CO885-(20-21) — Page 639

PUBLIC RECORD OFFICE

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Reference:

C.O.

885

21 PUBLIC RECORD OFFICE, LONDON

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2. Distinction of yellow fever cases.-In going round the wards I noticed it was unnecessary to inform the physicians which were the yellow fever patients, as they distinguished them at a glance, and I soon began to understand how it was possible to do this. Most of the patients were admitted into hospital on the third or fourth days of the disease, so that unfortunately I only saw very few in the early stage.

3. Appearances and symptoms.-The onset of the attack in most cases was sudden. The appearance of the patients was distinctive. The dull flushed condition of the face, congestion of the conjunctive, expression of anxiety, a look of alertness in the eyes with, even in some of the early cases, a suggestion of a yellow tinge, and no special restlessness, at once attracted attention, and on examination and enquiry other symptoms were elicited, viz., heat, headache, occasional vomiting, pains in the back and limbs of a muscular character, often faulty circulation observed on pressure on the skin, which at the same time showed a faint yellowish colouration which was not always otherwise observable.

The congested appearance of the conjunctive was often very marked, especially on the palpebral portion, where I always found it if it were not specially in evidence over the eyeball. Pain in and behind the eyes was more common than photophobia, which did not come much to my notice. The tongue was, in the majority of cases, red, the edges and tip especially so, and very pointed, with the papilla swollen and prominent. Later, in some cases the posterior portion became coated with a bilious fur, but the tip usually continued more or less as described. The guns were often swollen, bled easily, and oozing was sometimes observable. A red line at the edge of the gums close to the teeth was often marked, especially in the lower jaw. Tenderness was almost invariably elicited, if pain were not actually complained of, over the epigastric region or just below the edge of the ribs on the right side in the region of the gall bladder.

In uncomplicated cases the spleen was not specially noticeable.

In the later stages jaundice was unmistakeable.'

more marked and

Black vomit occurred in many cases, usually beginning as a few black specks or "fly wings" in a clear fluid, and later becoming more marked. At this stage the vomit on standing soon separated into two layers, the black specks settling to the bottom, leaving a clear fluid above. Later, the vomit became black, thick, and inseparable, or might be slatey or

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brownish black. If, as in some of the was profuse, the vomit was red and occasionally appeared to cases, the hemorrhage be pure blood. Care must always be taken to distinguish between the red blood of "black vomit," and the vomiting of red blood in the early stage which has been swallowed from the nose.

The vomiting is of a sudden gushing character in this stage. The patient, while lying quite still, and without any retching, suddenly vomits a quantity of fluid without any effort, and often before he is able to turn over, and then at once lies down again.

The bowels are usually costive, especially at first. The faces may early have a "bismuth" tarry. Severe hæmorrhages are a late manifestation, and, in appearance or become one case I saw, the patient, the bed, and the floor were covered with blood.

As I only saw a few cases in the very early stages I was unable to satisfactorily make out Faget's pulse curve in relation to the temperature, although it was distinct in one or two instances. A slow or even very alow (48 was observed) pulse was a frequent feature, following the fall of temperature after the initial rise, when there was no secondary fever. After the early stage, if the temperature continued, or if it rose again, the pulse curve followed it.

Abscesses occasionally occur, and parotitis, which may suppurate, seems to be fairly common.

Collapse, which often terminates fatally, is frequent, and requires very careful watching.

I saw no case of hyperpyrexia, death occurring in all instances from other causes.

Albuminuria was present in practically all cases, although in some it had to be most carefully and frequently sought.

Hemorrhage from the kidneys is very infrequent, and I obtained no history of hæmoglobinuria ever occurring.

Dr. Thomas informs me, in reference to albuminuria, that he almost invariably obtains a positive result at some time in the course of the first few days. The following is the method he employs, viz., a conical glass about 2 inches deep is half filled with filtered urine. Nitric acid is taken in a pipette and carefully introduced to the bottom of the glass. When sufficient acid has been put in under the urine (about -inch in the glass) the pipette is very carefully withdrawn