REMITTENT FEVER. 17 



the Gulf of Mexico. The localities that it most frequents are the 

 valleys of streams, the borders of lakes and ponds, the neighbour- 

 hoods of marshes, and the western prairies. The seasons in which 

 it occurs are the summer and autumnal months. 



Symptoms. — For several days previous to the invasion^ the 

 patient complains of uneasiness at the epigastrium, lassitude, pains 

 in the back, limbs, and head, and restlessness at night. The inva- 

 sion is attended by coldness of the surface, and frequently by shiver- 

 ing ; this coldness is soon superseded by heat, by febrile flushes, or 

 by alternations of heat and cold, by nausea, and occasionally by 

 vomiting. The pains in the head, back, and limbs, now become 

 aggravated; the mouth is clammy and dry; the tongue white or 

 loaded ; the surface very hot and parched ; the face flushed ; and 

 the pain of the head attended by a feeling of distention and throbbing, 

 often passing into delirium. The pulse is full, hard, and frequent ; 

 thirst is urgent ; the bowels constipated ; and the urine scanty and 

 high-coloured. There is usually more or less epigastric tenderness, 

 with nausea, and often with vomiting. These symptoms generally 

 continue from about ten or twelve to eighteen hours, when perspira- 

 tion breaks out ; the pulse falls in frequency and strength ; delirium 

 disappears, and the irritability of the stomach subsides : there is 

 merely a remission or abatement, but no intermission of the tebrile 

 symptoms. The remission is exceedingly variable in duration, in 

 some cases not lasting more than two or three hours, in others a 

 whole day ; being shorter or longer, according as the type of the 

 fever may be quotidian or tertian. Another paroxysm then occurs, 

 running the same course and ending in like manner, each successive 

 exacerbation becoming, generally, more severe and protracted, and 

 each remission less decided. 



The symptoms become now more violent. The remissions dis- 

 appear ; the skin becomes dry and harsh, or moist and clammy ; 

 the pulse small and irregular ; the tongue black and crusted ; and 

 the vomiting, and pain at the epigastrium, more constant. In the 

 most unfavourable cases, yellowishness of the skin occasionally 

 supervenes. The bowels become irritable, the evacuations being 

 watery, greenish, and, at last, almost black. The urine is scanty 

 and high-coloured, or sometimes of a yellowish-brown colour. The 

 headache is intense, accompanied often by vertigo, tinnitus aurium, 

 and delirium. 



The disease may run on thus for a time varying tromthe seventh 

 to the fifteenth day, when it either declines with a profuse perspira- 

 tion, a diarrhoea, or a general subsidence of all the symptoms, or 

 else it runs on to a fatal termination. Sometimes it terminates in an 

 intermittent ; at others in a continued fever. 



Bilio-injiammatory remittent fever. — This form differs but 

 slightly from the foregoing in its symptoms and course. Violent 



2* 



