REMITTENT AND CONTINUED FEVER. 689 



other cases are complicated with pneumonia, dysentery, etc., and still 

 others have indications of the so-called pernicious attacks. The dis- 

 ease usually lasts from eight to fourteen days. If it ends in recovery, 

 it usually first becomes intermittent. Death may occur suddenly with 

 the symptoms of a pernicious intermittent. 



The severest forms run their course with the symptoms of an indis- 

 tinct and irregular exacerbating and remitting fever of very adynamic 

 character. The patients collapse quickly, and soon fall into deep 

 apathy. There are also various but not constant disturbances of func- 

 tion and nutrition in almost all the organs, so that the symptoms of 

 the disease vary greatly. Many patients become jaundiced. There is 

 often epistaxis, vomiting of blood, and haematuria ; in other cases 

 there is albuminuria, or suppression of urine ; in others, symptoms of 

 cholera or dysentery ; the spleen and liver enlarge considerably, and 

 often become the seats of inflammation and suppuration. Inflamma- 

 tory exudations not unfrequently form in the serous membranes and 

 lungs also, and in the skin there are petechiae, bed-sores, and gangrene. 

 Death usually occurs in this stage, with coma or convulsions, or with 

 the symptoms of febris algida. 



TEEATMENT. According to G-riesinger, in the milder forms of re- 

 mittent fever, the acute affection of the gastro-intestinal mucous mem- 

 brane should be combated by absolute diet, acids, and, if requisite, by 

 emetics and laxative medicines. We should give quinine as soon as 

 the remissions and exacerbations become decided, and the latter begin 

 with a chill. Any complications should be treated separately, as 

 quinine alone does not answer for them. In the severer and severest 

 forms, the most important indication is the early and continued use of 

 quinine in large doses, till improvement begins. At the same time, 

 the congestive symptoms are to be treated symptomatically, just as in 

 pernicious intermittent fever. 



[At present malarial poison is by many supposed to consist of 

 microscopic vegetable parasites, in algae cells and spores, from the 

 decomposition of vegetable substances. Harkness asserts that the 

 algae cells, which Salisbury found in the sputa of patients and re- 

 garded as the active principle of malaria, are found not only in 

 malarial regions, but on the highest Alps, and occur in the sputa 

 and other secretions of healthy persons. 



Intermittent fever is a wide-spread disease. It is especially 

 frequent in the tropics at places which are not particularly dry ; 

 in the temperate zones it occurs at certain places ; but the frigid 

 zones escape. It is very common in Western Africa, the West 

 Indies, Mexico, and our Southern States, but occurs to some extent 

 in all the States. 



