AGUE. 



83 



although they are frequently used, they are not of much practical value. The 

 i olio wing table will enable the sufferer to see at a glance from what type of ague he is 

 Miiii-ring. We have in each case supposed that there was a fit on the Monday, and havn 

 employed the two kinds of crosses to indicate paroxysms differing in character and 

 intensity. 



It is only right to mention that there are certain cases in which the fits from 

 first to last observe no definite type or order of succession, and these are usually 

 spoken of as erratic forms of ague. 



What is it that determines whether the type of the attack shall be a quotidian, 

 tertian, or quartan ? It is very difficult to say, but it probably depends upon the 

 dose of malaria which is taken into the system. When the body is saturated with 

 the poison, it induces a fit every day, but when the poison is less concentrated, a 

 paroxysm at longer intervals suffices for its elimination. 



It is a curious fact that the hour at which the paroxysms commence is more 

 or less dependent on the tyj>e of the disease. Thus the paroxysms of quotidian ague 

 usually begin in the morning, those of the tertian at noon, and those of the quartan 

 in the afternoon. 



The duration of the paroxysm is also more or less influenced by the type. Thus 

 the fits last in the quotidian from ten to twelve hours, in the tertian from six to 

 eight hours, and in the quartan from four to six hours. It has been often remarked 

 that as the patient is on the point of recovering, as the result of successful 

 treatment, the paroxysms are postponed, or occur an hour or two later every day, 

 until finally they disappear. At the commencement of an attack, when the patient 

 is getting worse, the paroxysms not unfrequeiitly anticipate, or occur before the 

 expected hour. As the result of repeated attacks of ague, the spleen becomes 

 greatly enlarged, and may be felt as a hard mass under the ribs on the left side. 

 This readily attracts attention, and is usually known as the "ague cake." Ague is 

 sometimes complicated or modified by other complaints. Thus in summer the 

 patient is apt to suffer in addition from irritation of the stomach, diarrhoea, or 

 dysentery ; and in winter from bronchitis or congestion of the lungs. Occasionally 

 each paroxysm is attended with violent delirium, and sometimes even with 

 convulsions. 



Is ague a very dangerous disease 1 No, not in this country. Curiously enough, 

 there is a very prevalent opinion that ague is rather a good thing than otherwise 



