126 
the stools will become more and more tarry and offensive. The 
kidneys' begin to manifest signs of the strain, the albumin is increasing 
rapidly, and the amount of urine is decreasing. All the symptoms 
point to a collapse of the renal system, but even yet the case is not 
hopeless provided that the kidneys are able to perform their 
functions. Should anuria occur and continue for more than a few 
hours the prognosis is of the very gravest. All this time the 
temperature may continue elevated, but it is generally falling and 
may become normal or subnormal. The pulse is running; very often 
it is irregular. 80 to no. The mucous membranes are extremely 
pale and show the effects of the exsanguination. As the state of the 
patient progresses towards a fatal termination, the vomiting and 
movements of the bowels become intensified, or convulsions and coma 
intervene, and death occurs within a few hours, although we have 
seen the anuric state last for as long as fifty-six hours. With some 
patients the mind may be clear until the last few minutes. This is 
especially the case where collapse has occurred and the temperature 
has fallen very much below normal. 
Yellow fever is always an impressive and terrible disease. It is 
striking because it attacks those who are robust and in the prime of 
manhood. The suddenness of the onset and the rapidity with which 
death follows must necessarily impress the relatives and acquaintances 
° the v,ctim - Fortunately for the sufferer, the friends and 
ttendants, the battle is short, sharp, and decisive. Those who have 
passed through the ordeal generally come through unscathed. Very 
few permanent ill effects can be recorded. 
CKUGNOSIS 
t ie mild forms of yellow fever, recovery occurs in almost every 
? CC * t * lat ^ le patient is not already suffering from some 
U aniC isease ’ es P ecia lly of the kidneys, but even in these cases we 
have seen recovery follow. 
amnnnf^f more severe forms of the disease, where there is a certain 
____ ^astric disturbance and moderate albuminuria, with care 
\ >e , f ormed° 1, so OI th t a! 1 the end !„!!,' , adv ’ anced stapes of the disease hut little urea can 
carbonate of ammonium are retained S . of ., niet . abo,,sm . carbonate, lactate and perhaps 
J hus anuria and ammonaemia a c ! rcu, ation and act as additional poisons- 
convulsions, is due to ammonaemia and' not in^erni?™™ and coma - with or " lth ° 
