Advice to the people in general, with regard to their health

by S. A. D. Tissot

§ 252. The first Attack of an intermittent Fever often happens, when the Patient thought himself in perfect Health. Sometimes however it is preceded by a Sensation of Cold and a kind of Numbness, which continue some Days before the manifest Invasion of the Fit. It begins with frequent Yawnings, a Lassitude, or Sensation of Weariness, with a general Weakness, with Coldness, Shivering and Shaking: There is also a Paleness of the extreme Parts of the Body, attended with Loathings, and sometimes an actual Vomiting. The Pulse is quick, weak, and small, and there is a considerable Degree of Thirst.

At the End of an Hour or two, and but seldom so long as three or four Hours, a Heat succeeds, which increases insensibly, and becomes violent at its Height. At this Period the whole Body grows red, the Anxiety of the Patient abates; the Pulse is very strong and large, and his Thirst proves excessive. He complains of a violent Head-ach, and of a Pain in all his Limbs, but of a different sort of Pain from that he was sensible of, while his Coldness continued. Finally, having endured this hot State, four, five or six Hours, he falls into a general Sweat for a few more: upon which all the Symptoms already mentioned abate, and sometimes Sleep supervenes.

At the Conclusion of this Nap the Patient often wakes without any sensible Fever; complaining only of Lassitude and Weakness. Sometimes his Pulse returns entirely to its natural State between the two Fits; though it often continues a little quicker than in perfect Health; and does not recover its first Distinctness and Slowness, till some Days after the last Fit.

One Symptom, which most particularly characterises these several Species of intermitting Fevers, is the Quality of the Urines which the Sick pass after the Fit. They are of a reddish Colour, and let fall a Sediment, or Settling, which exactly resembles Brick-dust. They are sometimes frothy too, and a Pellicle, or thin filmy Skin, appears on the Top, and adheres to the Sides of the Glass that contains them.

§ 253. The Duration of each Fit is of no fixed Time or Extent, being various according to the particular sort of Intermittents, and through many other Circumstances. Sometimes they return precisely at the very same Hour; at other Times they come one, two, or three Hours sooner, and in other Instances as much later than the former. It has been imagined that those Fevers, whose Paroxysms returned sooner than usual, were sooner finally terminated: but there seems to be no general Rule in this Case.

§ 254. Intermitting Fevers are distinguished into those of Spring and Autumn. The former generally prevail from February to June: the latter are those which reign from July to January. Their essential Nature and Characters are the very same, as they are not different Distempers; though the various Circumstances attending them deserve our Consideration. These Circumstances depend on the Season itself, and the Constitution of the Patients, during such Seasons. The Spring Intermittents are sometimes blended with an inflammatory Disposition, as that is the Disposition of Bodies in that Season; but as the Weather then advances daily into an improving State, the Spring Fevers are commonly of a shorter Duration. The autumnal Fevers are frequently combined and aggravated with a Principle of Putrefaction; and as the Air of that Season rather degenerates, they are more tedious and obstinate.

§ 255. The autumnal Fevers seldom begin quite so early as July, but much oftner in August: and the Duration to which they are often extended, has increased the Terror which the People entertain of Fevers that begin in that Month. But that Prejudice which ascribes their Danger to the Influence of August, is a very absurd Error; since it is better they should set in then than in the following Months; because they are obstinate in Proportion to the Tardiness, the Slowness of their Approach. They sometimes appear at first considerably in the Form of putrid Fevers, not assuming that of Intermittents till some Days after their Appearance: but very happily there is little or no Danger in mistaking them for putrid Fevers, or in treating them like such. The Brick-coloured Sediment, and particularly the Pellicle or Film on the Surface of the Urine, are very common in autumnal Intermittents, and are often wanting in the Urine of putrid Fevers. In these latter, it is generally less high coloured, and leaning rather to a yellow, a kind of Cloudiness is suspended in the Middle of it. These also deposite a white Sediment, which affords no bad Prognostic.

§ 256. Generally speaking, intermitting Fevers are not mortal; often terminating in Health of their own Accord (without the Use of any Medicine) after some Fits. In this last Respect Intermittents in the Spring differ considerably from those in the Fall, which continue a long Time, and sometimes even until Spring, if they are not removed by Art, or if they have been improperly treated.

Quartan Fevers are always more obstinate and inveterate than Tertians; the former sometimes persevering in certain Constitutions for whole Years. When these Sorts of Fevers occur in boggy marshy Countries, they are not only very chronical or tedious, but Persons infested with them are liable to frequent Relapses.

§ 257. A few Fits of an Intermittent are not very injurious, and it happens sometimes, that they are attended with a favourable Alteration of the Habit in Point of Health; by their exterminating the Cause or Principle of some languid and tedious Disorder; though it is erroneous to consider them as salutary. If they prove tedious and obstinate, and the Fits are long and violent, they weaken the whole Body, impairing all its Functions, and particularly the Digestions: They make the Humours sharp and unbalmy, and introduce several other Maladies, such as the Jaundice, Dropsy, Asthma and slow wasting Fevers. Nay sometimes old Persons, and those who are very weak, expire in the Fit; though such an Event never happens but in the cold Fit.