Chapter 13 - Diseases of the General System and Miscellaneous Diseases
Introduction to Diseases of the General System and Miscellaneous Diseases
Blood Aneamia
Typhoid Fever
Prevention of Typhoid
Bilious Remittent Fever
Congestive Fever
Fever and Ague
Yellow Fever
Purple Disease
Bubonic Plague

13.12 Fever and Ague

Fever and Ague. Intermittent Fever.
This is the pernicious or malignant form of malarial fever. It is marked, either in the earlier or later stage, by a rush of blood towards one or more organs, by which they are crowded full and congested, hence its title of congestive fever. It may be intermittent or remittent, more commonly, it is the former. It may assume any of the types of periodical fever, but it is most frequently quotidian or tertian.
It is a kind of fever in which there is a succession of attacks with equal intervals and intermissions that are complete but unequal, on account of the uncertain duration of each fit.
An interval is the period of time between the beginning of one fit and the beginning of the next.
An intermission is the period of time between the close of one fit, and the beginning of the next.
The different varieties of ague take their designation from the length of the interval in each case.
The interval of a quotidian, or daily ague, is twenty four hours.
The interval of a tertian, or third day ague, is forty eight hours.
The interval of a quartan, or fourth day ague, is seventy two hours.
Laveran discovered about 1880, by persistently investigating the blood of persons suffering from malaria, a parasite in the blood. His researches were published and soon confirmed by physicians the world over, leaving no possible doubt that the only cause of malarial fever is a parasite which multiplies enormously in the blood of infected persons. But how does the parasite get into the blood?
About 1897 Professor Ross discovered that water breeding Mosquitoes do not obtain these parasites from decayed vegetable or animal matter but by sucking the blood of persons already suffering from malaria. These parasites in turn multiply rapidly in the stomach of the Mosquito which of course is infected, and when the Mosquito bites a person that person also becomes infected with malaria. Therefore malaria is not caused, as many suppose, by decayed vegetable matter and low marshy districts containing stagnant water except as these are the breeding places of the infected Mosquito that spreads the disease broadcast. (See articles in this book on Flies and mosquitoes.)

Symptoms. The disease first develops itself by an ague fit. This has three stages, the cold, the hot, and the sweating. The cold stage is very marked. The patient has a sense of debility, yawns, stretches, has no appetite, and does not wish to move. The face and extremities become pale, the skin shrinks, causing universal horripilation, or goose flesh; the patient shakes, and his teeth chatter.
After a time, these symptoms decline, and the hot stage comes on, which is characterized by high fever, with its various uncomfortable sensations.
When this fever passes off, it is followed by the sweating stage, during which a moisture breaks out, which increases, frequently, to a profuse sweat; the body returns to its natural temperature, the pains and aches disappear, and a feeling of health comes back.

During the cold stage, the blood is driven inward from the surface, and particularly oppresses the spleen, which, in cases of long standing, becomes swelled and permanently enlarged. This swelling may be plainly felt, and is often quite perceptible to the eye. It is called ague cake.
Ague fits begin at different hours of the day, and generally terminate in the evening.
A quotidian usually begins in the morning; a tertian at noon; and a quartan in the afternoon.

The cold stage is shortest in the quotidian, and longest in the quartan.
Thus the longest fit has the shortest interval, and the shortest cold stage; while the shortest fit has the longest interval, and the longest cold stage.
There are also double tertians and double quartans, wherein the fits repeat themselves, sometimes the same day, at other times on alternate days.
To these varieties, the terms postponing and anticipating are applied, according as the intervals are growing longer or shorter. When a person is recovering from ague, the interval may gradually grow longer, the attack being put off, or postponed. But if the disease be increasing in severity, the attack may anticipate its usual period, making the interval shorter.
Tertians are more common than either quotidians or quartans.
Agues are more prevalent in spring and autumn. Fall agues are most severe and dangerous.

Treatment. First clear the bowels with the fluid extract of senna or the preparation (21). Then, in the cold stage, give hot, and in some cases, stimulating drinks. Administer hot footbaths, and putting the patient in bed, apply bottles filled with hot water to the feet, sides, and back, and in every way try to excite warmth and comfort.
In the hot stage, give cooling drinks, and camphor (117), (118) in decided cases; or, what is better, quinine (67) in two teaspoonful doses every half hour, at the same time giving five &op doses of tincture or fluid extract of veratrum viride every hour.
During the sweating stage, stop the veratrum, and rub the patient with dry towels.
In the intermission, give quinine (62), in three grain doses once in three or four hours, and continue it, gradually decreasing the dose, a fortnight after the cessation of the attacks. The following is a good preparation: quinine, one scruple; elixir of vitriol, one dram; dissolve the quinine in the elixir, and add tincture of black cohosh, fourteen drams. Twenty drops are to be given, in a little water, once an hour.

Warburg's Tincture is a medicine which has had a very high reputation in India for administration in malarial and other diseases associated with chills and fever, and is there known as the antiperiodic tincture. It is supposed to contain in addition to 80 parts of quinine sulphate, 32 parts of rhubarb, 8 parts of camphor, 100 parts of aloes and one part opium. These are mixed with seven or eight different aromatics among which are mentioned cubeb, gentian, myrrh and elecampane. The dose is one to four teaspoonfuls taken as needed.
Quinine is the one medicine which surely relieves and cures this disease.
It is important, in fever and ague districts, to avoid the hot sun, and the damp evening and morning air.

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