THE 
NEW ORLEANS 
MEDICAL AND SURGICAL 
■ m ' r i: n . \ i.. 
JANUARY, 1874. 
ORIGINAL COMMUNICATIONS. 
Article I. Contributions to the Natural History of Specific Yel- 
low Fever. Composition and Character of the Urine in Yelloic 
Fever. By Joseph Jones, M. D., Professor ot Chemistry 
and Clinical Medicine, Medical Department, University of 
' Louisiana, Visiting Physician of Charity Hospital, Uew 
Orleans. 
Up to the present time our knowledge as to the composition 
of the urine in yellow fever has been imperfect. Beyond a few 
crude observations, and the important fact first announced in the 
work of Daniel Blair, that in this disease albumen appears in the 
urine, the medical profession has been without any quantitative 
determination of this excretion. 
It will be my object in the present paper to extend our know- 
ledge of the natural history of the terrible scourge of tropical 
and sub-tropical America, by presenting the results of careful 
and accurate quantitative analyses of the urine in cases of dif- 
ferent degrees of seventy. 
REACTION OF THE URINE IN YELLOW FEVER. 
The reaction of the urine in yellow fever is acid. Even in the 
gravest cases, attended with suppression of the urinary ex- 466 
Original Communications. 
| Jan. 
cretion, jaundice, and alkaline black vomit, the urine, however 
small the quantity excreted, maintains an acid reaction. 
SPECIFIC GRAVITY OF TIIE URINE IN YELLOW FEVER. 
As a general rule, the specific gravity of the urine in yellow 
fever does not vary greatly from that of health, and ranges from 
100b. to 1028. In those specimens which gave the highest spe- 
cific gravity, the increase in density was clearly referable to the 
increase of albumen; for when this constituent was coagulated 
by heat and removed by filtration, the urine was of low specific 
gravity. 
Thus iu a case in which the specific gravity of the urine was 
1020, after the removal of the albumen the specific gravity was 
reduced to 1012. 
In some of the gravest cases the specific gravity of the urine 
was only 1010, and presented a yellow color, and was tnrbid from 
the presence of cells and casts of the excretory tubes of the 
kiduey and granular fibroid matters and colorless corpuscles. 
COLOR OF THE URINE IN YELLOW FEVER. 
During tbo early stages of the disease the urine is normal in 
color, clearness and quantity; as the disease proceeds, the urine 
becomes of a deep yellow color, from the admixture of bile, and 
at this stage, after the full establishment of the febrile excite- 
ment, about the third, fourth or tilth day, becomes turbid from 
the presence of the excretory cells, tube casts, and yellow granu- 
lar albuminoid or fibroid matters. The color may deepen to 
orange red as the disease progresses; or it the case terminates 
fatally from diminution and suppression of the urinary excretion, 
it maintains a yellow color, sometimes presenting an oily appear- 
ance and motion, and consists of but little else than albumen, 
bile, excretory cells and casts of the tubuli uriniferi, iu a weak 
solution of the urinary constituents. 
In some cases of suppression, although the urea is greatly 
diminished in the small amount of urine excreted, it is rarely if 
ever entirely absent. 
If the case ends iu convalescence, the urine is copious and the 
color progressively increases iu depth, and may even appear 
black when viewed en manse. 1874.] 
Jones—Natural History of Yellow Fever. 
467 
ALBUMEN IN THE URINE OF YELLOW FEVER. 
As far as my investigations extend, albumen is an invariable 
constituent of the urine in well marked cases of yellow fever, and 
may appear as early as the first day of the disease, but most 
generally it appears upon the second, third or fourth day. 
The first fact recorded with reference to the occurrence of albu- 
men in the urine of yellow fever is to be found in the following 
note, by Dr. John Davy, to the 3d edition of Dr. Daniel Blair’s 
work on the Yellow Fever of British Guiana: 
“In many instances, in the fatal cases of yellow fever in Bar- 
badoes, the kidneys have exhibited a congested state, with ecchy- 
mosis of the investing membrane; and the urine, during life, has 
been found to be albuminous, coagulating when heated on the 
addition of nitric acid: this I have learned from staff surgeon, 
Dr. Codings, who has made many observations aud experiments 
on the subject. In a letter with which he has favored me on the 
28th of December, 1848, he says—‘In every case of decided 
yellow fever 1 have found the urine highly albuminous, a condi- 
tion which it assumes about the second or third day, and main- 
tains throughout, increasing as the disease advances, and in 
cases of protracted convalescence, continuing long after all symp- 
toms but debility have left the patient.’ Most of the albuminous 
precipitates he mentions were of a brownish color; in some cases, 
just before the fatal termination, the presence of blood in the 
urine may be recognized by the microscope. In two instances he 
found the albumen of the blood replaced by a substance having 
the properties of casein.”—(Note by Dr. John Davy to 3d edition 
of “Some Account of the last Yellow Fever epidemic of British 
Guiaua, by Daniel Blair, M. D., Loudon, 1852, pp. 98-99.) 
Blair, in his subsequent report, records similar facts—(British 
and Foreign Medico Chirurgical Bevieic, April, 1856: vol. xvi., 
appendix, pp. 9-13.) 
Crocker Pennel says that albumen is always preseut in the 
urine of yellow fever, and sometimes in such quantity as to make 
the urine quite solid with heat. (Medico Chirurgical Trans.; vol. 
xxxvi., p. 245.) 
Ballot found albumen invariably in 300 cases. 
Dr. Robert D. Lyons gives, as the result of his examination 
of the urine during the Lisbon epidemic of 1857, with reference 
to the presence of albumen: 468 
Original Communicatiom. 
[Jan. 
“Albumen was found in the urine in the following order of 
association— 
(а) “As the only abnormal element, with or without other 
blood element. 
(б) “In company of abundant deposits of lithates, with or with- 
out deposits of purj urin, or other coloring matters in excess. 
(c) “In connection with biliary coloring matters, the presence 
of which was shown by the usual reagents. 
(d) “In connection with pyrexial states, and 
(e) “In connection with apyrexial states.” 
Various other observers, as I)r. II. F. Gibbs, surgeon U. 8. N., 
and I)r. Peyre Porcher, of Charleston, have confirmed the accur- 
acy of the original observations of Dr. Codings, as contained in 
the work of Daniel Blair. 
BILE IN URINE OF YELLOW FEVER. 
The constituents of bile are almost universally present in the 
urine, even in those cases which progress favorably and end in 
convalescence, as will be illustrated by the following case: 
Urine collected from a stout young man in Charity Hospital, 
September 30th, 1871, on 5tli day of disease; patient at this time 
prostrated, with sluggish capillary circulation, slow pnlse, ami 
yellow color of conjunctiva. The symptoms, however, were 
favorable; the patient expressed a desire for food, and there was 
no restlessness, nausea, delirium, or aberration of nervous action. 
The urine presented a reddish yellow color, and upon chemical 
examination, was found to lx; acid in its reaction. 
Specific gravity, 1020; bile and albumen present in considerable 
quantities. 
Ui>on standing, the urine let fall a moderately heavy deposit 
of urate of soda, in the form of granules and globules, with 
stellate points attached; also prismatic crystals of triple phos- 
phates. 
The urine contained but few casts or cells from the excretory 
tubes of the kidney. 
Neither vibrios nor vegetable cells, nor animaleul* of any 
description, were observed in the urine when freshly drawn. 
The kidneys acted freely in this case, and the urine presented 
a reddish yellow color, and the patient progressed regularly and 
afely to complete health. 1874.] 
Jones—Natural History of Yelloic Fever. 
469 
In grave cases of yellow fever, on the other hand, the urine is 
much less abundant, and at the same time it is of a much lighter 
color. 
In many cases which recover, the urine presents a deep reddish 
yellow and brown color. 
WHEN THERE IS NO SUPPRESSION OF THE URINARY EXCRETION, 
THE UREA IS INCREASED ABOVE TIIE STANDARD OF HEALTH, 
DURING THE ACTIVE STAGES OF THE DISEASE, AND DURING 
THE PERIOD OF EXHAUSTION OR CALM. 
The following cases illustrating the preceding important pro- 
position, render it evident, that the febrile excitement ot the 
disease now under consideration, like fever generally, from what- 
ever cause arising, or however excited, is attended with an 
increase of those excrementitious products which result from the 
chemical changes of the blood, organs and tissues. And we 
will show by another series of cases, that even when there is 
complete absence of the urinary excretion on account of conges- 
tion and structural alteration of the kidneys, urea is still 
formed in large amount, and accumulates in the blood and ill 
certain organs, as the liver and brain. 
CASE OF YELLOW FEVER ILLUSTRATING THE COMPOSITION OF 
THE URINE. 
Albert Bugeu, age 37, native of Germany; light hair, light 
eyes; florid complexion; muscles well developed. Admitted into 
Charity Hospital, August 5th, 1871. At the time of admission 
patient had slight fever; hemorrhage from nose; conjunctiva 
congested; sclerotic coat of eyes, presents a yellow discoloration, 
with capillary congestion. The patient had suffered with fever 
for about 70 hours, before entering the hospital, and he appeared 
to be passing from the febrile stage to that of calm. Tempera- 
ture of axilla this morning 08°; pulse 82. Temperature of axilla, 
in the evening, 100° F. Urine red colored, and loaded with 
al bumen. 
October 6th, 9 a. m.—Temperature 98°; pulse 82; 9 p. m., tem- 
perature 100°. 
Examination of Urine.—Amount of urine collected from Octo- 
ber 7th, 10 a. m. to October 8th, 10 a. m. (24 hours), 900 cubic 
centimetres (grains, 14341.2). Specific gravity 1020. Reaction 470 
Original Communications. 
[Jan. 
of urine strongly acid, which it retained apparently undimin- 
ished for several days. Upon standing, the urine let fall a 
light yellow flocculent deposit. This deposit was found, under 
the microscope, to consist of casts of the tubuli uriniferi, excre- 
tory cells of the tubuli uriniferi, colorless corpuscles, oil globules, 
granular, fibroid or albuminoid matter, and urates of soda and 
ammonia. The casts of the tubuli uriniferi and the excretory 
cells contained granular fibroid matter and oil globules. 
Immediately after its passage, the urine was examined with 
magnifying powers ranging from 500 to 1080 diameters; but 
no living animal or vegetable organisms were discovered. 
Upon standing, vibrios were developed. 
When seen in mass, the urine presented a yellowish red color; 
but in thin layers it presented a decided orange yellow color. 
The yellow color was due to the presence of the coloring matter 
of the bile. 
Upon analysis the urine yielded the following results. 
900 cc (14, 341. 2 grains of urine, excreted during 24 kourx, con- 
tained): 
Urea grains 011.42 
Uric acid 10.50 
Phosphoric acid 30.12 
Sulphuric acid 42.71 
Chloride of sodium 15.81 
Chlorine in chloride of sodium 9.03 
Phosphorus in phosphoric acid 15.H0 
Sulphur in sulphuric acid 17.08 
Dried albumen 85.80 
As this patient was in a state of absolute rest, and almost 
absolute starvation, it is evident that the urea, uric aeid. and 
phosphorus and sulphur compounds were greatly increased; l»eing 
almost three or four fold more than in the urine of a healthy 
individual similarly situated. 
October 8th a. m.—Tenificrature 100°; pulse 85; p. m., temper- 
ature 100°. October 9th, temperature 98°; pulse 85, morning: 
temperature 100, evening. Patient weak, but continues to im- 
prove. Is able to take light nourishment with relish. Com- 
plexion sallow and slightly jaundiced. 
Amount of urine collected during 24 hours, from Octolier 8th, 
a. m. to October 9th a. m., 750 cc (grains 11.139.8). Specific 
gravity 1022. Reaction of uriue strongly acid; the acid reaction 1874.] 
Jones—Natural History of Yellow Fever. 
471 
continued for several days upon standing. Urine, orange red color, 
with a yellow tinge, from the presence of bilary matter. The yel- 
low color was very marked, when spread upon a white porcelain 
surface in thin layers. 
Upon standing, the urine deposited a yellow layer of urinary 
casts and excretory cells, with oil globules and granular albumin- 
oid matter and amorphous, urate of ammonia and soda. Under 
objectives ranging from 1-5 to 1-18 of an inch no vegetable or 
animal organisms were discovered in the fresh urine. 
7S0 cc {grains ll.189.8j of urine collected during 24 hours con- 
tained: 
Urea grains 474.78 
Uric acid 7.50 
Phosphoric acid 30.88 
Sulphuric acid 30.45 
Chloride of sodium 21.29 
Chlorine in chloride of sodium • 12.20 
Phosphorus in phosphoric acid 13.56 
Sulphur in sulphuric acid 15.70 
Dried albumen 56.25 
October 10th, a. m.—Temperature axilla 08°; pulse 80. P. 
in.—Temperature OS-. 
October 11th, a. m.—Temperature axilla 98°; pulse 80; p m. 
temperature 98°. 
The patient continued to improve slowly but steadily. The 
urine gradually assumed the color of health; the albumen pro- 
gressively decreased, and disappeared entirely on the 15th of 
October. The jaundiced appearance of the skin and eyes disap- 
peared very slowly, and even after the apparent complete restora- 
tion to health, the skin and “whites” of the eyes presented a 
thoroughly jaundiced appearance. 
Patient discharged on the 17th of October. 
Commentary.—It is evident from the preceding analysis of the 
urine, in this case of yellow fever, that the urea is increased at 
least four fold, even in the stage of calm or depression : that is, 
the urea is at least four times more abundant than the amount of 
this constituent which would be excreted by a patient in health, 
similarly situated, lying perfectly quiet in bed, and taking little 
or no nourishment. 
The same observation applies to the phosphoric and sulphuric 
acids. As the pulse and temperature had very nearly returned 472 
Original Comm unications. 
