In cases that proved fatal, the symptoms, for some time before death, resembled very much those of the fever before described at the same stage. There was either _coma_ or constant delirium, great seeming anguish, the mouth and tongue very dry, or with only a little ropy slime, a black crust on the teeth, picking of the clothes, and involuntary stools. TREATMENT OF THE BILIOUS REMITTING FEVER. The measures proper to be taken in the beginning of all fevers are pretty nearly the same. There is little difference in the first treatment of this from that of the ship fever, except that blood letting is here more frequently proper, and that a more free evacuation of the bowels is necessary on account of the more copious secretion of bile. In full and athletic habits the disease very commonly begins with pains in the limbs, back, and head, with a strong throbbing pulse; in which case it is proper first of all to let blood at the arm. This is also highly proper and necessary in those cases mentioned above, in which the patient becomes suddenly frantic. But though the cases requiring blood-letting are more frequent in this sort of fever than that already treated of, yet great caution and nice discernment are necessary with regard to it, in all cases, in a hot climate. As fevers in such a climate run their course faster, the symptoms succeeding each other in a more close and hurried manner, greater expedition, as well as discernment, are required in timing the different remedies than what are necessary in a cold climate. Blood letting unseasonably and injudiciously employed either endangers life, or has a very remarkable effect in protracting recovery, by the irrecoverable weakness it induces. With regard to the evacuation by the bowels, it has already been mentioned in another part of the work, when on the subject of prevention, that, before the fever comes on, there is a languor and general feeling of indisposition, and that then an emetic and a purgative, followed by some doses of the bark, were the most likely means of preventing the attack of the disease. If the fever has properly begun, which is announced by a _rigor_ taking place, then no time is to be lost in procuring evacuation; and, after blood letting, if the symptoms should require it, the best medicine is tartar emetic, which, if given in small divided doses, at short intervals, will most probably evacuate the whole intestines by vomiting and purging, and may even prove sudorific. But it will nevertheless be proper to administer a purgative medicine soon after; and what we found to operate with most ease, expedition, and effect, was, a solution of purging salts and manna, either in an infusion of sena, or in common water, or barley water, with some tincture of sena added to it.