This remedy is most suitable in epidemic and endemic form of chills and fever, being of little if any use in the general malarial cachexia. The paroxysms are irregular and it corresponds more to the tertian type, if to any. The precursory symptoms to the chill are nervous excitement, anxiety, headache, nausea and irritability. The chill is of short duration and it soon becomes mingled with the heat, and the remedy may be said to be one of the thirstless remedies in fever, as there is very little, if any, thirst during the chill and no real thirst during the heat, it being from a desire to moisten the mouth, rather than to quench the thirst, that the patient may desire water. During the fever the veins appear enlarged and there is congestion to the head, redness and heat of face, even though other parts of the body be chilly. During the chill the patient sits near the fire and wraps himself up, but the warmth obtained does no good. During the sweat, however, which is long and profuse, there is much thirst.
**Cinchona is seldom of use in inveterate cases, where the liver and spleen are hypertrophied or where much quinine has been taken, though a swollen spleen does not contra- indicate the remedy. The apyrexia is marked with debility, restlessness, loss of appetite or great hunger, anaemia, gray complexion, congestions, backache and oedema, scanty urine with brickdust sediment.
Nux vomica. [Nux-v]
**Nux vomica is another remedy not so much indicated in inveterate cases, but it corresponds to cases where the gastro- bilious symptoms are prominent, and accompanied by nervous symptoms proceeding from the spinal cord. The chill is perhaps more commonly quotidian, coming on in the afternoon and evening. The chill is predominant and starts with blueness of the fingernails, preceded by aching of the body, gaping and yawing, there being no special thirst, but a dull frontal headache and vertigo and nausea, disordered stomach and weakness of the limbs. There is no relief from covering or from external heat, and another condition may be an alternation of chills and heat.
**Eucalyptus globulus. Also useful in some forms. There are no characteristic indications.
**Pulsatilla. Long chill, little heat and no thirst.
**Menyanthes. Chill predominates without thirst; icy coldness of finger tips.
**Ignatia. Warmth from stove relieves; thirst only during chill.
**Lachesis. Desires heat, but no relief therefrom. A most important remedy after abuse of quinine.
**Carbo vegetabilis. Old cases, with coldness of feet.
This is one of our most important remedies, and, next to **Cinchona, it is more frequently indicated than any other. The characteristics are intensity and long duration of paroxysms, especially of the burning heat, the unquenchable thirst, anxiety and restlessness, a small, quick pulse and a clean tongue. The cleaner the tongue in violent paroxysms the more is it indicated. After the attack there is pallor and exhaustion. It is the sovereign remedy for the malarial cachexia; it antidotes quinine and its attacks are accompanied with a high grade of gastric irritability. Hughes and Kippax, however, do not consider **Arsenic as being suited to the typical forms of intermittent fever, but rather to those types known as typo-malarial fevers. Other characteristics of **Arsenicum are the illy- defined paroxysms with, perhaps, one of the stages wanting the collapse of vital power and the marked prostration.
The longer the disease has lasted the more likely will **Arsenicum be indicated.
Natrum muriaticum. [Nat-m]
This is a remedy seldom of use in recent cases corresponding more to inveterate and badly treated cases. The stages are very unequal, the chill perhaps being continuous, heat moderate with violent headache, and perspiration wanting or excessive and debilitating and relieving the headache. The complexion is yellowish gray and the spleen and liver are enlarged. Perhaps the most typical case calling for this remedy would have a chill commencing about ten o’clock in the morning, beginning in the back and feet with great thirst pains in the bones, pains in the back, headache, debility, accompanied with shortness of breath; and especially if fever blisters or hydroa form on the lips; this is most characteristic. Such patients during the apyrexia the apyrexia are dejected and apprehensive, have a swallow complexion and white coated tongue, sleepy in the daytime and sleepless at night. It especially corresponds to cases where there is a psoric taint.