[Jan. 
to the normal standard we must refer the increased elimination 
of the urea, and phosphoric and sulphuric acids, to the effect of 
the preceding febrile stage; that is, to the changes excited by the 
febrile poison, during the first stage of incubation and active 
febrile excitement. 
The urine collected on the 5th day of the disease yielded 50.12 
grains of phosphoric acid, which is equivalent to 15.80 grains of 
phosphorus; and 42.71 grains of sulphuric acid, which is equiva- 
lent to 17.08 grains of sulphur. 
As the patient, at this time, was taking no medicine, and little 
or no uouiishment, it is fair to refer the source of the phosphoric 
and sulphuric acids to the changes of those constituents into the 
composition of which sulphur and phosphorus enter. 
We have in these facts, determined by the analysis of the 
urine, data for the calculation of the amount of the constituents 
of the living solids and tluids, undergoing such changes as 
resulted in the formation of sulphuric and phosphoric acids. In 
such calculations, and in considering the several phenomena 
which mark the progress of yellow fever, we should never lose 
sight of the great importance of albumen in the living body. “It 
is met with,” says Lehmann, “in the largest quantity,iu the blood, 
and in all those animal juices which contribute towards the nutri- 
tion of the organs; and a more careful examination of many of 
the animal tissues shows that albumen requires only some very 
slight modifications to become consolidated under different forms; 
as, for instance, when it contributes towards the formation of 
the solid contractile parts, under the form of syntonin (muscle 
fibrin), by which alone both the voluntary and involuntary 
movements of the animal body are effected. We find it both in 
a dissolved and undissolved form in the most delicate organic 
combinations; as, for instance, in the contents of the nerve 
tubes.” The essential condition for the conversion of this 
principle into organized living tissue, is the continuous supply 
and chemical action of oxygen; and the changes thus excited 
under the most various circumstances, give origin to the numer- 
ous metamorphoses which the molecules of albumen undergo, 
before their final change into urea and similar substances. We 
may therefore calculate the amount of albumen undergoing 
change iu the l>ody, either from the amount of urea, or sulphuric 
acid, resulting from the decomposition or chemical change of its 
individual constituents. 1874 ] 
Jones— Natural History of Yellow Fever. 
473 
Chemists now recognize three well defined albuminoid prin- 
ciples: viz., albumen, fibrin and casein, the others are little 
knrwn, and are possibly only mixtures. In a chemical point of 
view fibrin presents all the characters of insoluble albumen; it 
only differs from it by its fibrous form and its property of 
decomposing oxygenated water. The different substances in 
question appear identical in their elementary composition, the 
slight differences given by analysis being most probably due to 
impurities, for these uncrystalizable substances cannot be com- 
pletely purified: and we may reasonably suppose that in reality 
there exists a single albuminoid substance, acting in the same 
manner as a weak acid, and capable, like certain well known 
bodies, of existing both in a soluble and in a coagulable state; if, 
therefore, the name albumen be reserved for this principle, 
fibrin should be considered as insoluble albumen, more or less 
mixed with earthy phosphates; albumen, as an acid albuminate 
of sodium, and casein as the neutral albuminate of sodium. As is 
well known, many chemists call in question the identity of composi- 
tion of the albuminoid substances, holding it to be impossible to 
prove the identity of a body whose molecule is so complex, 
especially as the compounds cannot be obtained in a pure 
state for analysis. Whilst admitting that this reasoning may 
be sound, on the other hand it cannot be shown by analysis, 
that these substances are not identical, and moreover, they 
give the same products of decomposition; we shall, therefore, 
for the purpose of the present calculaticn, adopt the preceding 
hypothesis. 
Riiliug found the amount of sulphur in eighty analyses of 
albumen to vary from 1.21) to 1.39 in the 100 parts, with a mean 
of 1.3 per cent. In adopting, for the present calculation, the 
actual determinations of sulphur in albumen, by these chemists, 
it is not necessary that we should adopt the hypothesis of Mul- 
der, that albumen is a compound of (hypothetical) protein, with 
(hypothetical) sulphamide. 
The view held by Mulder and some other chemists, that albu- 
men and fibrin contain a small quantity of phosphorous, as an 
organic constituent, does not appear to be tenable, and this sub- 
stance cannot form the basis of calculation for the metamorpho- 
sis of the albuminoid substances in the living body; on the other 
hand, the sulphuric acid, appearing in the urine during rest and 
fasting, may be correctly assumed as a measure of the changes 474 
Original Com m union tions. 
| .Jail. 
of the albuminoid substances, as the proportion of sulphur ap- 
pears to be very nearly the same in fibiin and albumen; and so 
intimate is its chemical union in these b dies, that it cannot be 
completely abstracted by the action ol the alkalies. 
If, therefore, every 100 grains of the dried albumen of the blood 
and tissues contain 1.3 grains of sulphur, it is evident that the 
17.08 grains of sulphur excreted during 24 hours by this patient, 
represents K108.3 grains of dried albumen; and as albumen forms 
7 per cent, of the blood, 17.08 grains of sulphur excreted in the 
form of sulphuric acid during 24 hours, represented the meta- 
morphosis of the albumen of 18,000 grains of blood. 
If we assume that the phosphoric acid in the urine resulted 
from the metamorphosis of the nervous structures, and assume 
as the basis of the calculation the mean of certain chemical ana- 
lyses, which give 1.0 per cent, of phosphorus in dried brain sub- 
stances, then the 15.80 grains of phosphorus excreted, as phos- 
phoric acid, during 24 hours, in this case of yellow fever, repre- 
sented 1)91.2 grains of dried brain substance, or between 3904.8 
grains and 4950 grains of fresh cerebral substance. 
Such a calculation, however, would represent the changes of the 
cerebral and nervous substance in an exaggerated light, because 
a considerable amount of the phosphoric acid in the urine is 
derived from the phosphates of the alkalies, and alkaline earths, 
existing in the blood and organs, and especially in the osseous 
tissue. 
The 85.5 grains of dried albumen excreted by the kidneys 
during 24 hours, represented the amount of this substance con- 
tained in 1220.94 grains of blood. 
Iu many cases the albumen appears in much larger quantities, 
amounting to near one ounce of dried albumen during tlie 24 
hours, which would represent the albumen of 14.28 ounces of 
blood, or nearly cf one pound avoirdupois, or nearly 1.1-5 pounds 
troy of blood. 
It is evident, therefore, that the loss of albumen by the urinary 
excretion in yellow fever must play an important part in the 
progress and result of the diseased actions, and that from this 
cause alone most important physical changes must be induced in 
the blood, while it is undergoing a loss of more than one seven- 
teenth of the entire amount of albumen in 24 hours. 
In this connection it is important to bear in mind, not only the 
great instability which characterizes and distinguishes the albu- 1874.] 
Jones—Natural History of Yelloic Fever. 
475 
minoid from other organic principles, but also that certain sub- 
stances in this group, simply by their presence, cause the hydra- 
tion of other bodies by means of certain chemical changes. 
Thus diastase, which is extracted from germinated barley, pos- 
sesses this property in a high degree; but M. Pasteur having 
demonstrated that fermentation is owing to the development of 
living organisms, to which the name ferment should properly be 
applied, the name ferment is not suitable for certain forms of 
the albuminoid constituents which, by their presence, are cap- 
able of exciting certain chemical changes. 
We are not justified, in the present state of our knowledge, in 
referring the chemical changes of the albuminoid substances 
which are so characteristic of yelloAV fever to the action of fer- 
ments, if this term is applied to living organisms; for, aside from 
the fact that living organisms characteristic of this fever have 
not been detected in the blood of the living patient, the 
phenomena may be explained by the supposition that the 
changes are induced by compounds which, like certain bodies, 
as the iodide of nitrogen, chloride of nitrogen, fulminate 
of mercury, nitro glycerine and pyroxylin, are in a state of un- 
stable equilibrium, but which are not themselves endowed with 
life. 
The transformation of salacine into glucose and saliginiu, and 
of amygdalin into glucose, bitter almond oil and hydrocyanic 
acid, by the emulsion of almonds (synaptase), the formation 
of volatile oil of mustard, in consequence of the action of the 
emulsion—like substance contained in it on the myrouic acid, the 
rancid putrefaction of fixed oils in the presence of albuminous 
compounds, the rapid conversion of starch into glucose by 
diastase, as well as the remarkable changes of the blood and 
organs, characteristic of acute atrophy of the liver and acute phos- 
phorus poisoning, are clearly not referable to the action of living 
organisms aud germinal matter. 
CASE ILLUSTRATING THE OCCURRENCE OF BLOODY URINE IN 
YELLOW FEVER. 
N. O., medic.nl student; resident student, Charity Hospital; 
native of Washington. St. Landry Parish, Louisiana; age 32. 
Large, well built, powerful man. States that he had an attack 
of yellow fever, August, 1870. The fever was prevalent at that 476 
Original Com m unioniums. 
[Jan. 
time in Washington. During the spring ami latter part of the 
winter of 1872, I treated Mr (). for severe ami obstinate inter- 
mittent fever, attended with enlarged spleen and jaundice, 
under the persistent use of quinine and iron, with careful atten- 
tion to the bowelR, Mr. (). was completely restored to health. 
Mr. O. entered the Charity Hospital, March, 1872. Several 
cases of yellow lever were treated during the months of October, 
September and November in the wards to which Mr. (). was 
attached, he also assisted in seveial post mortem examinations 
of yellow fever subjects, in the dead-house of Charity Hospital. 
The last case of yellow fever treated in the wards to which Mr. 
O. was attached, entered about the 1st of November, 1872. 
November 19th, 1872, a. in.—Mr. (>. says that he felt unwell, 
with pain in the head and back, and with oppression of breath- 
ing during the preceding night. I found him in bed. Appears 
drowsy and dull; complains of headache, oppression of breathing, 
sore throat, cough, and soreness over the whole body. No appe- 
tite Says that he has taken a violent cold, and b ars pneu- 
monia. 
November 20th—During the night had hot fever which lasted 
several hours and was not followed by sweating. 10 o’clock a. 
in.—Fever; moderately rapid and lull pulse; skin hot, tongue 
furred, red at tip and edges; capillaries of face, and of conjuntiva 
of eyes, congested; no appetite; restless; complains of headache 
and pain in back and thighs; oppression of breathing, sore 
throat, cough; soreness over the whole body: says that he “has 
taken a violent cold.” Percussion revealed dulness over right 
lung; and upon auscultation, the vesicular murmur was found to 
lie decreased, whilst the vocal fremitus was iucreased. 
R—Quiniie sulph., grs. xv; pnlv. ipecac et opii, grs xviij; mix: 
divide into three powders. One powder every three hours. 
Hiuapisin over right mammary, inferior mammary, and axillary 
and inferior axillary regions. 
P. M.—The fever, which had increased at 0 a. in. this morning, 
continued unabated until 7 p. m., when there was a marked 
decline in its intensity; fever, however, continued during the 
night, and the restlessness and dyspncea increased. 
November 21st, 10 a. m.—Patient expectorates tenaceons yel- 
low mucus, apparently tinged with the coloring matter of bile. 
Expectoration difficult; bowels constipated. Right lung con- 
gested, with increased vocal fremitus, and tubular breathing and 1874.] 
Jones—Natural History of Yellow Fever. 
477 
diminution of respiratory murmur. Capillaries of face, and of 
extremities and of eyes congested; capillary circulation sluggish. 
The countenance has a dusky, congested, unhealthy appearance. 
II—Piluhe comp.: cathartic No.: iij; administer at once and 
follow with effervescing powder in three hours; and after action 
of cathartic, repeat mixture of quinine and Dovers powder (5 
grains of quinine and 0 grains of Dovers powder) every three 
hours, until three doses have been taken. 
8 o’clock, p. m —Fever has continued during the day; medicine 
acted promptly upon the bowels. Fever continued to increase 
until midnight, when the patient labored under great dyspnoea, 
fear and anxiety, and general congestion of capillary circulation. 
In my absence, the Resident House Surgeon of Charity Hospital 
was summoned, and administered 10 grains of quinine and 
20 drops of laudanum (tincture of opium), which induced sleep 
and perspiration. 
November 22d, 7 a. m.—Feels somewhat relieved; still under 
influence of opium; and appears dull and lethargic; at 9 a. m., 
dull and stupid, drops into a doze, and then wakes again. Dis- 
inclined to converse, anxious and restless. Capillaries of face 
congested, complexion of a dusky unhealthy hue, as in adynamic 
fevers. Capillaries of extremities and of the surface greatly con- 
gested, giving a mottled purplish hue. Liver found upon per- 
cussion to be considerably enlarged, and tender upon pressure. 
Expectoration of yellow sputa has ceased, and the congestion of 
the right lung has greatly diminished. Slight bright yellow 
tinge of surface. Abdomen tense and swollen. Intense pain in 
back and head. Pulse full and only moderately accelerated. 
Temperature elevated, about 105'1 F. Urine orange color, abun- 
dant, and contains bile and small quantities of albumen, with 
a few granular casts of urinary tubes, and excretory cells of kid- 
ney. After the first day, I watched this case with great interest, 
and upon this day announced that it was undoubtedly a case of 
yellow fever. The tact that the patient affirmed positively that he 
had suffered with yellow fever in Louisiana; the fact that he had 
been for some time a resident student of Charity Hospital, and 
had been upon many occasions in contact with yellow fever sub- 
jects in the wards and in the dead house, and the still more 
striking fact, that he had in the beginning of the attack suf- 
fered with sore throat, cough, oppression of breathing, conges- 
tion of the right lung, attended with the expectoration of teua- 478 
Original Communication*. 
