INFANTILE REMITTENT FEVER. 19 



given cold^ it corrects the nausea and vomiting better than any thing 

 else. If it gripes, a little laudanum may be added to it. The neutral 

 mixture, and the spirit of Mindererus are also highly recommended. 

 Cold sponging is often very refreshing to the patient, but should be 

 discontinued if he complain of chilliness. Any complications that 

 may be present will require distinct treatment, according to the 

 organs that are affected. 



INFANTILE REMITTENT FEVER. 



This disease usually attacks children from nine or ten months to 

 twelve or thirteen years old. Jt generally arises from errors in diet, 

 and accumulation of morbid matter in the primse vice. It may 

 also arise from obscure miasmata. Writers in the three last cen- 

 turies imputed this fever to worms, hence the term *' u-orm fever ;'''* 

 but the presence of worms is rather a complication than a cause of 

 the affection. 



Symptoms. — This affection commences gradually ; the bowels 

 being irregular, generally costive, but occasionally relaxed and 

 irritated. The child remains feverish and drowsy towards evening, 

 but generally seems pretty well in the morning. The appetite is 

 variable; the pulse ranges from 100 to 140; and the tongue is 

 loaded. After these symptoms have lasted for several days, a dis- 

 tinct chill or rigor is sometimes observed ; vomiting ensues ; and a 

 more violent paroxysm of fever, drowsiness, flushed cheeks, and 

 shooting pains through the abdomen and head, follow. The child 

 constantly picks its lips and nose ; and occasionally stiffness of the 

 neck, great sensibility of the general surface, and tenderness in the 

 course of the spine, are observed. In the more advanced stages, 

 the ingesta are either thrown off unchanged, or passed undigested 

 from the bowels. In very young children, convulsions come on ; 

 in those of more advanced age, delirium often attends the night 

 exacerbations. This is the most common form of the disease. 



Acute variety. — This form may occur rather suddenly. The 

 bowels are irregular, commonly costive; the evacuations are morbid 

 and offensive ; the urine turbid, pale, or milky ; and the tongue is 

 loaded, especially at the base. Fever supervenes, and is ushered in 

 by rigors or chills, the child being hot and restless at night. During 

 the exacerbations, the child is drowsy ; and if it sleeps, moaning, 

 starting, and even screaming, or incoherence, are observed ; some- 

 times with vomiting, there is flatulent distension of the abdomen, 

 accelerated breathing and cough. The face is usually flushed ; the 

 abdomen and palms of the hands hotter than other parts of the 

 body ; and the pulse varies from 120 to 160, according to the age. 

 Occasionally the paroxysm terminates in a slight perspiration, which 

 is often partial ; the child falls into a quiet sleep, and the pulse sinks 

 in frequency. 



