The blood had no inflammatory crust; in warm weather it was florid like arterial blood, and continued in one soft homogeneous like mass, without any separation of the serum after it was cold. When there was any separation, the crassamentum was of too loose a texture.
This disease was not attended with any remarkable thirst; but, on the third day, as the fever began to lessen, or rather, says the Doctor, as the fulness of the pulse, heat and disposition to sweat, began to abate, a nausea, vomiting, or frequent reachings to vomit, came on especially after the exhibition of either medicines or food. A very few had a vomiting, either bilious or phlegmatic, on the first day. The whole febrile state was attended with an obstinate costiveness.
These were the principal symptoms with which the febrile state was attended, and which generally went off on the third day, or in seventy-two hours from the first attack, without any salutary crisis, and was soon succeeded by the second stadium, as our author calls it; a state, though without a fever, much more terrible than the former. The symptoms now were,
1. The pulse, though hard and small, became less frequent; very little more so than in health. Soon after it became much slower, and very soft; this softness remaining while any pulse could be felt. In many it gradually subsided, till it became scarce perceptible; neither could it be supported by any of the ordinary means used for that purpose. After this the yellow suffusion, the vomiting, delirium, restlessness, &c. increased to a great degree. Sometimes the pulse would recover its strength, but only for a short time.
2. The heat did not exceed the natural, and was still farther diminished as the pulse sunk; the skin became cold, and the face, breast and extremities acquired something of a livid colour. There was no great thirst, though the sick had a great inclination for strong liquors.
3. The vomiting or reaching to vomit increased, and in some were so constant, that neither medicines nor aliment of any kind could be retained. Some vomited blood, others only what was last exhibited, mixed with phlegm, while others had what is called the black vomit. But this, though its general appearance is black, appears not to be entirely so, but owes its colour to a great number of black flakey substances. These are by our author supposed to be the bile mixed with the mucus of the stomach, or adhering to it. He founds his opinion upon observations from dissection, where the mucus of the stomach was always found abraded, and the bile in its cystis black, and sometimes very viscid. This change in the state of the bile he has always observed in such as died of this disease, and likewise that the blood was very fluid, and the vessels of the viscera much distended. In one case he found the bile of the consistence of turpentine, and carbuncles or gangrenous specks on the stomach.
The reaching to vomit continued a longer or shorter time, according to the state of the pulse; an increase of fulness of the pulse being attended with an abatement of the reaching, and the contrary.
In this state the patients were extremely unquiet, even their sleep being frequently attended with dejection of spirits and debility. This last symptom was so excessive that if the patient was only raised up in bed, or sometimes if the head was only raised from the pillow, while a little drink was given, the pulse sunk immediately, and became sometimes so small, that it could scarce be felt: they became cold, the skin became clammy, the delirium increased, their lips and skin, especially about the neck, face and extremities, as well as the nails, acquired a livid colour. The restlessness and tossing were so great, that it was sometimes scarce possible to keep the sick in bed, though, even in this state, they made no particular complaint, and if asked how they did, the reply was, Very well.
A yellowness in the eyes became now very observable, and this was soon diffused all over the body; but in some, this colour did not appear until a little before death, when it spread surprisingly quick, especially about the breast and neck. Along with this were a number of small spots of a scarlet, purple or livid colour. These appeared principally about the neck and breast.
Some were obstinately costive, others the contrary, with large, liquid and black stools, but others were relieved by moderate stools, even though black. In some they resembled tar, in smoothness, tenacity, colour and consistence.