184 



FEVER. 



affected, we must act more vigorously, to prevent its 

 disorganization, and the consequent destruction of 

 life. When the character of the disease is changed, 

 the means proper will be such as are pointed out 

 under the head of Typhus. 



Yellow Fever. This fever is one of specific cha- 

 racter, and confined to situations in which great mois- 

 ture is joined with great heat. It prevails in the 

 West Indies, certain parts of Asia, South America, 

 occasionally in the northern parts of North America, 

 and pretty constantly in the southern. It is 

 endemial in many portions of the globe, and espe- 

 cially in the tropical climates, and is occasionally 

 epidemic in certain of the higher northern latitudes, 

 as at Baltimore, Philadelphia, and New York. It 

 is most common in seaports, and on large bodies 

 of water, but is occasionally found in inland situ- 

 ations. It differs materially from the endemial 

 remittent of tropical climates, and is, of course, not 

 merely an exalted form of the bilious remittent of 

 such places. It differs from the endemial remittent 

 of the West Indies, in its attacking strangers to such 

 climates only. The natives, and even such as have 

 been born or lived long in similar situations, are alto- 

 gether exempt from its attacks ; and, should the 

 stranger survive the dangers of an attack, he remains 

 free, for the most part, subsequently, though not 

 exempt from the endemial remittent of the place. 

 This immunity, however, may be forfeited by the 

 stranger living for a year or two in a northern lati- 

 tude : should the stranger escape for a year or two, 

 he becomes acclimateo, and is no longer liable to be 

 attacked by yellow fever. This disease has been 

 looked upon, by some, as contagious ; but this notion 

 is now altogether abandoned by far the greater part 

 of the profession ; and especially such as have had 

 opportunities to observe its phenomena, and ascertain 

 its habits for themselves. That it spreads rapidly 

 sometimes, is admitted ; but this is owing to the 

 causes which make it an epidemic, and not to any 

 contagious quality. This disease varies in its mode 

 of attack, as well as in the violence of its symptoms. 

 In almost every other febrile disease, as a general 

 rule, the risk is in proportion to the violence of the 

 symptoms ; but the masked or insidious form of yel- 

 low fever, is most commonly the most difficult of 

 management, and, consequently, the most dangerous. 

 Hence the " walking cases " are almost sure to prove 

 fatal. There are three modes of attack in yellow 

 fever ; and the phenomena of either may vary, as the 

 remote cause may have been more or less active or 

 concentrated. They may also be influenced by 

 individual habits or constitutions, or by the force of 

 the occasional or exciting cause ; and hence we find 

 it run its course rapidly sometimes ; that is, in from 

 two to five days, a part of the cases terminating in 

 black vomit. In this form of the disorder, the symp- 

 toms are generally less ferocious, and less distinctly 

 marked, though more certainly and speedily fatal ; 

 or it may run on to the fifth or to the seventh day ; and 

 though the sufferings are of a more acute kind, the 

 danger is less, as more time is given for the applica- 

 tion of remedies ; or it may present, like a regularly 

 formed remittent, regular exacerbations and remis- 

 sions. If it assume this form, it may run on to the 

 ninth or eleventh day. The first form observes no 

 very regular period of attack, though the evening is 

 the most common. The second generally takes 

 place after noon ; and the third, most frequently in 

 the morning. The mode of attack, however, is 

 pretty generally marked by the same train of symp- 

 toms, differing more in force than in character, if we 

 except the first, which often has the peculiarity of 

 betraying itself by scarcely any outward signs, 

 except weakness, slight headache, or nausea. This 



insidious character lulls the patient and his friends 

 to a fatal security. The patient has been known 

 to walk about until within a few minutes of dissolu- 

 tion. The unmasked or violent attack of yellow 

 fever is, therefore, less to be dreaded than the seem- 

 ingly mild form, as the derangement of the system is 

 more palpable, though it is always highly dangerous. 

 This disease differs in its attack from almost every 

 other form of fever, as it is seldom ushered in by a 

 well-defined chill, though the sensation of cold, and 

 a reduced temperature of the skin, will remain some- 

 times a long time before reaction will take place. 

 Much languor is always experienced ; for the most 

 part, intense headache, distress about the precordia, 

 and the eyes are of a peculiar red. The heat of the 

 skin is seldom great in the beginning, but soon 

 increases in intensity, conveying to the mind the sen- 

 sation of pungency. The pulse is rarely open and 

 strong ; indeed, it usually appears rather more feeble 

 than natural to the inexperienced practitioner, which 

 sometimes betrays him into dangerous errors. The 

 pulse in this state is termed the oppressed or depressed 

 pulse by authors; and, instead of requiring the aid 

 of stimuli, as has been too often supposed, calls 

 loudly for the proper use of the lancet. The face 

 assumes a peculiar, or, rather, a specific flush, which 

 is totally distinct from the redness of ordinary fever. 

 This reddening gives a very marked character to the 

 countenance, and can never be mistaken, by any eye 

 experienced in this disease, for a symptom of common 

 fever: on the contrary, it always denotes a high 

 degree of yellow fever. The tongue is usually moist 

 and clammy ; but rarely dry, rough, or red, in the 

 commencement, though these conditions of this organ 

 are sure to follow in a short time. Ths skin is dry 

 and harsh, for the most part ; though occasionally it 

 is found wet, with hot perspiration. This sweat is 

 sometimes early in its appearance, and, at times, 

 extremely profuse in its quantity ; but it neither 

 abates the action of the heart and arteries, nor miti- 

 gates the local sufferings as headache, pains in the 

 limbs, or oppression in the lungs. It is therefore 

 not critical, but, on the contrary, rather betrays 

 malignancy. There is rarely so great an abatement 

 of symptoms, at any period of the day, as to amount 

 to a remission, though there frequently is an exacer- 

 bation that is every way alarming, from its intensity; 

 and this may happen twice, or even thrice, in the 

 twenty-four hours. When this happens, the disease 

 proceeds, with hasty strides, to its fatal termination ; 

 for should not remedies at this time, especially 

 bleeding, abate the severity of the symptoms very 

 soon after their application, more fatal symptoms 

 quickly supervene ; the eye becomes more sad ; 

 lividity is added to the deep-toned colour of the cheek; 

 the tenderness is much increased by pressure over the 

 region of the stomach ; nausea and vomiting com- 

 mence or increase ; the patient tosses himself into 

 every position ; delirium ensues ; the urine becomes 

 intense in colour, and small in quantity ; the extre- 

 mities lose their heat ; the gums become swollen and 

 livid ; the tongue red, or brown, and dry ; thirst insa- 

 tiable ; and the drinks rejected, perhaps, as fast as 

 swallowed. After a continuance of these symptoms 

 for a few hours, the system seems to make a com- 

 promise with the disease, and passively yields itself 

 up to its ravages ; for there is no diminution of the 

 danger at this moment, though the system seem less 

 morbidly excited ; for if the suffering be less, danger 

 is increased. Now the stomach gives way ; the most 

 tormenting nausea and thirst, with almost incessant 

 vomitings, take place. The fluids discharged are, 

 for the most part, nothing but the drinks which the 

 patient has swallowed; for these, even in the begin- 

 ning, are rarely tinged with bile. But a threatening 



