6 E. malig Yellow thermometer should be above 80° of Fahrenheit: since, GEN. HI. like the plague, it demands for the activity of its mias-SPEC. II. mic corpuscles a certain range of temperature, below nus flavus. which it ceases to operate, and its specific particles fever. perhaps gradually become decomposed. It has never been known in North America nor in the South of Europe but at the season of the year in which tropical heats, that is those of 80° or upwards, prevail; and it has never failed to disappear in winter, even in the mild winter of Spain; though typhus may at the same time hold its full career of malignity*. fever, from ferent synochous. From the different impressions produced on febrile Remittent miasm under these diversities of origin and adjuncts, incidents we find, independently of other discrepancies, that the evinces diffever it excites sometimes assumes a caumatic or in- forms. flammatory cast, sometimes a typhous, and sometimes a Yellow synochous, or, in other words, begins with the first fever gene. rally the and runs rapidly into the second or third. And it is in effect into these three subsections, that the Andalusian yellow fever has been lately restored by Dr. Jackson in his excellent work on the subject. Generally speaking, the variety before us evinces the last of these characters, as does also the variety we have just treated of: the two varieties that yet remain will afford examples of a typhous and inflammatory bearing. progress. Its ordinary progress amongst those who are fresh to Ordinary the tainted atmosphere is thus accurately described by Dr. Mosely, who, from its resemblance to the causus of Hippocrates, denominates it endemial causus: a term which has since been adopted by Dr. M'Arthur †, and several others. "When a new-comer is seized with a sudden loss of strength, and a desire of changing, for rest, into every position without finding it in any, those symptoms which constitute the endemial causus may be expected. The following day, but sometimes within twelve hours from the first indisposition, the violence of the disease will commence thus: There will be a faint * Blane, Select Dissertations, &c. P. 314. † Account of the Causus or Yellow Fever of the West Indies, &c. GEN. III. nus flavus. Yellow fever, ness and generally a giddiness of the head, with a small 6 E. malig degree of chilliness and horror, but never a rigor. Then immediately will succeed a high degree of fever with great heat, and strong beating in all the arteries of First stage. the body, particularly observable in the carotid and temporal arteries; flushings in the face; gaspings for cool air, white tongue, but tinged with yellow, after the retchings have commenced; excessive thirst, redness, heaviness, and burning in the eyes; heaviness and darting pains in the head, and small of the back, and often down the thighs; pulse quick, generally full and strong, in some cases quick, low, and vacillating; skin hot and dry; sometimes with a partial and momentary moisture; sickness of the stomach from the first, which increases with the disease; and, immediately after any thing is taken to quench the thirst, retchings succeed in which bilious matter is brought up; anxiety with stricture, soreness, and intense heat about the præcordia; great restlessness; heavy respiration, sighing; urine deep-coloured, and but little in quantity. This is the first stage of the fever; and may continue twenty-four, thirty-six, forty-eight, or sixty hours, and this constitutes its inflammatory period. Second stage. "The second stage begins with an abatement of many of the preceding symptoms, and the rise of others: sometimes with a deceiving tranquillity, but with perturbation if the patient should fall into a sleep: then a yellow tinge is observed in the eyes, neck, and breast; the heat subsides, and sometimes with a chilliness; but not with that: sort of strong rigor which, when it happens, terminates the disease by sweat, or by copious bilious evacuations upwards or downwards. The retchings are violent and turn porraceous; the pulse flags, but is sometimes high and sometimes soft; the skin soft and clammy; the urine in small quantity, and of a dark croceous colour; the tongue in some cases is dry, harsh, and discoloured; in others furred and moist; there is confusion in the head, and sometimes delirium; with the eyes glassy. This stage of the disease sometimes continues only for a few hours, sometimes for twelve, twenty-four, thirty-six, or forty-eight hours, but never longer. GEN. III. SPEC, II, B E. malignus flavus. Yellow fever. In the third and last stage of the fever, the pulse sinks and becomes unequal and intermittent, sometimes very quick; frequent vomiting with great straining and Third stage. noise in vomiting, and what is brought up now is more in quantity, and has the appearance of the grounds of coffee, or is of a slate colour. Nothing can be retained in the stomach; difficult breathing; tongue black; cold clammy sweats; eyes hollow and sunk; yellowness round the mouth and temples, and soon after over the whole body." scene. In the earlier remissions, the pulse often sinks from Closing a hundred and thirty to ninety, and the general improvement is so considerable as to impress the young practitioner with the belief of a salutary crisis. He is soon, however, aroused from his deception, for the exacerbation soon returns with renewed violence; and as the symptoms grow more aggravated they are in the end accompanied with subsultus tendinum, black