[from the southern medical AND SURGICAL JOURNAL, AUGUSTA, JAN. 1857.] 
ADDENDUM 
To the "Essay on the Relation of Bilious and Yellow FeverT 
By Richard D. Arnold, M. D., Professor of the Theory and 
Practice of Medicine in the Savannah Medical College. 
Since the reading of my essay, several circumstances have 
occurred to me which I consider as bearing directly and practical- 
ly on the subject treated therein. 
The beginning of each summer, since our epidemic of 1854, has 
been a time of anxiety for many citizens, and the physician was 
often catechised as to his opinion, whether or not, Yellow fever 
was likely to appear. Being no prophet, I could not answer such 
queries; but, I always said, that if we had such an awfully hot 
summer as that of 1854, I should look out for an epidemic. The' 
difference of mean temperature does not give any correct idea of 
the relative heat of two summers. According to the registry pub- 
lished in our newspapers in 1855, the mean temperature of July, 
1854, was but one degree above that of July, 1855. When I 
state that the register was kept by my scientific friend, Dr. J. F. 
Posey, its correctness will not be doubted. Now, the contrast as 
to feeling was immense. July, 1855, was a remarkably pleasant 
month: July, 1854, will live in the memories of those who swel- 
tered under it in this city, as by far the hottest and most oppres- 
sive month ever experienced by the "oldest inhabitant." 
Measles prevailed epidemically, and with unusual severity dur- 
ing the latter part of January, and during February, March and 
April. 
In May, there was very little sickness of any kind. It is very 
rare ever to see a periodical fever of any type in that month. I 2 
was called on the 21st May to see a boy, a native, aged about seven 
years. I found him with a diarrhoea, and a good deal of general 
fever: I treated him accordingly. The fever abated notably to- 
wards evening, and the next morning it as notably exacerbated, 
again remitting at night to a perfect apyrexia. As there was thus 
evident periodicity, I determined to use quinine, which I did. 
On the morning of the 23rd, the apyrexia continuing, there being 
no pain of any kind, no nausea, a pulse down to 80, the skin of 
a temperature to entitle it to be considered normal, quinine was 
again given and kept up all day and in the evening, I quitted my 
patient for the night without the slightest anxiety. At sunrise, I 
was aroused by a hasty summons, and I found things very much 
changed with my little patient. The face was pinched, the nostrils 
dilated, the eyes sunk-, the complexion pallid, the expression of the 
face anxious and haggard, the pulse small, weak and compressible, 
A dark stain on the sheet attracted my attention. I was 
told that at about two o'clock, he began to be nauseated, and 
shortly after, threw up the black stuff which stained the sheet. 
The vomiting had continued until my visit. While examining 
him he threw some of it up, with the spasmodic jerk so often no- 
ticed, and it was literally squirted over my clothes. This contin- 
ued all day, until death closed the scene on the same evening. 
He was a very delicate child. What was his disease? I an- 
swer unhesitatingly, a case* of sporadic Yellow fever. The apy- 
rexia was the deceitful calm so often met with in that type of fever. 
About the black vomit, there could be no doubt. It was at once 
recognized by those about the child, for they had seen such too 
frequently in 1854. 
As I will not indulge in speculation, but deal only with facts, 
let us pass on through the summer. June was remarkably pleas- 
ant and remarkably healthy. On the 3d of July, I was called to a 
case in consultation with my friend, Dr. Wragg. He informed me 
that the patient had thrown up black vomit, in which I agreed 
with him after I had examined the ejecta. The skin was discolor- 
ed of a universal yellow. Death soon let down the curtain of 
existence. 
Here, again, was an undoubted case of sporadic Yellow fever. 
A singular fact is connected with the last case, a gentleman of 
about thirty-five years of age. He had passed untouched, through 3 
the epidemic of 1854, from beginning to end, and was a most ac- 
tive and untiring member of the Young Men's Benevolent Associ- 
ation ; for often and often had I met him during that fearful season. 
In neither case could an autopsy be obtained. 
Up to the very end of September, I never experienced a healthier 
summer in twenty-six years' practice. After a cold period of wea- 
ther at that time, there was a warm period. The cold had not 
produced any frost. I ascertained from various authentic sources 
that the sweet potato vines were not even wilted. During Octo- 
ber, there was a good deal of malarial fever, and of a congestive 
type. 
While attending a case of hydrocephalus, in consultation with 
my colleague, Dr. J. B. Bead, he informed me that he had a case 
of fever which looked very suspicious, as his eyes were bloodshot, 
his pulse was sixty, and there was glairy vomiting, and he feared 
black vomit would follow. 
On Thursday, the 23rd, he did throw it up. On Sunday, the 
26th, I saw the patient and the black vomit. Every symptom 
announced genuine Yellow fever. Here was another sporadic 
case of Yellew fever. An important question to determine, in 
case of death, was, will it present the same pathological appear- 
ances as a case of epidemic Yellow fever? 
With but faint hopes of recovery we gave him very large doses 
of acetate of lead, and champagne frappee, freely. 
