124 
which tends to compress the lumen of the ducts and vessels. lh 
stomach will only show congestion. 
Should the patient’s symptoms have not improved and the 
disease progress, the lesions rapidly increase. The kidneys will show 
all the characteristics of an acute parenchymatous nephritis, and small 
droplets of fat are seen. The epithelium of the convoluted tubules 
is especially degenerated ; in many places hyaline casts are filling 
the lumen of the tubules. In the liver, the changes are still more 
evident, the fatty degeneration is well advanced, the cells show large 
vacuoles, and their protoplasm is granular; the hepatic lobules are 
deformed and the contour distorted. Around the central vein the 
cells are most irregularly distributed. The infiltration of granulation 
cells about the vessels in the connective tissue of the portal spaces 
has increased, and many of the vessels and ducts are obliterated. The 
stomach shows little points of ecchymoses, especially about the 
cardiac and pyloric ends; all the vessels are engorged with blood. 
Remember these advanced conditions and that there is a general 
steatosis of all organs about the seventh day, and you will find it easy 
o understand the symptoms typical of all acute cases which so often 
in death. 1 here is a passive congestion due to the liver, 
caused by the accumulation of round cells about the vessels in the 
ective tissue of the portal spaces. These cells tend to compress 
essels, and the congestion is aided by the enlarged degenerated 
pa tic cells which compress the hepatic capillaries. Through the 
etion of the portal circulation, the blood is dammed back in the 
, ^ and intestine, especially about the pylorus and duodenum, 
. ’ aS ^ arr °h points out, the vessels the pyloric and duodenal 
fourfti ^ ° rt 3nC * ver - y ^ ew ana stomoses. By the end of the 
sip-ns f l *r 11C endodie h um the blood vessels is beginning to show 
wonder th degenerahon - Under such circumstances it is no 
black v > th rt SmaU Con S ested capillaries will rupture and cause 
a small 11 C ca P‘haries in the stomach distend and burst, and 
the stn ° 07 ^ ° T° Ci Wl11 §TaduaI1 y m ix with the acid secretions of 
vomitus. aC A hC J eSUlt 1S the . <coffee grounds’ or ‘fly-speck' 
chano-f-c f S m ° re ° t ^ ie capillaries rupture and ooze, the vomitus 
brQwn tjnt It is only when 
f"'y <9, 1902. James ' ibe tr eatmeat of Yellow Fever. Jour. Am. Med. Assoc' 
