10 On the Autumnal Bilious Fever 



fit, and do not appear in the milder one. Patients 

 suffering under this eruption are all costive, and have 

 a vomiting. 



A continual hiccup seizes on some : hot air and 

 warm drinks increase it. An inflammation now and 

 then falls upon the leg, with great pain and redness 

 from the ankle to the knee; and the chilliness, fever, 

 and all the symptoms become more moderate, and 

 almost vanish. 



The fever is a double tertian, the paroxysms alter- 

 nately worse, and alternately corresponding in the 

 periods of their return : to-day it comes on at noon, 

 to-morrow at night. The fever never goes quite off, 

 but becomes more moderate, until chilliness ushers 

 in the next paroxysm. The worst paroxysm is 

 ushered in by the greatest coldness, and this is fol- 

 lowed by a fever proportionally exasperated in all its 

 symptoms. The next paroxysm is milder, and all the 

 symptoms, in degree, less violent. The greatest fit 

 is, perhaps, attended with vomiting ; the lesser one, 

 perhaps, has neither chilliness nor vomiting. 



This was the appearance of our fever, last autumn ; 

 but there is one symptom I had like to have forgot. 

 The piles were, in a few patients, very troublesome 

 and painful : the hemorrhoidal veins swelled, and 

 distended with blood, brought on inflammation and 

 excruciating pain in the rectum, with COStiveness. 

 The danger was great, because the rectum, closed up 

 with the turgid vessels, would not admit of injections; 



