GEN. II.

Anetus. Intermittent fever.

Northfleet.

Hence no

Cullen's

Northfleet, is unaffected with intermittent fevers, the adjacent hills suffer considerably from them: and he refers to other anomalies of the same kind *. To unite remittents, therefore, with intermittents, from Ague. an idea of their having a single and common origin, is to depart from the clear line of symptoms into a doubt- sufficient ful region of etiology. If intermittent ought to be sepa- ground for rated (as unquestionably they ought) from continued arrangefevers, so ought remittent to be separated from intermit- ment. tent. To say that intermittents often run into remittents, is to say nothing, for remittents as often run into continued fevers; and it is now an established doctrine that there is no continued fever whatever without occasional remissions. In effect, all fevers have a tendency to run into each other, and many causes are perhaps common to the whole. The difficulty is in drawing the line: yet a like difficulty is perpetually occurring to the physiologist in every part of nature; and equally calls for discrimination in zoology, botany, and mineralogy: and Dr. Parr has correctly observed, that "if a specific distinction can be established in any branch of natural history, it must be in the separation of remittents from intermittents." Vogel unites remittent with continued fevers, to which Cullen, rightly enough, objects; but the former has as much reason on his side, as the latter has for uniting them with intermittent. Sauvages, Linnéus, Sagar, and most modern writers, correctly distinguish each from the other. It must nevertheless be admitted that marsh-miasm is by far the most frequent cause of intermittents; and hence the frequency and severity with which they visited our own country in the sixteenth and seventeenth centuries, before the lowlands were artificially drained of their moisture, and consequently the atmosphere of its taint: during the former part of which Dr. Caius tells us, that the mortality from agues in London was such that the living could hardly

* Select Dissertations, &c. p. 111.

GEN. II. bury the dead; and Bishop Burnet, that at one time, 1558, they raged like the plague.

Anetus.

Intermit

tent fever. Ague. Intermit

tents generally true to their

same per

son,

When an intermitting fever or ague is by the operation of marsh-miasm, or any other cause, once introduced into the system, and has once discovered its type, or given an interval of a particular measure between the type in the close of the first and the commencement of the second paroxysm, it continues true, as a general rule, not merely to the same measure or extent of interval, but to the length and severity of paroxysm, through the whole course of the disease; the character of the cold stage, determining that of the hot, and both together that of the sweating stage; and the paroxysm ceasing because it has completed its career. But the first interval, like the first paroxysm, which regulates the rest, is of different duration in different cases: of the reason of this difference we know nothing; sometimes it seems to depend upon the season or the temperament of the atmosphere, operating upon the febrile miasm that is diffused through it, and all who have agues in the same place or at the same time, have them of the same kind. Sometimes, on the contrary, it seems chiefly to depend upon the time of life, the idiosyncrasy, or the particular condition of the constitution, for, as already observed, different individuals even in the same place and under the same roof exhibit different types. But upon this subject we have no clear information.

but occasionally vary in different indi

viduals.

Nevertheless, whatever may be the cause of this difference, it lays a good foundation for dividing the intermittent genus into distinct species, and the five following are sufficient to comprise all its principal diversities :

As the connexion between all these is peculiarly close,

and they occasionally run into each other's province; and

more particularly as the same mode of treatment is com- GEN. II. mon to the whole, it will be most convenient to defer the Anetus. general history and praxis, till we have taken a survey tent fever. of these species in their respective definitions and the va- Ague. rieties they often exhibit.

Intermit

It may, however, considerably assist the student, and simplify his pursuit in acquiring a knowledge of their characters, to attend to the three following remarks:Firstly, the shorter the intermission, the longer the Axioms in

paroxysm.

Secondly, the longer the paroxysm, the earlier it commences in the day.

Thirdly, the more durable the cold fit, the less durable the other stages.

intermit

tent fevers.