[Jan 
ceous yellow sputa, led at first to a cautious examination and 
analysis of the symptoms, and a suspension ot tho final verdict 
as to the true nature of the disease: viz., yellow fever. 
Examination of Urine.—Whole amount of urine not collected, 
but the kidneys are acting freely. There is no deficiency of urea, 
as each 10 cc. of that portion ot the urine collected for examina- 
tion, yielded 330 millegrammes of urea. The urine also contained 
albumen, 30 cc. of urine yielding upon analysis 0.4 grain of albu- 
men. Reaction of urine strongly acid, which remained so, for 
more than one week. Red color, or rather, of deep orange rod, 
presenting the appearance of deep yellow bile when seen in thin 
layers, and of a deep red color when seen in mass. Urine slightly 
turbid. Under the microscope (objectives varying from £ to 
1.18 inch), it was found to contain a number of colored blood 
corpuscles, epithelial cells of the excretory tubes of tho kidneys, 
casts of the tubuli unriniferi, filled with yellow granular albumi- 
noid or fibroid matter. At the end of four days the reaction of 
the urine was still decidedly acid, and contained a number ot 
vibrios and cells of sarcina ventriculi and of the torulai cervisite. 
November 22d, a. m.—Sluggish; attention not easily aroused; 
capillaries of face of conjunctiva and extremities greatly congested. 
Dusky, mottled hue of complexion. Abdomen swollen, and the 
patient complains that it feels “uncomfortably tight.” Liver 
congested and enlarged; dullness, and tension or visible enlarge- 
ment for 1£ inches below border of false ribs on right side. Pain 
in region of liver, spleen and kidneys—greatest in small of back, 
in region of kidneys. Kidneys acting freely; urine orange red; 
strong acid reaction: contains bile, albumen, blood corpuscles 
and casts of tubuli nriniferi. Intellect sluggish, not easily 
aroused; and after answering questions, relapses into a doze, as 
if under the action of some potent poison. JIas fever; pulse fre- 
quent, but full. 
Evening.—Pulse 108; respiration 24; temperature of axilla 
102°. Urinates freely. Urine contains albumen, bile and casts 
of tubuli uriniferi, and blood corpuscles. The skin over the 
entire body has assumed a yellow, jaundiced hue. Tenderness 
over abdomen. 
November 24th.—Bested well during the night. Patient says 
that during the night he felt as if something was giving way in 
his abdomen, and alter this obtained relief. Some impiovement 
in capillary circulation. 8 a. in.—Pulse 100; respiration 28; tern- 1874.] 
Jones—Natural History of Yellow Fever. 
479 
perature of axilla 101.75. Head quite clear. Lies on right side. 
Tenderness over abdomen disappearing, but pain increasing in 
region of spleen and kidneys. Skin dry and yellow. Stomach 
irritable. Sclerotic coat of eyes, yellow and injected. Tongue 
red, furred, and fissured in middle. Eight lung relieved of con- 
gestion. No special feeling of congestion or oppression in breath- 
ing. Skin moist, and at times bathed in perspiration. Kidneys 
acting freely. Capillary circulation sluggish. Urine contains 
bile, albumen, casts, excretory cells of kidney and yellow granu- 
lar matter. Urine abundant. Amount of urine passed during 
last 24 hours—Nov. 23d, 10 a. in., Nov. 24th, 10 a. m.—5G oz.(— 
1750 cc.); specific gravity 1010. Reaction strongly acid. Upon 
standing, the urine let fall a tlocculent deposit, which consisted of 
numerous casts of the tubuli uriniferi and excretory cells, and 
granular albuminoid matter, and urate of soda and ammonia, 
colored yellow by the coloring matter of the bile. The tubuli 
uriniferi were filled with yellow granular matter. Urine also 
contained colored blood corpuscles and oil globules. 
Rapid desquamation of the excretory cells of the congested 
kidneys is evidently proceeding. Upon standing, the urine re- 
tained its acid reaction, and numerous vibrios and toruloe 
cervishe, were developed. Urine presents a red color when seen 
in mass, and a yellow color, like bile, in thin layers. 
Bile and albumen present; also grape sugar (diabetic sugar glu- 
cose) in small quantities. When dropped upon bibulous paper, 
a golden ring is formed by the coloring matter of the bile. After 
acidulation with a small quantity of acetic acid, boiling and fil- 
tration, so as to separate the albumen and casts, and excretory 
cells, the clear hot filtrate became turbid upon cooling, and let 
fall a heavy crystalline deposit of highly colored crystals of uric 
acid. Well formed torulce cervishe also formed in the urine after 
boiling and filtration. No effort, however, was made rigidly to 
exclude the atmosphere after boiling the urine, and after the 
separation of the albumen by filtration, and this experiment is 
of importance as seeming to illustrate cr indicate the fact, that 
the torulae originally observed in the urine were developed from 
germs introduced from without, and not from those which might 
have been supposed to have been separated from the blood by 
the kidneys. 
The development of these plants appear to have been favored 
by the presence of the grape sugar. The presence of the grape 480 
Original Communications. 
i'Jan. 
sugar appears to have l»eeu due to the same causes which in- 
duced the bile in the urine, and also, perhaps, to the sluggish 
capillary circulation. 
As the kidneys were apparently doing their full duty, 1 pre- 
scribed no drugs—only water charged with carbonic acid, and a 
small quantity of good French brandy diluted with the carbonic 
acid water, at intervals of three or four hours. 
1750 cubic centimetres of urine excreted during 24 hours—Novem- 
ber 23d-2-Uh—con ta i ned: 
Urea grains, G9300 
Uric acid 19.50 
Phosphoric acid 25.31 
Sulphuric acid 49.70 
Chloride of sodium 7.84 
Albumen 12.50 
10 o’clock, p. in.—Pulse 102; respiration 30; temperature of 
axilla 102° F. Urinary excretion continues abundant. Sinapisms 
have been freely applied over region ot spleen and kidney. Com- 
plains of great pain over right kidney. (Apply mustard foot bath 
and continue carbonic acid water.) 
November 25th, morning.—Rested pretty well during the 
night; complains of thirst; drinks freely of carbonic acid water; 
urinates freely. Free from pain and muscular soreness, with the 
exception of the pain in the region of the kidneys, which is now 
greatly mitigated. Temperature of axilla 98° 5' F.; pulse 82; respi- 
ration 32. Complains of some pain in head. Amount of urine 
passed during 24 hours up to November 25th, 10 a. m., 1575 cc; 
sjiecitic gravity 1014; red color in mass, golden yellow in thin 
layers; turbid when passed, from presence of blood and casts, 
and <rdls of tubuli uriniteri; reaction strongly acid. The tioccu- 
leut deposit, under the microscope, consists of casts of the tubuli 
uriniferi, and the excretory cells of the kidney, cells from mucous 
membrane of the bladder and pelvis of the kidney, blood cor- 
puscles, and yellow granular matter and amorphous urates. The 
colored blood corpuscles have greatly increased in numbers, and 
present a regular form, with bi convex outline. All the morpho- 
logical elements (cells and casts) were colored by bile. When a 
piece ot white bibulous pa|K*r was dipi>ed in the urine, it was 
colored of a bright golden hue. Upon standing, the reaction of 
the urine continued acid, and numerous vibrios and cells of the 
torula;, were developed. Urine contained a small quantity of 1874.] 
Jones— Natural History of Yellow Fever. 
481 
grape sugar. When the urine was slightly acidulated with acetic 
acid, boiled, and the coagulated albumen removed by filtration, 
upon cooling, the urine thus treated let fall a heavy deposit of 
lozenge-shaped crystals of uric acid. 
1575 cc of urine collected during 24 hours contained: 
Urea grains, 593.50 
Uric acid 10.50 
Phosphoric acid 48.51 
Sulphuric acid 41.74 
Chloride of sodium G.93 
Dried Albumen 3.00 
G o’clock p. m.—Pulse 10G; respiration 30; temperature of 
axilla 102c F. Skin deeply jaundiced. Patient resting quiet. 
No medicine prescribed: light nourishment at regular intervals, 
with carbonic acid water. 
November 26th, G a. m.—“Rested badly during the night;” 
mouth very dry; much thirst; restless; oppressed; complains 
of feeling a “painful burning spot upon the top of the head.” Lower 
extremities feel cool. Mustard frictions promoted capillary cir- 
culation and warmth, with some perspiration. There was no 
abatement of the pain in the head, however, after the establish- 
ment of the perspiration. Great pain and oppression in the head. 
Marked congestion of capillaries. Surface of face and ex- 
tremities mottled and of a deep yellow'color. Nausea, restless- 
ness and sleeplessness during entire night, until 2. a. in., when ice 
was applied to head. The ice appeared to relieve the pain in the 
head, and the patient fell into a calm sleep, from which he awoke 
in the morning refreshed. 
8.40 o’clock, a. m.—Temperature of axilla 101° F.; pulse 80; 
respiration 29. Amount of urine passed during the last 24 hours 
1700 cc. Specific gravity 101G. Strong acid reaction. Urine 
turbid when passed, from presence of tube casts, excretory cells 
of tubuli uriniferi, mucus cells of bladder, ureter and pelvis of 
kidney, colored blood corpuscles, yellow granular fibroid matter 
and amorphous urate of ammonia and soda. Color of urine deep 
reddish brown. Under the microscope tube casts and excretory 
cells of kidneys abundant, also colored blood corpuscles, and 
cells from mucus membrane of bladder, ureter and pelvis of kid- 
ney. The casts were filled with yellow granular matter. All the 
cells as well as the casts and amorphous granular matter and water 
were colored of a deep yellow by the coloring matter of the bile. 482 
Oriffinal Comm unications. 
| Jan. 
Upon standing, numerous vibrios and cells of the torultc were 
developed. I examined microscopically at the same time samples 
of urine passed by a distinguished member of the medical pro- 
fession, who was laboring under diabetes melitus, and could per- 
ceive no difference in the mode of development and ap]tearance 
of the fibres and cells and tliallus of the toruhe developed in the 
diabetic urine and that of this case of yellow fever, which con- 
tained grape sugar as well as albumen and blood corpuscles. 
1700 cc of urine excreted during 24 hour*, November loth 
10 a. m.—November 20/A, 10 a. m., contained 
Urea grains 827.70 
Uric .acid 21*42 
Phosphoric acid 52.00 
Sulphuric acid 45.01 
Chloride of Sodium 6.54 
Dried albumen 1.09 
It is evident from the small amount of albumen, only 1.60 
grains in 1700 cc of urine, that the amount of blood is compara- 
tively small; although the colored blood corpuscles are seen in 
numbers in every drop of the fluid submitted to microscopic 
examination. After the slight acidnlation of the urine with 
acetic acid, the application of heat, and the removal of the coagu- 
lated albumen by filtration, the fluid, upon cooling, let fall a heavy 
deposit of highly colored crystals of uric acid. 
November 26th p. iu.—Patient has been quite comfortable 
during the day, and appears to be improving. 10 o’clock p. m.— 
Pulse 68, slow and intermittent. Pulse intermits every three or 
four beats. Respiration 26. Temperature of axilla 100° 25' F. 
Had a hard stool at 11 o’clock p. m. 
November 27th—Slept well during the night. 7.30 o’clock a. 
iu.—temperature of axilla 10U F.; pulse 80; respiration 20. 
Patient complains of some pain in muscles of legs; otherwise in 
excellent condition. No medicine. Light diet. Amount of 
urine passed during last 24 hours, November 26th, 10 a. m.- 
November 27th, 10 a. m.—1685 cc; si>ecilic gravity 1016; deep 
red color; clouded when passed, and heavy flocculent yellow 
deposits upon standing. Deposit consists of colored blood cor- 
puscles, yellow granular matter, excretory cells and casts of the 
tubuli uriferi, and malpighian corpuscles and broken capdlariesnml 
cells from mucus membrane of bladder, ureters and pelvis of kid- 
ney, and granular amorphous matter and urates deeply colored 1874.] 
Jones—Natural History of Yelloio Fever. 
483 
by coloring matter of bile. Eeaction of urine acid. Small 
quantities of grape sugar present in urine; and upon standing, 
cells of the torulae were developed. 
1085 cc of urine, excreted during 24 hours November 2Gth—Novem- 
ber 27th, contained 
Urea grains 778.47 
Uric acid 10 85 
Phosphoric Acid 50.01 
Sulphuric Acid 41.08 
Chloride of sodium 0.40 
Dried albumen 2.52 
During health it is probable that the blood chiefly supplies 
the elements of chemical change, but it is evident from the large 
amount of phosphoric acid and sulphuric acid excreted by the 
patient in a state of absolute rest and almost absolute starvation, 
that the nervous and muscular machinery themselves are in- 
volved in the increased chemical changes. After acidulating the 
urine with acetic acid, and after the removal of the albumen by 
filtration, the liquid, upon cooling, let fall a heavy deposit of high 
colored lozenze-shaped crystals of uric acid. 
8 o’clock, p. m.—Pulse 96; respiration 22; temperature of 
axilla 100° 5' F. Pulse still intermittent. 
November 28th.—Rested well during the night; patient says 
that he feels well this morning- 8 o’clock a. m—Tongue moist, 
soft and clean. Temperature of axilla GO'' 2' F.; pulse 86; respi- 
ration 23. Capillary congestion greatly diminished; entire sur- 
face of body of a deep goldeu color. Has some appetite, and 
feels more cheerful; up to present time his spirits have been 
greatly depressed. 
Amount of urine passed during 24 hours—November 27th, 
November 28ch—1350 cc; specific gravity 1016; reaction acid; 
slightly turbid when passed, from presence of urinary casts, cells 
and granular matter. Flood corpuscles and tube casts diminish- 
ing in numbers. Color of urine brownish red. 
