Definition.-Fever occurring in marshy places, coming in paroxysms of one, two, or more days’ interval; commencing with chill, and followed by heat and sweat.
Diagnosis.-There is not much difficulty in distinguishing ague or intermittent fever from other fevers. The chill, followed by heat and sweat, the disappearance of the fever, and the return at more or less regular intervals, are characteristic. All these features are not always present in every case. There may be absence of chill or of sweat, but there will always be sufficient to decide its true nature. In the eruptive fevers there is the rash, and the fever is continuous, and there is affection of the joints. In ague there are often bone pains, but these are intermittent, like the fever.
General Treatment.-Where the air is malarious, the bedroom window should be open only a few hours in the middle of the day, and should never be on the ground floor. Nothing that lies heavy on the stomach should be eaten; pastry and baked or roasted things should be avoided. Attention should be paid to the clothing, which should be warm and well aired. During the swelling stage of the fever, the patient should lie between blankets. If he is thirsty, he may drink water if the water is good; if the water is not above suspicion, it should be boiled and filtered and toast- water made of it.
Prophylactic Treatment.-Now that the part played by the mosquito in disseminating intermittent fever has been made known, every care should be taken to secure protection against its bites. Before entering a malarious district, it is advisable to take, for a week or two beforehand, one dose daily of China I or Arsen. 3, and also from time to time whilst in the district. Those who live in marshy places, or near newly-opened canals or dug land, should take, as soon as they feel any signs of illness, a dose of China I, every two hours. After twelve hours, if no better, they should take a dose of Ipecac. 3., and after another twelve hours a dose of China again. If this does not suffice to dissipate the illness, one of the following medicines must be given.
Medicines.-(A few doses to be given at one or two hour intervals before an attack is expected, and after it is over, not during the attack.)
Much internal chilliness, which is increased by external warmth; little or no thirst in the cold stage, but much in the hot stage; clean or slightly furred tongue; nausea and vomiting, and oppression of the chest immediately before the attack, or during the cold and hot stages.
Ipecac. will often develop the characteristics of an attack. If there is any doubt about the remedy, give Ipecac. every four hours after an attack is over for one day, and then another dose just before the attack is expected. It may be there will be no other attack. If another attack occurs, another remedy must be given according to the indications.
When the different stages are not distinctly marked, chills, heat, and sweat occurring together; or when frequent changes from chilliness to heat, and internal chilliness with external heat; paroxysms imperfectly developed; little or no sweat, or none till long after the heat has subsided; prostration; burning pains; restlessness, anxiety; drinking often, and but little at a time; uneasiness about the heart or oppression and spasms of the chest; nausea or sickness and vomiting; bitter taste; violent headache continuing after the hot stage; buzzing in the ears during sweating. All the patient’s sufferings, as headache and pains in the limbs, are worse during the attack.
Paroxysm preceded by nausea; voracious appetite; headache; agitation; palpitation; sneezing; thirst during sweat, sometimes continuing all the time between the attacks; chills alternating with heat, or when the heat does not come on for some time after the chills have ceased; sleeplessness, or disturbed sleep; prostration and sallow complexion. When there is much thirst in the cold or hot stages China must not be given.