Thus, the quotidian has a longer paroxysm and a Illustrated. shorter interval than the tertian; and the tertian a longer paroxysm and a shorter interval than the quartan. And thus again, while the quotidian has the longest duration, it has the slightest cold stage; and while the quartan has the shortest duration, it has the longest cold stage. It is also the most obstinate to cure.

species sub

Each of these species, however, admits of considerable All the variations: for sometimes we find the paroxysm pro- ject to vatracted beyond its proper period; sometimes anticipat- rieties: ing, and sometimes delaying its proper period of return. In other cases, we find each of these species catenated with or giving rise to foreign symptoms or other diseases. And we also meet with a peculiar variety of the quotidian ague, in its being sometimes limited to a particular part or organ, in which case it is usually accompanied with very distressing pain.

The most irrregular of all the species is the fourth, for particularly this is sometimes found to deviate from all the three rules the fourth. I have just laid down: but particularly in the greater length of its interval, which is sometimes double or even treble that of the quartan, whose interval of seventy-two hours is the longest of the three more disciplined species; it is hence found under the various forms of a five-day, a six-day, a seven, eight, nine, and even a ten-day ague ;

Anetus.

GEN. II. and sometimes is so extremely vague as to bear no proportion whatever between the violence of its paroxysm, the duration of its stages, and the period of its return.

Intermit

tent fever. Ague.

The fifth species is distinguished from the rest by its peculiar complexity, consisting of double tertians, triple tertians, unequal tertians, duplicate tertians, together with as many varieties of the quartan type; the nature and key of which will be more particularly noticed under the species itself.

GEN. II.
SPEC. I

Resembles

the double

tertian.

How distinguished from it.

SPECIES I.

ANETUS QUOTIDIANUS.

Quotidian Ague.

INTERMISSION ABOUT EVERY TWENTY-FOUR

HOURS:

PAROXYSM COMMENCING IN THE MORNING; USUAL
DURATION UNDER EIGHTEEN HOURS.

THE genuine quotidian is of less frequent occurrence than the other species; but it has a considerable resemblance to that variety of the complicated intermittent, which has generally been denominated a double tertian, and with which it is often confounded. It is distinguishable, however, to an attentive eye by the regularity of its paroxysms, which are true to themselves on every return; while in the double tertian the alternate paroxysms only are true to each other, as we shall have occasion to observe more particularly in the proper place. The quotidian, like the tertian and quartan, has sometimes been epidemic.

The quotidian intermittent is occasionally limited in its attack to a particular part, and is occasionally connected with other affections. It deviates also now and then from its common rule, in having an imperfect intermission,

and in precipitating or procrastinating every subsequent paroxysm: and, hence, affords us the following varieties:

a Partialis.

8 Comitatus.

y Protractus.

Anticipans.

ε Cunctans.

Partial quotidian.

Catenating quotidian.

Protracted quotidian.

Anticipating quotidian.

Retarding quotidian.

In the PARTIAL QUOTIDIAN, the febrile attack is confined to a particular part or organ, and usually accompanied with distressing pain.

Under this modification, sometimes one side of the body has suffered, while the other has escaped; sometimes one or both eyes; but more generally the whole or half the head, not unfrequently resembling cases of cephalea, and particularly that species of it which is called hemicrania.

dianus co

quotidian.

In the CATENATING QUOTIDIAN, the disease associates A. quotiwith or gives rise to various foreign symptoms or other mitatus. diseases. And hence, is often found in union with rheu- Catenating matic affections, particularly lumbago and sciatica. Sauvages quotes a case in which it associated with daily attacks of a frightful epilepsy* And Dr. A. Munro, in the Edinburgh Medical Essays, narrates a similar instance, though less severe, and alludes to several others that had occurred to himt. Torti has made a collection of numerous examples of this variety, and has united them into one family, under the name of febres intermittentes comitatæ. Galen has described one or two of them under the name of epiala.

y A. quoti

dianus pro

tractus.

quotidian.

In the PROTRACTED QUOTIDIAN, the intermission is inordinately short or imperfect. In the former case the paroxysm is lengthened beyond the usual period of eighteen Protracted hours; and in the latter case it does not so completely subside as to leave the intermission totally clear of febrile symptoms. On which last account the Latins described this variety under the name of quotidiana continua ; and the Greeks under that of amphemerina.

Class Febr. Intermit. Quot. Spec. Iv.

Vol. I. Art. xix.