In this disease there was such a putrid dissolution of the blood that hæmorrhages took place from almost all parts of the body. In women the menstrua flowed, sometimes in great quantity, even at irregular periods. Blood flowed also from the eyes, nose, mouth and ears, and from those parts where blisters had been laid on. “Nay, (says our author) in the year 1739 or 1745, there were one or two instances of an hæmorrhage from the skin, without any apparent puncture, or any loss of the scarf-skin.” The urine was pale while the patient was not yellow, but a deep saffron colour when the yellowness had come on. Sometimes it was turbid, at others bloody, and the quantity of blood was always in proportion to the state of the pulse; diminishing as the pulse became more full, and increasing as it became weaker.
In the third stage, which always terminated in death, the pulse was exceedingly small and unequal, though soft; the extremities were cold, clammy and livid; the face and lips in some flushed, in others they were of a livid colour; the livid specks increased so fast, that in some the whole breast and neck appeared livid; the heart palpitated strongly; the heat about the præcordia was greatly increased, respiration became difficult, with frequent sighing; the patient became anxious and extremely restless, the sweat flowed from the face, neck and breast, blood from the mouth or nose or ears, and in some from all together; the deglutition became difficult, hiccup and subsultus tendinum came on, the patient picked the bed-clothes, was comatous or constantly delirious. In this terrible state some continued eight, ten or twelve hours before they died, even after they had been so long speechless, and without any perceptible pulsation of the arteries and wrists; whereas in all other acute diseases, death follows immediately after the pulse in the wrists ceases. When the disease was very acute, violent convulsions seized the unhappy patient, and quickly brought this stadium to its fatal end. After death the livid blotches increased fast, especially about the face, neck and breast, and the putrefaction began very early, or rather increased very quickly. In hot weather, and when the symptoms at first were very violent, there was little difference to be observed between the stadia, the whole tragedy being completed in less than forty-eight hours.
On this disease in general Dr. Lining remarks, that the infection was increased by warm, and lessened by cold, weather. In hot days the violence of the symptoms were augmented to such a degree as sometimes to become fatal to those who, in moderate weather, seemed to be in no danger; while, on the other hand, in cold days, some who had been in great danger were apparently saved from the jaws of death. The disease was also more fatal to those who lay in small chambers without a proper ventilation, to such as were of an athletic and full habit, to strangers, natives of a cold climate, and to such as were most afraid of it, as well as to those who had previously overheated themselves by exercise in the sun, or by excessive drinking of strong liquors. It proved also most certainly fatal to valetudinarians, or to such as had been previously weakened by any disease.
Dr. Lind observes that “a yellow colour of the skin is observed not only in common agues, but likewise in other fevers; sometimes denoting, as in contagious fevers, their malignant nature, at other times, as in some West Indian fevers, an universal dissolution of the blood and humours; and frequently this symptom accompanies gentle discharges of the bile, and a diseased liver.” In speaking of the disease in the West Indies, he mentions some fevers, which he derives from stagnated air, “of such a malignant nature, that the people after being there a few days are suddenly seized with violent vomitings, head-achs, deliriums, &c. and in two or three days more the whole body putrefies, and the dissolved mass of blood issues from every pore. . . . On considering the yellow fever particularly he is of opinion that the remarkable dissolution of the blood, together with the tendency to putrefaction in the whole body, the black vomit, and other characteristic symptoms, are often accidental though fatal appearances in fevers of the West Indies. They proceed, according to him, in such as are newly arrived, sometimes from a gross habit of body, excessive drinking of spiritous liquors, and from being afterwards overheated in the sun; but the intense heat and unhealthfulness of the air does much more frequently produce all those symptoms. This fever was once supposed to have been first carried into the West Indies by a ship from Siam: an opinion truly chimerical; as similar diseases have made their appearance, not only in the East Indies, but in some of the southern parts of Europe, during a season when the air was intensely hot and unwholesome. This happened in the months of September and October 1764, when excessive heat and want of rain for some months gave rise to violent epidemic bilious diseases, resembling those of the West Indies, in the city of Cadiz in Spain, of which an hundred persons often died in a day. At this time the winds blew mostly from the south, and after sunset there fell an unusual and very heavy dew. The disease began with alternate heats and chills, nausea, pains of the head, back, and loins, and at the pit of the stomach, These symptoms were often followed, in less than 24 hours, with violent reachings, and a vomiting of green and yellow bile, the smell of which was very offensive. Some threw up an humour as black as ink, and died soon after, in violent convulsions and in a cold sweat. The pulse was sometimes sunk, sometimes quick, but often varying. After the first day, the surface of the body was generally either cold, or dry and parched. The head-ach and stupor often ended in a furious delirium, which quickly proved fatal. The dead bodies having been examined by order of the court of Madrid, the stomach, mesentery and intestines were found covered with gangrenous spots. The orifice of the stomach appeared to have been greatly affected, the spots upon it being ulcerated. The liver and lungs were both of a putrid colour and texture.
