219 
PATHOLOGY. 
fionally, a dry cough with pain in the fide, and almoft 
invariably a fenfe of heat, oppreffion, and pain on prel- 
fure at the prsecordia, accompanied by eonftant fighing.- 
Vomiting-fometimes comes on very early in the attack. 
There is often great drowfinefs, but no refrelhing deep. 
In 1 'orne cafes an acute pain is felt in the right fide ; and 
a yellow colour of the Ikin often fupervenes. This yel- 
lownefs is occafioned by the prefence of bile, which is 
alfo detected in the urine and ferum difcharged from 
the blifters. Should the paffage of bile into the intef- 
tines fpontaneoufiy take place, or be procured by the 
aftion of purgatives, this jaundiced appearance will ge¬ 
nerally be prevented : neverthelefs, in feme cafes it may 
ofiibly a rife from a redundant fecretion, even when the 
ilious canals are free ; and a bilious vomiting and purg¬ 
ing may .occur with the yellownefs of the fkin, and carry 
off the attack. Thefe fymptoms proceed with various 
degrees of violence, and they occupy an uncertain period. 
Within twelve, twenty-four, or thirty-fix, hours, or 
perhaps after a longer but indefinite time, an important 
change takes place. It marks the commencement of the 
fiecond ftage. Many of the molt urgent fymptoms de¬ 
cline. The pain and heat of furface fubfide. There is 
a fenfe of cold with dampnefs of the Ikin. This change 
at fir ft fo much aflumes the appearance of febrile remif- 
fion as to give great hope to the inexperienced pra&i- 
tioner; but it fpeaks a ftate of the utmoft danger. In 
fome cafes the patient finks, at once, after the fubfidence 
of excitement, apparently deftroyed by the general affec¬ 
tion, without any previoufly-fevere determination of 
blood to particular organs; and he dies at the moment 
of hope in his amendment. But, more commonly, the 
cataftrophe is not fo fudden. With the diminution of 
heat and pain, the pulfe falls; the countenance exhibits 
great diftrefs ; the eye is funk; the pupil dilated ; fome¬ 
times delirium continues; at others, there is great in- 
fenfibility witli tendency to coma. Vomiting, occafion- 
ally, continues without intermiffion : at times, however, 
the ftomach remains tranquil; and this, when there is 
much cerebral difturbance. 
“ As the difeafe advances, a difcolouration of the fkin 
often takes place. It appears in yellow, brown, and 
livid, patches. This difcolouration never comes on un¬ 
til the fubfidence of the fymptoms of excitement, how¬ 
ever early in point of time. It occurs within the paftive 
haemorrhage from various parts : from the nofe, corners 
of the eyes, ears, &c. and at the fame time with the black 
vomiting. This change of colour appears to arife from 
ecchymofis proceeding from exhauftion of the vis vitae in 
the capillary veflels of the furface in confequence of pre¬ 
vious inordinate excitement. It is very diffimilar from 
the bilious yellownefs already noticed as an incidental 
fymptom of the firlt ftage of the difeafe. 
“ The firft difeharges from the ftomach are merely the 
ingefta; afterwards a large quantity of ferous fluid is 
ejected, when little has been drunk. In a more advan¬ 
ced ftage of the complaint, the material'thrown up is 
ropy, and mixed with numerous fmall ffreds, flocculi, 
or membranaceous films, which float in the ejefiied liquid. 
Thefe loon acquire a dark-brown, purple, or black, co¬ 
lour ; but do not, at firft, communicate much general 
tint to the fluid in which they are fufpended. After¬ 
wards, the matters vomited are more intimately mixed 
together ; and, with the addition of dark-coloured blood 
which is effufed into the ftomach, vitiated bile, and other 
morbid fecretions, give an appearance in the aggregate of 
coffee-grounds. There is at this period, ufually, a purg¬ 
ing of dark-coloured matter refembling tar mixed with 
black blood, 
“ Sometimes within the firft forty hours, at others af¬ 
ter a more protrafled period, the feene draws towards a 
clofe with the ordinary phenomena of approaching di Ab¬ 
lution which accompany the laft ftages of acute difeafe 
in general. There.are dilated pupil, ftrabifmus, ftngul- 
tus. fubfultus teadinum, conxsudeliquium, hemorrhage 
VOL, XIX. No. 1*99, ' 0 
from various channels, fupprefiion of urine, low mutter¬ 
ing delirium, total infenfibility, occaflonally violent 
raving, and an inceflant difpofition to rife in bed. Thefe 
are among the laft fymptoms of an unfubdued attack; 
and they mark the near approach of death.” 
