calm, one hundred and twenty hours; collapse, fourteen hours."" Dr. Lewis says that, in the fever of 1847, the febrile stage was considerably longer; running on generally to about three days. Dr. Dickson says this stage may pass by in four hours, or it may last for sixty or seventy; its average duration being from thirty-six to forty-eight. The three stages of yellow fever are very well described by Dr. Chisholm: "The history of the malignant pestilential fever," he says, "exhibits a very distinguishing character. We see in it a disease dispossessed of alternate paroxysms and remissions; and having in its progress three distinct periods or stages; the first characterizing an inflammatory diathesis of a peculiar nature, ushered in, generally, by a convulsive affection of the frame, or a sudden morbid excitement of the nervous system; the second, a kind of suspension of all the animal functions, accompanied with a more or less imperfect exercise of the mental faculties; and the third, a general sphacelus of the vital organs." Dr. Mosely also makes the same division, and he speaks of the "deceiving tranquillity" of the second stage. In relation to the treatment, he remarks, that "it is in the beginning of this second stage, when attempts have failed or have been neglected in the inflammatory stage, that the great struggle is to be made between life and death." Lempriere takes pains to call the disease a continued fever. Dr. Burnett says: "In many instances it proceeds through its whole course, bearing strictly the form of a continued fever; in others, there is a deceitful remission about the third day. But in by far the greater number of cases, though there are evening exacerbations, the remissions in the morning are so slight as scarcely to deserve that name. The most attentive observation, by myself, and others on whom I could rely, has failed to detect the distinct remissions ascribed to the disease by Dr. Cleghorn."" According to Bally the duration of the first stage, in cases that are prolonged to the seventh day, varies from forty-eight to seventy-two hours; in cases terminating before the fifth day, it is less; that of the second stage is about two days, a little more or a little less; and that of the third, from one to two days." SEC. III.—Duration. Yellow Fever is rapid in its IN. O. Med. and Surg. Journ., vol. i. p. 301. 2 Dickson's Essays, &c., vol. i. p. 348. 4 Mosely on Tropical Diseases, p. 436. progress and 3 Chisholm's Essay, vol. i. p. 195. 5 Burnett on Med. Fever, p. 10. • Du Typhus d'Amérique. Par Vr. Bally, p. 208, et seq. short in its duration. Perhaps there is no disease, excepting contagious puerperal fever, and Asiatic cholera, which terminates with such uniform rapidity, either in death or recovery as this. Life is sometimes destroyed in three or four days, and the average duration of fatal cases is less than a week, the largest number of deaths taking place on the seventh day, but many more cases terminating Of twenty-one fatal cases, rebefore this period than after it. ported by Dr. Barrington, death took place on the third day, in one; on the fifth day, in six; on the sixth day, in three; on the seventh day, in eight; on the eighth day, in one; on the thirteenth, in one, and on the twenty-eighth, in one.' Dr. Lewis says that during the epidemic of Mobile in 1843, it was not uncommon to hear of persons who were well in the morning and dead at night; but that these reports were always untrue, the disease never destroying life so rapidly. Dr. Barton, in his paper on the yellow fever of New Orleans, in 1833, gives the period of discharge from the hands of the physician in sixty-eight cases of recovery. This period was the second day, in four; the third, in ten; the fourth and fifth, in fourteen each; the sixth, in ten; the seventh and eighth, in four each; and after the eighth, in eight. Of forty-four cases, where the time of the returns of appetite was ascertained, this took place on the second day, in one; on the third, in seven; on the fourth and fifth, in fourteen each; on the sixth, in seven, and on the eighth, in two." The duration of the mild form of the disease is still less. SEC. IV. Convalescence. There are but few writers on yellow fever who make any special mention of the character or the duration of the convalescence from the disease. From their general silence upon this point, we might conclude that recovery is usually speedy and entire. But Louis says that, in the Gibraltar epidemic of 1828, the convalescence, both in grave and mild cases, was long in proportion to the duration of the disease; the strength of the patient, in severe cases, not being perfectly re-established sooner than from ten to twenty days after the cessation of the febrile symptoms.3 Dr. Chisholm says: "As long as the patient remained in the infected room or house, although all symptoms of the disease had disappeared, the progress of recovery was remarkably slow," but that a removal into the pure air was followed by rapid restoration Amer. Journ. Med. Sci., Aug., 1833. 3 Louis on Yellow Fever, p. 173. 