FEVER, YELLOW. 



FIBRIN. 



ee 



commence. The general excitement now gives way to depression. The 

 countenance becomes deeply expressive of anxiety. The congested 

 state of the eye begins to yield, and in ita place a slight yellow tinge is 

 observed. This goes on increasing till it extends down the ala; of the 

 nose and around the mouth. As the disease advances, in most cases 

 the yellow tinge spreads itself over the whole skin, giving to the whole 

 body, according to the complexion or temperament, various colours, 

 from a pale lemon to deep orange or saffron colour. The pulse becomes 

 slightly lessened in frequency. The coating on the tongue becomes 

 yellow, and this organ towards its roof and at the edges and tips lias a 

 clean and dry red appearance. The stomach now becomes irritable and 

 painful on pressure. Food is immediately rejected. There is a dis- 

 i,' sensation of internal heat. The vomiting is sudden, and not 

 accompanied with any severe retching. The matters vomited are gene- 

 rally ingesta and a clear fluid, and only sometimes is bile discharged. 

 The alvine secretions are mostly natural. The urine is diminished in 

 quantity, and very yellow. There is frequent sighing of a deep and 

 prolonged character. In malignant cases the breath exhaled has an 

 acid odour. The intellectual functions are much affected, and the 

 patient is in a state of low muttering delirium, or comatose. Some- 

 times petechiae and miliary vesicles occur in this stage. In this state 

 the patient may remain from two to seven clays. The countenance 

 then becomes more collapsed, the eye loses its full and prominent 

 character, dark-coloured blotches and petechi;e occur on the body, the 

 pulse becomes small and thready, the tongue loses its coating and 

 becomes bright red, thirst becomes urgent, and there is lastly the 

 vomiting of a dark and mucous-looking fluid, which has been called the 

 " black vomit," and has in fact given the name sometimes to this disease. 

 This symptom, however, does not always occur. As death approaches 

 the exhaustion becomes greater, the respiration is hurried and noisy, 

 the surface and extremities become cold, and covered with a general 

 clammy perspiration. In some the last moments are marked with 

 great pain and strong convulsions, whilst in others death seems to 

 eoine upon the patient unawares. 



These general symptoms are by no means presented in every case, 

 eome having been constantly observed by one medical writer, whilst 

 others have never witnessed them at all. Amongst the forms which 

 this disease assumes, three are mentioned by some writers a<s pointing 

 out important differences in the character of the disease : these are called 

 inflammatory, adynainic, and malignant. The inflammatory occurs in 

 full plethoric habits, and the whole of the symptoms indicate a greater 

 amount of excitement and activity, and the disease proceeds to a fatal 

 ition sooner. The adynamic variety occurs in those who have 

 ;it animal vigour. In this form of the disease the pulse is alow, 

 the skin cold anil clammy, no resistance appears to be made to the pro- 

 gress of the disease, and the patient sinks in the course of four or five 

 days. The mali;n the worst of all : from the first the 



patient seems attacked with death ; all the symptoms are low from the 

 Ming, and no re:i viblished. Persons seldom recover 



from this state, and many die during the fir.-it twenty-four hours of 

 the attack. 



The nature and origin of the black matter which is so often vomited 

 in cases of yellow fever has been the subject of much investigation. 

 The most correct view is probably th it of Dr. Fordyce, who considered 

 that it was identical with the incrustation of the tongue, gums, and lips 

 found generally in violent fevers, and that probably this is an exudation 

 thrown out from the surface of the stomach, or even from the duode- 

 num and jejunum. When collected and given to animals it produced 

 no bad effect upon them, and an atmosphere impregnated with its 

 exhalations does not appear to be injurious. Under the microscope it 

 has the appearance of minute scales of smoked mica, being of a dark 

 brown or red colour. It is probably nothing more than the globules of 

 iiroken down, which have oozed through the surface of the 

 mucous membrane, instead of the ordinary secretion, and perhaps 

 under the influence of the violent vomiting. It may frequently be 

 i with bile, but it does not appear in the majority of cases to have 

 the character of bile at all. 



Aa it is difficult to give a definition of yellow fever, so is it difficult 

 to give any mien by which it may be distinguished in individual cases 

 "Aer di.wasn. Ita occurring, however, generally in several indi- 

 viduals at the same time, soon leads to the development of the group 

 ' uptoms which we have described, and by which it may be 



in allied diseases. 



The mortality from thi.s disease is always very considerable. It is 



usually much greater at the commencement of the epidemic than it is 



at sii! , iods. In some instances all the cases occurring for 



the first few days after the breaking out of the fever have proved fatal. 



:we is very mild, and but few fatal cases 



. . The mortality is generally greatest amongst the young and 

 t, and this will perhaps account for its fatality amongst soldiers 

 i. This fever has been regarded as peculiar to places between 

 ' H. , an<l requires a climate in which the mean summer 

 t, less than 75", or, according to some authors, 80. More 

 temperate climates are not, however, free from its attacks. It ap- 

 peared at Li.slj. iii in 1857. One-twelfth of the whole population was 

 attacked with the disease, and of these OIH' -third died. The total of the 

 in the whuli: imputation was between five and six thousand. 

 s of this attack in Europe, we may learn that none of 



ARTS AND SCI. HIV. VOL. IV. 



our towns have an immunity from this disease, and that it is only by 

 carrying out those sanitary measures which are now so extensively 

 adopted, that we can expect to be free from such a visitation of this 

 disease as at Lisbon. 



