504 PRACTICE OF PHYSIC. 



the case, that many have supposed an unusual quantity of bile, 

 and perhaps a peculiar quality of it, to be the cause of intermit- 

 tent fevers. This, however, does not appear to be well founded. 

 Vomiting, by whatever means excited, if often repeated, with 

 violent straining, seems to be powerful in emulging the biliary 

 ducts, and commonly throws out a great deal of bile. This will 

 happen especially in the case of intermittent fevers ; for as, in 

 the state of debility and cold stage of these fevers, the blood is 

 not propelled in the usual quantity into the extreme vessels, and 

 particularly into those on the surface of the body, but is accum- 

 ulated in the vessels of the internal parts, and particularly in the 

 vena portarum ; so this may occasion a more copious secretion 

 of bile. 



These considerations will, in some measure, account for the 

 appearance of an unusual quantity of bile in intermittent fevers ; 

 but the circumstance which chiefly occasions the appearance of 

 bile in these cases, is the influence of warm climates and seasons. 

 These seldom fail to produce a state of the human body, in 

 which the bile is disposed to pass off, by its secretories, in greater 

 quantity than usual, and perhaps also changed in its quality, as 

 appears from the disease of cholera, which so frequently occurs 

 in warm seasons. At the same time, this disease occurs often 

 without fever ; and we shall hereafter render it sufficiently pro- 

 bable, that intermittent fevers, for the most part, arise from 

 another cause, that is, from marsh effluvia ; while, on the other 

 hand, there is no evidence of their arising from the state of the 

 bile alone. The marsh effluvia, however, commonly operate 

 most powerfully in the same season that produces the change 

 and redundance of the bile ; and, therefore, considering the vo- 

 miting, and other circumstances of the intermittent fevers which 

 here concur, it is not surprising that autumnal intermittents are 

 so often attended with effusions of bile. 



" It has been very universally observed, that warm seasons and 

 warm climates produce some change in the state of the bile in 

 human bodies ; and, in particular, that the cholera morbus, as 

 it is called, that is a copious afflux of some acrid bile to the in- 

 testines, is the particular effect of warm seasons and warm cli- 

 mates. Sydenham has said, that the spontaneous cholera con- 

 tinued to the month of August in the south of England where 



