225 
PATHOLOGY. 
not take place, the miafmatal irritant being thrown off 
gradually by perfpiration and other fecretions, the pa- 
roxyfms would always become milder as the difeafe ad¬ 
vanced. But this is not the cafe. 
This liypothefis, though far from being correft, ap¬ 
pears to us the beft yet promulgated ; and the hint de¬ 
rived from it fee ms to us to ferve as the foundation for 
a theory more confonant with acknowledged faffs. We 
mean, that the idea of accumulation of material agents 
maybe explained without the affumptiou (an affumption 
which a thoufand fafts deny) that internal irritants ex¬ 
cite, while external irritants diminifli, contraflility. We 
•Ihould rather fuppofe the following circumftances take 
place: that the miafma, or other caufe of ague, operates 
exclufively on the mucous membrane, it may be, of the 
Itomach or lungs, but we know not where: it may be 
conjeftured, however, on the Itomach ; that the irritation 
it excites is direftly tranffnitted to the brain and nervous 
fyftem in general, through the medium of which, as in 
continued fever, the capillaries are fo affefted as to pro¬ 
duce fever. Abforption of the miafma taking place, this 
irritation is no longer kept up on the nerves of the mu¬ 
cous expanfion 5 and, in unifon with the law often urged, 
a re-aftion takes place over the whole body, merely in 
confequence of the nervous diminution of motion. 
Without inferring an aftual accumulation of the miafm, 
fince that would be difturbed by the paffage of food, &c. 
we Ihould fay, that a number of imprejfions from the now 
fecreted miafms were neceffary to develop the fympathetic 
aflion of fever; and of courfe, as the conftitution was 
more or lefs irritable, fo would the febrile movements 
take place in a larger or Ihorter period. There is no ne- 
ceflity to infer that the quantity of miafm gets lefs, be- 
caufe we know that fecreting veffels often fecrete the 
fame irritant as that which caufed their morbid ad ion ; 
as is exemplified in morbific pains. Left it be faid, how- 
ever, this is only eftablifhed with regard to animal irri¬ 
tants, we Ihould account for the unaltered degree of fe¬ 
ver obferved in fucceeding paroxyfms on the well-known 
law of habit ; viz. that fympathetic movements are more 
eafily called into aftion in proportion to the frequency 
of their previous occurrence. It will be feen that much 
of this theory belongs in fad to Dr. Park; to whom 
moreover this much is due, that its ftrudure is entirely 
owing to the train of thought into which his reafoning 
has call us. And we fliall endeavour to conned thefe 
views with an explanation of tic douloureux and other 
periodical nervous affedions, when we come to the clafs 
Neurotica. 
The adions which give rife to the paroxyfms of inter- 
mittents, though kept up folely by irritation, being ne- 
verthelefs fimilar in their nature to thofe of continued 
fevers, it follows, as in other difeafes, that, if the con- 
tradility of the blood-veffels is impaired, adual inflam¬ 
mation will arife; and hence that continued fever will 
come on, or that a ftate nearly bordering on this, but 
at the lame time capable of increafe from the periodical 
adion of the exciting caufe, will occur; in which cafe 
we witnefs what is called a remittent fever. 
Each paroxyfm of an intermittent fever is divided into 
three different ftages, which are called the cold , the hot, 
and the fweutivg, Jlages, or jits- 
1. The cold Stage commences with languor, a fenfe of 
debility and lluggilhnefs in motion, frequent yawning and 
ft retching, and an averfion to food. The face and extremi¬ 
ties become pale, the features Ihrink, the bulk of every ex¬ 
ternal part is diminilhed, and the Ikin over the whole 
body appears conltrided, as if cold had been applied to 
it. At length the patient feels very cold, and univerfal 
rigors come on, with pains in the head, back, loins, and 
joints, naufea and vomiting of bilious matter; the refpi- 
ration is fmall, frequent, and anxious ; the urine is almoft 
colourlefs ; fenfibility is greatly impaired ; the thoughts 
are fomewhat confufed 5 and the pulfe is fmall, frequent. 
and often irregular. In a few inftances, drowfinefs and 
ftupor have prevailed in fo high a degree as to referable 
coma or apoplexy ; but this is by no means ufual. 
