2.20 , \ PATHOLOG Y. 
from the firA attack ; in others, the fever was uthered 
in with convulsions, delirium, and cold fweats, without 
any intervening heat of the furface, except at the pit of 
the 1 tomacli, which, in mod cafes, was burning-hot to 
the touch, and accompanied internally by a fimilar fen- 
fation according to the patient’s own feelings. 
‘'Haemorrhage from the mouth or nofe feldotn occurred; 
in two cafes, which terminated fatally, the blood did 
not coagdlate, but tinged the linen yellow. Aphthae 
appeared in a few cafes, and indicated danger. Subfultus 
tendinum often attended both on the low and high de¬ 
lirium. The pulfe never could be depended on. In the 
very laft ffage it has been regular ; but in general it is 
finall, quick, and either hard or ftringy and tremulous ; 
fometimes, during the reaction of the fyftem, full and 
hard. Deafnefs was very common, and an unfavourable 
fymptom. Two kinds of eruption appeared about the 
lips : one fuch as we often fee at the decline of common 
fevers; the other, confided of fmall black or brown 
fpots round the lips, and w’as likewife a dangerous, in¬ 
deed a fatal, fymptom. With this eruption, the teeth, 
tongue, and fauces, generally become covered with a 
brown or black cruft, and the breath intolerably fetid. 
Locked jaw took place in two cafes at Onruftffiofpital, 
but the patients were infenfible of it: both died. The 
brain appeared the organ chiefly affe&ed at firft—the 
ftomach and liver in fucceflion. In thofe cafes which 
occurred on-board, and where the patient had not flept 
on-fliore at Edam, the fymptoms were much milder, and 
the fever refembled more the bilious remittent of other 
parts of the Eaft. A great torpor prevails generally 
throughout the fyftem, with the low delirium ; blifters, 
medicines, &c. having little effefl on the patient, who 
appears as if intoxicated. When roufed, he recollects 
the perfon who is fpeaking to him, for a moment, and 
anfwers in a hurried incoherent manner: then lies on 
his back, his mouth and eyes half open ; both feces and 
urine often parting involuntarily. I have feentpatients 
remain in this ltate for hours, nay,' for days together, 
fcarcely moving a Angle voluntary mufcle all that time. 
Never was there a difeafe fo deceitful as this fever: I 
have frequently feen inftances where every fymptom was 
fo favourable, that I could almoft have pronounced my 
patient out of danger: when all at once he would be 
leized with reftleffnefs, black vomiting, delirium, and 
convulflons, which, in a few hours, would hurry him 
out of exiftence ! The fatal terminations generally 
happened on the third, fifth, feventh, ninth, and not 
unfrequently the eleventh and thirteenth, day; if they 
parted this period, they ufually lingered out twenty or 
thirty days. But very few indeed ever ultimately reco¬ 
vered, who had flept on-fhore, and were attacked at that 
dreadful ifland, Edam! No conrtitution was exempted 
from the aflault of this fever. It feized with equal or 
nearly equal violence on thofe who had been many years 
in India, and on the mod robuft and plethoric, or newly- 
arrived, European. Even the Dutch officers and Malays, 
who had been drawn from different parts of Java, and 
whom we had prifoners at Edam, fell viftims as fall, or 
nearly fo, as the Englifh. Several officers, feamen, and 
foldiers, were fent on-board from this ifland, in hopes 
that the change of air might mitigate the difeafe. Many 
» of even the worft cafes of thefe would promife fair for a 
few hours in the forenoon ; but night always difpelled 
our hopes, for then the patient relapfed as bad as ever: 
they almoft all died. But their fate was confiderably pro- 
craftinated by the change ; many of them lingering out 
a great length of time on-board, finking at laft from the 
confequences of the fever, rather than from the fever 
itfelf. Several of them changed into obftinate intermit- 
tents at fea, with great derangement of the liver, fpleen, 
and bowels. Indeed the liver, in moft cafes, feemed af- 
fefted from firft to laft in this fever; but, in all protradled 
ftates of it, this affeftion became the prominent fymptom. 
