It, COXTINUED. 



KKYKIt. YELLOW. 



t4 



in also diseased, the secretion* themselves must necessarily become 

 cd. 



Although UM* general symptoms are found more or leu in all the 

 farm* of continued fever, there are come which are regarded a* dia- 

 gnostic of the special forms mentioned above that are of the highest 

 interest. Thin it it found that the two latter fomu, typhoid and 

 typhiu fevers, are attended with eruption* of the akin a* eiwnti.illy 

 distinct a* those of measles and scarlet fever. The eruption in t\ -ph.'id 

 fever consist* of rote-coloured spots which conaut of (lightly elevated 

 papula or pimples. Their apice* are neither acuminated nor flat but 

 invariably rounded, and the bases gradually pan into the level of the 

 surrounding cuticle. These tpoU disappear completely on pressure, 

 and resume their usual appearance when the pressure is removed. 

 They leave no stain, or pit, or mark behind, and vary in size from a 

 line to a line and a half in diameter. Each papula lasts three or four 

 days, and fresh crops appear every day or two after their first eruji- 

 tion. These spots usually occur on the abdomen, thorax, and bock, 

 and only occasionally on the extremities. They usually appear be- 

 tween the seventh and fourteenth day of the disease. (Jenncr.) 



The rash of typhus fever is distinguished by its mulberry colour. 

 On its first appearance it consists of very slightly elevated spots of a 

 dusky pink colour ; each spot is flattened on the surface, irregular in 

 outline, and with no regular margin, but passing gradually into the 

 colour of the skin. It disappears completely on pressure. The spots 

 are of various size*, and a< they grow older do not entirely disappear 

 on pressure, but a stain of the cuticle remains to indicate where th-y 

 are. Thin eruption ii.-u.illy appears from the fifth to the eighth day 

 of the disease, and subsides between the fourteenth and twenty-first 

 days. These rashes must not be confounded with " miliary " vesicle*, 

 or " audaimna," which sometimes come on in these fevers. 



As already indicated in the definitions of these fevers, the typhoid 

 form is attended with a diseased condition of the mucous membrane 

 of the bowels, and the small glands (Peyers) are affected. The sym- 

 ptoms of this disease correspond to this condition. In the early stages 

 abdominal pains and diarrhoea set in, which continue to increase. The 

 belly enlarges as in mesenteric disease, and is resonant on percussion. 

 During the third week of the disease these symptoms become more 

 formidable, and the stools amount to from five to ten in the course of 

 the day. One of the most alarming symptoms is lucmorrhage from 

 the bowels, which occurs towards the end of the attack. This is one 

 of the most formidable symptom*, of the disease, although not always 

 attended with fatal results. These symptoms differ very much from 

 those which occur in typhus fever, where there is generally obstinate 

 constipation. 



Fever then ia a malady in which disease is simultaneously esta- 

 blished in the most important organs both of the organic and of the 

 animal life, in the vital fluid which nourishes mid stimulates the whole 

 system, in the excretory processes by which the purity of the blood is 

 preserved, and in the secreting processes by which all the different 

 tissues and structures of the body are formed. That it should If 

 always a dangerous disease is therefore not wonderful, but the real 

 extent in which it is the instrument of death is not generally known. 

 Taking together the whole class of febrile diseases, and including the 

 ravages committed by them at all seasons and in all parts of the globe, 

 it is estimated that of the deaths that take place in the human race 

 one half is always produced by these maladies. 



With regard to the causes of continued fevers considerable differences 

 of opinion exist. Some writers are inclined to the opinion that there 

 are no specific causes of these forms of disease, but that wherever 

 unimnl and vegetable matters exist in a state of decomposition, there 

 any one of these diseases may be engendered according to the pn di 

 position of the individual attacked. These writers even deny lli.it 

 there is a poison generated in the body capable of producing a disease 

 in another body. Another body of observer* believe that these fevers 

 may originate in external causes, but that they are all of them capable 

 of producing a poison a materies morbi which is capable of producing 

 the disease in unaffected individuals. Whilst again, recent investiga- 

 tions Mem to point out that typli >id fever is more especially dependent 

 on decomposing animal and vegetable matters, writers supporting this 

 view have called the disease pythngenic or drain fever. It is very 

 certain that this form of fever is more liable to break out locally than 

 typhus. It appears, however, to be communicable by the poison gene- 

 rated in the body, but not so much so as typhus. 



With regard to typhus fever, it is asserted that it is alone main- 

 tained and propagated by a special poison like small pox and scarlet 

 fever. Whatever may be the real causes of these forms of Hinnnno, all 

 opinion* point to the same means for the prevention of these diseases. 

 Wherever fever baa broken out, all sources of corruption should lw 

 removed. Drains should be cleansed, and foul deposits of every kind 

 should be got rid of. In order to preserve others, the rooms of the 

 sick should be well mtilniid, the linen should be washed, and every 

 precaution taken to prevent the discharges from the patient from 

 coming in contact with others. Chlorine and other disinfectants may 

 be advantageously employed. 1 he juitient should be ti/'arnlnl n* 

 much as possible from others, and the poison from his body should have 

 y chance of dilution t.y the free access of pure air. 



The treatment of these diirsim must depend very much on the 

 nature of the case. There is no cutting short the progress of a fever 



by medicines, and when the disease is progressing favourably little else 

 need be done than to attend to the dietetic wan 



In typli' .id I.-\.T the state of the bowels forbid any but the most 

 nntisj 4 purgatives, and that only in the beginning of the disease. 