“The stomach contained a quantity of an atrabilious liquor, which, when poured on the ground, produced a sensible effervescence; but, when mixed with spirit of vitriol, a violent ebullition ensued. The dead bodies turned so quickly putrid, that at the end of six hours their stench was intolerable, and in some of them worms were already found lodged in the stomach. His Majesty’s ship the Tweed being at that time in Cadiz bay, several of her men were taken ill when on shore, but, by being carried on board, all of them recovered. Neither did the black vomit or any other deadly symptom of that fever make its appearance in any of the ships. The dread of this distemper forced many people of fashion to retire into the country, where they remained in perfect safety.”
Dr. Lind further remarks, that in the yellow fever it is a bad sign if the skin is very dry and rough; “and the longer it continues in this state, the greater is the danger, as such patients seldom recover, though the pulse may give hopes, and the other symptoms also be fluttering; for many have a good pulse in this fever a little before death.” He also quotes Dr. Bruce, an eminent physician of Barbadoes, whose account of the disease is to the same purpose. He says it may come on at any season of the year, but that the symptoms are most severe when there is great heat joined with moisture. The blood, even in the beginning of the disease, is of a florid red colour, and as it were rarefied; the crassamentum scarcely cohering; the serum of a clay-coloured yellow. It sometimes finishes its course in 24 hours.
The account given by Dr. Hillary corresponds also very much with that already given. The subjects of the disease are the same with those already mentioned. He has seen it at all seasons of the year, but it is worst in a hot season, especially if it was preceded by moist and warm weather. “Blood, taken even at the beginning of the disease, is often of an exceeding florid red colour, much rarefied and thin, and without the least appearance of fiziness; and the crassamentum, when it has stood till it is cold, will scarce cohere, but fluctuates; the serum is very yellow. . . . On the second or third day the blood is much more dissolved, the serum more yellow, and the crassamentum loose, scarcely cohering, but undulates like sizy water when shaken, and sometimes has dark, blackish spots on its surface, showing a strong gangrenescent diathesis. . . . In the latter stage of this fever the blood is so attenuated and dissolved, that we frequently see it flowing not only out of the nose and mouth, but from the eyes, and even through the very pores of the skin; also great quantities of black, half-baked, half-mortified blood is frequently voided, both by vomiting and stool, with great quantities of yellow and blackish putrid bile, by the same ways; and the urine, which was before of a high icteritious colour, is now almost black, and is frequently mixed with a quantity of half-dissolved blood. . . . Soon after death the body appears much fuller of livid, large, blackish, mortified spots, particularly about the præcordia and hypocondres, especially the right; which parts seem to be, even from the first seizure, the principal seat of this terrible disease. And upon opening the bodies of those who die of it, we generally find the gall-bladder and biliary ducts filled with a putrid blackish bile, and the liver and stomach, and adjoining parts, full of blackish and mortified spots, and sometimes gangrenes, in those, as also in several other parts of the body. And the whole corpse soon putrefies after death, and can be kept but a few hours above ground.”
Dr. Jackson, in describing the yellow fever of Jamaica, acknowledges the difficulty of characterising the disease, even though he is of opinion that it “possesses some characteristics of its own, different from those of any other.” In a note at the end of his work, he observes the impropriety of calling it the yellow fever; because that yellowness sometimes does not appear at all; and in no one case does it ordinarily show itself till the latter stages. “I know also (says he) that most of the practitioners of Jamaica consider it only as an aggravated species of the remittent, the common endemic of hot climates. It appeared to me, I must confess, in a different light. . . . It may not, however, be improper here to take notice of the opinion of Dr. Moseley, who has endeavoured to persuade us that it is no other than the kausos, or ardent fever, of the ancients. But the yellow fever of the West Indies is, by Dr. Moseley’s own confession, in some measure peculiar to strangers newly arrived in tropical climates. The kausos, we are informed, made its appearance in the islands of the Archipelago, and on the coasts of the contiguous continents, indiscriminately among men and women, natives and foreigners: in fact it has not, as far as I can perceive, any claim to be considered as a distinct disease. If I rightly understand Hippocrates, or the description of the still more accurate Aretæus, kausos in reality is only an accidental condition of the common endemic of the country, where the force of the fever is chiefly exerted upon the stomach and alimentary canal. In this manner it appears frequently in Jamaica, and in the southern provinces of America. In the hot months of summer, it appears occasionally in every climate; and is not necessarily accompanied with, nor does it depend upon, a general inflammatory diathesis of the system for its existence.”
