P A T II O L O G Y. 221 
appetite fails him; he has fqueamiftinefs, efpe.cially at the 
light of animal food ; univerfal laflitude; alternate heats 
and chills ; ftupid heavinefs, if not pain in the head. 
The eyes are clouded ; the ears ring ; the bowels are in¬ 
variably coftive. In other cafes, the enemy approaches 
rapidly ; and rigors, great proftration of ftrength, verti¬ 
go, naufea, or vomiting, ufher in the difeafe. 
“The fii'lt paroxyfm, which is often attended with de¬ 
lirium and epiftaxis, after continuing an indefinite pe¬ 
riod with varying fymptoms, terminates in a fweat; 
not profufe and fluent, as after a regular hot fit of ague, 
but clammy and partial, with the effeft, however, of 
lowering the pulfe and cooling the body, but not to the 
natural Itandard. The latter ftill feels dry and uncom¬ 
fortable ; the pulfe continuing fmaller and quicker than 
it ought. This remiflion will not be of long Handing, 
without proper remedial meafures. A more fevere parox¬ 
yfm fconenfues, ufliered in by vomiting (fometimes of 
bile), and quickly followed by exceflive heat; delirium ; 
great thirlt; difficult refpiration; febrile anxiety; 
parched and brownifh tongue. The next remiflion (if 
it do take place) is lefs perfect than the firft, and brings 
ftill lefs relief. In this way, if medicine or a fponta- 
necus purging do not check the difeafe, it will run its 
fatal courfe, each fucceeding attack proving worfe than 
its predecefibr, till exhaufted nature begins to give way. 
The pulfe declines; the countenancefhrinks, and looks 
fallow ; the eyes become dim, the abdomen fwells from vif- 
ceral congeftion ; the ftomach loathes all food, when hic¬ 
cup, ftupor, and low delirium, ufher in death. Such fe¬ 
vere cafes, the committee think, were,-in general, owing 
to neglect or blunders at the beginning of the difeafe.” 
Between the bilious fever and the continued form of the 
weftern endemic we obferve little difference. In eacii, 
gaftric irritability, inflammation or fullnefs of the abdo¬ 
minal vifcera, oppreflion of the head, are for the mod part 
prefent. The other febrile fymptoms are by no means 
conftant and regular. Thus the pulfe is frequently re¬ 
gular, and fometimes up to 120 or 130 in the minute. 
It is the fame with the temperature of the fkin. Often, 
when mad delirium is prefent, the pulfe will be 86, and 
the thermometer in the axilla at 96° of Fahrenheit. The 
"bowels are almoft always conftipated, or in a ftate of dy- 
fenteric irritation. No fuch thing as natural flools in 
this fever are ever to be feen, unlefs procured by art. 
Frequently, but not always, yellownefs of the eyes, and 
even of the fkin, takes place ; and the mental functions 
are very generally affefted, which indeed is charafteriftic 
of all bilious difeafes. 
The following is the tnoft general order in which the 
febrile phenomena prefent themfelves. Severe pain in 
the head, arms, loins, and lower extremities; ftridture 
acrofs the bread, with great pain under the fcrobiculus 
cordis ; retching and griping. In fome cafes the pulfe 
intermits, and the temperature of the fkin is increafed ; 
in others, cold chills come on, attended with partial 
clammy fweats; but all patients complain of pain under 
the frontal bone; molt have white furred tongues, and 
third. An increafe rapidly takes place in the leverity of 
the pain in the head, limbs, loins, and acrofs the epigaf- 
tric region ; condant vomiting of vifcid bile comes on ; 
intermiffion of pulfe goes off. In fome, the fkin is cold ; 
in others hot, with infatiable third. Tongue, in mod 
cafes, covered with a thick white crud. Great irritabi¬ 
lity of the ffomach, and averfion to food. Bowels con¬ 
ftipated ; but a few patients have a fcetid bilious purging. 
The third or fourth days bring an increafe of pains 
acrofs the epigaftric region, and in the head, with fre¬ 
quent vomiting of bile ; tongue fwelled and furred, but 
no great heat or acceleration of pulfe. An increafe of 
all thefe fymptoms, efpecially the violent pain in the 
head under the frontal bone, takes place; delirium, and 
yellownefs of the fkin, come on ; and the fatal progrefs 
of the difeafe is precifely flmilar to that of the continued 
fever before detailed. Throughout the whole of the dif¬ 
eafe, the liver appears to be feverely affected. 
