The predisposing causes of intermit tents are, whatever tends to debilitate the body, a warm moist, or cold damp atmosphere, particular seasons, as spring and autumn : the occasional or exciting causes are, marsh miasm, contagion, and perhaps lunar influence.
Progiumis. Mildness and regularity of the paroxysm, a general cutaneous erup tion, or eruption about the mouth and behind the ears, accompanied with a swelling of the upper lip, when the pa roxysm is going a free hemorrhage from the nose during the paroxysm, and the urine depositing a latentious sediment in the last stage, are favourable symp toms. Coma, delirium, great anxiety, difficult respiration, attended with hiccup, swelling of the tonsils, the abdomen tumid, hard, and painful to the touch, accompanied with obstinate costiveness, tension and pain in the epigastric and bypochondric regions during the parox ysm ; listlessness, nausea, or debility, at tended with vertigo in the intermissions, or a few drops of blood falling from the nose in the paroxysm, are unfavour able symptoms. Intermittents are fre quently followed by, or attended with, ob structions in the different viscera, parti cularly in the liver and spleen ; dropsy, dysentery, jaundice, and various species of inflammation.
Treatment. In the paroxysms we are to endeavour to shorten the different stages, and thus to obtain a final solution of the disease. In the intermissions we are to prevent the recurrence of the paroxysms, and endeavour to obviate certain circum stances, which may prevent the fulfilling of either of the two first indications.
The first indication will be accom plished by the administration of an emetic at the commencement of the paroxysm, or during the cold stage ; for which pur pose tartar emetic is the best; it should be given in divided, but pretty large doses, the patient should at the same time be put to bed, kept in warm blan kets, and allowed warm diluent, but not stimulating liquors, except there is a considerable degree of debility ; and im mediately the hot stage is formed, a gen tle diaphoresis will be excited, and a final solution of the paroxysm procured, by the exhibition of opiates, assisted by moderate draughts of tepid, or, if the heat be preternaturally great, of cold liquids, and by the neutral salts. In the
intermissions, the bark should be admi nistered in doses of a drachm or more, every one, two, or three hours, so that an ounce, or an ounce and a half, may be taken during the intermission ; when the apyrexy is long, as in the tertian, its ex hibition may be delayed till within six or eight hours of the time when the next paroxysm is expected, which will fre quently more effectually prevent its re turn than when given in small doses dur ing a long intermission ; but if there be a great degree of debility, or where the intermissions are short, as in the quoti dian, the bark should be employed im mediately after the termination of the pa roxysm, at longer or shorter intervals, until the return of the nest fit, in such doses as the stomach will bear, and the urgency of the case may require : when this invaluable medicine purges, a few drops of the tincture of opium may be added ; and if, on the other hand, it in duce costiveness, a few grains of rhubarb will obviate it, and at the same time give tone to the stomach and bowels; it is sometimes of service to add about a scruple of snakeroot to each dose of the bark ; where the stomach is habitually weak, it will be advisable to combine aromatics or bitters with the bark, as calamus, or candle alba, &c. The sul phate of copper may be employed in its usual dose : the oxide of arsenic com bined with opiates, either in solution or in the form of pills, will frequently suc ceed, when bark and other remedies have been tried without effect. If the disease should prove obstinate, and any pain can be perceived by the patient upon pressing the right bypocondrium, small doses of the calomel, or friction with the unguen turn hydrargyri, continued until a slight soreness of the mouth is induced, will, in genera!, be attended with the most bene ficial effects, as its continuance is most commonly the consequence of obstructed viscera.