orehead and
eyes, in the back and thighs, and often in the calves. The face is
flushed and slightly swollen--particularly the upper lip--and the eyes
are bloodshot, and gradually, in the course of thirty-six hours, the
whites become yellowish. This is one of the most distinguishing
features of the fever, but is often absent in children. The tongue is
coated, there are loss of appetite, lassitude, sore throat, and
constipation. In the beginning the temperature ranges from 101 deg. to
103 deg. F., or in severe cases as high as 105 deg. or 106 deg. F., and the pulse
from 110 to 120 beats a minute. The fever continues for several
days--except in mild cases--but the pulse usually falls before the
temperature does. For example, the temperature may rise a degree
during the third day to 103 deg. F., while the pulse falls ten or more
beats at the same time and may not be over 70 or 80, while the
temperature is still elevated. This is another peculiar feature of the
disease. Vomiting often increases on the second or third day, and the
dreaded "black vomit" may then occur. This presents the appearance of
coffee grounds or tarry matter and, while a dangerous symptom, does
not by any means presage a fatal ending. The black color is due to
altered blood from the stomach, and bleeding sometimes takes place
from the nose, throat, gums, and bowels, with black discharges from
the latter. The action of the kidneys is usually interfered with,
causing diminution in the amount of urine. It is extremely important
to pay regard to this feature, because failure of the patient to pass
a proper amount of urine calls for prompt action to avert fatal
poisoning from retained waste matters in the blood. The normal amount
of urine passed in twenty-four hours in health is over three pints,
and while not more than two-thirds of this amount could be expected to
be passed by a fever patient, yet in yellow fever the passage of urine
may be almost or wholly suppressed. The course of the disease varies
greatly. In children--especially of the Creoles--it is frequently so
mild as to pass unnoticed. In adults the fever may only last a few
hours, or two or three days, with gradual recovery from the various
symptoms, and yellowness of the skin lasting for some time. This is
not seen readily during the stage of fever when the surface is
reddened, but at that time may be detected by pressure on the skin for
a minute, when the skin will present a yellow hue on removi