1350 cc of urine passed during 24 hours—November 27th, Novem- 
ber 28tli—contained: 
Urea grains, 680.07 
Uric acid 16.20 
Phosphoric acid 46.81 
Sulphuric acid 39.82 
Chloride of sodium 6.23 
Dried Albumen 1.125 484 
Original Communication*. 
[Jan. 
After acidulation with acetic acid, boiling and removal of albu- 
men by filtration, the urine, upon cooling, let fall heavy depo.-its 
ot high colored lozcnge-shai>ed crystals of uric acid. 
The patient was comfortable and cheerful during the day. 
Capillary circulation restored. All appearances of congestion 
and mottling of surface have disappeared, and the deep golden 
color of the skin is beginning to fade gradually. 9 p. m.—Pulse 
70; respiration 24; temperature of axilla 99 3 F. 
November 29th, 8 o’clock, a. m.—Pulse 72; respiration 24; tem- 
perature of axilla 99° 2' F. Patient continues to improve; jaun- 
dice disappearing; capillary circulation good; color of surface 
assuming a normal appearance, and the yellow hue is changing 
to a greenish cast. Appetite improving. Tongue clean. Hays 
that he feels well, with the exception of a slight heaviness of the 
head. Bowels have been moved regularly during the past four 
days. Amount of urine passed during the last 24 hours—No- 
vember 28th, 29th—1840 cc; specific gravity KUO; light red 
color, but much less deeply colored than during the active stages 
of the disease. Colored blood corpuseles, urinary exists and ex- 
cretory eells still present, but in small numbers. 
1340 cc of urine, excreted, during 24 hour*—November 2Hth-2fJth— 
contained: 
Urea grains, 660.35 
Uric acid 10.92 
Phosphoric acid 41.27 
Sulphuric acid 
Chloride ot sodium 4.12 
Dried albumen 0.07 
P. M.—Continues to improve; complains of slight pain in head. 
Pulse 80; respiration 23; temperature of axilla 99° 4'. Bowels 
moved once. 
November 30th, a. m.—Pulse 70; respiration 22; temperature 
of axilla 98° F. Continues to improve; good apfH*tite. P. M.— 
Pulse 08; respiration 22; temperature of axilla 99- 4'. Continues 
to improve. Urine much lighter in color; abundant; and the 
albumen, blood corpuseles and easts, have disappeared; specific 
gravity 1010. 
The convalesence of this patient was now rapid; he continued 
to gain strength, and was in a short time able to resume his i»OHt 
in the Charity Hospital. 
On the 17th of December, he suffered with a paroxysm of malari- 1874.] 
Jones—Natural History of Yellow Fever. 
485 
al fever (chill followed by high fever). I ordered 10 grains of calo. 
mel and 5 grains of quinine, to be followed in six hours by saline 
cathartic; and after the bowels were unloaded, 5 grains of 
quinine every two hours, until twenty grains were taken. 
Under this treatment relief was speedy, and up to the present 
time, August 24tli, 1873, Mr. O. has enjoyed good health, and is 
stouter than ever before, weighing 200 pounds. 
It will be observed that in the preceding case of yellow fever 
there was a marked increase in the urea, uric acid, phosphoric 
and sulphuric acid excretion; whilst there was a marked diminu- 
tion of chloride of sodium. 
There was no haemorrhage from the stomach, but blood was 
discharged by the kidneys. 
It is also worthy of note that grape sugar (diabetic sugar) ap- 
peared in the urine, during the active stages of the disease. I have 
never failed to detect both animal starch and glucose in the yel- 
low fever liver, whilst grape sugar I have found to be absent 
from the liver of malarial paroxysmal paludal fevers. 
In the following case of yellow fever large quantities of albu- 
men were excreted in the urine, and which also contained in 
addition to bile, leucine, tyrosin and hsematin. 
CASE OF YELLOW FEVER COMPLICATED WITH CIRRHOSIS OF 
LIVER: INTENSE JAUNDICE : URINE LOADED WITH ALBUMEN, 
AND CONTAINED ALSO BILE, LEUCINE, TYROSINE AND HH3MA- 
tin; preceding malarial fever and intercurrent pneu- 
monia. 
Charles Bell, age 25, native of St. Louis, Missouri, entered 
Charity Hospital, ward 13, bed 180, October 15th, 1871. Patient 
states that he had been working ou the Jackson Railroad for 
some time and came to New Orleans about two weeks ago (that 
is about the 1st of October), and about the 13th was taken 
with some fever, and being destitute was brought to the Charity 
Hospital for treatment. 
On the morning of his admission, 3d day of disease, was found 
laboring under a severe fever; frontal headache and anorexia; 
conjuntiva and skin tinged of a red color; capillary circulation 
sluggish, giving a mottled, dusky, congested appearance to the 
surface; urine of a deep red color when seen in mass, and of a 486 
Original Communications, 
[Jan. 
bright golden color when seen in thin layers, or spread upon a 
piece of paper. 
The urine was loaded both with bile and albumen, and resem- 
bled to a great extent the urine of yellow fever, only it was more 
deeply colored and of a redder hue than is usual in grave cases. 
Nitric acid produced a heavy precipitate colored of a deep green 
color from the presence of biliary matter, and more especially of 
the coloring matter of the bile. The patient appeared to be 
much prostrated from the fever, anorexia and profuse perspira- 
tion. Skin hot and moist. 
On the morning of admission, I ordered 10 grains of quinine 
to be taken every four hours until 30 grains were administered. 
On the following morning the patient complained of pain in the 
right side, fever, and oppression of breathing; bowels consti- 
pated. Viewing this case as one intimately connected with, if 
not dependent upon the action of malaria, especially too, as the 
patieut had been laboring in a low swampy region, along the 
Jackson and New Orleans Railroad, in the most sickly period of 
the year, 8 grains of calomel combined with 10 grains of quinine 
were administered at the morning visit. Light but nutritious 
diet; beef tea with small quantities of milk punch were ordered 
at regular intervals. 
October 16th; morning.—The calomel has acted freely, but the 
patient is still suffering with high fever; is very restless. Marked 
capillary congestion in the extremities and upon the forehead, 
and dependent portions of the trunk. Surface presents a 
reddish and purplish mottled color. Lower lobe of right lung dull 
upon percussion; complains ot [min in this region. 
Urine copious, high colored, and loaded with albumen and 
bile. 
Five grains of quinine and five drops of tincture of opium 
(laudanum) were ordered every four hours, and this combination 
of the sulphate of quinine with the officinal tincture of opium 
was administered three times a day, at intervals of four hours, 
until the 20th, without producing any |»erceptible change in the 
progress of the disease. It was evident that this was not a case 
of ordinary bilious remittent fever, and that quinine had no 
I>ower to arrest the progress of the disease. 
October 20th.—Fever still continues, with anorexia, restless- 
ness, and great capillary congestion. When the fingers are 
pressed ui>on the dusky, purplish yellow surface of the forehead 1874.] 
Jones—Natural History of Yelloiv Fever. 
487 
and extremities, white or yellowish white marks remain, into 
which the blood sluggishly returns. 
Color of urine when seen in mass, of a deep red color; when 
spread upon paper or a porcelain plate in thin layers, of a deep 
golden yellow. The urine contained a flocculent deposit, which, 
upon microscopical examination, was found to consist of golden 
yellow excretory cells of the tubuli uriniferi, casts of the tubuli 
uriniferi filled with yellow granular matter, and numerous bright 
red annular and acieular crystals, and globular masses of leucine 
tyrosine and heamatin; blood corpuscles, mucus corpuscles, and 
exudation corpuscles. The red acieular conglomerated crystals 
were not dissolved by acetic acid. The excretory cells of the 
kidney contained numerous yellow granules. There were no oil 
globules, as in the urine of many severe cases of yellow fever. 
The casts of the tubuli uriniferi were more delicate, and less dis- 
tended, and contained less granular matter and oil globules than 
similar deposits in grave cases of yellow tever. 
Reaction of urine strongly acid, and remained so at the end of 
GO hours; specific gravity of urine 102G. 
Heavy deposits of golden colored albumen upon boiling, and 
the albumen was coagulated in such large amount as to trans- 
form the whole quantity of urine thus treated into a thick gela- 
tinous mass, resembling “boiled custard.” 
After the coagulation and removal of the albumen, the specific 
gravity of the urine passing through the filter was 1012; thus by 
the removal of the albumen the specific gravity was reduced from 
1026 to 1012. 
G50 cc. (grains 11,901.00) of urine collected during 24 hours con- 
tained: 
Urea grains 401.44 
Uric acid 9.75 
Phosphoric acid 15.93 
Sulphuric acid 17.49 
Chloride of sodium 3.S4 
Chlorine in chlorides 1.20 
Dried albumen 452.40 
A portion of urine was lost during its collection, on account of 
the extreme illness and restlessness of the patient; it is evident, 
however, that there is a marked increase of urea and uric acid 
above the standard of health, during restand starvation. The 488 
Original Comm unications, 
[Jail. 
loss of albumen by tlie urine is also very great, being one ounce 
in the portion of urine collected. 
There is also a marked diminution of the chlorides; and such 
diminution is characteristic of the urine in yellow fever, as it is 
also of the urine of pneumonia, small pox, and some cases of 
typhoid fever. 
Patient complains of severe pain in right side (dulness upon 
percussion over region of lower lobe of right lung); great difli- 
culty of breathing; slight, painful cough, but no expectoration. 
Surface bathed in perspiration; this symptom does not possess 
the same significance that it does in malarial fever. Skin 
of a deep jaundiced hue; capillary circulation very, much 
embarrassed. Tongue red at tip and edges, and fuired in 
the centre. The nurse reports that the patient threw up a small 
quantity of black material, like black vomit, during the night; 
but as the matter ejected was not preserved, it was impossible to 
determine its chemical and microscopical character. In order to 
influence the capillary circulation, and, if possible, to arrest black 
vomit, upon the supposition that it might in a measure depend 
upon a want of tonicity in the capillaries, in some measure at 
least, I ordered 40 drops of the tincture of ergot every three 
hours. 
O.tober 21st, 10 a. m,—Patient very restless and feeble; great 
difficulty and oppression of breathing; great capillary congestion 
of surface and dependent portions of body. Eyee watery. Con- 
junctiva and skin deeply jaundiced. At times slight wandering 
of intellect. The patient complains of pain in right side. Tongue 
red at tip and edges, and coated in the centre. Anxious counte- 
nance. Patient complains of pain in head and side. Some apa- 
tite for food. Pulse 130; respiration 18; temperature of axilla 
102"" 5'. The nurse states that the patient again threw up black 
vomit during the night; matter again not saved. 14—Pulv. 
ergot, grs. xv; divide into three powders: one jiowder every four 
hours. 14—Olei terebinth, fsiij; syrupi simp., fjvj; mix: table- 
spoonful every three or four hours during the day. 
Amount of urine collected during the past 24 hours, 500 cc.; 
a ]>ortiori appeared to have been lost. Urine of red color, when 
seen in mass; in thin layers, of a golden color; when shaken in 
a bottle, it presents an oily ap|»earance; when dopped upon white 
bibulous paper, it gave a golden yellow stain like bile. The 
urine contained a fiocculent deposit; the deposit was found, ui>on 1874.] 
Jones— Natural History of Yellow Fever. 
489 
microscopical examination, to consist chiefly of casts of the tubuli 
uriniferi, excretory cells of the kidney, granular fibroid and albu- 
minoid matter, altered colored blood corpuscles, and accicular, 
globular, and stellate conglomerate crystals of leucine, tyrosine 
and heamatin. 
Reaction of urine strongly acid, even at the eud of 60 hours. 
Urine heavily loaded with bile and albumen. Specific gravity 
of urine 1026; specific gravity after removal of albumen by heat 
and filtration, 1012. 
When heated, the urine formed a yellow gelatinous mass, of 
the consistence and color of “boiled custard.''’ 
The following is the analysis of that portion of the urine which 
was collected: 
500 cc (8013.06 grains) of urine, collected during 24 liours, con- 
tained: 
Urea grains 308.80 
Uric acid 7.50 
Phosphoric acid 21.61 
Equivalent of phosphorus in phosphoric acid 9.50 
Sulphuric acid 13.72 
Equivalent of sulphur in sulphuric acid 5.48 
Chloride of sodium 3.03 
Chlorine in chloride of sodium 1.84 
Dried albumen 348.00 
The patient became more restless during the night. In the 
evening, S p. m., pulse 140; respiration 52; temperature of axilla 
103° 5 F. Later iu the night, although the patient was unable 
to articulate distinctly, he appeared to suffer excruciating pain 
in the right side and in the head. 
The great difficulty of breathing, and livid color of the blood 
in the capillaries, during the past four or live days, appeared to 
be due to the congestion of the lungs. 
11 p. m.—Pulse 130; respiration 52; temperature of axilla 
103° 5. 
Died at 5 o’clock, a. m., October 22d. 
Amount of urine collected during the last 24 hours of life, 300 
cc.; specific gravity 1028; red color, when seen en masse; golden 
yellow iu thin layers. Heavy fiocculent deposit, consisting of 
casts of the tubuli uriniferi, excretory cells of the kidney, altered 
colored blood corpuscles, and crystals of leucine, tyrosine and 
heamatin. 490 
Original Communications. 
|Jnn. 
Reaction of nrine decidedly acid, and continued so for two 
days. Upon standing, the urine emitted a foul, stinking odor. 
Urine loaded with albumen and bile; specitlc gravity of urine 
after coagulation and removal of the albumen 1014; it is evident 
that the albumen had increased the density to 1028. 
