, 

 or at least of commtinicability from tliefomitai 

 of the disease. Some persons are not subject 

 to it, and others who having had it are exempt, 

 but lose their protection by a residence in a 

 cold climate for a single season. 



During the summer and autumn of 1867, it 

 raired with great virulence in the West Indies, 

 proving unusually fatal in St. Thomas, Santa 

 Cruz, Cuba, and Ilayti ; some cases occurred in 

 the Florida ports, more in Mobile, while in 

 New Orleans it was more severe than it had 

 been since 1853, the deaths from it in August 

 being 255, in September, 1,637, and in October 

 (the first week), 431, and for some time it con- 

 tinued at the rate of from 50 to 60 deaths daily. 

 In Galveston it was still more severe, taking 

 all classes and producing a frightful mortality. 

 Throughout the coast portion of Texas it raged 

 with great virulence. It made its way up the 

 Mississippi and visited Natchez, Vicksburg, 

 Helena, and Memphis, all previously desolated 

 by cholera earlier in the season. The cities 

 of the Atlantic coast were' exempt from the 

 scourge, except a few cases on board one of tho 

 ships of the navy at Philadelphia, which had 

 just come from Florida, and the cases at Quar- 

 antine, New York. Of these last there were 

 390 cases of yellow fever which had occurred 

 in port, on the passage, and in quarantine, and 

 of these 112 were fatal. The epidemic was 

 peculiar in tho much greater frequency of pro- 

 found congestion than is usual. 



The most effectual treatment has proved to 



