122 
swollen and ex erted, and the space between the upper and lower lids 
is narrowed, causing the patient to present a ferrety-eyed appearance. 
The headache is splitting and is usually occipital and frontal. The 
least movement increases the pain, and the patient may feel as if his 
brain was hammering through the skull-cap. The tongue is generally 
coated with a light dirty yellow fur ; the tip and sides are red and 
clean, the scarlet papillae are very distinct. On examining the gums, 
small capillary injections are noted about the teeth along the' lead 
line. The mucous membrane of the inner sides of the cheeks is 
injected, and on examining the floor of the mouth around the base 
of the tongue, very minute bright red points will be seen. These are 
especially noticeable in yellow fever, and I have rarely found them 
so marked in any other febrile disease. Even in mild cases they are 
easily observed. Always examine your cases in strong, bright 
daylight, as it is impossible to ascertain the colour by artificial light. 
1 he radiating pains in the loins (le coup de barre) and legs are 
intense. I he limbs feel leaden. No comfortable position can be 
found, and the position in bed is being constantly altered. Very 
often the patient is driven to cry out. The soles of his feet throb. 1 
have had patients insist that they felt the toe nails lifting and 
throbbing. 
Thirst is a prominent feature and practically unquenchable. Thi 
nausea has lessened and vomiting ceased, unless the case is ai 
alcoholic or one with a history of gastritis. When vomiting continue, 
it may prove to be most troublesome and dangerous. Probably thi 
patient has not slept at all, and although feeling so tired and wear] 
eep will not come. The mind is active, the patient notices every 
an . ' s xcr V sus picious of his attendants and his surrounding: 
unnn is laiely found so early'. The temperature has now risen t 
1020 or 103° F. C 3 8’9° to 39*4° C.). The pulse is no to 120, stil 
AbouTtt? h r d f ' bU ! regUl:lr ' The respirations are about >S 
I,. , Wen ■' ourt h hour the pulse may not show an increase 
though the temperature may still be rising. Faget’s sign, tin 
oftenTe observed!' 56 " ° r 6Ven risi " e tem P erature ' “ 
of lorto tfl irty sixth hour the fever has probably reached a maxi 
39 40 to Ice 3 F ' (38 ' 6 ° l ° 39 - 4 ” C.) m mild cases, .03° to to 
94 40 C ) ln severe cases, and 105° to 106° F. ( 4 o '5 