The microscopical and chemical characters ot the urine were 
similar in all respects to those observed in the preceding sam- 
ples 
30!) cc of urine (grain* 4731.G) collectctl during the last 24 hours 
of life contained: 
Urea grains 198.17 
Uric acid 4.50 
Phosphoric acid 5.55 
Equivalent of phosphorus in phosphoric acid 2 44 
Sulphuric acid 14.92 
Equivalent of sulphur in sulphuric acid 5.96 
Chloride of sodium 3.G8 
Chlorine 1.91 
Dried albumen 207.14 
We have in this case, a progressive diminution of the urinary 
excretion whilst the temperature remained at an elevated point; 
urea must, therefore, to a certain extent, have accumulated in 
the blood; but this accumulation was much less than in many 
grave cases of yellow fever attended with great nervous agita- 
tion, restlessness, convulsions, vomiting of alkaline black vomit 
and coma. 
The elevation of temperature as well as the rapid pulse and 
rapid labored respiration were evidently due to pleuro pneumonia 
engrafted upon yellow’ fever. 
\Vre observe a great relative increase of the sulphuric acid, and 
a marked decrease of the chlorides, and an abundant transuda- 
tion of albumen and bile, together with hiematin, colored blood 
corpuscles, leucine and tyrosine. 
AUTOPSY FIVE HOURS AFTER DEATH. 
Exterior.—Dependent portions of head, neck, trunk, and ex- 
tremities of a deep purplish and yellowish purple mottled color. 
Superior portions of the face, trunk and extremities, w here the 
capillary congestion was less, of a bright yellow’, jaundiced color. 
Thorax.—The sinapism had produced a decided blister, uj»on 1874.] 
Jones—Natural History of Yellow Fever. 
491 
the right side, the cuticle being denuded, and the raw surface 
presented a dark purplish line. 
Pleura of right side, firmly bound, in several places, by adhe- 
sions of coagulable lymph, which appeared to have been thrown 
out for some time, and was undergoing transformation into 
organized fibrous tissue. 
Superior portion and surface of pericardium of heart also cov- 
ered with golden colored coagulable lymph. 
Muscular structures of heart pale, and more flabby than usual, 
but of a deeper color than in cases of yellow fever which ran 
their course without any inflammatory complication. 
Cavities of heart filled with loosely coagulated blood. 
Lungs.—Greatly congested; lower portions of right lung con- 
gested with blood, as if there had been rupture of the vessels, 
and effusion of blood among the tissues. The congested or hcpa- 
tized portion of lung sank when immersed in water. 
The cut surface of the muscles of the thorax and abdomen 
changed to a bright hue when exposed to the atmosphere. 
Abdomen.—Mucus membrane of stomach rose colored and 
punctated, but less congested than is usual in yellow fever. 
The stomach contained no black vomit. 
Liver.—Of a yellow mottled appearance, the lobuli beingdis- 
tinct, with congested centres, of a purplish yellow color, and 
peripheral portions of a deep yellow. The lobuli started out 
when cut, and the organ was evidently cirrhosed previous to the 
supervention of the fever, and was firmer than is usual in un- 
complicated yellow fever. 
The liver contained numerous oil globules, but they" were 
neither so large nor so numerous as in yellow fever livers, which 
were in a healthy state previous to the supervention of the 
disease. The liver cells also were paler, and contained less oil 
and granular matter than in uncomplicated yellow fever. 
Masses of altered hematiu were observed chiefly in the peri- 
phery of the lobules of the liver. The presence of these black pig- 
ment granules, and masses of altered hsematin, indicated that this 
patient had suffered with malarial fever before, and perhaps at 
the time of the recent fatal illness, and the correctness of the 
diagnosis was thus established. 
Spleen.—Somewhat enlarged and softened, but not, however, to 
so marked an extent as in uncomplicated malarial fever. 
Kidneys.—Of a yellow granular appearance. The yellow granu- 492 
Original Communications. 
[dan. 
lation was most marked in the cortical portions. Color of kidneys 
orange yellow. Under the knife the kidneys appeared firmer 
than usual, and as if cirrhosed. Capillaries of kidneys congested; 
the congestion was greatest in the capillaries of the malpigkian 
corpuscles. 
When carefully prepared sections of the kidneys were viewed 
under the microscope, the capillaries of the malpighian corpuscles 
were tilled with colored corpuscles, whilst the tulrali uriniieri 
were encumbered, in some cjises impacted, with yellow granular 
matter, exfoliated excretory cells, and oil globules. Acetic acid 
rendered more evident the granular albuminoid or fibroid mat- 
ter in the urinary tubes, and also revealed degeneration of many 
of the excretory cells. 
Gall Jiladtler.—Only partially filled with bile, only 200 grains 
being obtained. Specific gravity of b.le 1041; bile thick and 
turbid. Numerous cells from the mucus membrane of the gall 
bladder floating in the bile. When seen on masse, the bile | re- 
sented a deep greenish yellow color; in thin layers, a golden 
yellow eolor. 
Commentary.—The preceding case of yellow fever appears to 
have been preceded by cirrhosis of the liver and kidneys and 
malarial fever, and to have been complicated during its progress 
by the supervention of pneumonia, pleuritis and pericarditis. 
The fatal issue of the case appeared to have been determined 
chiefly by the inflammatory complications, and to the same causes 
must be referred the rapid pulse, rapid labored respiration and 
elevated temperature. The preceding cirrhosis of the liver and 
structural alterations of the kidneys were probably the result of 
the prolonged action of the malaria. 1 have carefully observed 
a number of cases of cirrhosis of the liver sensed by the pro- 
longed action of malaria, and atn convinced that this condition 
of the liver, resulting from malaria, may Ixj clearly distinguished 
from that induced by alcoholic stimulants, by the presence of 
numerous black pigment granules scattered through the lobuli, 
and by the absence of any marked increase of oil globules in and 
around the hepatic cells, capillaries and ducts. 
I have never observed black pigment granules occurring in 
cirrhosis induced by spirit drinking, and uncomplicated by the 
action of malaria. 
I low far the increase of albumen in the urine may have been 1874.] 
Jones—Natural History of Yelloio Fever. 
493 
due to the preceding alterations of the kidneys I am unprepared 
to say; but that this condition was not without some effect upon 
the urinary excretion must be admitted. 
During the three last days of the life of this patient 1007.54 
grains of dried albumen escaped in the urine; and the actual 
quantity was probably much greater. The albumen was separat- 
ed with the greatest care, and was carefully washed with diluted 
nitric acid and with alcohol and ether before desiccation. 
In these analyses, as well as in all the others recorded in these 
pages, the sulphuric acid of the urine wras pieeitipated with the 
nitrate or chloride of barium, after the complete removal of the 
albumen by heat and coagulation and filtration; and the nitrate 
of silver was in like manner employed for the precipitation and 
determination of the chlorine. The balance, and not the method 
by tritration, was employed in these determinations, and the 
results were as accurate as it was possible to make them by the 
careful performance of all the various processes. 
1007.54 grains of albumen, excreted during the last days of 
life, represented the albumen of 14,397.G4 grains of blood. 
It will be a question for future research, as to the occurrence 
of globulin in the urine of yellow fever, associated with the albu- 
men. 
In some recent observations, E. Hefsen affirms, with some 
degree of confidence, that he has found globulin in thirty-one 
cases of albuminuria (Virchow’s Archives, vol. lx., p 437); it 
must be admitted, however, that the separation and determina- 
tion of the globulin, with any approach to accuracy, is attended 
with difficulties and even uncertainties, especially when the 
globulin exists only in small quantities. 
We will consider, in the next place, those cases of yellow fever 
in which the urine is either greatly diminished in amount or 
wholly suppressed. 
DIMINUTION AND SUPPRESSION OF URINE IN YELLOW FEVER. 
Case of Yellow Fever: Suppression of TJrine—Jaundice—Copious 
Alkaline Black Vomit—Fatal Termination—Post-mortem Examina- 
tion—Lesions Characteristic of Yellow Fever— Urea and Bile De- 
tected in the Brain, Heart, Liver and Spleen—Little or no Urea 
Detected in the kidneys. 
Newton Simpson; age 21; native of Western Virginia; admit- 
ted into Charity Hospital October 12th, 1871. 494 
Original Communicationn. 
[Jan. 
Patient gives an imperfect account of his sickness; says that 
he has been living in St. Louis for some time; came down to 
New Orleaus ten days ago; was taken sick a few days after his 
jwrival. 
On questioning the patient closely, it appears that he was 
taken sick about six days ago with fever, thirst, anorexia and 
pain in the head, back and limbs. Patient is unable to state how 
long these symptoms lasted, but not getting lietter, he came to 
the Charity Hospital. On admission he complained of pain in 
the back, head, and over the region of the stomach, thirst and 
fever. At the present time, eyes, tongue, skin and mucus mem- 
brane of mouth, congested; tenderness upon pressure over abdo- 
men. Urine of a golden color, loaded with albumen, and greatly 
diminished in amount. Urine turbid from the presence of urin- 
ary cells ami casts. 
October 13th; evening.—Patient says that he feels letter, but 
he is still in an unnatural state, like one intoxicated. Tempera- 
ture of axilla 100° F.; pulse 80; respiration 10. Ordered the 
urine saved at 1 o’clock p. m. The nurse and attendants were 
strictly charged to save every particle of urine passed by the 
patient, 
Octol>er 14th, morning.—Vomited some broad which he had 
eaten against orders; complains of nausea. Temperature ot 
axilla 101° F.; pulse 72; respiration 10 per minute. Mustard 
plaster ordered over region of stomach. Diet, beef tea; frag- 
ments of ice in mouth to allay thirst. 
Amount of urine collected during 24 horns—October 13th, 11 
a. m., to Octolier 14th, 11a. in—110 cc. (grains 2H33.0); specific 
gravity 1012. Urine of a golden yellow color, slightly turbid. 
The urine contained a light flocculent deposit, which under the 
microscope (powers varying from 1-5 to 1 20 of an inch) was 
resolved into oil globules, casts of the tubuli uriniferi, ami granu- 
lar, fibroid and albuminoid matter. The casts of the tubuli 
uriniferi were coini>oscd chiefly of yellow granular fibroid matter. 
When first passed, the urine contained no living microscopical 
plants or animals perceptible under the highest powers, but after 
standing for some time, vibrios made their appearance. Vibrios 
form in this moist, warm climate, in very short jwriods of time, 
in all organic solutions, esj»ecially when albumen is present. 
When treated with acetic acid, lozenge shaped crystals of uric 
acid made their appearaucc. The yellow granular matter of the 1874.] 
Jones—Natural History of Yelloic Fever. 
495 
urine in this case appeared clearly to have been derived from 
the kidneys, as it was insoluble iu acetic acid and in the mineral 
acids, and often presented the form of the tubuli uriniferi, as 
if the agglomerations had been formed in the tubuli uriniferi, 
and were subsequently expelled. The tubuli uriniferi, and ex- 
cretory cells of the kidney, were loaded with yellow granular 
matter and oil globules, and were numerous. 
A portion of the yellow granular matter forming the deposit in 
the urine consisted of urate of ammonia, for acetic and hydro- 
chloric acids caused the separation of well defined lozenge shaped 
crystals of uric acid. 
180 cc. (grains 2833.6) of urine was the whole amount passed 
during this period, and the bladder at this time contained no 
urine, as was conclusively shown by the failure of the catheter to 
draw off any urine. 
Specific gravity of urine 1011; urine of a light yellow color. 
Reaction slightly acid. The acid reaction of the urine continued 
even to the end of the third day, although the temperature of the 
surrounding atmosphere was high. At the end of this time it 
gave only a faint urinous odor. 
As far as my observation extends, the urine of yellow fever, 
when fresh is free from any disagreeable odor, and in some in- 
stances, when freshly drawn, emits a faint sweetish aromatic 
odor. 
180 cc. (grains 2833.6) of urine contained: 
Urea grains, 77.81 
Uric acid 14.40 
Phosphoric acid 11.106 
Equivalent of phosphorus in phosphoric acid 4.87 
Sulphuric acid 6.175 
Equivalent of sulphur in sulphuric acid 2.46 
Chloride of sodium 3.649 
Actual amount of chlorine in urine 2.224 
Dried albumen 5.82 
Fixed saline constituents 10.80 
We observe from the preceding analysis, that the urine pre- 
sented very nearly the composition of a similar amount of this 
excretion in health, with the exception of a great increase of 
uric acid (14.4 grains), aud a relative increase of phosphoric acid, 
and the presence of albumen, granular albuminoid matter, and 
urinary casts and excretory cells. 496 
Origi nal Com m unicot ions, 
[Jan. 
October 14th.—Patient restless and in a state of delirious in- 
toxication; has passed no urine since early in the morning. 
Tongue dry, very red at tip and edges, and coated in the middle. 
Mucus membrane of gums, mouth and eyes, congested; counten- 
ance dull and lethargic. The patient, however, when roused, 
says he is well and 1‘eels hungry and desires something to eat. 
The patient, however, is in an unnatural state, resembling that 
induced by alcohol and certain narcotic poisons, in some in li- 
viduals. The muscles of the face twitch nervously; the patient 
is very restless aud appears to be wholly oblivious to his distress- 
ing condition. 
The skin of the face presents a dusky, jaundiced hue; there is 
great capillary congestion, especially of the extremities. When 
the dusky, purplish, red surface is pressed with the linger a 
white spot is left, into which the blood slowly returns. 
Patient has passed no urine during the day, and the use of the 
catheter shows the urine to be completely absent from the blad- 
ber. Tern ;>erature of axilla 100° 8'; pulse 80; respiration 18. 
October 15th, 9 a. m.—Complains of pain in region ot stomach; 
has been vomiting black vomit during the night and morning. 
Patient verv restless, with a mottled, congested appearance 
of the surface. Tongue dry and red; pulse full, regular, and 
apparently good, 80 per minute; respiration -0; iemi»erature of 
axilla 101r F.; patient dull, lethargic, but not actively delirious. 
