YELLOW FEVER. 25 



sometimes terminating in health, sometimes, however, running on to 

 extreme exhaustion, or assuming a typhoid form. 



Anatomical characters. — The membranes of the hroAn are often 

 found injected, and serum effused into the ventricles. The stomach 

 usually presents traces of inflammation, having its mucous coat 

 either reddened, thickened, softened, or eroded. The peculiar mat- 

 ter called black vomit, is now generally believed to be blood altered 

 by admixture with the acid secretion of the stomach. The liver is 

 altered in colour and consistence. According to Dr. J. Hastings, 

 U. S. N., it resembles old boxwood in colour, and is much harder 

 than natural. Sometimes it is dry and anasmic, though rarely in- 

 flamed. It varies in colour from a lemon yellow to a straw colour, 

 and in consistence, from being soft and friable to positive induration. 



Cause. — Speculation is rife as to the cause of this disease. There 

 is no doubt that it is as specific as that of small pox, though of its 

 precise nature nothing definite is known. Heat and filth, alone, are 

 not able to produce it ; neither are marsh miasmata, independently 

 of other causes. Strangers are more liable to it than long residents, 

 and whites more than negroes. Among the predisposing causes are 

 exposure, intemperance, fear, and sudden changes of weather. 



Diagnosis. — At first it is not easy. As the disease advances, how- 

 ever, the severe pains in the back and lower extremities, the peculiar 

 injection of the conjunctiva, the excessive irritability of stomach, the 

 yellowness of the skin, and finally the black vomit, are enough to 

 diagnosticate the disease. 



Prognosis. — Generally regarded as unfavourable, though much 

 depends upon the person attacked, the character of the epidemic, 

 and the severity of the symptoms. Symptoms of great prostration 

 are very unfavourable, and a total suppression of urine is a certainly 

 fatal sign. Strangury, however, is regarded as a favourable sign. 



Treatment. — Early in the disease, before there is much irritability 

 of stomach, an emetic is of great service, particularly if the stomach 

 be loaded ; it should only be used, however, under these circum- 

 stances. Bloodletting, to be of service, should be employed early, 

 and even then, not unless called for by the violence of the symp- 

 toms and the state of the pulse. Mercurials are, on all sides, de- 

 clared to be of great service in this disease. They should be admi- 

 nistered first with a view to their cathartic action, and then to their 

 specific infiuence, as rapidly as possible. Febrifuge medicines are 

 also called for ; of these perhaps none is so good as ice given inter- 

 nally, together with cool sponging externally; the latter with caution. 

 Ice also often allays the excessive irritability of the stomach. To 

 the same end the effervescing draught may be employed, and sina- 

 pisms or leeches externally. If the pain in the head is very great, 

 cups or leeches may be employed, together with cold applications to 

 the part. In the seco7id stage, the febrifuge and depleting remedies 



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