FEVEF. 



185 



change soon follows ; the fluids become thicker, and 

 somewhat ropy, and are now found to have mixed 

 with them a flaky substance, of a dark colour. These 

 flaky substances, there is reason to believe, are 

 portions of the villous coat of the stomach, 

 detached, and made to mix with the ejected fluids, 

 by the effort of vomiting. The urine, at this time, 

 is usually very scanty, or may be even suppressed ; 

 the bowels are tardy, or yield a blackish, tarry- 

 looking substance, of considerable tenacity. The 

 whole surface of the body, with the exception, per- 

 haps, of the abdomen, is colder than natural ; some- 

 times dry, sometimes moist; the hands and feet 

 deathly cold, mottled with stagnating blood ; the 

 pulse feeble, fluttering, or extinct; or it may be 

 slow, composed, and might, by the inexperienced, 

 be even pronounced natural. Sleep forsakes the 

 patient, or he doaes, to suffer more ; his respiration 

 is hurried, or preternaturally slow. His mind may 

 wander, but delirium is not a very usual symptom in 

 yellow fever. Indeed, the patients, in this disease, 

 often possess the entire use of their faculties to the 

 very last moment of life. Some die most tranquilly, 

 declaring, with almost their latest breath, that 

 nothing ailed them ; while others die in great 

 agony. When this happens, it is generally when 

 delirium is present, and when the brain, from sym- 

 pathy, seems to sustain the great force of attack. 

 The patient may now become more tranquil, from an 

 evident mitigation of all the severer symptoms ; and 

 this short-lived truce gives rise, in the inexperienced, 

 to hopes that are never to be realized ; for now the 

 yellowness of the skin, which gives its name to the 

 disease, begins to show itself, and becomes the har- 

 binger of the dreaded and fatal "black vomit." 

 This matter is thrown from the stomach, sometimes 

 in incredible quantities, and of various shades of 

 colour, from dark brown to the colour of coffee- 

 grounds, or blackness. It is ejected with very little 

 effort, and the patient, for the most part, denies the 

 existence of pain. Black vomit, however, does not 

 always precede death; it is occasionally absent. 

 But when this is the case, its place is supplied by 

 the eructation of prodigious quantities of gas, rapid- 

 ly and constantly secreted by the stomach. The 

 gums, and other portions of the body, at this time, 

 yield considerable quantities of blood, which renders 

 the aspect of the patient truly hideous. The teeth 

 become incrusted with sordes; the tongue black 

 and dry ; the pulse preternaturally slow and feeble ; 

 or it may be, at the wrist, extinct ; the skin and 

 extremities cold ; coma, or low, muttering delirium, 

 takes place ; sometimes convulsions ; then death. 

 The prognosis in this disease must always be re- 

 garded, even in its commencement, as unfavourable, 

 though this fever is not inevitably fatal. If the 

 disease have commenced in an open, undisguised 

 form, the chance is increased ; but if it attack insidi- 

 ously, the danger is almost in proportion to the 

 absence of prominent or decided symptoms. If the 

 disease assume, or can be made to put on, a regular 

 form, that is, have its remissions and exacerbations 

 in pretty regular order, though the symptoms run 

 high, there appears a better chance to increase the 

 one and moderate the other. But, on the other hand, 

 if the disease discover no tendency to regular remis- 

 sion, or if reaction be but feeble and transitory, the 

 risk is greatly augmented. If the patient sigh 

 deeply, immediately after waking, and before he 

 have recovered the powers of speech, the presage is 

 bad ; or if he complain of much soreness and pain, 

 without the part having any morbid appearance, it 

 is equally unfavourable. Those whose arms become 

 rigid seldom get well ; and those who have an entire 

 suppression of urine never recover. Black vomit is 



always a very unfavourable symptom, especially 

 when attended by hiccough, but is not necessarily 

 fatal, particularly in young people. The " puking 

 of wind," as it is called, is perhaps as deadly a symp- 

 tom as black vomit. On the other hand, should 

 there be a general abatement of the symptoms, 

 especially of headache, with a softened skin ; a 

 general and equally distributed warmth ; less jactita- 

 tion ; diminution of thirst, without nausea or vomit- 

 ing, and the tongue beginning to clean ; less tender- 

 ness in the epigastrium ; bilious foecal discharges ; a 

 free flow of lighter coloured urine (and particularly 

 if it deposit a lateritious sediment); a moderate, and 

 generally diffused perspiration, after the abatement 

 of the exacerbation, the disease may be considered 

 as less desperate, and as tending to a healthy solu- 

 tion. The pulse, in this disease, betrays, from be- 

 ginning to end, less concern, if we may so term it, 

 than ; in almost any other with which we are ac- 

 quainted. Indeed, but little dependence is to be 

 put upon it, if it alone be taken as a guide ; for it 

 has been known to resemble a pulse in health, when 

 dissolution has been near at hand ; while, again, it 

 has been known to cease, yet the patient recover. 

 Treatment. The treatment of this disease is very far 

 from being as efficacious or certain as its danger 

 requires ; yet it is not so,fatal, under favourable cir- 

 cumstances, as might, at first sight, be supposed. 

 In tropical climates, it rages among strangers almost 

 exclusively ; and these, for the most part, are of a 

 description unable to procure the best means of 

 mitigating suffering or averting danger. In norther- 

 ly situations, where the disease is, as it were, acci- 

 dental, the mortality, under the best circumstances, 

 is considerably less, though still very much too great. 

 We may attribute some portion of the mortality to 

 the discrepancy in the views that have been taken 

 of the habits and nature of the disease. Some sup- 

 pose it contagious in a high degree ; this infallibly 

 increases the mortality, by causing the necessary 

 means to be withheld from the suffering, under the 

 apprehension of personal danger ; while others look 

 upon its nature to be the same as that of typhus, and 

 fatally adopt a treatment conformable to such a 

 view ; and, consequently, thousands are sacrificed to a 

 hypothesis. The opinion is now, however, daily 

 gaining ground, that yellow fever is essentially an 

 inflammatory disease, and one which requires a vigor- 

 ous and strictly antiphlogistic plan of treatment. 

 But neither a correct pathology, nor the best con- 

 certed means, will avail, if the proper time for their 

 application be lost. To be successful in the treat- 

 ment of yellow fever, no time must be spent in tem- 

 porizing. Yellow fever, as has just been stated, 

 must, agreeably to the best authorities, be looked 

 upon as an exquisite gastritis; a fact that should 

 never be lost sight of : it is for the relief of this con- 

 dition of the stomach, almost exclusively, that reme- 

 dies are to be sought. It has been mentioned, that 

 the pulse, from its similated weakness, and the 

 feebleness of reaction in its more dangerous forms, 

 has misled the practitioner to the fatal use of stimu- 

 lants. It is the depressed, or oppressed pulse, so 

 called a pulse that always acquires vigour by the 

 abstraction of blood. The quantity to be taken at 

 any given time, cannot well be defined ; for this 

 state of the arterial system may require the loss of a 

 large quantity of blood to relieve it, or the pulse may 

 become open and free by the abstraction of only a few 

 ounces. The management of the bleeding must, 

 therefore, be left to the discretion of the medical at- 

 tendant. If the pulse rise, as it is wont to do under 

 this condition of the system, by the loss of blood, its 

 abstraction should be continued until it become soft 

 under the finger. Nor can any rule be laid down for 