2 Ibid., Nov., 1834. to health. Arejula, in his description of the Cadiz epidemic of 1800, observes, that the debility and want of appetite following the disease always remained for some time, even after the fever had subsided.2 These statements are corroborated by some tables, published by Dr. Barrington, for the purpose of showing the dif ference in the duration of the disease depending upon its treatment. Of seven patients treated on the non-mercurial plan, two were fit for duty in eleven days, and the others in from twelve to twenty. Of seven treated by mercurials, one was fit for duty in twenty days, and the rest in from twenty-two to thirty-nine. Devèze speaks of the convalescence as long and difficult, requiring all the aids of a good regimen. "Convalescence," says Bally, "is a true malady, which on account of profound lesions, and the continuance of consecutive disorders, often leaves but feeble hopes; the senses remain more or less dull; the digestive organs are feeble; and to these difficulties are frequently added, diarrhoea, cachexia, and marasmus."s M. Catel, M. Chervin, M. Mongez, and others, speak of convalescence as nearly always prompt and complete. Dr. Lewis, in speaking of the epidemic of Mobile, in 1847, remarkable for its harmless and mild character, says that, although the symptoms all subside on the fourth day, the patient is stripped of his strength, and can neither take exercise nor sit up for five or six days. Dr. Dickson says recovery is generally slow, and convalescence tedious and lingering. Convalescence is often accompanied by excessive activity of the sexual appetite. Devèze says he noticed this in both sexes at Philadelphia, and in St. Domingo. "Delicacy," says Dr. Rush, "forbids a detail of the scenes of debauchery which were practised near the hospital, in some of the tents which had been appropriated for convalescents." SEC. V.-Relapses. Relapses seem to be rare; many writers do not mention them at all. Louis speaks of them as sometimes occurring, in cases where the disease had been violent, and brought on generally by errors of regimen. According to Dr. Gillkrest, however, they would seem to be more common. He says that there were one hundred and two cases amongst the soldiers at Gi Chisholm's Essay, vol. i. p. 406. 2 Reports, etc., by Sir J. Fellowes, p. 53. 3 Amer. Journ. Med. Sci., Aug., 1833. Traité de la Fièvre Jaune. Par Jean Devèze, p. 33. Du Typhus d'Amérique. Par Vr. Bally, p. 272. 6 Dickson's Essays, &c., vol. i. p. 352. braltar, in 1828.1 Arejula says that at Cadiz, in 1800, relapses were very frequent and fatal. Dr. Burnett quotes several writers who speak of the frequent recurrence of relapses. ["Relapses," says Dr. Blair, "were frequent after the aborted attacks, but very rare after the disease had run to its second stage."] SEC. VI.-Sequelae. It does not appear that yellow fever often entails upon its subjects other and subsequent affections, either chronic or acute. A few writers, indeed, speak of chronic organic disorders, visceral obstructions, as they were formerly called, as amongst the consequences of the disease, but in such loose and general terms as to deprive their remarks of all value. Dr. Burnett says: "The foundation of phthisis pulmonalis is often laid by this. disease, and the patient, though saved from its immediate, is destroyed by its remote effect." [Bloody furuncles, and boils, are both frequently spoken of by Dr. Blair, as occurring on the subsidence of yellow fever. The former, he says, often occur in the last stages of the disease. The latter are spoken of by Dr. Schoolfield as common after the fever of 1855, at Portsmouth. Abscess of the parotid gland is also placed under this head. Jaundice, in Dr. Blair's cases, is considered one of the sequela, and was very In two of these cases, abscess of the liver followed the common. disease, and Bright's disease at least in one.] SEC. VII.-Period of Incubation. The period of time which etiological poison of yellow access of the disease, seems elapses between the reception of the fever into the system, and the formal to be generally limited to a few days. [Dr. Bayley fixed the period at five or six days.] Occasionally, however, this period is somewhat prolonged. Dr. Luzenburg, of New Orleans, states that in the month of February, 1844, there were received into the Marine Hospital two sailors with yellow fever who had arrived from the West Indies, and who did not fall sick until they touched at the Balize, thirteen days after their departure." Cyc. Prac. Med., vol. ii. p. 280. 3 Burnett on Med. Fever, p. 12. Reports, etc., by Sir J. Fellowes, p. 63. CHAPTER VII. MORTALITY AND PROGNOSIS. IT must at once be seen, from the preceding history of yellow fever, that it is not an easy matter to determine the average rate of mortality from the disease. This rate varies very widely in different seasons and localities, and with the different forms and grades. of the disease. In some instances, it is excessive-equal, perhaps, to that in the most malignant grade of puerperal fever. Dr. Gillkrest quotes Hurtado's Decadas, in which it is stated that of the first one hundred and thirty-four cases treated at Murcia, in 1804, only three or four recovered; he says, also, that in the early part of the epidemic at Gibraltar, in 1828, very few recoveries took place in the Civil Hospital; and that of the first thirty-five Jews received into the establishment, all but one were swept away. One of the deadliest epidemics on record is that of Mobile, in 1819. Dr. Lewis informs us that, out of a population not exceeding one thousand, more than one-half of whom were acclimated, there were four bundred and thirty deaths! "The mulatto, the black, the Indian, and the white, the native and the stranger-were alike its victims."2 Sir J. Fellowes estimates the population of Cadiz and its suburbs, in 1800, at fifty-seven thousand four hundred and ninety-nine. Official returns show that the number of persons attacked amounted to forty-eight thousand five hundred and twenty, of whom seven thousand three hundred and eighty-seven died. The population of Seville, at the same time, was eighty thousand five hundred and sixty-eight, out of which number seventy-six thousand four hundred and eighty-eight were attacked with the prevailing fever; the mortality amounted to fourteen thousand six hundred and eightyfive; more than one-sixth of the entire population.3 Of eight hun 1 Cyc. Prac. Med., vol. ii. p. 277. 2 N. O. Med. Journ., vol. i. p. 285. |