 A saline treatment so often adopted for typhus i> forbiddi n 1>< 

 sinking and exhausted states, ammonia, wine, and brandy are powerful 

 agents for good. Quinine has been strongly recommended in all 

 of continued fever by some writers, but Dr. Bennett, of Kdinburgb, 

 doubts ita value in the fevers of Edinburgh. The various comp!> 

 of the brain and respiratory system, in the course of the dims.se, 

 require remedies adapted to meet the special symptoms. 



(Sydeuhain'H works; Mead, Short Dueourrr 

 Comtayim, and On Method* to be ttted to Prertnt it ; Sir .lohn I 1 

 Obterratinni on He Mature and Can of Hiapital awl ///.' 

 letter to Dr. Mead: anil Otaerrationi on the IHteatei of the .' 

 C'lutterbuck on Perrr ; Southwood Smith, Treat ite onfifr; Pliili.- 

 * 'I'hy of Ilealth ; Copland. IHrt.iif Practical if > rlopwdio. of 



Practical Medicim ; \V.:t.-oii. Lecture* the Pi. /'liytic; 



Aitkeu, The Science and Practice of Medicine ; Jenncr on the / 

 or Non-identity of Typlua or Typhoid Ferer ; Jenner on the Dutaiet 

 nil/ mifuunded under the term Continued Fcrtrt.) 



KKVKi;. YELLOW, a disease of frequent occurrence on the 

 eastern and western coasts of America, in the Wext Indies, in Africa, 

 anil in Europe on the southern shores of Spain. The prevalence of 

 this disease in these countries, its great fatality, and the mortality it 

 produces in navies and armies, have attracted much attention towards 

 it both from governments and medical men. This disease has been 

 described under other names, such as typhus icterodes, Bulam fever, 

 bilious remitting fe\ir. vomito negro, vomito prieto, endemi.il casus, 

 in.il de grain, &c. Although this disease has a very distinct history, 

 and can be easily distinguished by the mass of symptoms it presents, 

 yet it is difficult to give in a few words anything like a satisfactory 

 definition. Dr. Gillkrest, one of the most recent writers on this sub- 

 ject, gives the following definition : a disease in which " yellowness of 

 the skin, partial or genera], and towards the fatal termination. 

 vomiting of a black or dark brown fluid, are frequent though by ii" 

 means constant occurrences." Such a definition would be of little use 

 for distinguishing the disease, and perhaps after all it will be found 

 that yellow fever is only a modification, under peculiar circumstances, 

 of some primary form of disease in which all fevers originate. It i- 

 certain that this disease has many symptoms in common will i 

 fevers, and that it assumes the types of the common, contim. 

 initteiit. and intermittent fevers. 



It has only been within a coni|>arativcly recent period that this 

 disease has attracted much exclusive attention, and on this a< 

 some writers regard this disease as one altogether of modern origin, 

 and fix the date of its generation during the latter part of the 

 eighteenth century. But although no accurate account of this disease . 

 as distinguished from other fevers exists, previous to its appear 

 the island of Granada, in 1793, yet there can be no doubt that the 

 records of the occurrence of destructive fevers in those disti i 

 which the yellow fever now occurs, refer to the same disease. 



The attack of yellow fever is mostly preceded by well-mark" 

 monitory symptoms. For two or three days previous to the attack 

 there is a depression of spirits and an unnatural inactivity without 

 any sufficient accountable cause. There is sometimes nausea, with a 

 creeping chilliness, and pains in the loins, back, arms, legs, and head. 

 The eyes are suffused, dull, and heavy, and the sight ia dim and some- 

 times double. There is often slight confusion of mind and a kind of 

 drowsy restlessness. The appetite is bad, the taste is perverted, and 

 the bowels are either confined or relaxed. The skin is in some cases 

 permanently dry, or there may be sweating after slight flushes of heat. 

 The pulse varies considerably ; it may be small, quick, and irregular, 

 or soft and full. Such symptoms do not however always occur, and 

 sometimes the patient is seized immediately with a shivering, the 

 indication of the near approach of the worst symptoms. Sometimes 

 during this premonitory stage there may exist a yellowness of the 

 eyes and of the skin, and also a vomiting of liilinus matter. 



The commencement of the febrile attack mostly takes place at ni Jit : 

 after the shivering, a state of general excitement t.ikes place, v In. li 

 sonic-times increases to a very distressing and unmanageable extent. 

 Pains occur in the head, in the eyeballs, in the back ami 1<>; 

 cramps in the gastrocneiuic muscles. The patient prefers the 

 recumbent position and lira upon his back, but is in a state of 

 restlessness, frequently throwing his arms alxiut, more especially 

 above his head. The face is usually flushed, sometimes of a crimson 

 hue, and occasionally swollen so as to appear bloated and heavy. The 

 eye has a heavy drunken appearance, is injected, swollen, and 

 moistened with tears; the pupil is generally permanently <lnat< d. and 

 the balls seem protruded aa if they would start from tlnir sockets. 

 The skin is in most cases flushed, dry, and warmer than natural. The 

 pulse is accelerated, soft, full, and compressible; in some cases, how- 

 ever, it is unusually slow, and under tin kin in 

 unnaturally cool. The tongue is swollen and coated with a white 

 mucous paste. Vomiting does not often occur in this stage. The 

 bowels are frequently more or less constipated, but easily act. 

 The intellectual functions are more or less deranged. These sym 

 last for twelve or thirteen hours, when the second stage may be said to 



