I generally began by giving a gentle vomit of tartar emetic. This medicine, if given while the fever was in its forming state, frequently produced an immediate cure; and if given after its formation, on the _first_ day, seldom failed of producing a crisis on the third or fourth day. The vomit always discharged more or less bile. If a nausea, or an ineffectual attempt to vomit continued after the exhibition of the tartar emetic, I gave a second dose of it with the happiest effects. If the vomit failed of opening the bowels, I gave gentle doses of salts and cream of tartar[37], or of the butter-nut pill[38], so as to procure two or three plentiful stools. The matter discharged from the bowels was of a highly bilious nature. It was sometimes so acrid as to excoriate the rectum, and so offensive, as to occasion, in some cases, sickness and faintness both in the patients and in their attendants. In every instance, the patients found relief by these evacuations, especially from the pains in the head and limbs. [37] I have found that cream of tartar renders the purging neutral salts less disagreeable to the taste and stomach; but accident has lately taught me, that the juice of two limes or of one lemon, with about half an ounce of loaf sugar, added to six drachms of Glauber or Epsom salt, in half a pint of boiling water, form a mixture that is nearly as pleasant as strong beverage. [38] This pill is made from an extract of a strong decoction of the bark of the white walnut-tree. In those cases, where the prejudices of the patients against an emetic, or where an advanced state of pregnancy, or a habitual predisposition to a vomiting of blood occurred, I discharged the bile entirely by means of the lenient purges that have been mentioned. In this practice I had the example of Doctor Cleghorn, who prescribed purges with great success in a fever of the same kind in Minorca, with that which has been described[39]. Doctor Lining prescribed purges with equal success in an autumnal pleurisy in South Carolina, which I take to have been a form of a bilious remittent, accompanied by an inflammatory affection of the breast. [39] The tertiana interposita remissione tantum of Dr. Cullen. After evacuating the contents of the stomach and bowels, I gave small doses of tartar emetic, mixed with Glauber's salt. This medicine excited a general perspiration. It likewise kept the bowels gently open, by which means the bile was discharged as fast as it was accumulated. I constantly recommended to my patients, in this stage of the disorder, to _lie in bed_. This favoured the eruption of the rash, and the solution of the disease by perspiration. Persons who struggled against the fever by _sitting up_, or who attempted to shake it off by labour or exercise, either sunk under it, or had a slow recovery.