The nearest approach to a great Irish epidemic in the second half of the 18th century was in 1771, as described by Sims, the type of fever being clearly the same low, putrid or nervous fever, with offensive sweats and muscular tremors, that was commonly observed in England also in the middle third of the 18th century. Early in the summer of 1771 a fever began to appear which, as autumn advanced, raged with the greatest violence; nor was it overcome by a severe winter. It claimed the prerogative of the plague, almost all others vanishing from before its presence. It began twelve months sooner in the eastern parts of the kingdom, pursuing a regular course from East to West. Some symptoms suggest cerebro-spinal fever. The symptoms were languor, precordial oppression, want of appetite, slight nausea, pains in the head, back and loins, a thin bluish film on the tongue, turbid urine, eyes lifeless and dejected. After the fourth day, constant watchfulness, the eyes wild, melancholy, sometimes with bloody water in them, constant involuntary sighing, the tendons of the wrists tremulous, the pulse quick and weak, most profuse sweats, small dun petechiae principally at the bend of the arm and about the neck. At the height of the fever, on the ninth or tenth day, the tremulousness of the wrists spread to all the members, “insomuch that I have seen the bed-curtains dancing for three or four days to the no small terror of the superstitious attendants, who on first perceiving it, thought some evil spirits shook the bed. This agitation was so constant a concomitant of the fever as to be almost a distinguishing symptom.” The patients lay grinding their teeth; when awake, they would often convulsively bite off the edges of the vessel in which drink was given them. They knew no one, their delirium being incessant, low, muttering, their fingers picking the bed covering. The face was pale and sunk, the eyes hollow, the tongue and lips black and parched. Profuse clammy sweats flowed from them; the urine was as if mixed with blood: the stools were involuntary. Petechiae almost black came out, having an outer circle with an inner dark speck; sometimes there were the larger vibices. Bleedings at the nose were frequent. Those who were put to bed and sweated almost all died. Death took place about the 13th day.