Page:Popular Science Monthly Volume 13.djvu/735

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YELLOW FEVER.

panied by headache, generally located immediately over the eyes, or shooting through from temple to temple, and often very severe. But the headache is frequently trivial in comparison with the frightful pains in the loins, which make the patient writhe in agony. The pulse is generally full, strong, and rapid, beating from ninety to a hundred and twenty times a minute. The skin is hot and dry, the face flushed, the eyes bloodshot, brilliant, and watery, and the tongue covered with a creamy white fur, but with red, clean tip and edges. There is usually some uneasiness of the stomach from the first, and in from twelve to twenty-four hours this develops into nausea and a persistent sensitiveness, which will not allow anything to be retained. The pit of the stomach is very tender on pressure, and vomiting is almost incessant. With all this there is intense thirst, and iced drinks are exceedingly grateful to the patient. The bowels are at first generally costive, and sometimes obstinately so, but, as the disease progresses, they become loose. The patient is usually very much debilitated, but is uneasy and tosses about in bed, and occasionally will try to rise and walk about the room. In most cases there is some confusion of intellect, not amounting to delirium, and the face expresses the greatest anxiety and distress. The fever continues for two or three days, being most severe in the evening, the temperature often reaching 104° or 105°, and, according to La Roche, in malignant cases, even 110°. Then the fever subsides, never to return, and the temperature within twelve hours may become nearly normal. The other symptoms mostly disappear, and the organs resume their natural functions. At this time, i. e., on the third or fourth day, the yellow discoloration of the skin appears upon the face and thence extends over the body. If the attack is mild, recovery is now rapid. In the vast majority of cases, however, this lull in the symptoms is deceitful, and lasts only from a few hours to a day, when the gravest stage of the disease sets in. The pulse soon becomes small and thready, beating only thirty or forty to the minute, and the heart often works vigorously after the pulse can no longer be felt at the wrist. The nausea and vomiting return and become constant, the respiration is often embarrassed, the tongue becomes dry and brown, the skin is cool and dry, there is often a distressing hiccough, and the thirst is insatiable. The mind is often clear, but singularly apathetic, or there may be delirium or stupor. The disorganization of the blood and the tissues has now gone so far that the small vessels of the mucous membranes no longer retain their contents, and blood oozes into the stomach. This produces intense nausea, and the blood is vomited up, changed in color by the acids with which it is mingled. This forms the dreadful "black-vomit," and varies in hue from brown to almost jet black, generally appearing like coffee-grounds floating in a thin, watery fluid. The urine, which becomes scanty early in the disease, may now be entirely suppressed, or, if excreted at all, is black and bloody. The discoloration of the skin increases, until the body is of a dusky brown,