In some cases the disease was attended with buboes and glandular swellings. “I met with three cases (says our author) of swellings in the inguinal, two in the parotid, and one in the cervical glands: all these patients recovered without any suppuration of their swellings. They were extremely painful in one case, in which no redness or inflammation appeared. In the others there was considerable inflammation, and but little pain.
“Several cases of carbuncles, such as occur in the plague, came under my notice. They were large, hard swellings on the limbs, with a black apex, which, upon being opened, discharged a thin, dark-coloured, bloody matter. From one of these malignant sores an hæmorrhage took place, which precipitated the death of an amiable lady. A large and painful anthrax on the back succeeded a favourable issue of the fever in another patient. I met with a woman who showed me the marks of a number of small boils on her face and neck, which accompanied her fever. . . . Notwithstanding the disposition to cutaneous eruptions in this disorder, it was remarkable that blisters were much less disposed to mortify than in the common nervous fever. Such was the insensibility of the skin in some people, that blisters made no impression upon it. . . . In every case of this disorder which came under my notice, there were evident remissions or intermissions of the fever, or such symptoms as were substituted for fever.”
The yellow colour rarely appeared before the third day, and generally about the fifth or seventh day. The eyes were not always affected with this colour. Sometimes it appeared first on the neck and breast; and in one case it appeared behind the ears and on the crown of the head, which had been bald for some years. It varied in the deepness of the tint, and sometimes disappeared altogether; but, though some cases of great malignity and danger appeared without any yellowness, it was always a dangerous symptom when it appeared early. The cause of this yellowness is by our author supposed to be an absorption and mixture of the bile with the blood.
After death the body appeared of a deep yellow colour, sometimes a few minutes after death; sometimes it was purple or black; and in one case yellow above, and black below, the middle. In some it was pale, as in common diseases, and many died with a placid countenance as in natural sleep. In some the body grew cold soon after death, in others not till six hours afterwards, and in like manner stiffness occurred sometimes in one hour, in others not till six. Where evacuations had been procured, symptoms of putrescence were longer in making their appearance than in those who had used no medicines for that purpose. Many discharged large quantities of black matter from the bowels, others, of blood from the nose, mouth and bowels.
“The morbid appearances of the internal parts of the body (says the Doctor) as they appear by dissection after death, from the yellow fever, are different in different countries and in different years.” Dr. Mitchill, in his history of the yellow fever in Virginia, in 1737 and 1741, informs us, that, in a female slave of forty, the gall-bladder was outwardly of a deep yellow, but within, full of a black, ropy, coagulated atrabilis (black bile) obstructing the biliary ducts. It was so thick, that it retained its figure when the gall-bladder was opened. It more resembled bruised and mortified blood than bile, though it would stain a knife or probe of a yellow colour. Two thirds of the liver on its concave surface were of a deep black colour, and round the gall-bladder it seemed to be mortified and corrupted. A viscid bile, like that just described, was found in the duodenum near the gall-bladder. The villous coat being taken off, the other parts were found red and inflamed. The whole was lined with a thick fur or slime. The omentum was so much wasted, that nothing but its blood-vessels could be perceived. The stomach appeared to be distended or swelled, lined like the duodenum, containing a quantity of bile even blacker than that in the bladder. It was inflamed both on the outside and inside. The lungs were inflated and all full of black or livid spots; and on these spots were small blisters like those of an erysipelas or gangrene, containing a yellow humour. The blood-vessels in general were empty; only the vena portarum seemed full and distended as usual. On cutting the sound part of the liver, the lungs or the spleen, blood issued freely.
Dr. Mackittrick found the liver sphacelated, the gall-bladder full of black bile, and the veins tinged with a black fluid blood. In all cases the stomach, duodenum and ilium were remarkably inflamed. The pericardium contained a viscid yellow serum, and in larger quantity than usual. The urinary bladder a little inflamed; the lungs sound.
Dr. Hume, of Jamaica, found the liver enlarged and turgid with bile, and of a pale yellow colour; the stomach and duodenum sometimes inflamed; and, in one case, the former had black spots of the size of a crown-piece. He had seen some bodies in which there was no appearance of inflammation of the stomach, though the patients had been afflicted with excessive vomiting.
Dr. Lind’s account is given on p. [394].
Drs. Physic and Carthrall, of Philadelphia, found the brain in a natural state; the viscera of the thorax perfectly sound; the blood in the heart and veins fluid, similar in its consistence to the blood of persons who have been hanged, or destroyed by electricity. “The stomach and beginning of the duodenum are the parts that are most diseased. In two persons, who died of the disease on the 5th day, the villous membrane of the stomach, especially about its smaller end, was found highly inflamed; and this inflammation extended through the pylorus into the duodenum some way. The inflammation here was extremely similar to that induced in the stomach by acrid poisons, as by arsenic, which we have once had an opportunity of seeing in a person destroyed by it. The bile was of its natural colour, but very viscid.”
In others the stomach was spotted with extravasated blood; and it contained, as well as the intestines, a black liquor like that which had been vomited and purged before death. The gentlemen were of opinion that this must have been a secretion from the liver, as a fluid of the same kind was found in the gall-bladder, of such an acrid nature that it inflamed the operator’s hands, and the inflammation lasted some days. The liver was of its natural appearance, or nearly so. These dissections were made early in the season; and at that time Dr. Rush is of opinion that the disease was not attended with any congestion in the brain, though it was so afterwards; and accordingly we are informed that Dr. Annan attended a dissection at Bush-hill, in which the vessels of the brain were remarkably turgid. Dr. Rush, however, is likewise of opinion, that the morbid appearances in the brain may cease after death, as well as the suffusion of blood in the face disappears after the retreat of the blood from the extremities of the vessels in the last moments of life. “It is no new thing for morbid affections of the brain to leave either slender or no marks of disease after death. Dr. Quin has given a dissection of a child that died with all the symptoms of hydrocephalus internus, and yet nothing was distinguished in the brain but a slight turgescence of the blood-vessels. Dr. Girdlestone says, that no injury appeared in the brains of those persons who died of the symptomatic apoplexy which occurred in a spasmodic disease which he describes in the East Indies; and Mr. Clark informs us that the brain was in a natural state in every case of death from puerperal fever, notwithstanding it seemed to be affected in many cases soon after the attack of the disorder.”