ters, have been denominated INTERMITTENTES LARVATÆ, or disguised intermittents. GEN. II. SPEC. IV. Anetus erraticus. Irregular ague. SPECIES V. ANETUS COMPLICATUS. Complicated Ague. PAROXYSMS INTRICATE, MULTIPLICATE, OR BOTH. THERE are numerous examples of ague which, to an inattentive eye, are as irreducible to any regular order as those which belong to the last variety of the preceding species; but which, when minutely examined, are found, however intricate, to be composed of types, not that uniformly resemble each other, but that recur in alternate sets, every set being true to itself, while it differs from that with which it alternates in the duration of its intervals, or of its paroxysms, or of the time of its accession. And hence, although in some shape or other, most of them return perhaps every day, and are often mistaken, for irregular quotidians, they are, in fact, double or triple tertians, or quartans, discovering their real nature by these alternating distinctions. The following are the chief varieties: a Tertianus duplex. Double tertian. 8 Tertianus triplex. Triple tertian. : The paroxysms of the one GEN. II. SPEC. V. Analysis of its intri cacy. y Tertianus impar. Double unequal tertian. Tertianus duplicatus. ε Quartanus duplex. ¿ Quartanus triplex. » Quartanus duplicatus. 9 Quartanus triplicatus. The one set evincing a more The paroxysms of the one set occurring in the intermissions of the other; and evincing a difference of duration or of violence: with an interval on the third day alone. Consisting of a single quartan with regularly return+ ing paroxysms; while each of the intervening days is marked with a slighter or separate attack. Consisting of a single quartan; with two paroxysmson the regular day of attack: the intervals being of ordinary duration. Consisting of a single quartan with three paroxysms on the regular day of attack: the intervals being undisturbed and of ordinary duration. Having thus distinctly noticed the several species and chief varieties of intermittent fever, I shall proceed to offer a few remarks upon its general history, and medical treatment. Whenever the accession of an intermittent is violent, be its type what it may, it is sometimes attended with very alarming symptoms, as syncope, apoplexy, vehe Anetus. tent fever. How far dangerous. How far serviceable. ment spasms over the whole system, or a coldness or GEN. II. torpor which threatens death. Yet, when not violent, nor of very long duration, and especially when of the tertian type, it is often serviceable to the general health, and carries off many chronic and lurking disorders of other kinds: Dr. Fordyce affirms that he has seen it of considerable use in curing or alleviating chronic rheu→ matism, habitual indigestion, cutaneous eruptions, protracted inflammations, epilepsies, and hysteria*. And his assertion is corroborated by other authorities +. It Depuratory is to this kind of remedial fever that Professor Frank Frank. gives the name of depuratory. fever of uncertain. The duration of intermittents is of great uncertainty. Duration The vernal agues generally disappear with the advance of summer: the autumnal are more obstinate, and es pecially the quartan§. Where they have remained long, and have become habitual, even their removal must be attempted with great caution; for when abruptly suppressed, they have been known to lay a foundation for a host of other maladies, often of a more fatal description, as paralysis, various visceral affections, and even sphacelus. Ludolf gives an instance of an eight-day ague (anetus erraticus octanus), continuing for eighteen years; yet this was probably a double quartan; while we have abundant examples of a continuance of the regular quartan for nine, twelve ¶, eighteen **, twenty ++, twentyfourt, and thirty years§§, and one instance of it lasting for not less than forty-eight years . It is in this spe • On Fever, Diss. 11. p. 16. + Salmuth, Cent. 11. Obs. 14.-Ephem. Nat. Cur. Dec. III. Ann. 111. Obs. 30. J. P. Frank, De Curandis Hom. Morb. Ep. Tom. I. p. 48. § Ib. p. 44. ¶ Avicenna, Fen. 1. Lib. iv. Tr. 11. Cap. vi. * Madai, Von Weekselfiebern. Sect. 144. ++ Eph. Nat. Cur. Dec. III. Ann. ix. and x. Obs. 51. #Marcellus Donatus, Lib. III. Cap. xiv. p. 291.-Pontanus, De Febr. Conel. L. VIII. 55 Binninger, Obs. Cent. v. N. 64. Wierius, Obs. p. 37. Gabelchover, Cent. vi. Obs. 74. nued Has contithrough a great part of life: GEN, II, Anetus. Intermit tent fever. cies therefore, that we chiefly meet with those congestions in the spleen which are called ague-cakes, as also with scirrhosities in the liver, pancreas, and other abdo. minal organs, which by Bonet, Swalwe, Senac, and other writers, have been regarded as causes of the disease, but congestions. by Van Hoven, and all the pathologists of the present day, are more correctly resolved into effects." and formed ague-cakes and other Has been found congenital. Has de stroyed in a single paroxysm. The paroxysm has been com pleted in a minute, more va riable than any other type. Schenck gives a case of congenital quartan, or in which it appeared in an infant immediately after birth and Paullini another, in which, though not strictly congeni→ tal, it appeared in very early infancy +. But such examples are rare. Among other singularities, I may observe that the accession has sometimes been so violent as to destroy the patient in the course of the first paroxysm, of which an instance will be found in Senac 4, while at other times it has been so slight and rapid, that the entire paroxysm has run through its course in a minute §. The character of the intermittent seems in a consider able degree to depend upon the age or idiosyncrasy of the individual and the temperament of the atmosphere! Quotidians We find also that variations more usually take place in the quotidian than in any other type, which we should, perhaps, ascribe to its occurring more frequently in early life, when the frame is more irritable; and to the debility which the constitution suffers from this type above that of any other, in consequence of the greater length of its paroxysms, and the greater brevity of its intervals, by which means the prostrated strength of the system has no time to rally or recover itself, o odg 73 In this metropolis, from causes which have not been handed down to us, and which, indeed, do not appear to have been traced at the time, intermittent fevers were more than ordinarily frequent from the year 1781 sto 1785: and the remarks I have just made apply in an Intermit tents peculiarly frequent in London, from 1781 to 1785. Anetus. especial manner to all these. As a single example, let GEN. II. us select those of 1782, as described by Sir George IntermitBaker and Dr. Reynolds, in an article drawn up by the tent fever. former with an admirable combination of learning and liberality, sound critical judgement, and inquisitive research. "The type of the fever of 1781-2", says Sir George, "was either tertian or quotidian; the former being more common in the first part of the winter; the latter, from the middle of February to the end of June. With respect to the former NOTHING OCCURRED to my observation which is worthy of notice. On the latter, Dr. Reynolds has communicated to me the following remarks: and any addition would be unnecessary relative to a subject which he has so well exhausted."* This communication is too long to be copied verbally, but it is fully entitled to the praise which the learned Baronet has bestowed upon it. It will be sufficient for our present purpose to transcribe its leading features. to Dr. Reynolds, in his communication to Sir George Baker, tells us that the quotidian fevers of the above year were irregular in their invasion, and uncommon in their appearance; and that no cases resembled each other except in very few circumstances. The first attack generally commenced with a horror; but the subsequent paroxysms, though often beginning with a sense of cold, were chiefly without horror. The intermission was short and seldom perfect. The symptoms were very severe, and in many cases dangerous, and leaned strikingly to a typhous form. Great and sudden oppression of the head, anxiety, depression of spirits, a dry, parched tongue, yet less covered with hardened mucus than might be expected; a pulse low, quick, and intermitting; bowels variable; urine dark-red and clear, without any sediment, constituted the ordinary signs. Many had a low muttering delirium; two or three, a laborious respiration ; a Medical Transactions, Vol. III. Art. xui.” Sir George count of 1781-2, Baker's ac as commuReynolds. nicated by |