The black vomit was carefully collected, and subjected to an 
immediate examination. 
This specimen corresponded in its general character to the 
typical black vomit of many writers. It consisted of a thin 
liuid, holding in sus(>ension dark flocculi and coffee-like, or dark 
brownish black granules. The dark masses tended to settle, ami 
above the dark granules the liquid was clear. 
Reaction of black vomit, acid. 
Under the microscope numerous altered blood corpuscles were 
observed diffused through the liquid, and the dark floccnlent 
masses were found to be composed of altered blood corpuscles 
and fragments of the coloring matter of the blood. Numerous 
cells of the mucus membrane of the stomach were also present; 
and the cells apj>eared to have undergone a change similar to 
that observed in the excretory cells of the tubuli uriniferi, and 
were tilled with numerous small granules aud oil globules. 
When the black vomit was carefully examined under magnify- 1874.] 
Jones— Natural History of Yellow Fever. 
497 
ing powers varying from 1- 5 to 1-18 of an inch, a few vibrios and 
a delicate branching fungus were seen, resembling those com- 
monly developed iu putrid fluids with great rapidity iu this warm, 
moist climate. 
The blood poured out into the stomach in yellow fever rapidly 
undergoes change from the loss of digestive power in the stomach, 
and from the presence of the urinary constituents eliminated 
by the gastric mucus membrane: the blood oozing from the 
gums and lips also undergoes decomposition and forms the 
nidus for the development of numberless plants and animalculse 
of simple organization. 
I have as yet been able to establish no relationship between 
the organic forms of black vomit and the characters, symptoms 
and progress of the disease. There appears to be no relationship 
of cause and effect between them: the presence of these forms 
appears to be a mere coincidence. 
I also clearly observed under the microscope a number of 
broken capillaries iu this sample of black vomit, which were filled 
with blood corpuscles variously altered in shape. 
Specific gravity of black vomit 1008 
Reaction of black vomit Acid. 
Solid matter in 100 parts of black vomit grains, 2.3 
“ “ “ 1000 “ “ “ 23.00 
Water « “ “ “ “ 977.00 
Solid matters of black vomit consisted chiefly of colored blood 
corpuscles, coloring matter of the blood, and albumen. 
Saline matters in 100 parts of black vomit 0.2 
“ “ “ 1000 “ “ “ 2.00 
Organic matters in 1000 parts ) Organic matters 21.00 
of black vomit ,23.00 f 8aline matters 2.00 
On account of the great restlessness of the patient, one-tliird 
of a grain of morphia was administered by subcutaneous in- 
jection. 
Evening.—No urinary secretion; complete suppression of urine 
during the past 24 hours. The morphia induced some rest, and 
appeared to arrest the vomiting. Capillary circulation greatly 
embarrassed. The injection of morphia was repeated, but with 
no perceptible effect, the stagnation of the blood iu the capilla- 
ries apparently preventing its absorption. Pulse slow and 
moderately full. 498 
Original Communicationa. 
| Jan. 
The patient died at 10 o’clock, p. m., and up to the time of 
death no urine had been passed. 
There was complete suppression of uriue during the last 40 
hours of life. 
AUTOPSY TEN HOURS AFTER DEATH. 
Exterior.—Black vomit running from tlie month. Superior 
portion of skin and face golden colored. Lower dependent por- 
tions of a mottled, dark purplish and yellow hue, as if the body 
had been beaten with a club. Muscular, well built subject. 
Head,—The membranes of the brain were congested, but not 
to a greater extent than is usual in fevers. There were no marks 
of inflammation or of exudation upon the membranes of the 
brain. The congestion appeared to be of the nature of a simple 
stasis of blood. 
Weight of brain 55£ ounces. 
Structure of brain moderately firm; no serous accumulations. 
In ventricles of brain only a small amount of serous fluid. The 
suppression of urine was not in this case attended with increase 
ot the serous fluid of the ventricles of the brain. 
After careful microscopical examination, with powers varying 
from \ to 1-18 of an inch objective, and the various occularies, l 
was unable to detect any structural alterations in the ganglionic 
cells or commissures of the brAin; neither were any living animal 
or vegetable cells or spores, however small, discovered. 
When the brain was finely comminuted in a porcelain mortar, 
and distilled water added in sufficient amount to make a thin 
paste, and then boiled, and the fluid filtered off from the coagiu 
lated nervous structures, the decoction presented a golden yellow 
color. Careful chemical examination showed that this color was 
due to the presence of bile. 
The watery extract was then slowly evaporated to dryness 
and treated with alcohol. The alcoholic extract in like manner 
presented a golden yellow color, and contained some of the con- 
stituents of bile. When the alcoholic extract thus obtained was 
allowed toevaporateslowly under the microscope upou a glass slide 
or in a watch glass, crystals of leucine, phosphate of ammonia, 
chloride of ammonium aud of urea, made their appearance. 
When chemically pure nitric acid was added, numerous lozenge 
shaped and tabular, rectangular, thin crystals of urea made their 1874.J 
Jones—Natural History of Yelloic Fever. 
499 
appearance. The urea appeared to be at least one thousand fold 
more abundant in the textures of this yellow fever brain than in 
the brain of those subjects whose kidneys have acted fully and 
freely up to the moment of death. 
The existence of urea in this brain, in considerable quantities, 
was clearly demonstrated to several distinguished physicians of 
New Orleans, as well as to a large number of students of the 
Medical Department of the University of Louisiana. 
Both bile and urea were thus shown to have accumulated in 
the brain of this yellow fever subject. 
Thorax.—Lungs congested with blood. The capillary conges- 
tion was especially intense in the more dependant portions. 
The tendency to capillary congestion in yellow fever is one of 
the most marked characteristics, and atfects all the organs and 
tissues. The distension of the capillaries with blood, and the 
bloody appearance of the muscular structures, cellular tissue, 
aud lungs especially, are due in great measure to the arrest of 
the functions of the kidneys and liver, and the retention, not 
only of the excrementitious materials, but also of the watery 
element of the bile and urine. 
When careful sections of the lungs were made, with Valentin’s 
knife, the microscope revealed a distended and congested state 
of the capillaries, which were impacted with colored blood cor- 
puscles. Nothing further, however, was discovered in this ex- 
amination; no animal or fungoid forms were discovered in the 
blood of the capillaries of the lungs, or in the air cells. 
Heart.—The heart contained in all its cavities dark fluid blood. 
The muscular structures of the heart presented a yellow color, 
like that of the kidneys, and appeared as if they were undergo- 
ing fatty degeneration. The muscular textures were softer than 
usual. The muscular structures of the heart were carefully ex- 
amined under the microscope, and the fibres were found to have 
lost their distinct transverse markings, and to have become 
loaded with oil globules. Oil was deposited throughout the tex- 
tures of the heart. 
Weight of heart, 8£ ounces. 
When the fibres of the heart were crushed in a mortar, and 
subjected to similar treatment to that employed in the examina- 
tion of the braiu, the watery and alcoholic extracts presented a 
golden color, from the presence of the coloring matter of the bile. 
The watery extract, or rather, decoction of the heart, before fil- 500 
Original Com m un i cat ion*. 
[Jau. 
tration, resembled a rich soup made from mai row of bones, the 
surface of the porcelain evaporating dish containing the decoc- 
tion being covered with a thick scum of yellow oil. 
When the alcoholic extract from the evaporated residue of the 
watery extract of the heart was evaporated slowly in a watch 
glass, crystals of chloride of ammonium, leucine and of urea, 
were clearly observed under the microscope. 
Chemically pure nitric acid, added to the watery extract, ob- 
tained from the residue of the alcoholic extract or solution (which 
was itself obtained from the residue of the water extract obtained 
directly from the structures of the heart), developed numerous 
characteristic lozenge shaped and tabular crystals of nitrate of 
urea. 
EXAMINATION OF THE HLOOI) FROM THE CAVITIES OF TIIE 
HEART. 
Reaction of tlie blood from the cavities of the heart, acid. 
Under the microscope many of the blood corpuscles presented a 
crenated wrinkled appearance, others were swollen, whilst others, 
again, presented a normal appearance. 
1 could not, after careful examination with high powers, detect 
any animalcuhe or simple vegetable forms in the blood, although 
the search was conducted with great care, with i>owersof various 
degrees, from the 1—4 to the 1-18 inch objectives, the magnifying 
power with the highest objective reaching 1050 diameters. 
The blood was fluid, with little or no fibrin or fibrinous clots. 
The fibrin was in so small amount, and in such a soft (readi- 
ly dissolved) condition that it was impossible to estimate the 
amount. 
Specifiic gravity of blood 1046 
1000 parth of blood contained: 
Water 852.70 
Solid residue 147 'to * °rtf»nic matter 137.50 
Solid residue, 147.JO }Fixod 8alinecon8fcitnents 0.80 
The sjiecific gravity of the blood from the heart was lower, and 
the solid matters less than in the blood of the vena cava. 
From experiments which I have conducted, it apf»ears that 
the 8|>ecific gravity of the blood in the cavities of the heart, 
after death from yellow fever, is less than that contained in the 
large blood-vessels. 1874.] 
Jones—Natural History of Yelloic Fever. 
501 
This appears to be due to several causes, as the effusion of the 
more watery elements of the muscular structures of the heart 
through its walls after death, into its cavities, and also be- 
cause this organ continues to circulate the blood, or rather, to 
force it through its cavities during the last moments of life; the 
red blood corpuscles are thus gradually arrested in the capilla- 
ries, and only the more tenuous or serous portions of the blood 
are returned to its cavities during the last momeuts of life. 
Alimentary Canal.—Mucus membrane of stomach intensely 
congested. The stomach contained only a small quantity—about 
fjj—of dark, thick black vomit, which emitted a foul, offensive 
smell, and contained numerous blood corpuscles, and cells of the 
mucus membrane of the stomach, and fragments of capillaries, 
loaded with colored blood corpuscles. With the exception of a 
few vibrios, no vegetable or animal forms were observed. 
The mucus membrane of the stomach presented an intensely 
injected appearance, and a deep purplish color. 
The reaction of the black vomit and mucus membrane ot the 
stomach was alkaline, and a rod, dipped in hydrochloric acid and 
held over the stomach, gave forth dense white fumes, from the 
presence of ammonia and carbonate of ammonia. The reaction 
between the hydrochloric acid and volatile alkali of the black 
vomit was marked, and the fumes of chloride of ammonia very 
dense. The urea eliminated by the stomach had been partially 
converted into ammonia and carbonate of ammonia: we say par- 
tially, because I found upon analysis, urea in considerable 
amount. 
The extract of the different organs also contained carbonate of 
ammonia; and this fact indicates either that the urea was par- 
tially converted into carbonate of ammonia in the blood, or else 
that this substance was reabsorbed from the gastro-intestiual 
mucus membrane. 
Keaction of small intestines alkaline. The fluid contents of 
small intestines contained ammonia. 
Spleen.—Weight of spleen, 12£ ounces; somewhat enlarged, 
and somewhat softer than usual in yellow fever. Splenic mud 
consisted of numerous colored corpuscles, and oil globules and 
granular masses; but no animal or vegetable forms were ob- 
served. 
Blood corpuscles of spleen not specially altered in appearance. 
Oil globules abundant in spleen. The spleen, as well as the 502 
Original Commitnicatiom. 
[Jan. 
heart and brain, contained urea. The decoction of the spleen 
presented a mahogany brownish red color, from the presence of 
the coloring matter of the blood. 
Liver.—Of a yellow box-wood color, resembling a fatty liver. 
Under the microscope the liver appeared to bo tilled with oil. 
The liver cells were distended with oil and granular matter, and 
the hepatic ducts appeared to be blocked up with oil globules 
and granular matter. 
The liver cells presented a swolleu, spherical appearance, and 
were distended with oil and granular matter. The changes of 
the liver were similar to those of the heart and kidneys. The 
matter deposited in the liver was not, however, entirely oil, but 
was of a fibroid and albuminous character, and was coagulable 
by heat. 
Weight of liver, 42 ounces. 
After standing 24 hours, the blood from the cut surface of the 
liver gave an acid reaction, and was found under the microscope 
to contaiu numerous prismatic crystals of the phosphate of am- 
monia, magnesia and lime. 
The blood of the liver contained numerous oil globules, but no 
specific animalcules or vegetable organisms. The reaction of the 
cut surface of the liver, wheu first removed from the body, was 
in like manner acid. 
Bile—Gall-Bladder.—Only partially filled with bile, and pre- 
sented a flaccid appearance. The coats of the gall-bladder ap- 
peared to be thickened. 
Specific gravity of bile, 1042.5. 
The bile gave forth, after standing a few hours, a most disa- 
greeable, stinking odor. 
The bile was thick, grumous and ropy. When viewed en 
masse, the bile presented a dark greenish brown, almost black 
appearance. 
The gall-bladder contained only 100 grains of this thick ropy 
bile. Upon careful evaluation, the 100 grains of bile yielded 
14.25 grains of solid residue; and upon incremation, 1.1 grains 
of saline matter. 
1000 parts o/ bile contained: 
Water M57.40 
Solid residue 142 50 \ °r&anic raatter .131.50 
fcoim residue, 14- j; 8aiine Inatter 11.00 
In this case the bile was almost as rich in solid matter (rela- 1874.] 
Jones—Natural History of Yelloic Fever. 
503 
tively) as the blood. iEther throws down the coloring matter 
from the alcoholic extract of the bile in yellow fever, but the 
etherial extract, as is usual with human bile, yields upon evapo- 
ration no crystals under the microscope. 
Under the microscope the bile was found to contain some blood 
corpuscles, and epithelial cells and casts of the biliary tubes, 
composed of granular, fibroid or albuminous matters, similar to 
those found in the tubuli uriniferi of the kidneys. 
