82 THE TREATMENT OF DISEASES. 



and more natural, and gradually a moisture appears on the forehead and face, and this 

 goes on increasing until the patient is in a state of the most profuse perspiration. 

 He is then in a condition of comparative comfort, the pulse soon regains its natural 

 frequency, the pains depart, and after a time the sweating subsides, and the fit is 

 over. 



The cold from which the patient suffers- in the cold stage of ague is purely sub- 

 jective : he feels cold, but is not so in reality, and if you put your hand to his skin 

 you will find that it is burning hot. A thermometer placed in the armpit usually 

 indicates a temperature of from 105 to 106 Fahr., a temperature as high or 

 higher than we meet with in scarlet fever. And yet at this very time the patient is 

 shivering with cold, often so violently as to .shake the bed, and perhaps the 

 whole room. Sometimes the chattering of the teeth has been so violent as to break 

 them, or if loose, to shake them out of the jaw. 



Sometimes the fits are incomplete, and the patient suffers from only one or two 

 of its stages. Thus he may shake and yet have no subsequent heat or sweating, or, 

 on the other hand, the sweating stage may be the only one to manifest itself. We 

 have all heard of the man who was so lazy that he wouldn't shake when he had the 

 ague, and it is to be presumed he suffered from the heat and sweating, without 

 the previous rigors. When the paroxysm begins at once with the hot stage, the com- 

 plaint is popularly called the " dumb ague," to distinguish it from the more common 

 form, what is called the " shaking ague." These incomplete fits are generally to be 

 regarded as an indication that the complaint is about to take its departure, but they 

 occasionally occur at other periods of the disease. One of the most curious cases on 

 record is that of a man who had his fits backwards, the usual order of the stages being 

 reversed. Among the vagaries of the paroxysm, a very singular one has been 

 noticed, in which the affection is confined to a single limb, which passes through the 

 several stages regularly, the remainder of the system being apparently undisturbed. 



The most curious and annoying thing about an ague fit is that it always returns. 

 If one could only have it out and then have done with it, we should not care so 

 much, but it is sure to come back again in a few days, unless, indeed, we succeed by 

 the use of appropriate remedies in arresting its progress. 



The frequency with which the fit returns varies very much in different attacks, 

 and certain terms are used to designate this difference. Thus, when there is a fit 

 every day the type of the ague is said to be quotidian. When the fit occurs every 

 alternate day, say Monday, Wednesday, and Friday, the ague is a tertian. The mode 

 of reckoning is to count the day on which the preceding fit happened as the first, 

 so that the next fit in this form occurs on the third day. When the paroxysm 

 occurs, say on Monday, Thursday, and Sunday, the ague is a quartan. These are 

 the regular types of ague, but others are recognised which are termed irregular. 

 Thus a double tertian differs from a quotidian only in having on alternate days fits 

 of corresponding severity, character, and duration. In the triple tertian there are 

 two fits on one day, and one on the next. In the duplicate tertian there are two 

 fits on alternate days, with an intermediate fever-free day. In a double quartan 

 there is a fit on one day, a mild one on the next, and then a fever-free day, and so 

 on. These terms are not very easy to understand, and it must be confessed, that 



