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.

    18/96 (page 16)
    always add in the first stage, and continues so generally till convalescence, when it becomes alkaline, or until it becomes heavily charged with bile. In the case of Macey (Seaman's Hospital), the urine in the advanced stages was neutral on being passed, and immediately became intensely alkaline. This happened also in the case of EUwood (Seaman's Hospital). These instances of alkalinity in fresh urine seemed due entirely to tlie presence of ammonia. Numerous experiments on the specific gravity of the urine were made without any striking general result being elicited. During the early stage of the fever the urine is normal in colour, clear- ness, and quantity. As the disease proceeds, about the third day, the colour alters, and becomes that of sulphur, or primrose, or straw, or light gamboge, and is perhaps slightly turbid, with a little floating sediment. The colour, during the progress of the disease, deepens, till it becomes yellow or orange; and if the case end in convalescence, the urine is veiy copious, and may appear, en masse, black. As the colour deepens, the sediment becomes more decided, both in quantity and gravity. It is, however, seldom very considerable in quantity, and might escape careless casual observation. But in one case, that of Theodore Temaban (Sea- man's Hospital), it contained a sediment which occupied one-half the m'inal. If the case is going to terminate with suppression, it generally does so in an abrupt manner. At other times, when the event is to be the same, the urine is expelled of an amber colour and of an oily con- sistency, and in quantities of a drachm to an ounce, as if with some tenesmus of the bladder. In one case only was diuresis noticed (Barnet, Seaman's Hospital, March, 18.53) during the active course of the disease. This was after the use of a tobacco clyster, and was at last followed by fatal suppression. About the month of June, 1853, the physical appear- ance of the urine was for a few weeks considerably altered. It then had a pale watery or smoky appearance, with a layer of blood corpuscles as a sediment; and in some cases the lu-ine was very bloody. In uncomplicated yellow fever the urine is never buff nor red (unless fi-om blood), and a glance of it at the bed-side of the patient has been sufficient to correct at once erroneous impressions as to the nature of the case. Fevers of rheu- matic and inflammatory origin have thus been discriminated from the epidemic. A pinkish sediment was observed in a few intermittent fever complications. Malingering is very rare during an epidemic; indeed, among the seamen, the chief difficulty lay in inducing them to enter the hospital early enough. There was one exception, however, and he was detected at once by the urine. Quillan, on the 9th of February, 1853, returned to the hospital after having been discharged cured of an attack of yellow fever. He complained much of nausea, and showed copious vomit in his basin. Pulse was very quick, and he looked ill and pros- trated. On looking at his ]iot, full of pale, non-coagulable ui-iue, his case ■was seen through fortliwith. He was partly maliiigering and partly suffering from hysterical excitement. On further inquiry, I found that he came from the Cojna, tlie master of which we had had fined for neglect of his sick men, and who liad the very worst reputation among the seamen for his severity or brutality. The Copia was about to sail, and Quillan's plan for leaving the vessel was to sham sickness. The crisis of his fate rendered him nervous, and his urine betrayed him. The