When this Fever prevails as an epidemic, as it usually does, in the southern part of the United States, it is a disease of the most malignant character. The proportion of _fatal_ cases under the Allopathic course of treatment, has been equal to, and, in some places, as in New Orleans, and some Towns in Virginia, has exceeded that of _Asiatic_ Cholera. It is almost entirely confined to Southern regions, and only prevails in hot weather, after the continuance of extreme heat for some weeks.
It usually begins with premonitory symptoms somewhat like those of ordinary fever, but with this difference: the patient, instead of losing his appetite, has often a morbidly increased desire for food. He complains of severe pains in the back, and more or less headache. Both the head and backache are of a peculiar character: the pains resembling rheumatic pains, the head feeling full and too large, the eyes early turn red, almost bloodshot and watery, a chill comes on, which may be distinct and quite severe, lasting for an hour or more, or, it may be slight, and hardly perceptible. The chill is followed by high fever, the pain in the head and back increasing, the eyes becoming more red and suffused, the forehead and face extremely red and hot, and the heat of the whole surface very great, the carotids beat violently, the pulse very frequent, and usually, at first, full and strong, though sometimes it is feeble from the beginning. However the pulse may be in the beginning, it very soon becomes small, but continues to be frequent. The tongue is at first covered with a white paste-like coating, which afterwards gives place to redness of the edges and tip, with a dark or yellow streak in the center. The stomach is very irritable, rejecting every kind of food, and all drinks, except, perhaps, a few drops of ice water. There is a peculiar distressed feeling in the stomach, often a burning sensation, so that, if suffered to do so, he would take large quantities of ice or water. One remarkable feature of the cases noticed in the epidemic, as it existed in New Orleans the past season, was, that the patients had a great desire for food, notwithstanding the nausea and distress at the stomach.