YELLOW FEVER. 693 



two days, or it may be the commencement of convalescence. In 

 the third stage the symptoms again grow worse, the temperature 

 rising to 104 ; the patient is usually apathetic, though he may 

 completely retain consciousness. Now come the jaundice and haem- 

 orrhages from the alimentary canal ; that from the stomach con- 

 stitutes the " black vomit " which has given one name to the dis- 

 ease. While this " vomit is thick and pasty, being raised in small 

 quantities, and thrown up mixed with natural mucus, the physician 

 does not despair of his patient. The thin black fluid with the coffee- 

 ground sediment is always, in Mobile, a fatal symptom." If the 

 disease continues, the kidney trouble may grow worse, and entire 

 suppression of urine occur. If this third stage is severe, it mostly 

 terminates in death (" from syncope, uraemia, apoplexy, or asphyx- 

 ia") ; but sometimes the temperature falls suddenly, the patient 

 sweats freely, and the severe symptoms all subside. Convalescence 

 is slow, and for a long time the stomach remains weak. In severe 

 cases the strength of the patient may not be " reestablished sooner 

 than from ten to ticenty days after the cessation of the febrile symp- 

 toms" " The average duration of fatal cases is less than a week." 

 THE TREATMENT of yellow fever, as of other epidemic diseases, 

 has varied greatly with different epidemics. Bleeding, salivation, 

 purging, sweating, etc., have each had their advocates ; but at pres- 

 ent the most favored plans may be considered first, that of ad- 

 ministering at the start a large dose (gr. xx each) of calomel and 

 quinine, followed after a few hours by a purge, and subsequently 

 to treat symptoms ; and, secondly, the treatment by laxatives, such 

 as cream-of-tartar and tamarind-water, followed by tonics, and, 

 if the disease goes on, by active stimulants. It is considered very 

 desirable to keep the patients well covered in bed, and in moder- 

 ate perspiration ; the latter may be aided by hot foot-baths under 

 the bed-clothes and by warm aromatic teas. Possibly frequent 

 small doses of jaborandi or its active principle, pilocarpin, might 

 prove beneficial.] 