The difeafe does not always proceed, however, in the 
manner here mentioned. Sometimes violent madnefs is 
the firft decided lymptom : the patient endeavours to 
commit fuicide, and lias been known to attack with fury 
thofe who have endeavoured to prevent his throwing 
liimfelf over-board, or committing fimilar acts of violence. 
The patient often falls fuddenly down, with fuffufed 
eyes and infenfibie limbs ; and awakes after fome time 
to undergo the molt violent inflammation of the brain. 
The appearances found on dijfcdling thofe to whom 
yellow fever has proved fatal, are fuch as commonly fol¬ 
low inflammatory aflion ; and, according as this aftion 
has been violent or otherwife, we obferve the various gra¬ 
dations of mortification or (laughing, of abfcefs or ulce¬ 
ration, of adhefion or effufion, or (rarely) of Ample red- 
nefs and dilatation of veffeis. 
The parts principally affected are, the brain, the mem¬ 
branes of which are often found adhering together, and 
the ventricles containing watery or bloody fluids,; the 
liver, the ftruftureof which is varioufly affected, from a 
flight hardnefs and darkened colour of its edge, to a ftate 
fo completely diflblved and broken down, that with the 
flighted preffure the finger runs into if. The gall-blad¬ 
der is almoft always turgid with bile; the ftomach and 
fmaller inteftines inflamed in various degrees, the fto¬ 
mach being frequently ulcerated or fphacelated, and the 
inteftines exhibiting various difeafed products : it rarely 
happens that the inflammation extends to the colon. 
The thoracic vifcera are not generally much aflefted, 
though occafionally polypi arefound forming in the heart, 
or the pericardium is unufually diftended. But ulce¬ 
ration or abfcefs of the lungs is perhaps the-lead fre¬ 
quent organic lefion of the vifcera. The fkin is often 
affefted with inflammatory aftion, as exemplified by its 
frequent termination in (pots and ecchymofes. It is to 
be remarked, that fometimes the abdominal vifcera are 
very much difeafed, while the brain is tolerably found : 
but much variety exifts as to the organs affefted. 
We pafs over numerous hiftories of the forms of yel¬ 
low fever. We have dated what appear to us the princi¬ 
pal divifions. To attempt to detail the perpetually- 
changing varieties in febrile difeafe is equally beyond our 
limits or our power; fora hiftory, fo far complete, that 
it embraces all the forms of yellow fever that have hi¬ 
therto appeared, we again refer our readers to the work 
of Dr. J. Johnlon, before quoted, and to which we have 
been much indebted in our compilation of the hiftory of 
this difeafe. 
The courfe of few maladies fo ftrongly exemplifies the 
danger of following with unvarying meafures difeafes 
fimilarly named as that of the yellow fever. The treat¬ 
ment of this difeafe muft change according to the pre¬ 
valence of particular fymptoms, according to the mode 
of attack, and according to the efteifls it produces. 
It cannot uniformly be grounded on the divilion of 
ftages, fo ufeful in moll ailments ; for we have before 
feen, that it fets in in various and oppofite ways; being 
fometimes attended with coldnefs and diminution of all 
the phenomena of life ; fometimes, on the contrary, 
with raving delirium, and great exaltation of ftrength, 
heat, &c. It cannot altogether be founded on the exci¬ 
ting caufe; for the intenfer and the milder forms equally 
arife from the aftion of the fame agent, if the conftitu- 
tion be different; nor can an obfervance of the conftitu- 
tion of the patient always lead us to difcrimination, fine* 
the weakeft patients have borne depletory meafures un¬ 
der which the robuft have funk, and of courfe vice verfa. 
The firft acceflion of the fever being the period at 
which alone remedial agents can be depended on, it be¬ 
hoves us to meet it with the utmoft promptitude and de- 
cilion. If the cold ftage be firft manifelted, we (hould 
lofe no time in putting in force thofe meafures of bleed¬ 
ing/. 