In thofe that were cut off during the firft eighteen, twen¬ 
ty-four, or thirty, hours, the bra'm appeared to be the 
organ opprefled.” 
The remittent form of yellow fever is that moft fre¬ 
quently met with in the Eaft. We (hall accordingly pro¬ 
ceed to defcribe the marfh remittent, or endemic fever of 
Bengal, in the words of Dr. Clark. “This fever at¬ 
tacked in various ways, but commonly began with ri¬ 
gors, pain and ficknefs at ftomacii; vomiting, head-ache, 
oppreffion on the praecordia, and great dejection of fpi- 
rits. Sometimes, without any previous indifpofition, the 
patients fell down in a deliquium, during the continu¬ 
ance of which the countenance was very pale and gloomy; 
as they began to recover from the fit, they exprefied the 
pain they fuffered by applying their hands to the fto- 
mach and head;” fo great indeed, that delirium often 
came on at once; but, “after vomiting a conliderable 
quantity of bile, they foon returned to their fenfes. 
Sometimes the attack was fo fudden and attended with 
fuch excruciating pain in the ftomach, that I have been 
obliged to give an opiate immediately. 
“In whatever form the difeafe appeared at firft, the 
pulfe was fmall, feeble, and quick: the pain at the fto¬ 
mach increafed, and the vomiting continued. As the 
paroXyfm advanced, the countenance became flufhed,the 
pulfe quick and full, the eyes red, tongue furred, thirft 
intenfe, head-ache violent; delirium fucceeded ; and the 
patient became unmanageable; but a profufe fvveat 
breaking out in twelve or fourteen hours, generally mi¬ 
tigated all the fymptoms. In the retniffions, the pulfe, 
which before was frequently 130, fell to 90. The patient 
returned to his fenfes, but complained of great debility, 
ficknefs at ftomach, and bitter tafte in the mouth. This 
interval, which was very fliort, was fucceeded by another 
psroxyfm, in which ali the former fymptoms were ag¬ 
gravated, particularly the thirft, delirium, pain at the 
ftomach, and vomiting of bile. If the difeafe was neg- 
ledfted in the beginning, the remiffions totally difappeared, 
and the (kin now became moift and clammy ; the pulfe 
was fmall and irregular, the tongue black and crufted, 
and the pain at the ftomach and vomiting of bile became 
more violent.” It is needlefs to fay, that from this period 
till death clofed the fcene, the features of this fever were 
fuch as charafterife the laft moments of all violent and 
fatal fevers. 
The unfavourable terminations are generally between 
the third and feventh day, though in fome cafes the fever 
goes on to the fifteenth or twentieth day: but vifceral 
obftrudtions are almoft always the confequence ; and he¬ 
patitis and dyferitery complete what the fever fails to 
accotnplifh. Dr. Johnfon adds, that feveral cafes oc¬ 
curred under his infpeftion where there was a yellowifli 
fufFufion on the fkin, as in the endemic of the Weft, 
with vomiting of matter bearing a conliderable fimilarity 
to the grounds of coffee. This however is by no means 
an uncommon fymptom in the fevers of the Eaft. 
Occafionally, in the advanced feafon of the year, or 
when cold weather fets in, this fever aflumes an inter¬ 
mittent form. The fimilarity in the nature of the two 
forms of difeafe is well fupported by a Report drawn up 
by Drs. Ainflie, Smith, and Chriftie, on the epidemic 
fever of Coimbatore. The Report ftates, that it was 
either remittent or intermittent, according to theconfti- 
tution, treatment, and feafon of the year. People by 
nature delicate and irritable, or rendered fo by irregula¬ 
rities or want of care, were fometimes attacked by the 
difeafe in the remittent form, proving bilious or nervous, 
as the conftitution inclined. “The fame happens to 
the more robuft, when improperly treated, as where bark 
is given early and before proper evacuations have been 
premifed. As the feafon becomes hotter too, the remit¬ 
tent form prevails overthe intermittent. Males fuffered 
more than females, and young people and thofe of mid¬ 
dle-age more than old people and children. The remit¬ 
tent form fometimes makes its approach very infidioufly. 
The patient feels himfelf out of forts for a few days ; his 
appetite 
