There were generally remissions in this fever every morning, and sometimes in the evening. The exacerbations were more severe every other day, and two exacerbations were often observed in one day.
A rash often appeared on the third and fourth days, which proved favourable. This rash was accompanied, in some cases, by a burning in the palms of the hands and soles of the feet. Many people at this time, who were not confined to their beds, and some, who had no fever, had an efflorescence on their skins.
In several persons the force of the disease seemed to fall upon the face, producing swellings under the jaw and in the ears, which in some instances terminated in abscesses.
When the fever did not terminate on the third or fourth day, it frequently ran on to the eleventh, fourteenth, and even twentieth days, assuming in its progress, according to its duration, the usual symptoms of the typhus gravior, or mitior, of Doctor Cullen. In some cases, the discharge of a few spoons-full of blood from the nose accompanied a solution of the fever on the third or fourth day; while in others, a profuse hæmorrhage from the nose, mouth, and bowels, on the tenth and eleventh days, preceded a fatal issue of the disease.
Several cases came under my care, in which the fever was succeeded by a jaundice.
The disease terminated in some cases without sweating, or a sediment in the urine; nor did I observe such patients more disposed to relapse than others, provided they took a sufficient quantity of the bark.
About the beginning of October the weather became cool, accompanied by rain and an easterly wind. This cool and wet weather continued for four days. The mercury in the thermometer fell to 60°, and fires became agreeable. From this time the fever evidently declined, or was accompanied by inflammatory symptoms. On the 16th of October, I met with a case of inflammatory angina; and on the next day I visited a patient who had a complication of the bilious fever with a pleurisy, and whose blood discovered strong marks of the presence of the inflammatory diathesis. His stools were of a green and black colour. On the third day of his disease a rash appeared on his skin, and on the fourth, in consequence of a second bleeding, his fever terminated with the common symptoms of a crisis.
During the latter end of October, and the first weeks in November, the mercury in the thermometer fluctuated between 50° and 60°. Pleurisies and inflammatory diseases of all kinds now made their appearance. They were more numerous and more acute, than in this stage of the autumn, in former years. I met with one case of pleurisy in November, which did not yield to less than four plentiful bleedings.
I shall now add a short account of the METHOD I pursued in the treatment of this fever.