24 PRACTICE OF MEDICINE. 



YELLOW FEVER. 



Synonymes. — Typhus Icterodes. — Bulam Fever. ^-Vomito negro. 

 — Vomito prieto. 



This is a disease of warm climates, occurring mostly during the 

 summer months, and ceasing on the appearance of frost. It is met 

 with chiefly in towns upon the seaboard, or upon streams emptying 

 into the ocean. 



Symptoms. — The attack may or may not be preceded by pro- 

 dromic symptoms, very often coming on without any warning, and 

 occurring in the midst of ordinary health. It is generally ushered 

 in with a chill, and severe pains in the back and limbs. After febrile 

 reaction has been established, the skin is hot and dry, the respiration 

 hurried, the face flushed, the eyes red and watery, and the con- 

 junctiva much injected. There is a sense of uneasiness, sometimes 

 tenderness at the epigastrium, accompanied by nausea and vomiting. 

 The tongue is at first moist and covered with a yellowish-white fur ; 

 there is also extreme thirst. The pulse ranges from the natural 

 standard to 120 or even 140. Sometimes it is unnaturally slow ; 

 either extreme is significant of great danger. Sometimes there is 

 delirium and prostration; at others, the mind is clear, and the mus- 

 cular strength unimpaired. The bowels are ordinarily costive, and 

 when discharges are obtained, they are commonly unhealthy in 

 character. As the disease advances the pain in the limbs becomes 

 more intense, especially in the lower extremities, the calves and 

 front of the legs. This stage is called by some authors the stage of 

 invasion^ and lasts from a few hours to three days ; the shorter the 

 duration, the more violent, generally, is the disease. 



After this comes the stage of remission, or, as it is sometimes 

 called, the stage ivithout fever. AH the symptoms abate, and the 

 patient seems to be convalescent ; there are symptoms present, how- 

 ever, by which the experienced are warned of the continuance of the 

 disease. The epigastrium is even more tender upon pressure, the 

 skin becomes yellow or orange colour, the urine assumes a yellow 

 tinge, and the pulse sometimes sinks as low as 40 in the minute. 

 After a short calm the stomach assumes its former irritability, and 

 the peculiar substance called black vomit is ejected. The tongue is 

 dry, brown, and chapped. The patient becomes more and more 

 prostrated ; there are, at times, passive hemorrhages, at others, sup- 

 pression of urine, or retention. The pulse becomes more and more 

 feeble, the respiration sighing, the matter ejected from the stomach 

 is brought up without effort, and discharges of the same matter take 

 place from the bowels. This stage is sometimes called the stage of 

 collapse. Sometimes, instead of collapse, symptoms of reaction set 

 in, which are always to be regarded as a salutary effort of nature, 



