AGfK. 81 



Debility greatly favours the action of the exciting cause. On many occasions 

 soldiers have been exposed to the action of malaria without suffering in any way 

 whilst strong and in good health, but have speedily succumbed when weakened 

 by exertion and fatigue, or dispirited by defeat. It must be distinctly understood, 

 .1. that no amount of debility or privation would in itself excite ague, and 

 that the presence of the malarial poison is absolutely necessary. 



Ague is not very common in England. It is confined almost exclusively to Essex, 

 ( 'ambrid.ueshire, Norfolk, and Lincolnshire ; counties in which there are either marshes 

 or fens or low-lying ground which is occasionally covered with water. The disease 

 TV uncommon in London, and you might go to half the hospitals in the 

 metropolis without seeing a single case. The majority of our cases are fortunately 

 not of home manufacture, but are, so to say, imported. The bargees on the Thames 

 ionally suffer, but even this is quite exceptional. London, however, has not 

 always been so fortunate, and a couple of centuries ago the disease was extremely 

 prevalent in this city. It will be remembered that both James I. and Oliver Crom- 

 well died from tertian ague contracted in the metropolis, and that Sir "Walter Raleigh 

 was suffering from the same malady at the time of his execution. In the account 

 of Raleigh's last moments we are told that as the morning was very cold the sheriff 

 said would he come down to a fire for a little space and warm himself. But Sir 

 Walter thanked him, and said no, he would rather it were done at once, for he was ill of 

 fever and ague, and in another quarter of an hour his shaking fit would come upon 

 him if he were still alive, and his enemies might then suppose that he trembled 

 for fear. It is evident that it was to his complaint that he referred when, before laying 

 his head upon the block, he felt the edge of the axe and said that it was a sharp 

 medicine, but would cure the worst disease. Our modern methods of treatment are 

 almost as certain, and far less disagreeable. As regards the prevalence of ague, the 

 Dutch at the present day are not much better off than the English were a couple of 

 hundred years ago, for the malady is still very prevalent amongst the inhabitants of 

 the low and level coast of Holland. In Italy the Pontine Marshes near Rome have 

 for ages enjoyed an unenviable reputation for the production of malaria. 



We must now consider the phenomena which characterise an ordinary fit of ague. 

 It is usually composed of three distinct stages, which are distinguished as the cold, 

 hot, and sweating stages. A person who is about to have an ague fit usually suffers 

 from certain warning or premonitory symptoms, and these ordinarily consist of nausep., 

 languor, lassitude, and pains in the back and legs. Soon he begins to feel chilly, he 

 grows pale, his features shrink, and his skin becomes dry and rough. Gradually the 

 feeling of cold becomes more intense, the sufferer shakes and trembles all over, his 

 limbs are shrunken, his teeth chatter, his hair bristles, his cheeks, lips, ears, and nails 

 U r et blue, the breathing becomes hurried, the pulse quick and feeble, and the pains in the 

 head, back, and loins are increased. After a time this condition of distress is succeeded 

 by another of quite a different kind. The sensation of cold gradually decreases, and the 

 shrunken condition of the limbs and features disappears. The face then becomes red 

 and turgid, the skin hot, dry, and pungent, the temples throb, the pulse is full and strong, 

 as well as rapid, and the patient is parched with thirst, and is in an extremely restless 

 and uncomfortable condition. At length another change occurs, the skin feels softer 

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