He died on the night of the 28th. Dr. Read fortunately suc- 
ceeded in obtaining permission for an autopsy, which was made 
the next morning by Dr. Bead, and by my pupil, Mr. Theodore 
McFarland, who was in the Savannah epidemic of 1854, and then 
conducted my autopsies, and was one of the Savannah volunteers 
who went to Norfolk in 1855, assisted by my other pupils, Messrs. 
Joseph M. Turner and Franklin Jones. 
The notes were taken by me on the spot, and sanctioned by Dr. 
Read, who, in addition to his experience here in 1854, was sent 
on by the City of Savannah to Norfolk, in 1855. 
Autopsy fourteen hours after death. Body fat, of a bright yel- 
low color. 
Liver, enlarged, filled with bloody serosity, presenting the pecu- 
liar box-wood color, described before as the characteristic color of 
Yellow fever livers as presented in this locality, during a period 
of time now covering twenty-nine years. 4 
The acini were not distinct, the liver when cut, was smooth and 
compact The liver was much enlarged. The pancreas was also 
very much enlarged, and had tubercular deposites in the circum- 
jacent glands, and under the peritoneal coat. 
Spleen was enlarged, of a lively purple color. 
Stomach was intensely and uniformly injected, of a dark red. 
The veins of the stomach were very much congested, showing 
themselves by a black streak, as well as by their distension. The 
blood in them was black and fluid. The mucous membrane at 
the cardiac extremity tore off in flakes a quarter of an inch long; 
in the larger curvature the flakes were half an inch long. 
The mucous membrane was mammellonated over most of its 
surface. Black specks could be seen scattered about all the surface. 
Lungs healthy. 
Heart softened, the finger passing easily through the walls of 
the right auricle. 
There was a very large deposit of fat in the omentum. Several 
of the glands near the pancreas were enlarged, and contained a 
black fibrinous deposit resembling the softening coagulum of an 
aneurism. 
The gall-bladder contained a small quantity of thin dark bile. 
Not a trace of bile could be found in the intestinal tube, from the 
cardiac orifice to the anus. 
The kidneys were natural. There had been the usual suppres- 
sion of urinary secretion. 
The head was not examined, because it was not affected until 
shortly before the termination of the case. 
Dr. Read saw autopsies of Yellow fever in 1852, in 1854, and 
in Norfolk in 1855; Mr. McFarland, in 1854, here, and in Norfolk 
in 1855. They all agreed as to the perfect similarity of all the 
Yellow fever livers they had ever seen. 
I consider it useless to spin out any further proof. The color 
compared well and accurately with the lithograph of the Yellow 
fever liver executed for me, by Thomas Sinclair & Co., of Phila- 
delphia, which, with the two others of the bronzed liver, and the 
varieties of colors of Bilious fever liver, executed by the same 
artists, from drawings from nature in my possession, will be sent 
to the various members of the profession to whom these articles 
will be sent in a pamphlet form, 5 
Let us hasten on and ascertain if any of the peculiar colors of 
the Bilious fever liver can be found at the present day. 
A British seaman, in the Marine Hospital, came under my care 
in my clinic at the hospital, on the loth of November. He had 
been aboard of his ship for five weeks. Now frost did not occur 
until the first week of November, and consequently he had been 
exposed to the exhalations of the concentrated poison of malaria 
late in the fall. 
Without going into detail, suffice it to say, the case was 
marked by distinct periodicity, by the pallid anaemic hue so 
peculiar to malarial fevers, and many cases of which I have point- 
ed out this season to my class, in cases of prolonged malarial 
intermittent. 
There was always a torpor about him, and two days before he 
died, he sank into a profound stupor. He died on the 22nd, at ten 
o'clock, P. M., and was examined thirteen hours afterwards. 
Body, considerably reduced. Sallow, pallid, anaemic hue. 
Head. Very little blood in sinuses or veins, a good deal of se- 
rum escaped while taking out the brain. 
The arachnoid was distinctly pearl-colored and opaque where it 
passes over the interstices between the convolutions of the brain ; 
also, where it passes from the nates and testes to the medulla ob- 
longata. I cannot say the effusion was as great as I have often 
seen. The substance of the brain was anaemic. There were a great 
many air-bubbles under the arachnoid. 
Spleen, usual color, perhaps a little enlarged. 
Kidneys, much larger than natural, nothing peculiar inside. 
Liver, externally, of a bluish slate color. 
Gall-bladder, distended with bile. Liver undoubtedly enlarged 
about a third above its ordinary size; when cut into, of a uniform 
bronze color, easily broken, friable, breaking into small pieces, a 
good deal of serum in it. 
Stomach. Mucous membrane injected, arborescent towards 
cardiac extremity. Towards the greater curvature, it was of an 
olive color, with, occasionally, spots of a blackish brown. 
The mucous membrane was thickened and corrugated, a piece 
of white paper rubbed on its coat, received a yellow tinge of bile. 
A piece rubbed on the cut surfaces of the acini of the liver, also 
received a decidedly yellow tinge. The lower part of the ileum 6 
was cut open;-it was perfectly sound and contained yellow bilious 
matter. 
The foregoing facts prove conclusively, that sporadic cases of 
Yellow fever do occur, having all the symptoms of those during 
an epidemic, and the same pathological appearances after death.