YELLOW FEVER is a disease endemic in low districts near the sea, but under certain circumstances sporadic in other places, never appearing beyond 48° of n. lat., nor with out a temperature of at least 72° F., nor above the-elevation of 2,500 ft. above the level of the sea, depending in part on causes not yet known, but in circumstances favorable to its production, capable of being propagated by contagion. It usually commences suddenly (generally in the night or early morning) with a sense of coldness, a rigor, or actual shivering, followed by vascular reaction, as shown by the heat and dryness of the skin, headache, especially over the eyes, and pain of the eyeballs, which are suffused, and have a strange drunk-like aspect. The limbs and loins are painful; the tongue is loaded, and its edges are red. There is a peculiar and characteristic flush or suffusion of the face, occupying a zone of about an inch above and below the eyes. Nausea, gas tric uneasiness, and a tendency to vomit soon supervene. These symptoms may gradu ally lessen, and the patient will then regain his ordinary health in 24 or 36 hours; but if the symptoms persist, they soon become more aggravated, and the stomach ejects at first a clear fluid, which soon becomes of a dirty-brown tint, and is finally succeeded by the true black vomit. A yellow tint on the conjunctiva is observed, which extends to the skin of the face; and as the disease advances, the whole body becomes of a yellow color, varying in intensity from a pale lemon to a deep orange tint. The anxious coun tenance indicates the distress of the patient, who appears to be agitated by fearful apprehensions or incipient delirium. The skin feels constricted, and is of a pungent heat. The bowels are constipated, and the red, clean, and tremulous state of the tongue indicates the presence of intestinal irritation, and consequently the increase of danger. The urine and other excretions are more or less suppressed. Eructations, hiccoughing. and vomiting increase the distress and weakness. The disease in fatal cases usually terminates on the second or third day. The above train of symptoms is by no means constant. Sometimes, when everything seems favorable, black vomit suddenly appears, and the patient immediately succumbs. In other cases, patients experience uo symp
toms except severe pains in the legs and suppression of urine, and die without taking to their beds. In all cases terminating fatally, albumen appears in the urine on the second or third day. In females, the catamenial discharge is sure to appear, whether due or not. The discharges from the bowels, toward the close of the disease, may be black or dark green, and these dark evacuations are succeeded by what is termed the "caddy-stool,' resembling dark sandy mud. As yellow fever is not a disease of this country, we shall not enter more fully into its symptoms. According to Dr. Jackson, who has written an excellent treatise on this disease, the usual course, of yellow fever in its most concentrated form consists of 12 hours of forming period, 36 or 38 of formed or proper fever, and 24 or 36 of declining or concluding period. When the symptoms are less intense, the patient may survive to the 14th day. In the milder modifications of this disease, the morbid symptoms are prolonged to a considerable extent. Death may occur at any period of the disease, and the mode in which it occurs is by syncope (fainting), uraemia (or poisoning of the blood by the accumulation of urea), apoplexy, or asphyxia or suffocation. When the black vomit is plentiful, and the urine free, the intelligence remains unaffected, but the skin becomes cold and damp, the pulse small, and finally imperceptible at the wrist, and death ensues from gradual exhaustion and syncope. When the black vomit is scanty, and the urine suppressed, the poisoned blood acts upon the brain, and the patient exhibits wild delirium, followed by coma, convulsions, and death. The ratio of deaths to cases in the disease is always very high. From Tulloch's statistical reports on the diseases of soldiers, it appears that in the wind ward and leeward command, the ratio was 1 to 24- (or 3 in every 7 eases died), in the Jamaica command it was 1 to 11 (or 3 in every 4 cases died), while in Gibraltar it was 1 to 1l (or 3 in every 5 cases died).