INTERMITTENT FEVER (ante), a form of fever characterized by febrile parox ysms and intermissions. It is also called fever and ague, chills and fever, shaking fever, and periodical fever. It belongs to the class of malarial fevers which are sup posed to originate in the action of in miasm, which latter is, again, supposed to be produced principally by decomposing vegetable matter in swamps and low grounds. Postmortem examinations in the few cases which are fatal reveal a condition of the liver, spleen, and brain called bronzing, and the presence of a dark pigment in the blood. More or less of this condition probably exists in cases not fatal. There is frequently an enlargement of the spleen, but this is not particularly characteristic of the disease, while the is. Intermittent fever may be divided into two distinct periods, the period of the paroxysm, and the period of intermission; or, the active and the quiescent. The paroxysm is divided into three distinct stages—the cold, the hot, and the sweating stage. There are usually sonic premonitory symptoms, but except in afew cases they are slight and often unnoticed. The marked premonitory' symptoms are headache and weariness, accompanied with yawning, but they are not characteristic, and serviceable only to those who have had, or suspect an attack of, the disease. The cold stage is ushered in with 'a feeling of chilliness in the back and limbs; there is also Fain in these parts and head ache. The skin and to some extent subcutaneous muscles are contracted, pro ducing that condition known as "goose flesh." A thermometer placed in the axilla, however, indicates an increase rather than a diminution of temperature, although exposed surfaces and the extremities are cooler than natural. Rigors, accompanied by regular slinking of a rhythmical character, are sometimes violent. The pulse is quick ened, but small and feeble; the face very pale, and if the attack be severe, livid, as are the roots of the nails, the circulation in the fingers being almost The duration of this stage is variable. sometimes a few minutes, sometimes two hours; the average being about 40 minutes. The second or hot stage usually follows gradually, with !lashings of heat, until a decidedly febrile condition is developed. The cold stage is sometimes absent. but is replaced by a nervous condition, or drowsiness, and some times coma (q.v.). This occurs in those cases which are called malignant intermittent, and which will be noticed further on. hot stage.—The fever which follows the cold stage is often intense; the pulse is full and and the face crimson. The pain in the hack and limbs ceases, but the headache continues. A thermometer placed in the axilla indicates a temperature of from 105 to F., and there is great thirst. This stage lasts from three to eight hours, when the sweating stage commences, perspiration appear ing first on the face, then passing to the body end limbs, while the heat. headache, thirst, and all other unpleasant symptoms gradually depart, the patient often passing into a natural slumber. This stage usually lasts three or four hours, when the parox ysmal or active period is over. The sweating is often, but not always, very profuse.
The period of intermission now commences, and according to its duration, before another paroxysm conies on, the disease receives certain distinguishing names, denoting certain types. If the paroxysm come on every day it is called a quotidian type. If the intermission be of two days' duration, that is to say, if the paroxysms succeed each other on the third days, the type is tertian. If three days intervene, or when the par oxysm reappears on the fourth day, the fever is said to be of the grartan type. The quotidian and tertian types are the most common, the quartan is rather rare. Statis tics of the U. S army show that the quotidian and tertian types occur with about equal frequency, but it is probable that the cases which come under observation in private practice would place the tertian form in the majority. Of 98,237 eases in the U. S. army, 51,623 were of the quotidian, 44,857 of the tertian, and 1757 of the quartan type. Cases have been reported of a quintan, a sexton, a lnptan, and even 'an octave type, but in these cases it is not certain that there is sufficient regu larity in the recurrence to justify a type title. The type frequently changes from a quotidian to a tertian, and sometimes to a quartan, or iu the other direction; but a lengthening of the period of intermission is more common, especially if the patient be under mild treatment: active treatment generally eradicates the disease or causes a cessation of the paroxysms before a change of type can take place. The type may also be compound, that is, the quotidian paroxysm may occur twice every day, in which case it is called a double quotidian. In a double tertian, a paroxysm may take place every day. hut they will have a different character on succeeding days; in other words, there will be two distinct forms of the tertian type, alternating with each other. Sometimes a double tertian occurs in which there are two paroxysms every other day. Another form is a double (parkin. when a paroxysm occurs on two suc cessive days, while there is none on the third day, the paroxysms being unlike. A triple quartan has also been observed, in which there are three successive paroxysms on three successive days, but differing from each other, as in the double forms. nese forms are all rare, except the double tertian, which is not infrequent. In the period of intermission the condition of patients varies: some feel quite well, while others experi ence many unpleasant Symptoms, such as loss of appetite; headache, nausea, and sometimes palpitation of the heart. There is necessarily a more or less anwinie
