24 



reaction in this disease. Haylin, granular and epithelial casts, which 

 may be bile-stained, are commonly encountered in the sediment. 



Liver. — Except jaundice, which has already been discussed, there 

 appear in uncomplicated cases no symptoms, referable to this organ, 

 the dimensions of which are, as a rule, not materially altered. ' 



Spleen. — In uncomplicated cases the spleen does not undergo any 

 material change in size. 



JVei'vous system. — Sleeplessness, more or less marked, is a frequent 

 symptom. Delirium is of common occurrence; in many cases it is only 

 a slight mental wandering during the first or second night after the 

 onset. In some of the grave cases this wandering gives place to a 

 muttering or an active maniacal delirium; toward the end in some 

 fatal cases unconsciousness, more or less profound, supervenes and 

 the scene is closed with tonic convulsions involving particularly the 

 muscles of the face and flexors of the arms. In all mild, in many 

 grave, and in some fatal cases the mind is clear and alert throughout 

 the course of the attack. 



Duration: — The great majority (75 per cent) of all cases terminate 

 before the ninth day. A fatal termination rarely occurs before the 

 third day, but it has been recorded as late as the twenty-second. 



Complications. — In the vast majority of cases yellow fever runs its 

 course without any disturbing complications. Occasionally, however, 

 a deep-seated muscular abscess or an inflammation of the parotids may 

 occur. 



The most common complication is malaria, which may manifest 

 itself either during the febrile period or, and more commonly,* during 

 convalescence. 



Yellow fever may occur as a complication in the course of some 

 chronic diseases such as pulmonary tuberculosis, cirrhosis of the liver, 

 dysentery, malarial cachexia and ankylostomiasis, or some acute 

 infections such as typhoid fever and gonorrhea. 



Convalescence. — With the termination of the fever the patient finds 

 himself, even after a relatively mild attack, markedly depressed in 

 strength. As a rule, however, recuperation is rapid. Occasionally 

 convalescence is retarded bj r the occurrence of complications such as 

 malaria, f urunculosis, and peripheral neuritis. 



Relapse and second attacks. — A return of the fever and other symp- 

 toms characterizing an attack of yellow fever after convalescence has 

 been established is rare. Cases of relapse have, however, been 

 observed after an interval of 2 or 3 days to 2 weeks or a month. It 

 is a question whether so-called relapses occurring after an interval of 

 2 weeks or a month should not more properly be considered second 

 attacks. 



As a rule with but very rare exceptions one attack of the disease 

 confers immunity on the individual for life. Nevertheless, there are 



