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.
Alternate chills and heat; external coldness and internal heat; heat in the head and face, with coldness of the limbs, and clammy hands and feet, sometimes cold up to the abdomen; giddiness; feeling of heaviness in the head and limbs; violent pains in the small of the back, and anxiety.
Sulph. 0 or 3.-
Attacks coming on in the after part of the day, with evening chills, fever during the night, with sweating in the morning; palpitation of the heart. After checked eruptions.
Veratrum3. – External coldness with internal heat; cold, clammy sweat, especially on the forehead, and general coldness of the whole body; chilliness without heat, or chilliness and heat by turns; giddiness; constipation or diarrhoea; sometimes nausea or vomiting, or pain in the back and loins.
When the slightest disorder of the stomach brings on a relapse. Absence of thirst during the whole attack, or thirst only during the hot stage; heat and chilliness at the same time; bitter taste in the mouth; bitter or sour vomiting of phlegm or bile; the attacks come on in the afternoon or evening, and the patient complains of chilliness continually.
When there is thirst in the cold stage but not in the hot; chilliness relieved by external warmth; heat of some parts of the body and chill of others; heat externally only; pain in the bowels during the cold stage, followed by heat, with debility and sleepiness.
When the attack begins with great debility and desire to lie down; giddiness; cramp in muscles of abdomen or calves; stitches in the sides; alternate heat and chills, or heat preceding the chills; heat externally and chilliness internally, or vice versa; desire to be constantly covered, even during the hot and sweating stages; external warmth gives no relief; heat and pain in the head; buzzing in the ears; redness of the cheeks; thirst and anxiety during the hot stage; constipation.
Natrum mur.6 –
Useful in intermittents of old standing after the abuse of quinine. The special symptoms are, violent pains in the head during the chilliness, and increasing during the heat; prolonged chills, beginning about 10 a.m.; dimness of sight and partial loss of consciousness during the fever and during the time between the attacks; lips chapped or blistered, slight fever continuing through the intermission.
Chilliness preceded by thirst, followed by heat without thirst; chills, violent and long-continued, beginning in the back between the shoulder-blades; intense burning both internally and externally; accumulation of phlegm in the mouth and throat; slimy, burning diarrhoea; great intolerance of noise.
Eupatorium perfoliatum. 3.-When the attacks are preceded by violent pains in the bones and thirst, persisting through the attack.