The Van Buren press., 1878-09-03
Remarks ON the Form and Contag-
iOusness OF Yellow-Fever.
From the Louisville MedicA. News.l

There is nothing more striking in
the modern literature of yellow fever
than the little advance it displays on tho
line of investigation, and the mode of
treatment followed by the numerous
writer's who recorded their experience
and views at the BEGINNING of the CEN
tury. Now, as then, one body of medi-
cal practitioners regard yellow fever as
presenting various FORMS AZ arising from
local causes and not from contagious,
and as frequently appearing sporadcally
rs well as from time to time in the form
of severe epidemic. Another body
considers that yellow fever arises from a
poison given OFF by a person who is al
ready laboring under it, as being a con-
tinued fever, and never presenting u re-
mitting or intermitting form, and as new
er appearing sporadica,ly, or arising
without communication, directly or me-
diately. with previous case while they
rclegate the sporadic cases every West
Indian and many an American practi-
toner are familiar with, and the frequent
occurrence Of which cannot be ignored,
to what has been variously designated
"a form said to present very close re-
sembanee to true yellow fever, includ-
ing the yellowness of the surface and
black vomit, but which may be dstin
gushed from yellow fever by the non
occurrence of albumen in the urine. 1t
is worthy of observation that the great
majority Of the members of tho profes.
sion, who have resided scme years in
the tropics, and had constant experience
OF yellow fever, entertain the first opin-
ion, and it is only among those who have
met the disease occasionally, or who have
never been brought into contact with it,
that the second is generally received.
Yellow fever is a tebrile disease, usu-
ally terminating in convalesence ordcath.
from the fourth Or seventh day, but Ell
ther may occur rs early as the second
day, or not before the tenth or twelfth
or even later. There is generally yel.
lowness of the surface, commencing at
various periods in different individuals
or epidemics. Upon the evening of the
third day, or morning Of the fourth, the
urine usually contains traces Of albumen,
and on the latter considerable sediment
appears in it, almost wholly consisting
of the scaly epithelum from the blad-
der +; this is succeeded by an equally copi-
Gus oneon the morning Of the fifth day,
which consts almost exclusively of gran
ular tubecasts from the kidneys, with
scarce trace of epithclium from the
bladder. By this time the albumen has
usually become considerable, the chic
rides have been gradually reduced, and
the urine as a whole is usually scan
ty, and may even 60 on to complete sup
preston. If there be much yellowness,
the urine may contain variable quanti-
ty of the coloring matter of the bile.
The alvine discharges are devoid of the
natural feculent appearance, especially
from the third day onward till the dis
ease gives way. AS the alvine and uri-
nary sccrctions assume these peculiari-
ties, there is a great tendency to black
vomit, or discharges of similar matter
from the bowels, or the so-called hemor-
rhages from the various mucous surfaces
or even in some cases from the skin and
after death such may often be found in
the sinmarh ar irtostii,as ,,,Le.. s-sA '..--..-
ifested during life. Such are tho distinc-
tive features in a normal case of yellow
fever, but in some the occurrence of the
urinary symptoms may take place eari-
er than here mentioned, and in others
they seem to be delayed for day or
two but whenever watched from day
to day, and properly examined, it is
found that the changes in tho urine not
only embrace the presence of albumen
but indicate dcsquamation Of the blad-
der and kidneys as regular features OF
the disease. 1t is important to bear this
in mind, for in some varieties Of inter
mittent albumen has been found in the
urine but in such cases it occurred du-
ring the cold stage only, rs the fever
came on, and was not preceded or ac-
companied by the desquamation process
present in yellow fever, but which is not
met with in the pure intermittent or re.
mittent.
First-Yellow fever is not disease
always presenting continued form, but
it is met with frequently as remittent,
and even as an open intermittent.
Second-The sporadic cases present
lHG NtllpN llCSS VI lllC anu pittSh
vomit are also found to have the train
of urinary symptoms characterzing yel-
low fever, and are consequently identi-
cal with those met with during an cpl
demic.
Third-In very many instances whore
persons in the vicinity of yellow fever
cases are attacked with the dieease, the
facts do not admit of the exclusion OF
local causes, and such instances therefore
cannot enable us to decide whether these
causes or personal contagion have orig
mated the disease, but from time to time
other instances occur in which the exclu-
sion of local causes can be assured, and
in these, however extensive the expos
ure of susceptible individuals to the en-
anations from the sick may have been
the uniform result is, that no commune
cation Of the disease has taken place.
1t is no cxaggeration to say that health
| 10 n larue inura1ipnt in what the world