The palate is congested and swollen; the gums may also swell and bleed.
The congested appearance of the face at the onset of the disease tends to subside; so that by the time the asthenic stage is reached the features may have become shrunken and small, the eyes sunken, and the eyelids discoloured by ecchymoses.
In some cases the skin is hot and dry throughout; in others it may be bedewed with perspiration from time to time; or the sweating may be constant, especially so if collapse sets in.
By the third day the scleræ assume a yellowish tinge, and very often the skin acquires the yellow colour from which the disease derives its name. It must not be understood, however, that every case presents this colour of skin; in some it is entirely absent, but if carefully looked for there is always some yellowness of the sclerae to be discovered. The yellow tinging of the skin generally shows about the end of the first stage, deepening in intensity as the case advances, and remaining apparent for a considerable time after convalescence has become established. It ranges in depth from a light saffron tint to a deep mahogany brown. In fatal cases it is always present; not necessarily during life, but invariably after death. The skin in bad cases is said to emit a peculiar odour like gun washings, or, as Jackson puts it, like the smell of a fish market.
Petechia], erythematous, papular, and other eruptions may show themselves in different cases; but in yellow fever there is no characteristic eruption, unless it be an erythematous congestion of scrotum or vulva, which occurs in a proportion of cases and is said to be diagnostic.
An important feature, from the diagnostic as well as from the prognostic point of view, is the appearance, in some cases almost from the outset of the disease, of albumin in the urine, together with a tendency to suppression. In mild cases these features may be little marked; but in severe cases, particularly during the stage of depression, the urine may fall to a few ounces, and be loaded with albumin to the extent of
