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III. Some account of the Autumnal Bilious Fever of the
Atlantic side of Virginia. In a letter to the EDITOR
from the late Dr. JAMES GREENWAY, of Dinwid-
die-County, Virginia.


YOU ask if our Autumnal Fever is ever contagious. I answer, no, never contagious. The negroes are not so subject to it, or to common intermittents, as the white people. Nor do they have it so bad ; nor do they require more than half the medicines that white people do, when these last are sick of it.

It arises from effluvia exhaling from mud : and from water at rest, though deep, such as mill-ponds, the same exhalations are produced. I took the infection myself, some time ago, from the exhalation of stagnant water, covered with a scum, and suffered all the usual symptoms of the Bilious Remittent common to this climate.

The autumnal fever attacked sooner, and with more violence, last fall, than it has done in the last 25 years past. It was more tediously continuing ; required more medicines to cure it ; the sick were more liable to relapse, and many of them still remain in a weak state. The winter has been too warm, and not sufficiently cold to brace them.

A yellowness of the skin, but always in the eyes, takes place in every one attacked with our fall-fever ; and I have, now and then, seen one very yellow. Some I have seen spurt up bile from the stomach, without any motion to vomit. But these were such as had lived in low places, for a long time ; or had often exposed themselves to the inclemency of the weather.

In the autumnal fever all suffer more or less in the stomach. There is a continual nausea, and frequently a vomiting of yellow or green bile, particularly during the exacerbation of the fever. A bilious diarrhoea sometimes attends the fever towards its remission, and is generally salutary ; but in sickly places, the bile is secreted in such quantity that it continually discharges through the intestines, until the patient becomes emaciated and dies.

A costiveness is still a more common symptom, occasioned by a spasmodic stricture in the intestines caused by the heat and acrimony of the bile passing through, and out of, the ductus communis choledochus, in a vitiated state.

A pain and heat about the region of the liver, and a heat and burning (as they themselves frequently express it) in the stomach, are very grievous and common complaints. A scarlet eruption, or petechiae, sometimes appears on the skin, like those caused by the stinging of nettles ; and these came out regularly with the exacerbation of the fever, and totally vanished in every remission : and where the paroxysms are alternately worse, these spots only attend the worst 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 alternately 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 followed 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.; and laxatives taken by the mouth, produced, in their operation, great pain, and an increase of the fever and inflammation. I was, therefore, obliged to imitate nature, in her operation on the inflamed leg, before-mentioned ; and this never failed of success.

Wine, bark, and opium, were the common weapons that this disease was attacked with ; and many died.

I am an old-fashioned follower of Sydenham, and proceeded on his plan and method of cure. The consequence of it was, that not a single patient of mine died, though I attended some that were very old, even of the age of sixty, and seventy ; and one near eighty, who all recovered, and arc still alive.

Dinwiddie County,
March 3, 1794.


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