218 V A T H O 
a great exacerbation of the fever; he becomes reftlefs ; 
the heat and drynefs of the (kin increafe ; there is much 
pain of the eyes and frontal finufes ; the pain of the thighs 
and legs is augmented ; third is increased, with a fenfa- 
tion of preffure about the region of the domach. Naufea 
and vomiting occur towards the end of the fird twenty- 
four hours. If the fever has not been arretted within 
thirty-fix hours from its commencement, the patient is 
in imminent danger, and all the fymptoms are aggrava¬ 
ted; the pulfe is ftrong and full, and pulfation of the 
carotids appears diftindl on each fide of the neck. The 
(kin continues hot and dry ; the third is increafed ; there 
is much anxiety, the patient continually (hifting his pof- 
ture ; the urine becomes high coloured ; all his uneafinefs 
is referred to his head and ioins. A fenfation of pain is 
felt about the umbilicus, when prelfed upon ; the white 
o( the eye now appears of a dirty concentrated yellow 
colour, and apparently thickened, fo as to form a ring 
round the margin of the cornea. The blood-velfels of the 
eye appear more enlarged and tortuous ; knees drawn up¬ 
wards to the abdomen ; frequent vomiting, with much 
ftraining;mucus,and hiscommon drink only,beingejefled. 
“Delirium comes on about the end of the fecond day. 
There is now a drynefs, or (light fenfation of forenefs, 
of the throat when fwallowing ; and about this time an 
urgent fenfation of hunger frequently comes on, and a 
remarkable want of power in the lower extremities, re- 
fembling partial paralyfis of the limbs. About this time, 
alfo, the pain of the loins is fo fevere, that the patient 
exptefl'es himfelf as if his back was broken. The third 
day, or dage, begins by apparent amelioration of all the 
bad fymptoms, the vomiting and third excepted. The 
matter ejefted has fmall membranaceous-looking flocculi 
floating in it, refembling the crufl wadted from a port- 
wine bottle- The third is now urgent, and there is an 
inceffant demand for cold water, which is almofl imme¬ 
diately reje&ed by the domach. The heat of the (kin is 
reduced; the pulfe finks to, or below, its natural flan- 
dard ; the patient, for an hour or two, exprefi'es himfelf 
to be greatly relieved ; and, at this time, a perfon unac¬ 
quainted with the nature of the difeafe would have hopes 
of his recovery. This date, however, is of fiiort dura¬ 
tion, and the delufion foon vaniflies. The delirium in- 
creafes ; the matter ejected from the domach becomes 
black as coffee-grounds, and is fiomewhat vifeid. Diar¬ 
rhoea comes on ; firfl green, then black, like the matter 
vomited. The patient often complains of being unable 
to pafs his flools, from a want of power i n the abdominal 
mulcles. There is an acrid burning fenfation of the do¬ 
mach, and forenefs of the throat, extending along the 
whole courfe of the oefophagus, in attempting tofwallow; 
eyes, as if fuffufed with blood ; (kin a dirty yellow ; parts 
round the neck, and places preffed upon in bed, of a 
livid colour. More or lefs haemorrhage takes place 
from the nofe, mouth, and anus; and a depofition of 
blood from the urine. The delirium becomes violent; 
the body as if it were writhed with pain, the knees in- 
celfantly drawn up to the belly. The patient feizes, with 
convulfive grafp, his cradle, or any thing within his 
reach, and prefers the hard floor to his bed. The pulfe 
now finks; refpiration becomes laborious; the counte¬ 
nance collapfed; the ludre of the eye gone. For fome 
hours, he lies in a date of infenfibility before death ; at 
other times, expires after fame convulfive exertion, or 
ineffectual effort to vomit. The tongue is fometimes 
but little altered during the courfe of the fever; and, if 
loaded in the early dages, it often becomes clean and of 
a vivid red before death. 
“Such is the regular fucceffion of fymptoms which 
characterize this fever, but of longer or (horter duration, 
according to the violence of the difeafe, or drength of 
the powers of life to refid it. In weakly habits, the vaf- 
cular aCtion at the beginning is lefs marked ; and, in 
thefe cafes, the fever is generally more protracted, and 
LOGY, 
the patient expires unaffeCted by the laborious refpira¬ 
tion, and convulfive motions, which attend the lad drug¬ 
gies of life in the more violent degrees of this endemic. 