Kidneys.—Weight, lOf ounces. These organs presented a 
light yellow color, similar to that of the liver. Under the micros- 
cope, it was found that both the cortical and medullary substauce 
of the kidneys were filled with oil globules. 
When careful sections of the kidneys were made, with Valen- 
tin’s knife, and examined under different powers of the micros- 
cope, the malpighian corpuscles were greatly congested with 
blood, and the tubuli uriniferi and excretory cells filled with oil 
globules and yellow, granular fibroid matter. 
The bladder of this patient contained after death 100 cc. of 
urine; this was the entire amount excreted by the kidneys, from 
October 14,11 a. m., to October 15th, 10 p. in., the moment of 
death. 
During a period of 35 hours, therefore, only 100 cc. of urine 
were separated from the blood. 
The urine presented a light golden yellow color, and turbid, 
oily appearance. 
Specific gravity of urine, 1012. 
The urine, upon standing, let fall a heavy light-colored floccu- 
lent deposit. Under the microscope this deposit was found to 
consist of casts of the tubuli uriniferi, filled with granular mat- 
ter. Sections of the kidney of this yellow fever patient were 
carefully compared with the deposits under the microscope, and 
the tubuli uriniferi in both were found to have undergone a 
similar change. In fact, the tubuli uriniferi of the kidney itself 
were loaded with oil globules and granular matter, of a yellow 
color, in a precisely similar manner. 
Somewhat similar appearances are presented in the urine of 
malarial heamaturia; that is, in some cases, after congestion of 
the kidneys resulting in hemorrhage has continued for varying 
lengths of time, exfoliation of the excretory tubes and cells takes 
place; but the casts and cells are not of the golden hue of yellow 
fever, they are frequently either stained with the heamatin of the 504 
Original Communicationh. 
[Jan. 
blood, or else the urinary tubes are loaded with altered blood 
corpuscles and the altereil coloring matter of the blood. 
ANALYSIS OF TIIE URINE ABSTRACTED FROM THE BLADDER OF 
TniS PATIENT AFTER DEATH. 
Amount of urine excreted (luring the last 35 hours of life, 100 
cc. (grains 1580.74); reaction, acid; specific gravity 1012. 
100 cc. of urine (grain* 1580.74) excreted during 35 hours con- 
tained: 
Urea grains, 33.90 
Uric acid 2.00 
Phosphoric acid 4.32 
Equivalent of phosphorus ill phosphoric acid 1.89 
Sulphuric acid 2.74 
Equivalent of sulphur in sulphuric acid 1.09 
Chloride of sodium 7.70 
Chlorine in urine 4.09 
Fixed saline constituents 0.00 
Dried albumen 9.00 
This sample of urine approached more nearly to the standard 
of health, in its chemical constitution, than that excreted on the 
14th of October. Thus in the latter the uric acid was greatly in- 
creased, amounting to 14 grains. 
If the two analyses of the urine of this patient be combined, 
we will thus have a correct view of the amount and character of 
the urinary excretion during the last 59 hours of life. 
Urine Ferreted during 24 IInure—October 13, 
11 a. in., October 14/A, 11 a. in.—180 cc. 
(grain* 2033 6) contained : 
Urea.. — grs. 77 81 
Uric acid 14.40 
Phosphoric acid .11.10 
Phosphorus in phosphoric acid 4.87' 
Sulphuric acid ~..8.17 
Sulphur in sulphuric acid 2 44 
Chloride of sodium .3.84 
Chlorine 2 22 
Fixed saline constituents 10.0' 
Dried albumen. 5.82 
Urine Ferreted during 35 Pour*—October 
14/A, II a. m., to October 15/A, 10 p. in.— 
10) cc. (grain* 1600.70) contained: 
Urea »/••■ 33 90 
Uric acid lot 
Phosphoric acid 4.33 
' Equi valent of phosphorus 1,09 
Sulphuric acid. 2 74 
Sulphur in sulphuric acid 1.00 
j Chloride of sodium. 770 
Chlorine 4 09 
Kixed saline constituents 0.00 
1 Dried albumen 9.00 
If the preceding analyses be combined, we will then have the 
analysis of the urine excreted duiing 59 hours, as iu the following 
table. 1874] 
Jones— Natural History of Yelloic Fever. 
505 
Urine excreted during 59 hours—October 13th, 11 a. m., to Octo- 
ber 15tk, 10 p. m.—280 cc. (grains 4414.30) contained: 
Urea grains 111.77 
Uric acid 16.40 
Phosphoric acid 15.42 
Equivalent of phosphorus in phosphoric acid G.7C 
Sulphuric acid 8.91 
Equivalent of sulphur in sulphuric acid 3.55 
Chloride of sodium 11.34 
Chlorine in urine (chloride of sodium) 6.91 
Fixed saline constituents 16.80 
Dried albumen 14.82 
It is thus established that during the last 59 hours of life, only 
111.77 grains of urea were excreted by this patient, notwith- 
standing that there was fever and great nervous agitation, rest- 
lessness, and aberration of intellect, which are always accompanied 
by an increased formation of urea. 
It would be just to estimate the amount of urea actually formed 
within the system, during the last 59 hours of life, at not less 
than 1500 grains; the amount may have greatly exceeded this 
calculation: if from this be subtracted the actual amount ex- 
creted by the disabled kidneys, we have, as the result, not less 
than 1388.23 grains of urea remaining in the system. The amount 
was probably much greater, as the cessation of the function of 
the kidneys was most probably gradual and not sudden. 
We have in this large amount of urea retained in the blocd 
and various organs, and especially in the brain, as shown by 
actual analysis, an explanation of the peculiar state of intoxica- 
tion manifested by the patient, as well as the existence of alka- 
line black vomit. 
CASE OF YELLOW FEVER: ALKALINE BLACK VOMIT; SUPPRES- 
SION OF URINE; DEATH; PATHOLOGICAL LESIONS. 
Jacob Siegarest; age 26; native of Germany; admitted into 
Charity Hospital October 14th, 1871. 
Patient states that he came from Havre, three months ago, to 
New Orleans, since which time he has been living at 433 Tchoupi- 
toulas street. ‘‘Was taken sick with fever” five days ago. At 
the present time—October 14th, evening—intellect dull, and the 
patient appears to be unable to express his feelings or explain 506 
Original Com m unications. 
| Jan 
his symptoms. Commenced vomiting blood shortly after his ad- 
mission into tho hospital, and this vomiting has continued up to 
the present time, at short intervals. The blood is gulped up 
with little or no effort. 
Patient lies quiet; does not complain of any pain, or even un- 
comfortable feeling. When, however, pressure is made over the 
region of the epigastrium, shows signs of distress. Complexion 
jaundiced and dusky; tongue dry, red at tip and edges; tracheal 
mucus membrane of mouth and gums congested; dark blood 
oozing from gums. Capillary circulation feeble and depressed. 
When pressure is made upon the discolored mottled surface, tho 
blood is forced out of the sluggish capillaries and a white spot 
remains, which gradually assumes the dusky, congested appear- 
ance, as the dark blood slowly returns. Pulse 84, full and appa- 
rently of good volume; respiration 10; temperature of axilla 
1(XT o'. 
It is worthy of note, that in ranee of uncomplicated yellow fever, 
during the most dangerous period, viz., that characterized by exhaus- 
tion,passive hemorrhages, black vomit, jaundice, and suppression 
of the urine, neither the respiration nor the pulse are increased in 
frequency, and may be even slower than in health. 
When, however, an inflammatory disease is engrafted upon yellow 
fever, as pneumonia, pleuritis, pericarditis, or abscess, the pulse and 
respiration are both increased in frequency. 
October 14th, morning.—Bowels opened once during tho night; 
vomited black blood this morning. Condition of patient much 
the same, only he appears weaker and more lethargic; appears 
to be wholly unconscious of his condition, notwithstanding that 
dissolution appears to be imminent. Temperature of axilla lor F.; 
pulse 02; respiration 20. Has passed no urine since admission 
into the hospital; catheter introduced, and only about one drachm 
(GO drop*) of turbid yellow urine were drawn off. Reaction of 
urine, acid. Urine contained bile, and was also loaded with 
albumen. Under the microscope, the turbidity of the urine was 
found to l»e due to the presence of numerous casts of the urinary 
tubes, fdled with granular, fibroid matter and oil globules: the 
excretory cells of the tubuli uriniferi, and from the pelvis of the 
kidney, were also present m large numbers. 
Evening.—Patient has remained in the same listless, depressed 
state, without active delirium, and apparently wholly unconscious 
of his distressed state. Htill vomiting small quantities of dark, 1874.] 
Jones—Natural History of Yellow Fever. 
507 
defebrinated blood. Has passed no urine during the day; it is 
impossible to draw off any by the catheter, and the bladder is 
entirely empty. The kidneys have ceased to act. 
Temperature of axilla 100c F; pulse 80; respiration 18. 
EXAMINATION OF BLACK VOMIT. 
It should be borne in mind that this patient has suffered with 
complete suppression of urine since his entrance into the hospital. 
The catheter was introduced, as we have said, several times, and 
only upon the first introduction was about one drachm of light 
colored yellow turbid urine drawn off, which, as we have stated, 
was loaded with albumen and urinary casts and cells. This 
represents the whole amount of urine excreted during 30 hours. 
At the present time, October 15th, the patient gulps up, with 
little or no apparent effort, what resembles almost pure dark 
defibrinated blood. As we have stated, this vomiting of blood 
was noticed shortly after his entrance into the hospital. 
The black vomit resembles in appearance and in color, dark 
defibrinated blood. 
Under the microscope, the black vomit was found to consist of 
numerous blood corpuscles, with some mucus cells and broken 
capillaries filled with blood corpuscles; but no living vegetable 
or animal organisms were discovered with the highest powers of 
the microscope. I have kept blood drawn from yellow fever 
patients, also sections of the liver, taken from the bodies of yel- 
low fever patients after death, upon my table, freely exposed for 
days and weeks, and months, in this warm, moist climate, and 
examined with the microscope and with the naked eye, the vege- 
table structures which formed within and upon the surface, 
reasoning thus—that if the disease had been caused by fungi, 
they would sooner or later make their appearance upon the sur- 
face of the organs and blood, which were supposed to form a 
nidus for their development. 
Up to the present time, nothing peculiar to yellow fever has 
been discovered. Blood now standing upon my table, exposed 
in an open beaker glass (said blood having been drawn, some 
two weeks before, from the arm of a yellow fever patient), has 
upon its surface a light white mould, which presents under the 
microscope the appearance of the yeast plant. Similar growths 
appeared upon starch and urine, and albuminous fluids, and 508 
Original Communicatiom. 
[Jan. 
upon organic substances which had no connection whatever with 
yellow fever. 
ANALYSIS of black vomit, ejected by this tatient during 
LIFE. 
Black vomit resembles dark grnmons dcfibriuated blood. 
Black vomit emits a disgusting putrid odor. 
Specific gravity of black vomit 1020. 
Beaction of black vomit, alkaline. 
Heavy fumes of chloride of ammonium evolved, when a glass 
rod dipped in hydrochloric acid is held over the black vomit. 
Careful chemical analysis demonstrated the presence, in the 
black vomit, of both ammonia and ukea. 
The urea was separated from the black vomit with great 
care, and every precaution was employed in the analysis to 
secure accurate results. 
1000 part* of black romit contained: 
Water 935.20 
Organic matter, consisting 
chiefly of colored blood cor- 
puscles, altered coloring matters 
of the blood 
Albumen 
Urea 
Ammonia 
Solid residue, 74.80 
72.20 
Fixed Haline constituents 2.00 
The black vomit was carefully examined for inm, and this 
constituent was present in the same relative proportion that 
would have been present in an equivalent amount of ordinary 
blood. 
The presence of unaltered blood corpuscles, as well as of the 
broken capillaries, in the black vomit, is proof that there is a 
solution of continuity of the mucous membrane of the stomach 
in some cases of yellow fever; and that black vomit is not a 
secretion, strictly so called, although it may be intimately asso- 
ciated with the elimination of certain elements of the urine, by 
the gastric mucus membrane. 
The cells of the mucus membrane of the stomach weie filled 
with granular matter and oil globules; thus indicating that a 
similar change takes place in the mucus membrane of the stomach, 
which is so marked in the excretory structures of the kidueys. 1874.] 
Jones—Natural History of Yelloiv Fever. 
509 
This patient died, October 16th, at 0 a. m., without becoming 
actively delirious, although the intellect was sluggish and wan- 
dering. 
AUTOPSY THREE HOURS AFTER DEATH. 
Exterior.—Black vomit had run out of the mouth down the 
sides of the face and along the chest. Complexion, golden yel- 
low; dependent portions of body mottled with yellow and purple; 
intense capillary congestion of dependent portions of the trunk 
and extremities. 
Thorax.—Heart of a light yellow color, relaxed and flabby. 
Weight of heart, ounces. Under the microscope, the textures 
of the heart were found to be loaded with oil globules. 
The decoction of the heart was covered with a thick layer of 
golden-yellow oil, resembling the rich soup from marrow bones. 
The alcoholic extract from the watery extract gave crystals of 
leucine, and chloride and phosphate of ammonia, and urea, under 
the microscope. 
When treated with nitric acid, numerous well formed lozenge- 
shaped crystals of nitrate of urea were developed. 
Both cavities of the heart contained warm fluid blood, which 
gave a slight acid reaction to litmus blue, and upon standing, 
coagulated, forming a soft gelatinous clot, which possessed no 
contractile power. 
The aorta, vena cava, and pulmonary arteries and veins, in like 
manner, contained warm fluid blood, which coagulated imper- 
fectly upon standing. 
