FEVER, YELLOW. 



315 



stitation in which the democratic principle 

 was thoroughly carried out. He made himself 

 very popular in Geneva by many municipal 

 reforms, and by the embellishment and en- 

 largement of the city, which since that time 

 has made great progress. In the federal as- 

 semblies of Switzerland, in which he repre- 

 sented Geneva for many years, he also obtained 

 great influence. In 1853 he succumbed to a 

 coalition of several opposing parties; but in 

 1855 he was restored to power, his success be- 

 ing chiefly due to a coalition with the Catholic 

 party. In 1862 he was again deprived of a 

 controlling influence in state affairs by his op- 

 ponents, who were greatly embittered against 

 him and had assumed the name of Indepen- 

 dents. He was not afterward able to regain 

 his lost influence, although he was generally 

 supported at the elections by the entire Catho- 

 lic vote, Fazy was the author of " Precis de 

 1'Histoire de la Republique de Geneve jusqu'a 

 nos Jours" (two volumes, 1838-'40), and 

 u Coursde Legislation constitutionnelle" (1874); 

 and he edited and contributed to numerous 

 reviews. 



FEVER, YELLOW. During the summer of 

 1878 an epidemic of almost unprecedented ma- 

 lignity visited a portion of the Southern States. 

 Differing in many points from the disease as 

 manifested in previous years, this malady is 

 still classified by the majority of physicians as 

 yellow fever. Dr. Faget, of the Paris Faculty, 

 describes yellow fever as "a continued fever of 

 a single paroxysm, rapidly attaining its high- 

 est point, to decline immediately and then slow- 

 ly returning to the normal standard, having 

 had no stationary stage. . . . The pulse is 100, 

 sometimes 110 to 120, the first day, begins to 

 fall the second, continues to decrease regularly 

 the third, and gives from that time 70 or 80, 

 sometimes much less. . . . The regular and 

 rapid decrease of pulse is such in yellow fever, 

 from a record of a hundred observations, that 

 we could recognize it as the true characteristic 

 of that fever. This decline of the pulse is not 

 a simple abatement of the fever, since it oc- 

 curs at the height of febrile excitement, and 

 even, in the great majority of cases, during the 

 increase of temperature. By thus carefully 

 watching the temperature with the thermome- 

 ter and counting the pulse with a seconds- 

 marking watch, we can give a correct diagno- 

 sis in the very first hours of the disease." The 

 patient is generally seized with a chill, espe- 

 cially if attacked at night, followed by intense 

 pain in the back, limbs, and head, supraorbital ; 

 eyes red and injected ; face has a congested ap- 

 pearance, increasing with the disease, and due 

 to the congestion of the capillaries, so well 

 marked that pressure with the finger will leave 

 a white spot. Vomiting does not set in until 

 the second or third day. 



Dr. J. 0. Nott remarked : " However sus- 

 picious the case of bilious fever may be, and 

 however violent in grade, if there be bilious 

 vomiting after the first forty-eight hours we 



may safely say that it is bilious fever ; if there 

 be yellow skin and black vomit, haemorrhage, 

 etc., it is yellow fever." 



This year the yellow fever in New Orleans 

 was largely complicated with paludal fevers, 

 which made it difficult of diagnosis. Accord- 

 ing to the definitions of the distinguished Dr. 

 Faget, yellow fever has but one paroxysm; in 

 paludal fevers there are two or more. In yel- 

 low fever the period of defervescence until the 

 pulse becomes normal varies from thirty to 

 forty-eight hours ; in paludal fevers it averages 

 ninety-six hours. In yellow fever the sphygmic 

 line descends while the temperature maintains 

 itself or rises; in paludal fever there is perfect 

 concord between the pulse line and the tem- 

 perature. The divergence of the sphygmic and 

 thermal lines is then a distinctive mark of yel- 

 low fever. When visceral congestion super- 

 venes, the pulse rises and temperature falls 

 with extreme rapidity. In fatal cases the tem- 

 perature sinks below the normal, while the 

 pulse is too rapid to be counted. There is then 

 no terminal fever, and true yellow fever con- 

 sists of a single non-remittent paroxysm. The 

 more violent the attack, the greater the diver- 

 gence between pulse and temperature. When 

 complicated with malarial fever, the action of 

 the pulse is irregular. The variations between 

 the types of the disease in Memphis and New 

 Orleans are exhibited in the following table : 



In regard to the origin of the epidemic great 

 differences of opinion exist among scientific 

 observers. It is admitted that the disease ex- 

 ists perennially in the West Indies. It is a 

 disease of warm climates, but its limits can not 

 be determined. At its first introduction on the 

 continent of North America, it ravaged Bos- 

 ton in 1780. It subsequently appeared in New 

 York and Philadelphia, and reappears at inter- 

 vals, the last epidemic in New York being in 

 1822, and Philadelphia having been visited still 

 later. 



The malignant form of this epidemic and its 

 wide extent may have been due to the peculiari- 

 ties of the seasons. A remarkably mild winter 

 was followed by an intensely hot summer. The 

 climatic lines were virtually carried a thousand 

 miles north of their ordinary position. An un- 

 acclimated people as far north as the Ohio were 

 exposed to the ordinary temperature of the 

 Gulf States, while the Gulf States were tropi- 



