rise to about 103° or 104° F. During the three or four succeeding days the mercury slowly sinks to 98° or 99°, the daily fluctuations being seldom more than half to one degree. It occasionally happens that high temperature is maintained for two or three days, and also that the maximum is not attained till the third day; as a rule the thermometer behaves as described, the maximum being reached within a few hours of the onset of the disease.
With or soon after the initial chill or rigor, severe headache sets in, and is generally a prominent feature. For the most part the pain is concentrated about the forehead, in the circumorbital region and in the eyeballs themselves. In many cases it is associated with intolerance of light.
Loin pain is another very distressing symptom; it may amount to positive agony. The legs, too, ache excessively particularly the calves, knees, and ankles; they feel as if broken. Epigastric pain is generally a prominent symptom.
The face is flushed and swollen; the eyes are shining, injected, and ferrety; the skin is dry.
What with pain and febrile distress, the patient rapidly passes into a very miserable condition. He is restless and continually tossing about.
At first the pulse ranges from 100 to 120, and is full and strong; but as the disease progresses the pulse loses its sthenic character, gradually falling in force and frequency until, at the " period of calm," it becomes remarkably slow and compressible, beating perhaps only 30 or 40 times per minute.
At the outset the tongue is not very dirty, but it soon acquires a white coating on the dorsum, the edges remaining clean. It is not so swollen and flabby as in malarial fever; on the contrary, it is rather small and pointed throughout the disease. This is regarded as an important diagnostic mark; taken along with the progressive diminution in the strength and frequency of the pulse, and the peculiar behaviour of the temperature, it is nearly conclusive as to the disease being yellow fever. Later, the tongue dries, and, at the same time, thirst becomes intolerable.
