INTERMITTENT FEVER. 679 



after the disease has lasted a long time, or particularly after numerous 

 relapses. 



The course of intermittent is so often modified by the administra- 

 tion of medicines, especially of quinine, that few physicians have 

 actually observed a case left to itself, or, as is generally said, the nor- 

 mal course of an intermittent. On this point also we are indebted to 

 the homoeopaths for some important information. In the first place, 

 there is no doubt that the peculiar fever paroxysms and apyrexias, 

 which characterize infection with malaria, almost always continue for 

 a time, even if the patient be removed from further action of the 

 poison. Among other cases, I know of a young sailor who suffered 

 from intermittent fever in Greifswald, and who had a relapse while at 

 sea, four weeks after his last attack. It is also certain that, when a 

 long time has passed since the action of the poison, the symptoms of 

 malarial poisoning almost always disappear without medical aid. To 

 avoid illusion, we must bear in mind that it is not only those who fly 

 from the malarious region after acquiring intermittent fever, but also 

 those who remain in the place till the malaria has disappeared, that 

 finally escape the action of the poison. At a time when no new cases 

 are observed in a place which has been visited by intermittent, it 

 would be foolish to regard the final cure of a case, which had previous- 

 ly been treated ineffectually, as a proof of the peculiar efficacy of the 

 remedy last used. As the prevalence of the malaria among us only 

 lasts a few months, the number of spontaneous cures is certainly much 

 greater than is usually supposed. 



Another question is, whether, from continued action of the poison, 

 the organism becomes so blunted to its injurious influence, that the 

 symptoms of intoxication cease. At all events, such cases are rare, 

 and it is more frequent to find those where continued action of the 

 malaria has only modified the symptoms of intoxication, so as to 

 change a pure intermittent into an intermittens subcontinua, or 

 clironic malarial illness without fever. As was stated, when speak- 

 ing of the individual paroxysms and apyrexias, after a prodromal 

 stage but little characteristic, most cases of intermittent begin as 

 tertian or quartan fevers, the apyrexias being at first imperfect, 

 but becoming pure after a while. When the disease has lasted even 

 a very short time, the patient appears very pale and cachectic, and 

 this symptom is the earlier and the more marked, the greater the en- 

 largement of the spleen. If the spleen remain small, from rigidity of 

 its capsule, or from other unknown causes, the patient does not have 

 this peculiar pale and sickly appearance until later. From this fact, 

 which may be observed in most cases, as well as from the second fact, 

 that the healthy color quickly returns when we can rapidly reduce the 

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