condition, even when the natural or individual force of the person impels him to shake off his unpleasant symptoms, and maintain his bodily and mental functions by activity. Every person laboring under the protracted influence of malarial poison gen erating intermittent fever has mere or less of a pinched appearance. All the functions of nutrition are to a certain extent interfered with, sometimes producing enlargement of the spleen. The general appearance observed in persons laboring under intermittent fever is called by physicians malarious eathevia. Protracted continuance of the disease is liable to bring on a variety of organic difficulties, according to the constitution of the individual, the liver probably being the organ most often implicated. The causes of intermittent fever are obscure in one sense, yet the conditions which produce the disease are well known. Though marsh miasm is known as the principal factor in the generation of the disease, we cannot precisely state what marsh 'plasm is. Although, as will be noticed further on, certain low forms of vegetable life have been discovered and claimed to be present wherever intermittent fever prevails, and to be absent when it does not prevail, the.observations have not yet been verified; and awaiting further investigations, we can assert only that there is in marsh miasm such a disease-generating force. Wherever marsh iniastn can be excluded as a factor, there intermittent fever is always absent. There are, however, marshy districts where intermittent fever does not prevail. It appears, therefore. that the marsh miasm which generates the fever is of a peculiar nature, or that the emanations of marshes are not always miasmatic; that there must be something added to the exhalations which arise from simple vegetable decom position ordecay, or that sonic peculiar organism must be developed which when taken into the system will produce the disease. Viewing the question in this light, the theory of the generation of intermittent fever which was proposed by Dr. J. H. Salisbury (an account of which is contained in the Anze,rican Journal of Medical &knees for Jan., 1860 deserves attention and careful test. Certain facts have lung been known in regard to many of the conditions which propagate the disease. It does not prevail in high mountain regions where the soil is barren, or upon extensive sandy sea-beaches, where it is impossible for any of the products or peculiar accompaniments of marsh decomposition to be present. Therefore that a certain influence is generated in marshy districts which is capable of producing malarial fever cannot be doubted. The disease does not occur in those zones where the temperature never rises above 60°. Malarious influences increase as we approach the equator, and are noticeable along tide-waters where the shores are low and alternately inundated and left exposed to the heat of the sun. Turning up the soil or excavating for the streets of cities and for railroads, the clearing away of forests, and the consequent exposure of the rich soil to the action of the sun's rays, often converts a salubrious section into one exceedingly unhealthful. Many facts connected with malarial influence are worthy of noilee. The malarial poison, whatever it is, seems to have a specific gravity. When it travels over the earth it keeps near the surface; per sons occupying the upper stories of houses located on a malarious plain are less affected than those living nearer the ground, particularly if they remain in-doors after sunset, for it is another well remarked fact that night air contains more of the malarious than the air of day does, as though a degree of sensible moisture were necessary for its propagation. Now, the theory of Dr. Salisbury meets many of these facts. His obser vations were made on low-lands in the Ohio and Mississippi valleys, principally in the vicinity of Lancaster, Ohio. He discovered certain organisms in the expectorations of persons laboring under the disease, which he also found in the soil, or collected upon glass plates in the vicinity of the residence of the patient. He suspended glass plates at different elevations over different localities, and found that there was a certain level above which the malarial influence did not pass, and that this level was also the limit to the passage of these organisms. He also found that the organisms were not present in the dry air of day, arising only in the damp air of evening or night. The organisms in ques tion arc a species of alga resembling palynelk, which he found upon the surface of the soil, particularly where it bad been disturbed,. asby the feet of cattle, or by wagons. They have the appearance of green, red, and white incrustations, resembling a saline deposit from evaporation. Dr. Salisbury has given the name gemiagma to the plant, to which he also applies the name of ague plant. He enumerates the following species; G. rubrum, G. verdang, G. paludis, G. ptunsosis, G. elba. Dr. Salisbury remarks that the lesions in intermittent fever, are confined mostly to epithelial structures, and therefore the liver and spleen are organs that suffer specially, and refers to a case reported by Morgagni in which the spleen weighed 8 lbs., and to one by Bailly in which it weighed 10 lbs., and was a mere mass of pulp. Dr. Salisbury found the ague plant in the urine of the patients; if the plant be the cause of intermittent fever, this would form a diagnostic symptom of value in obscure cases. Dr. Salisbury- states (Oct., 1880) that subsequent observations have, in his opinion, confirmed the results of his investigations as published iu 1866.