Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair.

  • Blair, Daniel.
Date:
[1856]
Catalogue details

Licence: Public Domain Mark

Credit: Report on the first eighteen months of the fourth yellow fever epidemic of British Guiana / by Daniel Blair. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    third clay the punctuations will have fused, and a continuous crimson, appearance will be formed. On the fourth or fifth day, if the disease has been aborted, or subsided after acid elimination, the dottings will be restored, and then speedily disappear. These little speckles are sometimes faint red, and sometimes fiery; but in all cases are distinctly discernible through any fur that may be on the tongue. At the tip and edges, the usual site of morbid redness, the tongue is always clean. When the dots project above the surface, these sparse papillae are always crimson or scarlet. The general appearance of the tongue, however, is imiform red- ness of the tip, or tip and edges together; and the general shape is in- clined to be compressedj or wedge-shaped. If we might describe by differences—the contrast with a yellow fever tongue would be a broad, flat, flaccid, pale tongue, round at the tip, and broad and indented, or thin and diaphanous at the edges—a tongue, as if slightly (Edematous, and circulating little red blood in its capillaries. Such a tongue, in a yellow fever patient, would be clean gain. The next change which appears in the yellow fever tongue refers to the upper flat surface. The fur, which at first is smooth and unifoi-m, seems as if it had been curdled, and lies on the surface in innumerable little greyish-white wavy flakes. This appearance is most observable when the tongue has been broad and sordid. In the case books of the hospital it is called curdled—-it might be called pilose, or villous. But its first name is derived from its close resemblance to milk acted on by acids, and from the idea, once enter- tained, that it was perhaps induced by the vomiting of the first acid- matters of the stomach. But although it is generally associated with that stage of the disease, it is not in the relation of cause and eSect, for this condition of the tongue has frequently been observed previous to the stage of acid elimination. A modification of the curdled tongue is the tessellated tongue. In this case the villi are not tufty and flaky, but appear like separate pavement-shaped forms on the surface of the tongue. This is a more advanced stage of the morbid tongue, but the altered appearance is probably due to a gi-eater shortness of the villi from wear. The tongue (where there is no inflammatory complication or head aSec- tion) is always sufiiciently moist during its changes. The next step in the tongue symptom is the peeling of the epithelium. This generally begins at the point, and proceeds to the edges and down the raphe, and may continue till the whole surface is denuded and the papillse obliterated, and the tongue becomes smooth and dryish, and the colour and appearance of raw beef This desquamation of the tongue, as in the fatal case of Juan de Nobriga, may extend into the larynx and bronchi, causing complete ajihonia and dry sonorous rhonchi under the stethoscope. It is seldom that the basement membrane is eroded or ulcerated; but this sometimes happens. In the late stages the tongue is liable to be iucrusted by the buccal haemorrhage. In one case, ulceration of the tonsils was observed. One death occurred from gangrene of the larynx, and suflbcation therefrom. In the smouldering form of yellow fever, and when the case is passing into convalescence, and where there has been little peeling of the epithelium, the fur at the base and centre fre- (juently apj)ears as if stained with tobacco juice. This appearance can seldom be traced to any lesion of the tongue itself, but is found to be a