urine, deadly coldness of the limbs; delirium, faltering speech; hemorrhage, or oozing of blood from the mouth and nostrils, corners of the eyes and ears; black bloody vomiting and stools; vibices, hiccough, muttering, coma, death. After the first prostration of strength, produced by General the symptoms of invasion or accession, the prodromes of remarks. M. Deveze, the disease runs on violently through its stage of excitement till the sensorial power is exhausted. Through its entire course, till the patient is sinking, the intellect is not particularly disturbed, and the organs chiefly affected are the abdominal; those which, for reasons already assigned*, principally suffer in the malignant autumnal remittent of our own country; more especially the stomach and the liver. Hence the intense heat and anxiety about the præcordia, the saffron dye of the urine, the yellow tint of the skin, and the vomitings first of a bilious and afterwards of a chocolate or sangui Epanetus malignus, ut suprà, p. 152. GEN. III. 6 E. malig nus flavus. Yellow fever. to the se cond and third stages in some cases. neous colluvies. In the Andalusian variety, however, according to Dr. Jackson, the brain is sometimes the first organ affected, and the abdominal organs consecutively *. In some cases the disease opens with great vehemence, Rapid rush and rushes forward at once to its acme, constituting the second stage of Dr. Mosely. The patient is sometimes cut off in four-and-twenty hours: and from the violence so suddenly committed on the liver, its proper function is instantaneously suspended, and, instead of an excessive emulgence of high-tinted bile, a chlorotic secretion takes place, which, forced into the sanguineous system, gives a ghastly lividity to the entire surface. Shortly after which, if the patient live long enough, the gorged bloodvessels of the inflamed and gangrenous liver itself, and sometimes also of the spleen or stomacht, give way, and repeated tides of dark granulated grume, like the grounds of chocolate, are ejected by the mouth. Black vomit. Description of the disease in its fever. Dr. Pym has very forcibly described this overwhelming onset of the disease in the following terms: "There rapid march; is at the first attack a peculiar shining or drunken apby Pym, called Bulam pearance in the eyes; the head-ache is excruciating and confined to the orbits and the forehead; has no remissions; when it terminates favourably, is rarely attended with yellowness of the skin, which, if it do take place, is of a very pale lemon colour. It runs its course from one to five days, is attended with a peculiar inflammation of the stomach, which, in most cases that prove fatal, terminates in gangrene, or in a diseased state of the internal or villous coat of that organ, accompanied with a vomiting of matter resembling coffee-grounds, and a livid or putrid appearance of the countenance which it is impossible to describe; but those wishing to form an idea of it may see its fac-simile in the countenance of any person with a florid complexion, during the burning of Remarks on the Epidemic Yellow Fever, &c., on the South coast of Spain, 8vo. Lond. 1821. † Chisholm, Manual of the Climate and Diseases of Tropical Countries, &c. p. 36. spirit of wine and salt in a dark room, as is practised GEN. III. in the game of snap-dragon during the Christmas gambols." SPEC. II. 6 E. malignus flavus. Yellow fever. and hence supposed to be distinct from yellow fever. In this state the disease is unquestionably for the most part, though not always, contagious: and as Dr. In this Cullen has laid down contagion as a distinctive character state, unof fevers originating from human effluvium, in contrast contagious, questionably with those originating from the effluvium of marshes, Dr. Pym has endeavoured to draw a line of distinction between yellow fever in this state of intensity and in its ordinary career; contending that the former (to which he limits the name of Bulam fever) is in every instance derived from human effluvium, and consequently that the two must of necessity be distinct diseases. And to make the distinction still clearer, he has ventured to assert that the symptom of a more pallid or bloated countenance, together with that of black vomit, or the discharge of coffee-like grounds from the stomach, is peculiar to the contagious fever, and is rarely if ever an attendant on that produced by marsh miasm even in its most impetuous and fatal course. at variance with the disease, as it has appeared in different places. This distinction, however, is in both instances at va- But this riance with the history of the disease as it has occurred supposition in most other parts of the world, and more especially with respect to the symptom of black vomit; which, in its last stage or severer incursions, is common to it from whatever source derived. Nothing is more frequent in the Andalusian or Spanish variety, where the discharge is sometimes inky-black, like the fluid disgorged by the cuttle-fish; and it is thrown forth from the anus as well as the stomach +. Black vomit occurred more especially in the fatal epidemic of Antigua in 1816, which was decidedly an offspring of marsh-effluvium. "The island had for some years", observes Dr. Musgravet, at whose description we have already glanced slightly, "been pecu * Observations upon the Bulam fever, &c. 8vo. 1815. &c. By R. Jackson, M.D. Lond. 8vo. 1821. Medico-Chirurg. Trans. Vol. ix. p. 92. Yellow fever at Antigua, as described by Musgrave. |