INTERMITTENT FEVER. 



aeve tne feeling of chilliness nor increase the temperature in the pe- 

 ripheral parts, which is diminished in spite of the increased temperature 

 of the blood ; but we may yield to the generally urgent entreaties of 

 the patient for warm drink, so far as to allow him a few cups of tea, if 

 we are certain that he will be moderate. If there be severe vomiting 

 during the cold stage, we may give effervescing powder, and, if this 

 fail, a few drops of laudanum. If the patient become so collapsed as 

 to alarm us, we may give analeptics, strong coffee, wine, camphor, 

 ether, and opium, have the patient rubbed, and apply sinapisms. In 

 the hot stage we may try cooling treatment, light covering, plenty of 

 cold drink in small quantities ; where there is severe congestion of the 

 brain, use cold water or ice-compresses to the head, and sometimes 

 local blood-letting. Venesection is only to be practised in the most 

 urgent cases, as it rarely does good, and may cause dangerous collapse ; 

 in its place, in attacks of pernicious fever, besides local blood-letting 

 and derivatives, the use of opium has proved the most efficient treat- 

 ment. The sweating stage must be awaited in bed. Especial treat- 

 ment to increase the sweating is unnecessary, as there is no advantage 

 Irom its being very profuse. The patients should not change their 

 underclothes till this stage has terminated. The treatment during the 

 apyrexia aims at preventing the return of paroxysms by the adminis- 

 tration of quinine, unless there be some peculiar objection to giving 

 that medicine. The formerly common idea, that it was advantageous 

 for the patient to have a certain number of paroxysms, and that the 

 fever should not be arrested till after the third, fifth, or even seventh 

 attack, was based on false premises. The sooner he is freed of his 

 paroxysms the better for him. A morbid state of the gastric mucous 

 membrane, however, which occasionally occurs after the first paroxysm 

 of intermittent, contraindicates the administration of sulphate of 

 quinine, and, in mild cases at least, this morbid state should be re* 

 moved before ordering the irritating salt. In treating intermittent 

 fever, the diagnosis of gastric catarrh, or foul stomach, is not made 

 very exactly, and emetics are used too freely ; some physicians begin 

 the treatment with an emetic, as a matter of course ; others prescribe 

 muriate of ammonia till the tongue is thickly coated, and then give an 

 emetic to prepare the patient for quinine. Unless certain indications, 

 that we have given for the administration of emetics in gastric catarrh, 

 be present, we consider it improper, or at least superfluous, to open 

 the treatment of intermittent with one. But if, at the commencement 

 of the fever, the patient has made great errors of diet, especially if, 

 just before the paroxysm, he has filled his stomach with food which 

 has remained undigested, and by decomposing has irritated the gastric 

 mucous membrane, there is just cause for giving an emetic. We have 



