(From bilis, bile). The bilious fever; called also the marsh, remittent, autumnal remitting, and camp fever. Febris flava, febris maligna Barbadensis, icterodes.

When a fever is accompanied with bilious discharges by vomit or stool, whether it be continual, intermittent, or remittent, it is called bilious. It is the second species of typhus in Dr. Cullen's Nosology, named icterodes, defined a typhus with yellowness of the skin. In his First Lines, vol. i. he observes that the typhus is a genus that comprehends several species; that these, however, are not well ascertained by observation; many of the different cases do not imply any specific difference, and seem to be merely varieties, arising from a different degree of power in the cause, from different circumstances of the climate or season in which they happen, or from different circumstances in the constitution of the persons affected. One effect, arising from these circumstances in the constitution of the persons affected, is an unusual quantity of bile appearing in the course of the disease, which is almost a distinguishing character of intermittent fevers; but if it should appear with a continued fever, it could only be considered in such a case as a coincidence owing to the state of the season, producing no different species or fundamental distinction, but merely a variety of the disease.

In Britain it generally prevails in the first cold that succeeds hot weather; in hot countries it is most frequent in damp marshy places, and after great rains that are followed by great heats. In both situations, those who are exposed to damps, and to the night air, are most subject to it.

Besides the causes in general of fevers, it is occasioned by a copious secretion of the bilious fluid poured into the duodenum and stomach, whence the symptoms proper to this fever arise.

Besides the usual symptoms of fever, there are an extraordinary . inquietude and anguish, a burning heat, cardialgia, nausea, vomiting, and purging; and, in consequence, a copious discharge of bile. The thirst is excessive, and the dejection of spirits equally so; the pulse is small but quick; sometimes it remits very sensibly, at others the remissions are more obscure; and at last an inflammation of the bowels comes on. If the evacuations are cadaverous, death is approaching; and an involuntary discharge of the excrements is usually fatal.

If the pulse is full and hard, bleeding may be admitted in the beginning; a repetition is rarely, if ever, required; and in hot countries it is best to omit this evacuation. In all cases a grain or two of antimonium tartarisatum, as an emetic, is necessary.

If saline medicines are given, the citrated potash is the most proper; but each dose should be administered in the act of effervescence.

As soon as an intermission is perceived, the bark, which is the chief dependence, must be given. But if the disease be very violent, or the disease occur in a hot climate, the bark must be given before the intermission, for on its early use depends the cure; a drachm may be given every hour in wine and water, or what the patient uses for his common drink. If the bark, in substance, is not agreeable, a cold infusion of it may be substituted, which may be acidulated with the acidum vitrioli dilutum, and the patient may take it as freely and frequently as his stomach will bear. If it excites stools or vomiting, a few drops of the tinct. opii will prevent the inconvenience.

In colder climates and less urgent circumstances, the pulv. rad. columbo, gr. xv. ad xx. with the kali vitriolat. Э i. ad Э ii. given every four, five, or six hours, produce both speedy and beneficial effects. The neutral salts, Dr. Percival observes, abate the febrile heat, allay thirst, and bring on a gentle salutary diarrhoea; whilst the columbo supports the patient's strength, obviates the sickness, and checks the septic ferment in the primae viae. Dr. Haygarth adds, that after the primae viae are cleared from their bilious contents, the columbo root allays the nausea so constantly attendant on this disorder: and that in this fever, though the remissions are very evident, and the accession marked with chills and other symptoms of an intermittent, yet the bark is not always so successful in this climate as to encourage its use. The columbo, he observes, answers our warmest wishes, by correcting the bile, restoring the proper tone of the stomach, and of the whole habit; it also prevents relapses, to which, in this fever, the patient is peculiarly disposed.

Biliosa ardens febris. The burning bilious, called also the yellow, fever, the West Indian fever. It is a variety of the typhus icterodes of Cullen, and has no connection with the biliosa febris just noticed, except in the bilious discharges, and the colour of the skin. This, as just observed, is a typhus of a very rapid and dangerous kind, as nervous debility, torpor, and mortification, soon come on. It is the fever which has made such considerable devastation on the North American continent, and, with a little variety, in Spain and Gibraltar. It has proved a more general and fatal epidemic than any other, the plague excepted, to which it bears no inconsiderable relation. This subject we must however soon again return to.

It attacks with a transient chilness and shivering, which are soon succeeded by a burning heat all over the body, but more particularly about the praecordia: the pulse is high and quick, but not hard; the eyes are heavy, the face flushed, a violent headach comes on, with beating in the temporal arteries, and a thick laborious respiration; a nausea soon follows, and what is discharged upwards is black and highly bilious. Anxiety is very great; a shooting pain is complained of in the back and loins, and an uneasy lassitude in the limbs. In about twelve hours after the first invasion of this disease, the tongue is very dry, rough, and discoloured; thirst is excessive, vomiting incessant, anxiety increased, a soreness is felt all over the body, and a delirium comes on. In the last stage, which soon arrives, the patient labours under a coma, manifests a great oppression about the praecordia, the respiration is very difficult, the face swollen and darkly yellow, and at length the tendons tremble; cold sweats and convulsions usher in death. Blood taken the first day is florid but thin, and the crassamentum scarcely coheres: on the second or third day it is still more loose, and the serum is more yellow. When the patient recovers, the crisis usually happens in the fourth day after the attack, and generally discovers itself by a brighter suffusion of the bile all over the body. The yellow tinge sometimes appears in the eyes twelve hours after the symptoms of this fever come on; the sooner it appears the more favourable is said to be the prognostic. This however is not correct, for the bilious suffusion is only salutary when the disease is protracted. If the skin continues dry and rough the patient rarely recovers, however good his pulse may be. Incessant vomiting, and the discharges growing darker coloured, with dark spots on the skin, are fatal signs; and if a dry skin accompany an inflamed redness of the eyes, death may be expected in a few hours.