S YMPTOMA TOLOG Y 



1237 



by headache, pale, then flushed, face, injected eyes, and pains in 

 the body, and after the second day albuminuria; while the second 

 attack shows the jaundice from which the disease obtains its name, 

 and the haemorrhages, of which black vomit and black motions form 

 such ominous signs. 



Onset. — Prodromata are usually absent, but general malaise may 

 be felt for some little time previously. The attack begins with a 

 sensation of coldness, with or without rigors, and with severe frontal 

 headache, pains in the back and limbs, while the face, at first pale, 

 becomes flushed and painful, the skin congested, the eyes brilliant 

 and injected, and photophobia is often present. The temperature 

 rapidly rises to 103° F. or more; the respiration quickens and is 

 laboured; the pulse is quick, full, and bounding, reaching to 100 or 

 120 per minute. The appetite is lost, and there is usually vomiting, 

 associated with pain and tenderness in the region of the pylorus, and 

 usually constipation. The urine is generally diminished, acid in 

 reaction, with a high specific gravity, and albumen is present from 

 the first or second day. Its passage may cause a sensation of burn- 

 ing. During this stage there is often insomnia. 



Intermission. — On the second to fourth day the remission sets in, 

 the temperature either dropping with a crisis, accompanied by 

 sweating, to normal, or remitting to about 100° F., the flush and 

 pains disappearing. In the former case the disease ends and con- 

 valescence begins. More usually, however, after a few hours' re- 

 mission, during which the patient feels much better and sleeps well, 

 the temperature again rises to 104° or 105° F. ; but a most char- 

 acteristic feature, called ' Faget's sign,' now shows itself, in that the 

 pulse does not increase in rapidity as the temperature rises. On the 

 contrary, as days go on, the pulse-rate tends to become slower and 

 slower, without regard to the temperature. This sign depends upon 

 the severity of the case, being most noticeable in severe types, in 

 which it may be only 70 to 60 per minute, though associated with 

 a high temperature. 



Second Attack. — ^During the second attack all the symptoms of 

 the first paroxysm return, but the congestion of the skin is not so 

 marked, and the yellow tint of jaundice appears for the first time, 

 and deepens as the illness proceeds. The vomiting and tenderness 

 in the stomach return, and are associated now with much thirst 

 and prostration. The tongue is dry and furred, with red tip and 

 edges. Haemorrhages may now occur from the nose, mouth, or 

 uterus, and the bad signs of black vomit and melaena may appear. 

 The urine diminishes in quantity, and the albumen increases. In 

 bad cases its excretion may totally cease. There is generally much 

 restlessness, and often delirium. 



Terminations. — ^Two courses are now possible. The first is that 

 after three to four days' illness the temperature may decline, the 

 urine increase in amount, the albumen diminish, and the vomiting 

 gradually cease; while sweating may occur, and the patient, passing 

 into a deep sleep, awakens on the road to convalescence. The second 



