livid or mahogany color, and there are frequent hæmorrhages from the mouth, nose, eyes, or even under the skin, forming livid spots and blotches. The body now exhales a cadaverous odor, the tendons of the wrist twitch convulsively, hiccough is constant, the features are pinched and ghastly, cold sweats come on, and the patient passes away in convulsions or coma, though occasionally he retains his intellectual faculties unimpaired to the last.
Patients may recover in either of the three stages above described. A favorable termination is indicated by a gradual amelioration of all the symptoms, or sometimes by profuse perspiration, sudden cessation of nausea, rapid return of the pulse to its natural fullness and strength, or other marked event, which seems to indicate a crisis in the disease.
The symptoms of yellow fever vary exceedingly at different times, in different localities, and in different persons. Sometimes a person is smitten with the disease as with apoplexy, falls into a profound collapse, and dies in a few hours. Others walk about the room, or even out in the street, and insist that they are perfectly well; or, if they acknowledge that anything is the matter with them, complain merely of weariness or debility. They often betray no symptom of the disease to the casual observer; but the physician will see an expression of dullness or listlessness in the face, and a wateriness of the eye, and will find the pulse feeble or even absent. The patient may even be talking, smoking, or reading, when black-vomit comes on, and he is speedily a corpse. To a non-professional person the exceeding variability of the symptoms cannot, perhaps, be better shown than by quoting a line or two from the work of La Loche, of 1,400 pages, on "Yellow Fever:" "The skin is hot, dry, harsh, and pungent, or it may be dry, unctuous, or perspiring, flabby, and cold. . . . The pulse becomes rapid, irregular, and depressed; or, more generally, it is natural in frequency, or even slower than in health." And this, of the post-mortem appearances, is a gem in its way: "The liver is usually of a light-yellow, nankeen, fresh-butter, straw, coffee-and-milk, gum-yellow, buff, gamboge, light-orange, or pistachio color; or it may be dark-yellow, brown, red, purple, bluish, slate, chocolate, or livid." Even the characteristic symptoms of yellow skin and black-vomit may occur in other diseases, and they may both be absent in yellow fever. These differences in the disease are largely due, in all probability, to individual idiosyncrasies, and to the simultaneous presence of other morbid processes. Thus, the present terrible epidemic at the South, from all we can learn, seems to be decidedly modified by the malarial atmosphere of that region, and presents so many of the features of the pernicious malarial fevers that some physicians (whether competent or not I do not know) decline to report their cases as yellow fever.
The disease lasts from three to nine days, and in severe cases recovery is apt to be very slow. Relapses are not common. The black-