2. Thefe fymptoms abating after a fhort time, the fe- 
cond ftage commences with an increafe of heat over the 
whole body, rednel's of the face, drynefs of the Ikin, 
thirft, pain in the head, throbbing in the temples, anx¬ 
iety and reftleffnefs ; the refpiration is fuller and more 
free, but ftill frequent; the tongue is furred, and the 
pulfe has become regular, bard, and full. If the at¬ 
tack has been very fevere, then perhaps delirium will 
arife. 
3. When thefe fymptoms have continued for fome time, 
a moifture breaks out on the forehead, and by degrees 
becomes a /meat.; and this, at length, extends over the 
whole body. As this fweat continues to flow, the heat 
of the body abates, the thirft ceafes, and molt of the 
fundtions are reftored to their ordinary ftate. This con- 
ftitutes the third ftage. It mult, however, be obferved, 
that in different cafes thefe phenomena may prevail in 
different degrees, and their mode of fucceffion vary; 
that the feries of them may be more or lefs complete ; 
and that the feveral ftages, in the time they occupy, may 
be in different proportions to one another. 
Such a depreftion of ftrength has been known to take 
place on the attack of an intermittent, as to cut off the 
patient at once ; but an occurrence of this kind is very 
uncommon. Patients are feldom deftroyed in intermit- 
tents from general inflammation, or from a fulnefs of the 
veffels either of the brain or of the thoracic vifeera, as 
happens fometimes in a continued fever; but, when they 
continue for any length of time, they are apt to induce 
other complaints, fuch as dyfpepfia, difeafe of the liver, 
dropfy, &c. which now and then prove fatal. In warm 
climates, particularly, intermittents are very apt to ter¬ 
minate in a fatal manner. When the paroxyfms are of 
fhort duration, and leave the intervals quite free from fe¬ 
ver, we may expeft a fpeedy recovery 5 but, when they 
are long, violent, and attended with much anxiety and 
delirium, the event will be doubtful. 
Diffeftions of thofe who have died of an intermittent, 
fhow a morbid ftate of many of the vifeera of the thorax 
and abdomen ; but the liver, and organs concerned in the 
formation of bile, as likewife the mefentery, are thole 
which are ufually moft affefted. 
The treatment of an intermittent fever refolves itfelf 
into thofe means which may be employed during a pa¬ 
roxyfm to arreft its progrefs, or to mitigate its violence ; 
and thofe which may prevent any return, and effeft a per¬ 
manent cure. This forms of courfe the more important 
part of the plan ; but it is fometimes neceffary to pal¬ 
liate urgent fymptoms; and it is always definable to fuf- 
pend a paroxyfm, if poffible, not only to prevent mil- 
chief, but alfo that there may be more time for the ule 
of the moft effeftual remedies. When therefore a fit is 
commencing, or (hortly expefted, we may try to obviate 
it by fome of thofe means which excite movements of an 
oppofite defeription in the fyftem : an emetic will gene¬ 
rally anfwer the purpofe, determining the blood power¬ 
fully to the furface of the body. Should the paroxyfm 
have already come on, and the cold ftage be very fevere, 
the warm bath, and cordial diaphoretics in repeated 
moderate dofes, may aflllt in bringing warmth to the 
furface : when, on the contrary, great heat prevails, the 
antiphlogiftic plan is to be purfued; and it is highly ne¬ 
ceffary, if any organ of importance be much inflamed, 
to take blood, efpecially if the patient is plethoric and 
rebuft : acidulated drink may be exhibited, with purges, 
keeping the furface cool at the fame time. In the inter- 
millions, ftimuli of various kinds are recommended; at 
the head of which we place cinchona and arfenic, the 
former of which is to be taken largely in fubftance, 
where the difeafe is not complicated with vifceral affec¬ 
tion 5 in a quotidian an ounce at leaft Ihould be given 
between 
