YELLOW FEVEB. 717 YELLOWHAMMER. tended by pains in the back, limbs, and head. Tlio tongue is coated but briglit red at the tip and sides; there is tenderness and pain over the epigastrium, with nausea and vomiting. About the second or third (hiy jaundice begins in the conjunctiviO, and (juickly spreads over the whole body. In favorable cases the fever abates at the end of the fourtli or fifth day, and recovery is complete in two or three wt^eks. Hut in severe eases the symptoms continue with increased vio- lence. The skin becomes yellower, small hemor- rhages take place into the skin, and vomiting becomes frequent. The rejected material is at first light in color ('white vomit'), l)ut is soon followed by the 'black vomit,' which is rightly considered an ominous symptom, since it be- tokens an extensive alteration in the blood. Black vomit has somewhat the appearance of coffee grounds, and consists of blood which has been extravasated into the stomach and further altered by the action of the gastric juice. Blood may also be discharged from the bowels and hemorrhages take place from the nose, mouth, or gums. At this stage delirium is apt to set in and the patient soon lapses into unconsciousness. In very violent cases death sometimes takes place within a few hours of the onset of the first symptoms. In these eases jaundice and high temperature are absent. Death is due to hemor- rhage, cardiac failure, suppression of the urine, or to the direct effect of the poison on the vital centres. The mortality in different epidemics varies greatly and may be as low as 10 per cent. or as high as 85 per cent, of the individuals at- tacked. Among alcoholic patients and those who are weakened from hardship or other causes the death rate is exceedingly high, as it is also among unacclimatized persons. The solution of the problem of preventing out- breaks of yellow fever is one of the most recent and remarkable achievements of sanitary science. The disease is known to be favored by heat, moisture, bad drainage, house and connnunal un- cleanncss, and generall.y unhygienic conditions, and these must be remedied as a first step in stamping out the malady. Chief attention, how- ever, is paid to the mosquito, and its breeding places should be destroyed. During an epidemic the greatest care is exercised to prevent yellow- fever patients from being bitten by mosquitoes ; special pains are taken to disinfect houses and rooms in which a case has occurred and to kill all mosquitoes in them. People residing in in- fected districts should be careful to guard against being bitten by these insects, both indoors and out. It is proposed to inclose patients suffering with yellow fever in large wire cages with meshes so fine that mosquitoes cannot penetrate them. It is customary to enforce a strict quarantine against vessels sailing from ports where it is known that yellow fever exists. (See Quar.^n- TINE.) Sanitary scientists predict confidently that the world will soon be rid of this scourge. Preventive inoculations of specially prepared serums have been tried, but not foimd generally effective. Serums also have been used for treat- ment, but with indefinite results. Yellow fever is a *lf-limited disease, but is likely to be attended by serious lesions of im- portant organs. Absolute rest in bed, from the first appearance of symptoms until convalescence is well established, is imperative. In no other disease is rest so important, and disregard of this precaution fraught with such serious dan- ger. Sudden death has occurred from too early exertion when the patient was apjiarcntly on the highroad to recovery. Careful nursing, fresh air, proper ventilation, and scrupulous cleanli- ness of bedding and clothing are all necessary. At the outset of the attack a mild emetic .such as ipecac or warm water and mustard may be given to empty the stomach, and the bowels should be evacuated quickly by means of castor oil, or an effervescent saline cathartic, as citrate of nuignesia or a Seidlitz powder. During the following days one or two daily bowel movements should be obtained, preferably bj' enemas of sul- phate of magnesia in warm water. Fever is best controlled by means of cold sponging. Baths, while effective in lowering the tem])erature, are dangerous on account of the movement they en- tail. Antipyretic drugs have to be given with caution because of their tendency to depress an already weakened heart. Internally alkaline carbonated waters, vicliy and apollinaris, are useful in allaying nausea and vomiting, and to cleanse the stomach and promote the action of the skin and kidneys. Warm drinks will serve the same purpose. To overcome severe vomiting, blisters to the epigastrium, small doses of co- caine, or larger ones of subnitrate of bismuth may be necessary. Threatened suppression of the urine is a grave complication and is combated by wet or dry cups over the region of the kidnej's, intravenous or intracellular injections of nor- mal saline solution, or high rectal injections. Restlessness and sleeplessness are relieved by suitable doses of morphine or chloral. No reme- dy will certainly check the hemorrhage, but ergot, acetate of lead, and adrenalin may do so. Free stimulation with whisky and strychnine is neces- sary at times to counteract the tendency to col- lapse and heart failure. The conduct of attend- ants and nurses should be such as to allay fear and quiet excitement. Many yellow-fever pa- tients die of fright. If possible, attendants should be immune. Contrary to the practice in other fevers, no food should be allowed yellow-fever patients for the first three or four days, or longer in severe cases, and then only the blandest and most easily digestible liquids may be taken. Milk and lime water, or vichy, barley water, or buttermilk, may be contiiuu'd well on into conva- lescence. Solid food cannot be alisorbed by the patient and it )nay work serious harm. YELLOWFISH. See Nigger-Fish. YELLOWHAMMER (from yrUoic + ham- mer, from AS. amcrc, amore. OHG. amero, Ger. Amnicr. bunting, 3'ellowhammer) . A name popu- larly, but very erroneously, given in some parts of the United States to the common flicker (q.v. ). The name properly belongs to a fringilline bird of Europe, the yellow bunting (Emberiza citri- nella) , which is one of the most common of small birds in Great Britain and in most parts of Europe. It is about seven inches long, and the male is a bird of brilliant plumage. The . head and nape of the neck are bright lemon yel- low, with a few dusky black patches : the upper jiart of the back and wings are reddish brown, tinged M'ith yellow: the wing and tail quills are chisky black, with narroAv external edges of bright yellow or bright brown; the upper tail- coverts reddish chestnut, edged with yellow; the
