PERNICIOUS FEVER. 23 



ordinary intermittent paroxysm runs its course and ends in profuse 

 and exhausting perspiration, during which the pernicious symptoms 

 appear. When the animal functions are affected the paroxysm 

 usually begins with drowsiness, loss of memory, confusion, gradually 

 passing into deep coma, or an apoplectic state with stertorous respi- 

 ration. Pulse full, and either faster or slower than in health. Some- 

 times convulsions are present. In some cases coma is preceded by 

 delirium. 



Cause, — The cause is undoubtedly the same as that of ordinary 

 intermittents and remittents. What it is that gives rise to its pecu- 

 liar character is unknown ; probably a more intense action of the 

 poison, or a greater susceptibility to its influence. Its localities 

 differ from those of ordinary bilious fever ; while the latter occupy 

 the table lands, the pernicious fevers prevail especially in the low 

 lands skirting the rivers. 



Frog7iosis. — Exceedingly unfavourable ; three-fourths of the cases, 

 when not properly treated, die. Sometimes whole settlements are 

 swept off by the disease. If seen during the first or second paroxysm 

 the danger may be averted. 



Treatment. — The first indication is to bring about a reaction as 

 speedily as possible. One of the most obvious remedies is artificial 

 heat ; sinapisms to the extremities and abdomen, or along the spine, 

 and frictions with turpentine or cayenne pepper should be used. 

 Opium is useful for its stimulating and anti-emetic properties, and 

 for its influence in arresting alvine discharges ; it is best adminis- 

 tered in substance, but should not be used when there is any affec- 

 tion of the brain, as shown by active delirium or stupor. Internal 

 stimuli should also be administered ; of these the sulphate of quinia 

 is the best, and may be given even in the paroxysm before reaction. 

 It should be used, however, in decided doses, and may be employed 

 in any prostrate case, in which it can be borne by the stomach. 

 Another remedy decidedly called for is calomel, and it may be ad- 

 vantageously joined with both quinia and opium. The internal 

 administration of cayenne pepper is also of great benefit; it may be 

 taken in five grain doses. The proportions of these remedies must 

 vary to suit the circumstances ; so also must the articles employed. 

 If these means fail to bring about reaction, wine or brandy may be 

 given : cold affusion is also recommended, but it should not be car- 

 ried too far. When coma is present, blood should be takisn by cups, 

 or from the arm, if admissible. The treatment in the intermission 

 or remission should be the same as in ordinary intermittent, except- 

 ing thaf the sulphate of quinia should be given in much larger doses. 

 From 30 to 60 grains should be taken from the beginning of one 

 paroxysm to that of the next. 



