Bilious Remittent Fever.
THERE are three principal varieties of periodical fever, which, though varying considerably from each other in several particulars, are yet essentially, in their substance, but one disease. These are Bilious Remittent Fever, Pernicious Intermittent or Congestive Fever, and Intermittent Fever or Fever and Ague. According to the custom of most writers, I shall treat them separately, beginning with Bilious Remittent Fever.
Symptoms. The attack is generally sudden and well marked. Some writers say it has no premonitory symptoms; others that it has. The more general understanding is, that for a day or two, or even longer, before the onset, there is a sense of languor and debility, slight headache, lack of appetite, furred tongue, bitter taste in the mouth in the morning, pains in the joints, and general uneasiness.
The formal onset is nearly always marked by a distinct chill or rigor, sometimes slight and brief; at other times severe and pro. longed. The chill may begin at the feet, or about the shoulder. blades, or in the back, and thence run like small streams of cold water poured in every direction through the whole body. There is generally but one well marked chill, the returns of the paroxysms of fever being seldom, after the first, preceded by the cold stage.
At certain periods of the day there is an increased intensity in the symptoms of the disease, occasionally preceded, though generally not, by the chill. Between this period of severity in the feverish symptoms, and a similar period which follows it, there is generally a decrease in the violence of the symptoms, during which the fever moderates, but does not, as in fever and ague, entirely go off ; has distinct remissions, but not complete intermissions.
During the hot stage, the pulse is up to one hundred and twenty, or one hundred and thirty. There are pains in the head, back, and limbs, of a most distressing kind.
The tongue is generally covered with a yellowish or a dirty white fur; and in bad cases in the advanced stage is frequently parched, brown or nearly black in the centre, and red at the edges. There is no appetite for food, and generally nausea and vomiting; and usually there is pain and tenderness in the epigastrium. The bowels are at first costive, but afterwards become loose, and there are frequent evacuations of dark, offensive matter.
Causes. This disease is produced by malarial exhalations from the decomposition of vegetable matter. It is most prevalent in hot climates, and in the summer and autumn.
Treatment. If the fever be in the formative stage, and has not fully developed itself, give an emetic (1), (2), and follow it with a mild cathartic (7), (13).
If the disease be already developed, sponge the body all over several times a day, with cold or tepid water, according to the feelings of the patient, and give cooling drinks (132), (133), (298), (299). To moderate the fever, give three to ten drop doses of tincture or fluid extract of veratrum viride. The compound powder of ipecac and opium is a valuable preparation for the same purpose. Give cold water as drink if desired by the patient, or let him eat ice.
Men the headache is very severe, let poultices be applied upon the temples or behind the ears; and the same remedy to the pit of the stomach, when there is great tenderness, is often desirable; though a mustard poultice will sometimes do better.
During the remissions of the fever, quinine and other tonics are to be given, as in fever and ague. Quinine, in large doses, acts almost as a specific for these diseases.
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