The morbid appearances of the body after death do not throw any 

 light on the nature of this disease. In the head the dura mater is 

 found studded with dark-coloured spots ; under the arachnoid is fre- 

 quently accumulated a yellowish serosity. The lesions in the chest 

 are not remarkable. The stomach is generally distended with air, its 

 mucous surface is occasionally suffused with blood, and its vessels are 

 generally gorged with blood. The orifices of numerous canals may be 

 seen, from which by slight pressure oozes a fluid which appears to be 

 the " black vomit." The small intestines participate in some measure 

 in the lesions of the stomach. The liver is sometimes engorged with 

 blood, and sometimes it is hard and dry. The spleen is usually in- 

 creased in volume and softened. 



In the treatment of yellow fever much difference of practice has 

 prevailed, according to the opinions of those called upon to treat the 

 disease ; and unfortunately that kind of evidence does not at present 

 exist on which we could rely with regard to the value of any particular 

 course of treatment. Under these circumstances the judicious prac- 

 titioner will act on general principles, and treat whatever cases come 

 before him according to the symptoms they present. As is mostly 

 the case in the treatment of fevers which in their course exhibit both 

 active and low symptoms, two very different plans of treatment have 

 been recommended; the one antiphlogistic, the other stimulant. 

 Without discussing the respective merits of these plans of treatment, 

 it may be stated that both may be rendered necessary in different 

 stages of the disease. 



Amongst antiphlogistic remedies, blood-letting has been highly 

 commended, but it is not so frequently employed as formerly. The 

 next remedy in importance is mercury. Some of the best writers on 

 yellow fever, and those who have had the largest experience, consider 

 mercury as their sheet-anchor in this disease. It should be adminis- 

 tered in doses of sufficient quantity to affect speedily the mouth. 

 Many practitioners who use this remedy do not employ blood-letting 

 as an ordinary remedy, but only in those cases in which the inflam- 

 matory symptoms preponderate. In addition to these means, purgatives, 

 emetics, autimonials, and cold affusion have had their advocates. These 

 remedies are however all of them adapted more to particular states of 

 the system than to the disease of yellow fever, and should be adminis- 

 tered according as circumstances arise which may indicate their 

 necessity. In cases where the disease assumes a remittent form, 

 quinine may be administered with advantage. Dr. Stevens particularly 

 insists on the administration of saline medicines in yellow fever, to 

 which there is no objection, provided the stomach will retain them, 

 and they probably have a beneficial effect on the system according to 

 his theory. 



Of all the questions connected with yellow fever, perhaps that 

 which regards its cause has been discussed with the most zeal and 

 bitterness. We cannot here go into any details of this discussion, but 

 the great point in dispute is the contagiousness of this disease. Many 

 of the early writers on yellow fever concluded that it was contagious, 

 and on this account persons who have been exposed to its influence 

 are obliged to submit to the most rigid quarantine regulations. But 

 whilst there is much evidence to prove that this disease is communi- 

 cable by a morbific matter generated in the human system in a state 

 of disease, there can be no doubt that it has in most cases a local 

 origin. Many recent writers have supposed that the local cause of this 

 disease was to be found in the temperature and other atmospheric 

 phenomena in the district visited by the disease ; but this cause is too 

 general to account for the exceeding local character of the disease in 

 many instances. Cases are recorded in which the inhabitants of par- 

 ticular parts of a town, the one side of a street, or even one room of a 

 house, have been attacked, whilst all others have escaped. The true 

 theory of the production of these diseases is probably to be found in 

 the fact that they originate in decomposing animal and vegetable 

 matter, and afterwards become susceptible of communication from one 

 individual to another by a poison generated in the body. The history 

 of the development of the disease at Lisbon is remarkably confirma- 

 tory of these two points. 



(Library of Practical Medicine, article " Yellow Fever," by Dr. 

 Shapter ; Cyclopaedia of Practical Medicine, article " Yellow Fever," 

 by Dr. Gillkrest ; Bancroft, A n E<say on the Disease catted Yellow Fever ; 

 Dr. R. D. Lyons, Report on the YcUoto Fever at Lisbon, in 1857.) 



FIBRIN. Fibrin is an important constituent of animal and vegetable 

 organisms. In animals it occurs dissolved in the blood, to the extent 

 of 'Jj parts in 1000, and is the principle of which muscle and the 

 fibrous tissue of flesh are built up ; indeed, these parts are usually 

 looked upon as consisting of fibrin itself, though altered in several 

 respects from the condition in which it exists dissolved in blood : the 

 name also is derived from the fibrous character of these tissues, par- 

 ticularly from the bundles of fibres composing the muscles. 



Fibrin has already been shortly noticed under the article ALBUMEN, 

 as forming, with a few other closely allied substances, that interesting 

 class of bodies known as the protein or albuminoid group ; they are 

 sanguigenous or blood-forming matters, and hence are usually termed 

 plastic malerialt of nutrition, to distinguish them from those consti- 



