The hot stage comes on gradually with the disappearance of the pinched and blue appear ance of the skin. From feeling comfortably warm the patient becomes intensely hot, the face being flushed, skin dry and harsh, pulse full and frequent, and thirst being great. The person becomes restless, and sometimes slightly delirious. The headache is severe; and the sickness continues. This stage lasts from one to four or five hours, or even longer.
The sweating stage begins with the appear ance of beads of perspiration on the face and brow. The hands and skin begin to get moist, and the person feels more comfortable. Soon copious sweating out all over the body. The fever falls the pulse becomes slower and softer. The breathing is less hurried than in the hot stage. Soon the fever is quite gone, and the patient comparatively well, but tired and inclined to sleep. The average length of the whole attack is from five to six hours, but it may be prolonged for double that time. In some cases one or other of the stages may not be well marked.
After a varying time a second attack comes on, as already noted, which goes through a similar course.
There is no definite time when the whole illness will pass away. But a person who has suffered from ague is always liable to renewed attacks on the slight provocation of a cold, he digestion, &e.
Persons who continue to reside in a malarious district, and who suffer from periodical attacks, gradually pass into a chronic state of ill-health, marked by a peculiar sallowness of complexion. Serious changes occur in the blood, liver, and spleen, producing a condition of poverty of blood and a tendency to dropsy, jaundice, and various other affections.
Treatment.—The treatment of ague is rally twofold : that of the attack and that of the intermission. During the attack little can be done except in the way of making the patient as comfortable as possible. From the nature of the disease it is needless to attempt to arrest itP progress. During the cold stage, therefore, the use of a plentiful supply of warm coverings, hot drinks, hot-water bottles, &c., will be grateful to the patient; and so, on the other band, will be light coverings, a cool atmosphere, and tepid sponging of the body during the hot stage. It is during the period of absence of fever between two attacks that medicine must be administered to ward off, if possible, a new attack. The medicine to be given is quinine. Ten grains should be dissolved in water, to which a drop or two of tincture of steel have been added to aid the solution, and this dose given at the end of the sweating stage. It is to be repeated in four or six hours. After each renewed attack the quinine is to be administered in this way, and after the fever has ceased to return, the use of a daily dose of quinine must still be persisted in for a week or more. Nourishing foods should be administered, and to aid in the restoration of strength 30 drops of Easton's syrup (syrup of quinine, iron, and strychnine) should be given in water thrice daily before food.
Whenever possible a person attacked by ague should be at one removed from the marshy district.
The prevention of ague is best accomplished by efficient draining and cultivation of the district where it occurs, by the clearing of jungle, and by similar means. The exercise of great care may enable one to evade the disease. The person should sleep in the upper part of the house, should avoid going out late in the afternoon and early in the morning ; all water should be filtered or boiled before use ; exces sive fatigue should be avoided; and quinine should be regularly taken.
Remittent Fever (Bilious Fever) is a form of ague, but more severe in its symptoms and of a much mere fatal tendency. It is due to the same cause as ague, and presents similar symptoms.
Symptoms.—The disease has its cold, its hot, and its sweating stage like ague. The cold stage is, however, very short, and hardly recog nizable. The fever of the hot stage is very high, and this period is prolonged, lasting from six to twelve hours. The vomiting which occurs is violent and distressing. The material vomited up is first colourless, then bilious and sometimes bloody. The sweating stage is not so marked as in ague. With it the fever diminishes and the other symptoms Improve, and the remission occurs, which differs from the interval of ague iu the important fact that the disease does not disappear for a time as in ague, but simply abates to renew its violence in a short time— from ten to twelve hours. The remission usually occurs in the morning, and the fever is at its height at midnight. Day after day the attacks recur, usually at first with increas ing severity. The illness lasts from five to fourteen days, and a favourable termination may be expected when the remissions are distinct and last for several hours.
Treatment is similar to that of ague. It is said to be well to begin with a purgative as soon as the disease manifests itself, and to an ordinarily strong adult 3 to 5 grains of calomel, the same of compound extract of colocynth and of powder of scammony, with 5 grains of quinine are advised. One blue and one compound colo cynth pill with 5 grains of quinine form about the same dose. No more medicine is to be given till the first remission, when 10-grain doses of quinine must be administered as ad vised for ague. If the person cannot retain the quinine ou the stomach it should be carefully injected into the bowel (see ENEMA). To relieve the sickness, small pieces of ice should be given to slick, and warm clothes are applied over the stomach. When the fever remits, nourishing food is necessary, and if the exhaustion is great, stimulants in repeated very small quantities. The other directions given under Ague apply equally to Remittent Fever.
Malta or Mediterranean Fever (Undulant Fever—Bock Fever—ffeapolitan Fever) is com mon in Malta and in countries bordering on the Mediterranean. It is due to an organism, the Micrococcus Melitensis, extremely common among herds of goats, so numerous in Malta, by the milk of which it may be communicated. The organism is also .found in the urine of in fected animals, which, saturating the soil, may spread the infection. It is not communicable from one person to another. It may be mis taken for typhoid or malaria. It is charac terized by waves of fever, of an intermittent type. This irregular fever may continue coining and going for many months, and is accompanied by constipation, profound amemia and weak ness, profuse sweats, rheumatic andi nerve pains, and enlargement of the spleen. Change of climate is the best remedial agent, no remedies being of much value. Monkeys arc very susceptible to it, and may assist in spreading the infection.