It is subject, however, to extreme and rapid variations in temperature, to alternations of dry and humid winds (the latter, called catias, being irritating and oppressive), to chilling night mists brought up from the coast by the westerly winds, and to other influences productive of malaria, catarrh, fevers, bilious disorders and rheumatism.
A fever that is to be remittent will usually declare itself from the outset: it begins with chills, but without the shivering and shaking fit of the intermittent; the hot stage soon follows, presenting the same characters as the prolonged hot stage of the quotidian, with the frequent addition of bilious symptoms, and it may be even of jaundice and of tenderness over the stomach and liver.
Severe remittents (pernicious or bilious remittents) approximate to the type of yellow fever, which is conventionally limited to epidemic outbreaks in western longitudes and on the west coast of Africa.
There are the usual malarial, bilious and intermittent fevers, and liver, stomach and intestinal complaints prevalent in tropical countries; but unhygienic living is, in Cuba as elsewhere, mainly responsible for their existence.
Intense application during early youth had weakened a constitution never robust, and led to accesses of feverish exaltation culminating, in the spring of 1761, in an attack of bilious hypochondria, which permanently lowered the tone of his nervous system.
Bilious remittent fever occurs in the summer months, and smallpox prevails from November to March.
The mean annual temperature is about 82° to 83° F.; malarial and bilious fevers are common, the latter being known as "Guayaquil fever," and epidemics of yellow fever are frequent.
Smallpox, dysentery and fevers, frequently of a bilious character, are endemic and occasionally epidemic. Cholera breaks out from time to time and works great havoc, as was the case in 1903 when one of the raja of Sarawak's punitive expeditions was stricken while ascending the Limbang river by boat, and lost many hundreds of its numbers before the coast could be regained.
"He is a nervous, bilious subject," said Larrey, "and will not recover."
He had what the doctors termed "bilious fever."