We shall first trace the prominent features of the general febrile Class, descending progressively through the different Orders and Genera. In most fevers, of whatsoever genus, one or more of the following symptoms occur: shivering, chilliness, and heat of the skin alternating: the circulation of the blood, and consequently of the pulse, as felt at the wrist, accelerated more than in the natural state; in adults, to upwards of 96 strokes every minute; and in infants, is considerably more increased in velocity: also general languor, lassitude, and debility of the nerves and muscles; dryness of the mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing, and generally headach: in most of the continued and remittent fevers, there is total suspension of appetite, sickness at the stomach, nausea and vomiting; increased heat of the skin, at least burning sensation; aversion to motion; the sick are mostly confined to bed, unable to walk, or frequently even to sit erect; and this is commonly the case, even in the intermittent genera during the febrile paroxism: the remittent and continued have usually an evening or nocturnal febrile exacerbation: the voice and countenance frequently express condolence: and in the genera of topical inflammations, there is fixed pain in the different parts affected.
Intermittent Fevers,
or Agues, notwithstanding their febrile type, fall under the Chronic class. They are usually distinguished into different genera, or types; into Quotidian, Tertian, Quartan, with their separate species and varieties. It would seem, by the London registers, that very few die of agues, from which no age is exempted, but to which adults are much more obnoxious. Intermittent havock, if not immediately, yet in its chronic effects, is far more fatal than the London bills represent. Towns in general, it is true, are less harrassed with agues than country places. Pringle remarks, that during the campaigns of the British troops in the marshy countries of Holland and Flanders, where, in all such climates, and in damp soils and situations, agues and remittent fevers are epidemick, that the soldiers quartered in towns were less afflicted than those stationed in country cantonments: that in the former, the fires, sewers, drains, and paved streets, prevented an exuberance of moisture: and that, if the men slept in the upper floors of the house, they were still more secure from damp and intermittent sickness.
The invasion of Intermittent Paroxisms, is during certain periods only, and generally consists of a successive series of shivering and cold, burning heat, and profuse sweats: and exhibits the fundamental outlines of all fevers. Intermittent paroxisms, and consequently the genera and species, vary in duration, in recurrence, and in the symptoms. Quotidians, Tertians, and Quartans, consist of paroxisms, at the respective intervals of 24, 48, and 72 hours. An interval denotes the length of time from the beginning of one paroxism to the next succeeding: an intermission the vacation between paroxisms. Other distinctions, perhaps too refined, are made of intermittents, as Quintanæ, Septiminæ, Decimanæ, Erraticæ, Vagæ. Each of the three primary intermittent genera, are likewise subdivided into duplex and triplex. The double tertian is a very universal form, but may be referred to remittents: it implies that every other or second day the paroxisms are similar, but different in the intermediate days. Again, the type of intermittents is often obscured under a cloud of irregular and adventitious symptoms; and from one predominant symptom, or from similarity to various other diseases, these three fundamental genera are split by Nosologists into other species and varieties; the Quotidiana or intermittens, into simplex, cephalalgia, ophthalmica, nephralgica, stranguriosa, ischiadica, sputatoria, catarrhalis, anginosa, epileptica, hysterica, partialis: the Tertiana into simplex, hemitritæa, duplex, triplex, pleuritica, asthmatica, arthritica, emetica, hysterica, apoplectica, urticata, and other species of double tertian enumerated under the remittent type: the Quartana into cataleptica, epileptica, hysterica, maniaca, comatosa, nephralgica, splenetica, arthritica.
The three stages of intermittent fevers, during their periodical revolution, affect, more or less, the brain and nerves, the inherent muscular power, the heart and arteries, the stomach and intestines, and the sensible qualities of the body; the symptoms usually succeeding in the following progressive order: languor, sluggishness, debility, impaired sensibility, sometimes drowsiness and coma, oscitation, sensation of coldness in the back and spine, overspreading the body and extremities; accelerated and weak pulse; laborious respiration with anxiety; impaired appetite, and often sickness, nausea, and vomiting of bile; thirst; limpid urine; pale face, extremities, and trunk, and cutaneous collapse; rigor and trembling of the extremities and trunk, and gnashing of the teeth, as if cold water was poured on the body. This stage is various in duration in different persons, and in the different intermittent types. Nature at length rallies its powers with success, and with the expulsion of the cold, the second or hot stage is kindled up with undulating flushes of heat, and its preternatural increase over the body; the cutaneous blood vessels are dilated with suffusion of the countenance, redness, and burning heat; the pulse becomes strong, full, and more regular; the respiration continues oppressed, and is accelerated; with headach, throbbing of the temporal arteries, and sometimes delirium. After some continuance of this febrile struggle, and tumultuary rage of the re-acting organs of sensation and motion, the third stage of sweat is introduced by some moisture oozing throughout all the cutaneous pores, and poured out often in profuse streams: with this the heat of the body, the pulse, respiration and appetite become more natural; the urine less transparent deposits a sediment; the febrile tempest abates to a calm; and the body recovers the exercise of all its usual functions. Sometimes indeed there are varieties; such as little or no cold stage, or sweat.
Intermittent paroxisms are always terminated in less than twenty-four hours. Quotidians have the least cold stage, but the longest paroxism: tertians are in the intermediate degree in both respects; quartans have the most violent, or at least the longest cold stage, but the shortest paroxism: their cold stage may be two hours, or longer. The hot and sweating stages therefore constitute the greatest portion of intermittent conflict. Quotidian paroxisms rarely exceed eighteen hours: tertians are from six to twelve: quartans somewhat shorter. Quotidians generally assault in the morning; tertians and quartans in the noon and afternoon. Vernal are said not to be so refractory as autumnal intermittents. But in young sound constitutions, agues, if not inveterate, are frequently cured after a few paroxisms. When death happens in them, it is generally during the cold stage. More frequently their fatality is by transition into some other chronic diseases: such as maladies of the stomach, digestive organs, liver, and intestinal tube; bilious cachexy, jaundice, consumptions, dropsy. Some inveterate corporeal infirmities have been relieved by intermittents. During their revolution the type is frequently changed: quartan and tertian into quotidian: the latter into remittent; and these into continued fever.
Remittent Fevers:
fevers with remissions and exacerbations, or which have not a temporary and total cessation, are the most universal febrile form in all parts of the globe. Throughout the equatorial oven, or middle regions of the earth, from Cancer to Capricorn, intermittents, but, above all, remittents and dysenteries are the most universal type of fever. They are the locusts which devour whole crops of mankind. During the periodical rainy seasons of the tropical zones; particularly where they are choaked up with woods and morasses, and in uncultivated new settlements, these fevers often ravage with the desolation of an Egyptian pestilence; and are sometimes so precipitate as to kill in one or two paroxisms, if not sooner repulsed; the doctor, lawyer, and priest quickly succeeding each other in their visits. They destroy not only multitudes immediately, especially of the new European settlers; but when improperly treated, or when convalescents from irregularity, fall back into relapses, they often terminate in fatal chronic diseases, similar to those recently enumerated under the intermittent train.