YELLOW FEVER.
Symptoms. — The symptomatology as here given was studied by Dr. Murray, of the Marine-Hospital Service.
The patient may complain of having sickened in the night or early morning, and of headache and malaise, with some gastric distress. A chill sufficiently se vere to be spoken of is rare, but chilli ness is usually complained of. Distress in the early morning is a rule. Failure to eat a good breakfast is a bad omen, but it suggests a mild case. Fever of 101° to 103°, with pulse of 110 to 120; cutting pain through the forehead, with aching eyes; fullness of eyes with some pain and suffusion, generally with injec tion, are probable signs. The back and thighs are painful in a severe case; there is some soreness in the mildest cases. Severer cases will have pain in back of neck and in calves.
By pressing firmly and deeply over the region of the gall-bladder, one will generally elicit a noise resembling a squeak. The face is full and less mobile than in health, with a fullness of the upper lip.
[Passed Assistant Surgeon White re ports that he made two diagnoses with the swollen upper lip as the first notice able symptom.] The cheeks arc more or less dusky, the hue depending also on the patient's color; they are sometimes faintly pur plish. Sweating diminishes these facial signs in a few hours. There is conges tion of the sclerotics, which increases, until after thirty-six hours, when they tend to become yellowish: in children, the eyes remain pearly. Frequently pressure on the eyeballs will cause pain, especially in had cases. Primary com plete constipation 01 scmiconstipa Lion is always present.
The superficial circulation is abnor mal and sluggish; the skin may be streaked by passing the finger over it or paled for a quarter of a minute by pinch ing; this is a good sign, especially after the disease has progressed thirty-six hours. The skin is moist, as a rule, and stays so to the end, whether drugs are given or not. Yellowness of the skin is not to be looked for early. Unless there is nausea or headache, the patient lies quietly.
There is less rapidity of pulse than the febrile condition present warrants, judging from lung disorders and enteric fever. An inveterate smoker's pulse may become reduced when the amount of tobacco used is also reduced. After or 3 days the pulse falls below 70 and later on lower yet; fright and irri tation cause the slowness to pass unob served. The pulse should be counted without the patient's knowledge.
The above signs are sufficient to war rant isolation, even if there is no known case of the fever within a thousand miles.
After sixty hours there should be some albumin in the urine, but it may be absent. Anuria may exist, but in women is not reliable, while in children it is sometimes difficult to obtain. Al bumin should not be confounded with mucin. Other symptoms should not be treated lightly because no albumin is found in the urine.
At this stage some brown mucus; or black discharges, or "bismuth" stools may be looked for: early in mild cases— late sometimes in severe ones. This is only confirmatory evidence, however. Mild cases suffer from distaste for usual food only, and, of course, there is ano rexia from the beginning. The vomit ing of the last food taken is usual, and bile is voided early if the early nausea is not checked, but no bile will be vomited during the thirty-six hours following proper bowel movements.
After vomiting the last food taken and a little bile, the vomit usually be comes white, and remains so until blood oozes into the duodenum or stomach: the source of the black vomiting. Hic cough and retching appear, and the black fluid may be heard regurgitating through the pylorus into the stomach.
[The gravest two symptoms that can arise during the course of a case of ye] low fever arc undoubtedly black vomit and suppression of urine. Black vomit is caused by rupture of walls of capillaries or venous and arterial radicles, and the discharge of blood into the cavity of the stomach, where, coming into contact with hyperacid gastric juice, it becomes altered into small masses of brownish black color. Somewhat cof fee-grounds in gross appearance. Its ad vent may also indicate a general Mentor rhagic diathesis, which may be mani fested by hemorrhages from the nose, gams, fauces, rectum, or by extravasa tions into the connective tissue of the scrotum. The abrupt appearance of black vomit in large quantities without warning is unusual. Careful search will often show minute brown or black par ticles floating in clear fluid, and pre senting the appearance described some authors as "bee's or butterfly wings." it is not uncommon, however, that patients just before death should vomit a large quantity of black vomit, and that after death the stomach should be found to contain several quarts of the fluid. It would seem probable that in these cases the which produces it was more of an active hem orrhage than a capillary oozing, and that death comes quickly as the result of shock. IL GEDDINGs, T. S. M. II. S.]