PATH 
and a dry parched (kin, with a quick, full, tenfe, and 
generally ftrong, pulfe, though it is fometimes oppreffed 
and irregular. Thefe fymptoms are fpeedily accompanied 
by frequent efforts to vomit, efpecially after fwallowing 
food or drink, with difcharges, firft of fuch matters as 
the ftomach happens to contain, and afterwards of con- 
fiderable quantities of bile, appearing firft yellow and 
then green, fometimes tinged with blood, but in the 
progrefs of the diforder with matters of darker colours : 
an increafe of pain, heat, and forenefs of the prsecordia, 
alfo occurs, with conftant wakefulnefs, and frequently 
with delirium more or lefs violent. This paroxyfm, or 
exacerbation, which has been called the inflammatory or 
the febrile itage, generally lafts thirty-fix hours, but is 
fometimes protratted for feventy-two hours, and even 
longer, probably in confequence of either general or 
local inflammation, (particularly in the brain or llomach,) 
or of irregularity in the circulation, which are known to 
prolong the paroxyfms in fevers of type. 
“A remiflion then occurs, in which many of the fymp¬ 
toms fubfide, fo as often to induce a belief that the fever 
is at an end, and recovery about to take place. Fre¬ 
quently, however the foundations of irreparable injury 
to the brain or ftomach have already been laid in the 
former paroxyfm ; and in fuch cafes the remiflion is fliort 
and imperfedt. During thefe remiflions, the pulfe often 
returns apparently to the condition of health ; the flcin 
feels cool and nioift, and the intelledt, if previoufly dis¬ 
turbed, Fometimes becomes clear; fometimes, however, 
the patient remains in a quiet and ftupid ftate, a fymptom 
generally denoting great danger. Another fign of dan¬ 
ger, as denoting a very morbid condition of the ftomach, 
is the renewal of the efforts to vomit, when preffure is 
made on that organ, or food is fwallowed. After a certain 
interval, this remitting ftage is fucceeded by another, 
which may be called a lecond paroxyfm, and which, pro¬ 
bably, would appear as a renewed exacerbation, if the 
violent effefts of the firft had not almeft exhaufted the 
patient’s excitability, and in conjunction with the ex¬ 
treme depreflion of ftrength which ufually attends in¬ 
flammation of the brain or ftomach, rendered him nearly 
unfufceptible of thofe morbid addons which are neceffary 
for that purpofe. In this latter ftage, then, inftead of 
great febrile heat,'and ftrong arterial aCtion, the warmth 
of the body, and the frequency and ftrength of the pulfe, 
are often lefs than when the patient was in health; but 
frequently the pain and heat in the ftomach become ex¬ 
cruciating, with inceffant (trainings to vomit, which, in 
moft of the fatal cafes, are followed by hiccough, and re¬ 
peated difcharges of matters refembling turbid coffee 
more or lefs diluted, or the grounds of coffee, and alfo by 
evacuations of fimilar dark matters from the bowels. 
Here it is to be obferved, that, when thefe fymptoms oc¬ 
cur, (indicating a violent affeCtion of the ftomach and 
bowds,) the patient is, in general, fufficiently in poffeflion 
of his intellects to know thofe about him, and to give 
diftinCt anfwers to queftions made to him, although his 
exceflive weaknefs often renders him incapable of mental 
exertion, and his inability even to raife his head may 
induce the appearance of coma. In thofe cafes, however, 
in which the brain has fuffered greater injury than the 
ftomach, the retching and black vomit, juft defcribed, 
do not fo commonly occur; but, inftead of them, low 
muttering, or coma, with convulsions of the mufcles of 
the face, and other parts of the body, fupervene. About 
this time, alfo the tongue and teeth are covered with a 
dark-brown fur ; yellownefs of the (kin and petechias 
make their appearance ; the urine has a putrid ftnell and 
dark colour; the feces likewife become moft offenfively 
putrid; haemorrhages fometimes take place from the nof- 
trils, gums, and various other internal furfaces. There 
is in fome patients, a fuppreflion of urine ; in others, an 
involuntary difcharge of it, and of the feces: the pulfe 
becomes feeble and intermits; the breathing is laborious; 
O L O G Y. 217 
portions of the (kin affume a livid colour; the extremi¬ 
ties grow cold ; and life is gradually extinguifhed.” 