Very often the patient retains his fenfes till within a few 
minutes of his death; and fometimes will predict, with 
confiderable precifion, the hour of his didolution. 
“ In the early dages of the word cafes of this fever, 
there is much anxiety in the countenance of the patient, 
who expreffes a defpair of recovery; and I have never 
noticed a remijfwn during the whole courfe of the fever. Se¬ 
veral cafes of remittent fever under my care terminated 
in the endemic fever. 
“A certain number of thofe attacked by this fever, if 
prompt meafures to fubdue it had been employed, reco¬ 
vered from its fird dage. They exhibited evident figns 
of amendment within the firll twenty-four, or at far- 
thed thirty-fix, hours, from its fird attack. Alfo, a 
confiderable proportion recovered from the fecond dage; 
that is to fay, previoudy to black vomiting unequivocally 
appearing. But I have only known thirteen cafes, in 
above five years, to have recovered from the lad dage. 
Some of thefe were afterwards invalided, in confequence 
of dyfpeptic complaints, and generally-difordered dare 
of the domach and other abdominal vifeera. In thefa 
cafes, the domach gradually became retentive ; the eyes 
and (kin became of a more vivid yellow; they had re- 
frelhing deep, but continued extremely weak and languid 
for a longtime. The oozing of blood from the fauces 
and gums alfo continued for fome days ; and the depo¬ 
fition of blood in the urine remained longed ; this ex¬ 
cretion being always the lad to return to its natural 
healthy condition. 
“ Pain of the back, early dretching round to the na¬ 
vel; forenefs in the throat and cefophagus ; heat and 
acrid fenfation in the domach; urgent third ; hunger; 
want of power, refembling paralyfis of the limbs ; violent 
delirium ; defpondency ; enlargement of the blood vef- 
fels, and a red-yellow colour of the white of the eye, 
either fingly or colledlively, indicate extreme danger ; 
and, when the black vomit has appeared, fcarcely a hope 
remains.'” 
The next form of yellow fever, is the inflammatory en¬ 
demic which attacks new comers, (efpecially when they 
live intemperately,) on their arrival in the Wed Indies. 
The reader will fee the precife fimilarity between this 
fever (which is allowed to arife from the united influence 
of plethoric conditution, intemperate habits, and changes 
in the temperature of the air) and yellow fever. Its 
fymptoms are thus deferibed by Nodes Dickinfon : “ In 
its feverer afpeft, and when negledted at the attack, this 
fever confids of two dages. In the fird, there is increafed 
excitement, refulting from an unufual dimulus applied 
in an excefiive degree to a fydem peculiarly fenlible to 
its impreflion : it produces a derangement in the func¬ 
tions of fome or many vifeera. If this goes on, the fe¬ 
cond dage appears, in which the drufture of thefe vifeera 
is altered to a degree incompatible with the living date. 
Thus the difeafe proceeds from high excitement to ir¬ 
reparable exhaudion, as we (hall perceive by attending 
to the hidory of its fymptoms,. In the lefs fevere ex¬ 
ample there is chillinefs at the onlet, foon followed by a 
permanent and univerfal fenfe of heat, fluflted face, in¬ 
flamed eyes, head-ache, increafed fufeeptibility to tbs 
imprefiions of light anti found, vertigo, drawfinefs, figh- 
ing, white tongue, arid fauces, third, wandering pains, 
lofs of appetite, codivenefs, high-coloured urine, dry 
(kin, naufea, with full and frequent pulfe;—(hould thefi* 
fymptoms in a fevere degree remain without control, 
the difeafe is foon increafed to its mod aggravated form. 
The patient is extremely refllefs, with a continual defire 
to alter his poiition, but without relief. The heat and 
head-ache are intenfe; the carotids throb with unufual 
violence. There is fometimes a furious delirium; tin¬ 
nitus aurium, and even lofs of fight. There is. occa- 
fionaily, 
