Medical diagnosis : with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa.

  • Da Costa, J. M. (Jacob Mendes), 1833-1900.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis : with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    ache is relieved; the breathing is no longer oppressed. But the gastric irritability does not wholly disappear, and a deep yellow or orange hue gradually tinges the eye and the whole surface of the body. The patient is cheerful, and wishes to get out of bed. And indeed his sufferings may be over, his convalescence may have set in: after a few dark-colored, biliary stools, the yellow- ness of the skin fades, and he is well. But it is not often that the disease relaxes its hold so easily: more generally the deceptive improvement, does not last a day, and after the brief lull the struggle for life begins. The patient grows again very uncomfortable and anxious. In truth, the symptoms of the first stage reappear with increased intensity. In addition, new signs, of the gravest import, show themselves: the pulse sinks, and becomes slow and extremely irregular; the skin is cool, dry, very dark, and in some cases of a bronze hue, and spots may occasionally be seen on its surface. The stomach is as irritable as before, but the act of vomiting is easier; and, without much retching, large quantities of altered blood, or black vomit, are ejected. Blood oozes from the mouth, from the gums; sometimes from the eyes and nostrils, from the bowels, and from the vagina;* or hemorrhage takes place into internal cavities, and the blood is retained.f The phenomena of collapse become now more and more un- mistakable: the black vomit often ceases, because the contractile power of the stomach has ceased; a low, muttering delirium sets in, and the patient dies prostrated. Yet the mind may remain clear almost to the last, and the strength be but little impaired. Should reaction take place, recovery is only very gradual. But yellow fever does not at all times and in all localities pre- sent precisely the same degree of intensity or the same group of symptoms. Sometimes it exhibits frank, active febrile phenomena; at other times there is little febrile excitement, but a disjDosition to internal congestions and to early prostration. This congestive form is far more dangerous than the inflammatory; yet both are highly destructive. From 10 up to 75 per cent, are the figures * Cases in the epidemic of 1856-57 at Lisbon, reported upon by Lyons, London, 1858; also by Alvarengo, Fievrejaune a Lisbonne, Paris, 1861. f In a case at the Pennsylvania Hospital, in 1853, the pericardium was filled with blood resembling; black vomit.