The Doctor divides this disease into three species: 1. Where “signs of putrefaction are evident at a very early stage, which is generally rapid in its course, and which casually terminates in black vomiting. Yellowness seldom or never fails to make its appearance in the present instance; and perhaps it is the only one which, strictly speaking, can be called the yellow fever. 2. A form of fever which has either no remissions, or remissions which are scarcely perceptible; in which signs of nervous affection are more obvious than symptoms of putrescency; and in which yellowness and black vomiting are rare occurrences. 3. Another form, in which regular paroxysms and remissions cannot be traced, but in which there are marks of violent irritation, and appearances of inflammatory diathesis in the earlier stage, which give way, after a short continuance, to signs of debility and putrescency, to which yellowness frequently succeeds, or even sometimes the so much dreaded vomiting of matter of a dark colour. The disease in these three forms appears to be in reality one and the same. The difference of the symptoms probably arises from very trivial or very accidental causes. It is in some measure peculiar to strangers from colder regions soon after their arrival in the West Indies, and may generally be distinguished from the common endemic of the country, not only by a total want of paroxysms and remissions, but likewise by a certain expression of the eye and countenance, with something unusually disagreeable in the feelings, of which words convey only an imperfect idea.”
The symptoms enumerated by Dr. Jackson are in general the same with those already taken notice of. He mentions likewise a degree of confusion frequently joined with grimness, difficult to be described in words, but which a person acquainted with the appearances of the disease immediately recognises as one of its distinguishing marks. In the second stage he says, that no sweat or moisture was now observable on any part of the body: the state of the skin impressed the idea as if it were not pervious to any degree of perspiration, and heat gradually forsook the surface and extremities: the tongue became moist, and at the same time frequently clean about the edges: the gums became redder, more spongy, and showed a greater disposition to bleed: vomiting was troublesome: the matter thrown up was ropy, in large quantity, and abounding with villous or mucous flakes of a darker colour. The circulation in the extreme vessels became gradually more languid; the natural heat retired from the surface of the body, which was now dry and impervious; the pulse returned nearly to its ordinary state, or became slow, full and regular; the yellowness increased fast, so that the whole body was frequently yellow as an orange, or of as deep a colour as the skin of an American savage: anxiety was inexpressible; vomiting was irrestrainable, and the vomiting of a matter like the grounds of coffee at last made its appearance. This matter was often as black as soot, where the progress of the disease had been rapid; while it was not only less intensely black, but often tinged with green, where the disease had been more slow and gradual. The number of villous or mucous flakes, in the matter discharged by vomit, increased as the disease advanced, and with them were joined streaks of blood, which seemed principally to come from the throat and gums. As the disease advanced, the vomiting became more frequent, but was seldom accompanied with any violent retching. Quantities of liquor were discharged, so enormous that it was often difficult to imagine whence they came; after which the patient enjoyed some respite, till a similar collection was made. As soon as the matter discharged by vomit acquired this dark and sooty colour, the belly generally became loose, the stools being black, smooth, and not unlike tar or molasses; the tongue became clean, the gums putrid; hæmorrhages, or rather oozings of blood, were sometimes observed in different parts of the body, while livid blotches made their appearance on the belly and insides of the thighs. The pulse, which during the latter stages of the distemper could scarcely be distinguished from that of a person in health, became at last irregular, quick, or intermitting; soon after which coma or convulsions closed the scene. Sometimes the yellowness succeeded the black vomiting. In these the vomiting began unexpectedly, or without much previous affection of the stomach: the colour was commonly intensely black; the patient turned yellow almost in an instant, and died in a very short time. When any one recovered from this deplorable situation, of which there were some few instances, the termination was not by any regular crisis. The black vomiting ceased, sometimes apparently in consequence of treatment, sometimes evidently of its own accord: but a vomiting of a ropy, glutinous matter continued for a great length of time, together with an extreme irritability of the stomach, and a very peculiar state of the skin; which sometimes did not recover its natural smoothness and unctuosity for several weeks.