In these simple forms the tendency to hemorrhage first manifests itself in the calm stage. The gums become red, tumid, and spongy, the tongue pointed and red at the tip. Epistaxis is liable to occur. The eyes and skin may be slightly yellow, and the urine may show traces of albumen. However mild the other symptoms may appear, the tendency to hemorrhage, to albuminous urine, and to jaundice in the calm stage bears a direct relation in frequency of occurrence and in degree to the blood-stasis, or sluggish capillary circulation, of the first stage.

The foregoing is a recital of the clinical phenomena of typical and simple forms of yellow fever. The departures from type have been divided by different writers into a variety of forms. The most important of these will be referred to in connection with suggestions as to treatment.

PROGNOSIS.—Prognosis is variable in different epidemics, this observation being understood to apply to the same localities. Some of those circumstances which affect epidemic force, so as to increase the mortality-rate, are appreciable. If an epidemic invades a population after an interval of exemption sufficiently long to allow a large number of unprotected persons to have accumulated in its midst, the crowding of the sick will increase the death-rate. We may naturally assume that this is attributable, first, to sheer multiplication of the infection; second, to lack of proper attention to the sick, and to fright, grief, exhaustion, etc.

Tabulated Abstract of Practice in Yellow-Fever Epidemic of 1878, New Orleans Charity Hospital.

AGES. July. August. September. October. Total. Per
cent.
White. No.
treated.		 No.
fatal.		 No.
treated.		 No.
fatal.		 No.
treated.		 No.
fatal.		 No.
treated.		 No.
fatal.		 No.
treated.		 No.
fatal.
Under 5 ... ... 7 3 3 1 ... ... 10 4 40.0
5 to 10 ... ... 2 1 1 1 ... ... 3 2 66.66
10 to 20 8 3 26 7 25 6 7 ... 66 16 24.2
20 to 40 18 9 246 141 175 91 61 24 500 265 53.0
40 to 60 9 6 75 45 83 45 18 10 185 106 57.3
60 to 80 2 2 7 6 5 1 1 1 15 10 66.66
Total. 37 20 363 203 292 145 87 35 779 403 51.7
Black.
10 to 20 ... ... 2 ... 5 ... 1 ... 8 ...
20 to 40 ... ... 11 3 8 1 5 1 24 5 20.8
40 to 60 ... ... 2 1 1 1 3 1 6 3 50.0
Total. ... ... 15 4 14 2 9 2 38 8 21.0
Grand total. 817 411 50.3

Prognosis is especially bad in hospital practice. The foregoing statistics of cases admitted to the Charity Hospital of New Orleans during the greater part of the epidemic of 1878 illustrate the usual results of hospital practice.

Many of these patients were conveyed to the hospital in extreme conditions; occasionally they were moribund on admission. It is hazardous to the life of a yellow-fever patient to transfer him over the rough streets of a city, often for two or three miles, unless this is done in the very earliest hours of the attack.

Prognosis is seriously influenced by the condition of the patient at the moment of attack. If pregnancy exists or delivery has just occurred, it is, under most circumstances, extremely unfavorable. Fatigue, anxiety, despair, or grief, all render prognosis more gloomy.

The march of temperature is also important in determining fatal results.

The following statistics show the influence of temperature in relation to mortality from yellow fever: