INTERMITTENT FEVERS, OR AGUE. 15 



the afternoon. It has the longest cold fit, but the shortest paroxysm 

 altogether. There are also double quotidia?is^ having two paroxysms 

 every day. Double tertians, having a paroxysm every day, but at 

 different hours. Sometimes there are two paroxysms on one day, 

 and none the next ; this is called a duplicated, or doubled tertian. 

 The triple tertian has two paroxysms on one day, and one on the 

 intervening. In double quartans, out of three days, two have each 

 one paroxysm, and the other none. Of all these varieties, the 

 double tertian is the only one which often occurs. 



A distinction is made between the interval, and the intermission 

 of an ague. The interval, is the space between the beginning of 

 one paroxysm, and the beginning of the next ; which in the tertian 

 is forty-eight hours ; the intermission, is the space from the end of 

 one paroxysm, till the beginning of the next : in other words, the 

 time when the patient is free from the disease; which in the tertian 

 is about forty-two hours. This is also called apyrexia. The type of 

 the fever has a reference to the length of the interval. Besides the 

 varieties mentioned above, there are quintans, sextans, octans, &c., 

 but they are very rare. 



Seasojis of occurrence. — The quotidian commonly occurs in 

 spring ; the tertian at the end of summer, and beginning of fall ; 

 the quartan later in the fall. 



Symptoms. — An ague fit consists of three stages : 



1. The cold staoe, — This beo-ins with chilliness and constriction 



~ o 



of the whole body; the nails are blue; the rings drop off' the 

 fingers ; the skin is rough (cutis aJtserina), and there are violent 

 shiverings, and chattering of the teeth ; head-ache and back-ache, 

 quick, small pulse, oppression at the precordia, and sometimes 

 vomiting. After these have lasted some time, there comes the 



2d, or hot stage, beginning with flushes of heat, which gradually 

 increase, till the skin becomes very hot and dry, the face flushed, 

 the temples throbbing, and the pulse full and hard. After a dura- 

 tion of from three to eight hours, comes the 



3d, or sweati?ig stage. — Perspiration begins on the head and face, 

 and becomes profuse all over the body ; and the urine deposits a 

 copious lateritious sediment. Now, in uncomplicated cases, the pa- 

 tient feels well, but weak, till the next recurrence of the fit. Some- 

 times one of the stages is wanting, as for instance the cold stage. 

 This form is called a dumb ague. Sometimes the fever is wanting, 

 or has neui-algic pains substituted for it. The sweating stage is also 

 sometimes absent, or is supplied by copious urination, or diarrhoea. 



Treatment in ordinary cases. — First of all, give a grain or two 

 of calomel with an aperient, so as to clear the bowels. If the sto- 

 mach is very foul, an emetic may be used, though it is not essential. 



Then, during the paroxysm. During the cold stage, warm drinks 

 of tea, or wine-and-water, if the patient be feeble, or addicted to its 



