MEDlClNEi. 
fits being almost always ushered in by hor- 
Iror or trembling. One paroxysm only in 
the day. The continued family are defined 
thus ; fevers without intermission, not oc- 
casioned by marsh miasm, attended with 
exacerbations and remissions, though not 
very perceptible. 
The remote causes of fever hre not always 
to be easily or accurately distinguished, and 
of the proximate causes we may fairly be 
said to know nothing, since so many dif- 
ferent conjectuies, often in direct hostility 
to each other have been offered, by writers 
of the first reputation, and the system of 
yesterday has so frequently fallen before 
that of to day. Without entering therefore 
into this controverted subject, we shall pro- 
ceed to an account of the general symptoms 
and mode of treatment. ' 
Tntermittents. — Symptoms. A regular pa- 
roxysm of this fever is divided into three 
stages — the cold, hot, and sweating stage. 
The first stage commences with yawning 
and stretching ; there is at the same time 
an uneasy sense of weariness or inaptitude 
to motion, accompanied with some degree 
of debility ; paleness and sin inking of the 
features and extremities are also observ- 
able; at this period some coldness of the 
extremities may be felt by another person, 
although the patient takes little or no no- 
tice of it ; the skin, however, becomes 
rough, as is the case in cold weather, and is 
less sensible than usual ; a sensation of 
coldness is now felt by the patient himself, 
which is at first referred to the back, and 
gradually spreads over the whole body, 
producing an universal shaking : after 
this has lasted for some time, the patient’s 
sensation of cold still continuing, the 
warmth of his skin, to the feeling of 
another person, or measured by the ther- 
mometer, gradually increases ; there is 
nausea, and frequently vomiting of a bilious 
matter ; pains of the back, limbs, loins, and 
head-ach, or more commonly drowsiness, 
stupor, or a considerable degree of coma at- 
tend this stage ; the respiration is frequent 
and anxious ; the pulse is small, frequent, 
sometimes irregular, and often scarcely per- 
ceptible ; the urine is almost colourless, and 
without cloud or sediment. 
As the cold and shivering, after alternating 
for some time with warm flushings, gra- 
dually abate, the hot stage is ushered in by 
a preternatural heat, the pulse becomes full, 
strong, and hard, the respiration is more 
free, but still frequent and anxious, tlie 
paleness and shrinking of the features, toge- 
VOL. IV. 
ther with the constriction of the skin, now 
disappear, and are succeeded by a general 
redness and turgescenee ; the tongue is 
white and dry, the thirst is considerable; 
the skin continues parched, the head-ach, if 
it was absent in the first stage, now comes 
on, is accompanied with throbbing of the 
temporal arteries, and frequently rises to 
delirium, and the urine is high coloured ; 
as the hot stage advances, the nausea and 
vomiting abate, and on the appearance of 
moisture upon the skin, they generally cease 
altogether. The hot stage is at length ter- 
minated by a profuse sweat, which breaks 
out, first about the face and breast ; it gra- 
dually extends oyer the whole body, and 
terminates the paroxysm ; most of the 
functions are restored to their natural state, 
the respiration becomes free, the urine de- 
posits a lateritious sediment, the sweat gra- 
dually ceases, and with it the febrile symp- 
toms ; the patient is, however, left in a 
weak and weaiied state : between the pa- 
roxysms, the patient is more easily fatigued 
than usual, complains of want of appetite, 
and the skin is parched, or he is more 
liable to profuse perspiration than in healths 
The cold fit of this species is longer than 
that of the quotidian, but shorter than tljat 
of the quartan, and the whole paroxysm is 
shorter than that of the quotidian, but longer 
than that of the quartan. 
The predisposing causes bf intermittents 
are, whatever tends to debilitate the body, 
a warm moist, or cold damp atmosphere, 
particular seasons, as spring and autumn : 
the occasional or exciting causes are, marsh 
miasm, contagion, and perhaps lunar in- 
fluence. 
Prognosis. Mildness and regularity of the 
paroxysm, a general cutaneous eruption, or 
an eruption about the mouth and behind the 
ears, accompanied with a swelling of the 
upper lip, when the paroxysm is going off ; a 
free hemorrhage from the nose during the pa- 
roxysm, and the urine depositing a lateriti- 
ous sediment in the last stage, are favourable 
symptoms. Coma, delirium, great anxiety, 
difficult respiration, attended with hiccup, 
swelling of the tonsils, the abdomen tumid, 
hard, and painful to the touch, accompanied 
with obstinate costiveness, tension and pain 
in the epigastric and hypochondric regions 
during the paroxysm ; listlessness, nausea, or 
debility, attended with vertigo in the inter- 
missions, or a few drops of blood falling 
from the nose in the paroxysm, are unfa- 
vourable symptoms. Intermittents are fi-e- 
quently followed by, or attended with, ob- 
A a 
