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Northfleet, is unaffected with intermittent fevers, the ad- Gen. II. jacent hills suffer considerably from them : and he refers 1
Intermitto other anomalies of the same kind *.
tent fever. To unite remittents, therefore, with intermittents, from
Northfleet. an idea of their having a single and common origin, is
Hence no to depart from the clear line of symptoms into a doubt- sufficient ful region of etiology. If intermittent ought to be sepa- grou
Cullen's rated (as unquestionably they ought) from continued arrangeferers, 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. tent fever. When an intermitting fever or ague is by the operaAgue.
tion of marsh-miasm, or any other cause, once introduced Intermittents gene- into the system, and has once discovered its type, or rally true given an interval of a particular measure between the to their
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 differbut occa
ence we know nothing; sometimes it seems to depend sionally vary in dif- upon the season or the temperament of the atmosphere, ferent indi.
operating upon the febrile miasm that is diffused through viduals.
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.
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 :
1. ANETUS QUOTIDIANUS. QUOTIDIAN AGUE.
TERTIANUS. TERTIAN AGUE.
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:
Intermitgeneral 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.
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
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.
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.
Each of these species, however, admits of considerable All the variations : for sometimes we find the paroxysm pro- :
species subtracted 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 șix-day, a seven, eight, nine, and even a ten-day ague;
Gen. II. and sometimes is so extremely vague as to bear no pro
portion whatever between the violence of its paroxysm, tent fever. the duration of its stages, and the period of its return. 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.
INTERMISSION ABOUT EVERY TWENTY-FOUR HOURS:
PAROXYSM COMMENCING IN THE MORNING; USUAL
Gen. II. The genuine quotidian is of less frequent occurrence Resembles
• than the other species ; but it has a considerable resemthe double blance to that variety of the complicated intermiitent, tertian.
which has generally been denominated a double tertian, How distinguished
and with which it is often confounded. It is distinguishfrom it.
able, 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,
.] SANGUINEOUS FUNCTION. [ORD. I. 111 and in precipitating or procrastinating every subsequent Gen. II.
Spec. I. paroxysm: and, hence, affords us the following varieties :
Anetus quoa Partialis. Partial quotidian. B Comitatus.
Quotidian Catenating quotidian.
ague. y Protractus. Protracted quotidian.
Anticipans. Anticipating quotidian.
& Cunctans. Retarding quotidian. In the PARTIAL QUOTIDIAN, the febrile attack is con- 4. A. quoti
dianus parfined to a particular part or organ, and usually accompa- tialis. nied with distressing pain.
Partial quoUnder 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 cephalæa, and particularly that species of it which is called hemicrania. · In the CATENATING QUOTIDIAN, the disease associates ß. A. quoti
h dianus cowith 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. In the PROTRACTED QUOTIDIAN, the intermission is in- y A. quoti
dianus proordinately short or imperfect. In the former case the pa- og roxysm is lengthened beyond the usual period of eighteen Protracted hours; and in the latter case it does not so completely 9 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 sb Febr. Intermit. Quot. Spec. iv.
– Vol. II. Art. xix.