To eftablifh our aflertion of the identity of the various 
forms of yellow fever, we Ihall now give a defeription 
of this fever as it occurs in the eaft and other parts. In 
many parts of the eaft, the comforts and habits of the 
people are far from proving fuch powerful predifpofing 
caufes of yellow fever as in the weft ; but, as this is by no 
means general,we often meet with the precife fymptoms of 
continued fever, as exemplified in the following excel¬ 
lent defeription of the endemic of Batavia, drawn up by 
Wade Shields. “The patient, without much previous 
notice (of the firft attack), is fuddenly feized with gid- 
dinefs and cold chills, a fenfe of debility, and vomiting, 
with pain over the orbits, and in the epigaftric region. 
He frequently falls down, and is infenfible during the pa- 
roxyfm ; his body covered with cold clammy fweats, 
except at the pit of the ftomach, zvhich always feels hot to the 
palm of the hand; the pulfe is fmall and quick. On re¬ 
covering a little, this train of fymptoms is fucceeded by 
flulhings of heat, increafed pain over the orbits and in 
the linciput, pain and a fenfe of internal heat about the 
ftomach and prsecordia, oppreffed breathing; the lower 
extremities, at this time, not unfrequently covered with 
cold fweats. The eyes now become, as it were, protru¬ 
ded, and the countenance fluffed. Retching, and, at 
length, vomiting of difcoloured bilious matter, comes 
on ; the tongue white and furred, the abdomen tenfe 
and full, with pain in the loins and lower extremities. 
The length of this paroxyfm varied from fix to eighteen 
hours, and was generally fucceeded by cold rigors ; very 
often low delirium, preparatory to the next ftage or pa¬ 
roxyfm of the fever. The intellectual functions now be¬ 
come much impaired, the patient not being at all fenfible 
of his fituation, or of any particular ailment. If alked, 
how he is ? he commonly anfvvers, “Very well;” and 
feems furprifed at the queftion. This was a very dan¬ 
gerous fymptom, few recovering in whom it appeared. 
In this ftage all the fymptoms become gradually, often 
rapidly, aggravated; particularly, the head-ache, pain 
and tenfion in the epigaftric region, and vomiting. Some 
patients, on-ffore, were carried off in eighteen, twenty- 
four, thirty, or forty, hours, and others not till as many 
days after the attack, efpecially when removed on-board, 
from the more noxious air of the ifland. A great pro¬ 
portion changed, in a few days, to a bright yellow ; fome 
to a leaden colour: other cafes terminated fatally, in a 
very rapid manner too, without the flighted: alteration in 
that refpeCh Generally, however, the change of colour 
indicated great danger. Vomiting of black bilious Huff, 
refembling the grounds of coffee, trequently commenced 
early, and continued a raoft diftrefling fymptom 5 too 
often baffling all our attempts to relieve it. In fome, a 
purging of vitiated bile, or matter refembling that which 
was vomited, occurred; in a great many, a torpor pre¬ 
vailed throughout the inteftinal canal; rarely did any 
natural fseces appear fpontaneoufiy. The pupil of the eye 
was often dilated, and would not contraft on expofure 
to a ftrong light 5 in others there was great intolerance 
of light: both indicated danger. Low delirium was a 
pretty eonftant attendant on this fever, from firft to laft; 
fometimes, though more rarely, raging-high delirium. 
The latter cafe is attended with red, inflamed, and pro¬ 
truded, eyes; great inquietude, hot dry Ikin, and fmall 
quick pulfe. The patient’s mind is aftively employed 
about his ufual occupations. During the violence of 
the paroxyfms, he is quite infenfible to every thing that 
goes on around him, conftantly grafping at, or wrench¬ 
ing, objefls within his reach. In the low delirium, alfo, 
the mind is much occupied on avocational fubjefts: if a 
feaman, about the fhip’s duty ; if a foldier, about hk re¬ 
giment, marching, &c. Some patients were comatofe 
3 & from 
