_Stage of Remission._—About the close of the 3rd day or upon the 4th day there may occur a fall in the temperature and a decided amelioration of the symptoms. This however is frequently not noted and even when present may last only for a few hours. It is often called the _stage of remission or calm_. By the 3d day the congestion of the facies and other sthenic manifestations have disappeared and, possibly preceded by the short period of remission, there is ushered in the _second or asthenic stage_. _Asthenic Stage._—It is at this time that we have the appearance of the most characteristic features of yellow fever—the jaundice and the haemorrhages. The jaundice is first noted in the sclerotics and rapidly spreads over the body as a lemon to orange yellow tinging. Swelling and bleeding of the gums are the earliest signs of the damage to the capillaries. This may go on to bleeding from the nasal mucosa, the intestines and, best known and most dreaded, the coffee ground vomiting or black vomit of gastric haemorrhage. Epigastric tenderness is often marked. In very severe cases haemorrhagic extravasation into the skin may appear. The mind is peculiarly clear, the patient alert and suspicious. At times patients may be delirious even to the extent of wild struggling to throw themselves out of bed. In favorable cases the temperature rapidly falls to normal, associated with an unusually slow pulse rate, even below 45. In the first few days there is a normal white count, with an increase in the percentage of the polymorphonuclears and later on an increase in the large mononuclears. [Illustration: FIG. 46.—Temperature chart from one of the experimental yellow fever cases reported by the U. S. Army Yellow Fever Commission. A severe case with recovery.] Besides the typical course we may have cases so mild that the albuminuria is insignificant and the jaundice and haemorrhages entirely absent. On the other hand we may have fulminating cases with jaundice and black vomit setting in by the end of the 3rd day and rapidly going on to a fatal termination. =Symptoms in Detail= _The Temperature._—This rises abruptly, reaching its maximum by the 1st day. Very high temperatures are not a feature of yellow fever. There is nothing characteristic in the further course of the fever chart and it should be borne in mind that the so-called intermission is transient and deceitful. _General Appearance._—On the 1st day the face is swollen and congested. This florid congestion, which may extend down the neck to the upper part of the chest, is more marked in yellow fever than in any other disease. The eyes are shining, the conjunctivae injected and there is photophobia.