On the above defcription Dr. J. Johnfon remarks, that 
the propriety of characlerifing the fubfidence of great 
heat and vafcular adion at the clofe of the firft ftage as a 
remiflion, is very queftionable. It is, in fact, (fays he,) 
the tranfition from inordinate adion to exhauftion; to 
that almoft hopelefs ftate which (the foundation of almoft 
irreparable mifchief having been already laid in the moft: 
important vifcera) is fpeedily to terminate in diforgani- 
zation and death, and has nothing in it of the falutary 
tendency of a remiflion. As Dr. Gillefpie obferves, “it 
is proper to caution young praditioners againfta miftake 
very common with regard to the yellow, or ardent fever; 
that is, of taking the fatal ftage which follows the ceffa- 
tion of ardent heat and great excitement, and which ac¬ 
companies a fphacelus of the vifcera, for a falutary crifis 
of the difeafe.” Difeafes of Seamen.—“ Cette diminution 
des fymptomes en impofe quelquefois au malade, et memo 
aux medecins inexperimentes.” Did. des Sciences Me- 
dicales, tome xv. p. 336. 
This declenfion of fever at the clofe of the firft ftage 
excited early attention, and is often fo marked as to have 
been frequently miftaken for a proof of returning health. 
It is noticed by Dr. Hume, who had the charge of the 
naval liofpital at Jamaica between the year 1739 and 
1749, an d was afterwards a commiflioner of the Sick and 
Hurt Board, in the following terms : “The pulfe is at 
firft full, quick, and ftrong ; but in forty-eight hours 
after feizure, or thereabouts, it fometimes becomes calm 
and regular, fcarcely to be diftinguiftied from the pulie 
of a perfon in health.” See Dr. Hume’s Account of the 
Yellow Fever, publiflied by Dr. Donald Munro. 
Now, that we may more firmly eftablifh the accuracy 
of the above defcription, as well as fliow the corrednels 
of Dr. Johnfon’s remark, that the partial diminution of 
pain and uneafinefs is not properly a remiflion, we fub- 
join the following account of the fame fever as it oc¬ 
curs in another part of the weft. It is detailed by Dr. 
M'Arthur. According to that author, this fever is ufually 
ufttered in by the fenfations which precede other fevers ; 
fuch as lailitude, ftiffnefs, and pain of the back, loins, 
and extremities; generally accompanied by fome degree 
of coldnefs. Tilde are foon fucceeded by a fevere pain 
of the head ; a fenfe of fullnefs of the eye-balls; into¬ 
lerance of light; ikin dry, and imparting a burning heat 
to the hand; pulfe full and quick ; tongue covered with, 
a whitifli mucus, but often not materially altered from 
the ftate of health ; bowels bound. “ I may here remark, 
that the adual degree of heat, as indicated by the ther¬ 
mometer, is not proportionate to the intenfity commu¬ 
nicated to the touch. It generally varied between 99 0 
and ioa°, very feldom exceeding 103 0 . yet the Ikin im¬ 
parted a burning cauftic fenfation to the hand at thefe 
times. If the patient has been attacked in the night, he 
awakes with oppreflive heat, head-ache, and the other 
fymptoms of fever, the fenfation of cold having pafled 
unnoticed. At other times, after fatiguing exercife in 
the fun, and fometimes after a hearty meal, the violent 
head-ache, and other fymptoms of the fever, are ulhered 
in by an inftant lofs of mufcular power, and immediate 
depreflion of nervous energy. The patient, as if he were 
ftunned by a blow, falls down, his eyes fwimming in 
tears. In thofe cafes, delirium is an early fymptom. 
In a few hours, the pain of the loins increales, and, in 
aggravated cafes, llretches forward towards the umbili¬ 
cus ; the countenance is flufhed ; the white of the eye as 
if finely injeded by blood veffels, the albuginea appear¬ 
ing through the interftices of the network of veffels, of a 
peculiar blue (hining cartilaginous whitenefs. 
“ During the firft twelve hours, the patient is not par¬ 
ticularly reftlefs, enjoys fome fleep, and, when covered 
by the bed-clothes, has partial perfpirations on his face, 
neck, and breaft. About the end of this period, there is 
tVgreat 
4 
