II. I have but little to add to the remarks I made upon the use of _purging_ in the year 1793. I gave jalap, calomel, and gamboge until I obtained large and dark-coloured stools; after which I kept the bowels gently open every day with castor oil, cremor tartar, or glauber's salts. I gave calomel in much larger quantities than I did the year before. John Madge took nearly 150 grains of it in six days. I should have thought this a large quantity, had I not since read that Dr. Chisholm gave 400 grains of it to one patient in the course of his fever, and 50 grains to another at a single dose, three times a day. I found strong mercurial purges to be extremely useful in the winter months, when the fever put on symptoms of pleurisy. I am not singular in ascribing much to the efficacy of purges in the bilious pleurisy. Dr. Desportes tells us that he found the pleurisy of St. Domingo, which was of the bilious kind, to end happily in proportion as the bowels were kept constantly open[121]. Nor am I singular in keeping my eye upon the original type of a disease, which only changes its symptoms with the weather or the season, and in treating it with the same remedies. Dr. Sydenham bled as freely in the diarrh[oe]a of 1668 as he had done in the inflammatory fever of the preceding year[122]. How long the pleurisies of winter, in the city of Philadelphia, may continue to retain the bilious symptoms of autumn, which they have assumed for three years past, I know not; but the late Dr. Faysseaux, of South-Carolina, informed me, that for many years he had not seen a pleurisy in Charleston with the common inflammatory symptoms which characterised that disease when he was a student of medicine. They all now put on bilious symptoms, and require strong purges to cure them. The pleurisies which the late Dr. Chalmers supposes he cured by purging were probably nothing but bilious fevers, in which the cool weather had excited some pleuritic symptoms. [121] Page 140. [122] Wallis's edition, p. 211. vol. i. I have nothing to add to the remarks I have elsewhere published upon the efficacy of _cool air_ and _cold drinks_ in this fever. They were both equally pleasant and useful, and contributed, with cleanliness, very much to the success of my practice.