INTERMITTENT FEVER. 675 



geographical extension of intermittent fever is immense ; in the torrid 

 zones the disease is especially frequent, and it prevails in most places 

 that are not very dry : in the temperate zones it chiefly affects certain 

 more or less extensive districts ; in the frigid zones it does not occur. 

 For further information, we refer to G-riesinger*s work and to the very 

 exhaustive treatise of Hirsch on the geography of intermittent fever. 



ANATOMICAL APPEARANCES. Autopsies of persons who have died 

 of simple intermittent fever are rare. They show no characteristic 

 changes beyond those that we have already described (Vol. I., Dis- 

 eases of the Spleen). If simple intermittent fever depends on infection 

 with malaria, the anomalies of the blood dependent on the infection 

 have so far escaped chemical and microscopical examination. The im- 

 poverishment of the blood in red corpuscles and albumen, which always 

 results from long-continued intermittent, depends on consumption from 

 high fever, and perhaps also on degeneration of the spleen. On 

 autopsy of persons who have died of pernicious intermittent, we often 

 find signs of melansemia and occasionally remains of inflammation, 

 effusions of blood, or excessive hyperaemia in different organs. 



SYMPTOMS AND COTJKSE. I. Simple Intermittent Fever. The pe- 

 riod of incubation of the malarial infection is not exactly known. It 

 is probable that, at most, two weeks may pass from exposure to the 

 miasm till the first symptoms appear ; in some cases the latter seem 

 to follow the former immediately. 



Before the intermittent character of the disease, to which it owes 

 its name, becomes very evident, before attacks of fever (paroxysms) 

 and intervals of exemption from fever (apyrexias) alternate, the infec- 

 tion with malarial poison not unfrequently evinces itself by a con- 

 tinued, only more or less remitting and exacerbating, disturbance of 

 the general health and various functions. This constitutional disturb- 

 ance, which is called the prodromal stage of intermittent, has no char- 

 acteristic peculiarities, and can only be rightly interpreted and distin- 

 guished from the prodromal stage of other infectious diseases by bear- 

 ing in mind the endemic and epidemic circumstances. After the pro- 

 dromal symptoms have lasted several days, or in other cases without 

 their appearance, the first fever paroxysm occurs. 



A paroxysm of intermittent fever consists of three stages : chill, 

 fever, and sweating. The chill begins with a fit of weakness, and 

 great faintness; the patients gape, and stretch then* limbs. These 

 symptoms are soon accompanied by a subjective sensation of cold, at 

 first consisting of cold shiverings over the skin ; afterward, of continued 

 chilliness, so that the patient wants to wrap up as warmly as possible. 

 When the chill increases, the limbs tremble involuntarily, the lips 

 quiver, the teeth chatter, and the whole body is often shaken around 



