484 Observations on the medical effects 



and a paroxysm of the symptoms occurs about noon, and 

 terminates in a rigor, which proves the commencement of the 

 paroxysm of fever. This first attack assumes the type, from 

 which the other forms of intermittent fever are supposed to 

 be derived. Should the febrile state be increased twice a day, 

 so that a fresh attack occurs before the previous attack had 

 subsided^ it forms the remittent fever; from which the remain- 

 ing continued type is deduced in which the remission becomes 

 gradually less distinct. This continued, or more severe form 

 of fever, as it diminishes in violence, has a tendency to take 

 a regular or an irregular form, and at last intermissions 

 occur. These remarks regarding the nature of fever evince 

 the propriety of varying the treatment to be followed, and by 

 observing the premonitory symptoms, the physician by the 

 judicious employment of remedies, will be enabled to render 

 the disease milder and less dangerous ; whether it arise from 

 the impression of cold, or from a contagious source. In both 

 cases the first symptoms that declare themselves are much the 

 same, and they will pass through their course varied under 

 different circumstances, unless these symptoms are checked, 

 or the fever cut short. This has been attempted to be done 

 by the violent action of medicine, such as a full dose of tartar 

 emetic, the sudden shock of the cold affusion or a large 

 bleeding, so as to enable the constitution to throw off the 

 disease ; but these methods are now considered dangerous, 

 and are very rarely had recourse to. 



The first symptoms observed of an attack of ague are a 

 feeling of langour, a sense of debility and sluggishness, in 

 some cases nausea, and vomiting of bilious matter, an aver- 

 sion to food, and a diminution of the secretions. The face 

 of the patient becomes pale, the features and external parts 

 shrink, and the skin becomes constricted. The person feels 

 very cold ; rigors come on, with pain in the back, head, loins, 

 and joints ; the sensibility is impaired, the thoughts confused ; 

 the pulse is small, frequent, and often irregular ; and the 