EXAMINATION OF FLUID BLOOD, FROM CAVITIES OF HEART, 
THREE HOURS AFTER DEATH. 
The blood, after its abstraction, coagulated, forming a loose 
clot; the fibrin, however, rapidly dissolved, and no serum was 
separated. 
Under the microscope, the blood corpuscles presented no spe- 
cial alteration: when spread upon the glass slide, and also during 
the coagulation of the blood, they rapidly agglomerated together, 
forming rouleaux, as in inflammatory diseases. 
The running together of the colored blood corpuscles was as 
rapid and complete as in cases of well marked inflammation. 
It was impossible to determine the weight of the fibrin, or to 510 
Original Communications. 
[Jan, 
collect pure serum, free from the colored blood corpuscles and 
the coloring matter of the red corpuscles, as the fibrin rapidly 
dissolved. 
The fibrin appeared to bo in very small amount; it was not 
more than one-twentieth of the quantity usually found in healthy 
blood. 
Specific gravity of blood from the cavities of the heart, 1047. 
1000 part* of blood from the cavitiex of the heart contained: 
Water 821.57 
Organic matter 
Colored corpuscles 
Albumen-fat 
Urea ammonia, extractives... 
Solid residue, 1,8.43 
170.59 
Fixed saline constituents 7.84 
Fibrin Trace. 
EXAMINATION OF FLUID BLOOD FROM VENA CAVA A8CENDEN8, 
THREE HOURS AFTER DEATH. 
Specific gravity of blood from vena cava, 1002. Blood of vena 
cava fluid and warm when first drawn; coagulated, forming a 
very loose coagulum, which did not enclose the whole amount of 
colored blood corpuscles. 
This coagulum gradually dissolved, and it was impossible to 
determine the amount of fibrin, or to obtain clear serum free 
from colored corpuscles. 
Reaction of blood from vena cava, slightly acid. 
1000 part* of blood from rena cava contained: 
Water 775.00 
Organic matters 
Colored blood corpuscles.... 
Albumen fat and extractives. 
Urea and ammonia 
217.13 
Solid residue, 225.00 
’ 
Fi'>rin Truce. 
Fixed Haline constituents 7.01) 
It will be observed from the preceding analysis, that the blood 
in the vena cava contained more solid matter than that obtained 
from the cavities of the heart. It would appear that the return- 
ing current of blood from the capillaries and venous system, 
owing to the tendency to coagulation, and to the settling of the 
colored corpuscles, contained more solid matter than the blood 
of the heart. 1874.] 
Jones—Natural History of Yellow Fever. 
511 
After careful microscopical examination, I was unable to dis- 
cover any animal or vegetable organisms in the blood. 
Abdominal Cavity—Stomach.—The stomach contained a small 
quantity—about one fluid drachm—of black vomit, which gave 
a strong alkaline reaction. Under the microscope, the black 
vomit was found to consist chiefly of colored blood corpuscles, 
cells of the mucus membrane of the stomach, and broken capil- 
laries, floating in an alkaline albuminous fluid. 
Reaction of mucus membrane of stomach, strongly alkaline. 
When a rod dipped in hydrochloric acid was held over the 
mucus membrane of the stomach, dense white fumes of chloride 
of ammonium were given off. 
Enaction of intestinal canal, in like manner, alkaline from the 
presence of ammonia. 
After careful microscopical search for living organisms, no 
vegetable cells or animalculse were discovered in the contents of 
the stomach or intestines. 
The cells of the mucus membrane of the stomach were filled 
with oil and granular matter (the oil in the form of small glo- 
bules), and presented an appearance similar to those of the kid- 
neys and liver. 
This observation appears to throic some light upon the causes 0/ 
blade vomit, and indicates that the poison of yellow fever affects the 
mucus membrane of the stomach, producing profound alterations") 
similar to those existing in the liver, hidneys and heart, as if the most 
active organs were those most subject to its action: this icould most 
probably be the case if the poison acted chiefly uponjthe blood. 
Liver.—Weight of liver, 48f ounces. Liver of a uniform yellow 
color; the appearance and color of this organ was characteristic 
of yellow fever. 
Liver loaded with golden yellow oil. Oil, in the form of glo- 
bules, existed within and around the liver cells and capillaries. 
The hepatic capillaries contained oil globules and granular 
matter. The structures of the liver also contained much yellow 
granular albuminoid matter. 
The granular matter found in the liver of yellow fever is simi- 
lar to that observed in the kidneys, and is different from that 
black granular pigmentary matter of malarial fever, which is 
thickly deposited in the lobuli of the liver, being, as a general 
rule, most abundant upon the periphery of the lobuli, and in the 
capillaries of the portal system. 512 
Original Communications. 
fJan. 
1 hare never observed in the yellow fever liver the disorganized red 
corpuscle* and masse* of heamatin characteristic of malarial fever. 
This observation applies to uncomplicated yellow fever. When, how- 
ever, yellow fever is engrafted upon malarial fever, or occurs in one 
who had suffered at some previous time with a prolonged attack of 
malarial fever, the pigment granules are present. A nd without doubt, 
the contradictory statements of the appearance of the liver in yellow 
fever, may to a certain extent be referred to the presence or absence 
of the effects upon this organ of the malarial poison. 
Both the watery and alcoholic extracts of the liver were of a 
golden color, and contained bile. Leucine and urea, ami am- 
monia salts, were detected in the alcoholic extract obtained 
from the watery extract of the liver. 
Urea in considerable amount was determined by the standard 
chemical method. 
After standing 24 hours in a porcelain dish, the blood which 
flowed gradually from the cut surface of the liver was found, 
under the microscope, to contain numerous prismatic crystals ot 
triple phosphate and oil globules, but no specific animal or vege- 
table organisms. 
The gall-bladder was flaccid, and contained only 110 grains 
of dark green, almost black, bile. In thin layers the bile pre- 
sented a golden yellow color: a few drops of this concentrated 
bile were sufficient to color, of a decided yellow color, a large 
basiu full of water. 
Specific gravity of bile, 1040. 
110 grains of bile contained: 
Water grains, 80.55 
Organic matters 13.45 
Saline constituents 1.20 
1000 parts of bile contained: 
Water 877.73 
Solid residue, 122.27 
Organic matters 110.82 
Fixed saline constituents 11.45 
The coloring matters of the bile were precipitated by aether 
from the solid residue in considerable amount; but, as is usual 
with human bile, no crystalliue substances were obtained. 
Kidney*.—Somewhat congested. The kidneys presented a yel- 
lowish color, or rather brownish yellow color, of a similar but 
deeper shade to that of the liver and heart. 
The structures of the kidney cut under the knife like those of 1874] 
Jones— Natural History of Yellow Fever. 
513 
the liver. There were no granular appearances, as in cirrhosis, 
or granular degeneration. Tubuli uriniferi filled with oil glo- 
bules and granular matters. 
The decoction of the kidney contained bile, but yielded little 
or no urea. This was the case with the kidneys in the previous 
case. It would appear that the urea was in greater amount in 
the brain, next in the heart, then in the liver and blood, and 
lastly, in the kidneys. This organ without doubt continued to 
excrete the constituents of urine, as long as life lasted, in very 
small amount, and it is to this cause that we must attribute the 
small amount of this constituent in these organs. We have in 
such facts a refutation of the views held by certain physiologists, 
that urea is formed in the kidneys. I could get only traces trom 
these organs, by processes which yielded abundant crops of crys- 
tals from the brain. Weight of kidneys, 12£ ounces. 
The bladder, after death, contained only 115 cc. of urine, which 
was the whole amount excreted by the kidneys from the entrance 
of the patient into the hospital up to the time of death. 
The urine gave an acid reaction immediately after its removal 
trom the bladder, three hours after death. The urine, however, 
changed in 24 hours to an alkaline reaction, and then threw down 
an abundant crop of crystals of triple phosphate, and emitted a 
most foul stench, resembling that of the American Polecat. The 
odor was disgusting in the extreme. 
Specific gravity of urine, 1012. 
The urine contained a flocculent deposit, consisting of granu- 
lar matter, casts of the tubuli uriniferi, and cells from the excre- 
tory structures of the kidney. 
Here, then, in these two cases of yellow fever, lying side by 
side, in the same ward, in adjoining beds, almost, precisely the 
same amount of urine was obtained from the bladder after death; 
the physical and microscopical characters were the same; the 
chemical characters also were alike. 
Specific grvity of urine 1012. 
Amount of urine obtained from bladder after death, 115 cc. 
(grains 1821.G) representing the whole amount of urine excreted 
during the last 45 hours of life. 514 
(friginal Com m unicalions. 
| Jan 
. Urine excreted during 43 hours (grains 1821.0) contained: 
Urea graius 35.74 
Uric acid Undeterinined. 
IMiosphoiic acid 2.12 
* Phosphorus in 'phosphoric acid 0.03 
Sulphuric acid 7.10 
Sulphur in sulphuric acid 2.84 
Chloride of sodium 4.00 
Chlorine in chloride 2.83 
Fixed saline constituents 5.75 
■ Dried albumen .. 11.42 
Spleen.—Weight, 5£ ounces. Spleen not enlarged but normal in 
appearance; under the microscope the splenic mud contained, 
in addition to altered colored corpuscles, numerous oil globules. 
Decoction of spleen contained both urea and uric acid. 
The urea was in less relative amount in the spleen than in the 
liver and brain. 
The whole amount of urea excreted during the last 45 hours 
of life amounted to only 35.14 grains. The amount of urea re- 
tained in the blood of this patient, in consequence of the sup- 
pression ot the action of the kidneys, was therefore as great 
as in the preceding case, and the peculiar state of intoxication 
must be referred, in like manner to the retention of the urinary 
excretion. 
It is evident that during the active stage of yellow fever pro- 
found changes take place in the organs and tissues, and especially 
in the kidneys, heart and liver; and oil and granular fibroid or 
fibroid matters transude through the capillaries, and till up the 
cells and excretory ducts, and arrest the functions of these organs. 
The appearance of albumen in the urine of yellow' fever is 
attended also with the presence of casts of the tubuli uriniferi, 
and also of the excretory cells of the kidney. This phenomenon 
resembles that of scarlet fever, and also of malarial luematuria. 
In intermittent, remittent and pernicious malarial paroxysmal 
fever, uncomplicated by hemorrhage from the kidneys; albumen 
and casts are almost always absent, as I have demonstrated by 
numerous careful chemical and microscopical examinations, and 
the urine presents periodic changes in its constitution corres- 
ponding with those of the paroxysms. 
Thus, during the chill, and at the commencement of the 
hot stage of malarial paroxysmal fever, phosphoric acid dis- 1874.] 
Jones—Natural History of Yclloic Fever. 
515 
appears almost entirely from the urine; as the hot stage 
progresses, and the febrile action and the heat commence to 
decline, there is an augmentation of phosphoric acid, and 
most generally heavy crystalline deposits of the triple phos- 
phates ami amorphous urates; uric acid is either increased 
or remains at the normal standard during the chill, dis- 
appears almost entirely during the fever, and then increases 
rapidly, and rises to a high figure after the subsidence of the 
febrile excitement, and very often continues, for days, two, three, 
and even six times more abundant than in the normal state. 
Both urea and chloride of sodium appear in increased quanti- 
ties during the chill and fever. If the disease be prolonged, the 
chloride of sodium progressively decreases, from the diminution 
of the usual supply of food during the fever, whilst the urea re- 
mains in large amount. 
The fever of the first stage of yellow fever, likefevei in general, 
however caused, consists essentially in elevation of temperature, 
arising from chemical changes in the blood and tissues, and is 
attended with changes in the physical and chemical constituents 
of the blood, and aberrated nervous action. As long as the skin, 
kidneys, lungs, and gastro-intestinal canal perform their func- 
tions, this stage is characterized, as in other fevers, by an in- 
crease in the amount of solids excreted. But this increased 
elimination of the products of chemical change is not, in yellow 
fever, a constant concomitant of the increased temperature, be- 
cause, in virtue of the lesions of certain organs, as the kidneys 
and skin, the constituents of the urine and bile accumulate in 
the blood, and become the active agents in the production of 
aberrated nervous and muscular actions, and even of death 
itself. 
USTot only are large quantities of the products of oxidation 
formed during the hot stage of yellow fever, but, as we have 
shown by numerous analyses of the blood, black vomit, urine, 
brain, heart, liver, spleen and kidneys, in this disease, they are 
altered to a certain extent from those conditions characteristic 
of health; the albumen of the blood, under the action of the 
poison, being transformed iuto nitrogenous and noil-nitrogenous 
compounds, a portion of which, as the fatty matter and altered 
fibrin, being arrested, or accumulated in certain organs, as the 
heart, liver and kidneys. 
The importance of the preceding observations, upon the con- 516 
Original Comm unicat ions. 
[Jan. 
stitution and changes of the urine in yellow fever, are placed in 
a clear light, when they are considered in connection with the 
causes of death in this disease. Thus death may he caused in 
yellow fever: 1st; by the direct action of the febrile poison upon the 
rlood and nervous system, depressing and deranging the action 
of the one, and rendering the other unfit for the proper nutrition of 
the tissues; 2d—by the suppression or alteration, or diminution of the 
Junctions of certain organs, as the KIDNEYS and the LIVER, and the 
retention in the blood of the excrement it ious matters normally elimin- 
ated by these organs; 3d—by the structural alterations of the HEART, 
and consequent loss of power in this organ; 4tli—by profuse 
HAEMORRHAGE from the STOMACH and ROWELS; r>th—by the ab- 
sorption from the stomach and bowels of putrid slack vomit, 
which acts as a powerful poison, deranging the blood, and prostrat- 
ing the nervous and muscular forces. 
493 St. Charles Street, New Orleans, La. 
October, 1873. :