Page:The American Cyclopædia (1879) Volume VII.djvu/173

FEVERS 165 the next paroxysm. Compound types, as they are termed, are the double quotidian, two par- oxysms occurring daily ; the double tertian, a paroxysm occurring daily, the paroxysms dif- fering in certain respects on two successive days, but corresponding on alternate days ; a double quartan, in which a paroxysm occurs on two successive days, and on the third day there is no paroxysm. Extremely rare vari- eties of type are a quintan, sextan, heptan, and octan; these names expressing the length of the intervals. The facts thus exemplifying a law of periodicity are, with our existing knowl- edge, inexplicable. A paroxysm of an inter- mittent fever, when complete, consists of three periods or stages, called generally the cold, the hot, and the sweating stage. These different stages are of variable duration, the length of the paroxysm in different cases varying from three to eight hours. The cold stage is some- times characterized by shaking, that is, mus- cular tremor or rigor, and sometimes only by a sense of chilliness. This stage is sometimes wanting. The intensity of the fever varies much in different cases in the hot stage, and so the amount and continuance of the sweating which follows. If not arrested by remedies, intermittent fever tends to continue indefinite- ly, and is apt to induce notable anemia or impoverishment of the blood (see CHLOKOSIS), and sometimes general dropsy. Enlargement of the spleen is an occasional result of the disease. There are certain remedies which possess the power of arresting the parox- ysms, and these remedies are therefore called antiperiodics. The drugs which especially have this power are the salts of quinia or quinine. (See CINCHONA.) In the vast ma- jority of the cases of intermittent fever, the disease is promptly cured by quinine, which, given judiciously, does no harm. This drug also has a prophylactic power ; that is, it pre- vents the occurrence of intermittent fever, and protects against relapses. Other remedies which are efficacious, but in a less degree, are salacine, bebeerine, ferrocyanide of iron or Prussian blue, strychnia, and arsenic. Remit- tent fever is also often controlled by quinia and other periodics. In general, intermittent and remittent fevers are not immediately dangerous to life, even if they be allowed to continue; but they are sometimes attended with great danger, and they may cause death within a few hours. In these cases the disease is distinguished as pernicious intermit- tent or remittent fever. In some, portions of this country it is called congestive chill. Pa- tients affected with this fatal form may fall quickly into unconsciousness (coma), from which they do not emerge; some cases are characterized by delirium, and sometimes vomiting and purging occur, followed by a state of collapse resembling that in epidemic cholera. Pernicious intermittent or remittent fever is more apt to occur in tropical than in cold and temperate climates. Cases are more likely to occur at certain seasons than at others ; and whenever their occurrence is ob- served, it is immensely important to arrest the disease in every instance as speedily as pos- sible, lest succeeding paroxysms may prove to be pernicious. If .a patient pass through one paroxysm in which the symptoms threatened danger, the treatment which succeeded in pre- venting another paroxysm may be the means of saving life. Quinine should be given promptly and boldly under such circumstances. The nature of the special cause of intermit- tent and remittent fever is unknown. Wheth- er it be a chemical product or a living en- tity (animal or vegetable) is as yet a question which can only be met with reasoning and speculations. The cause is endemic in certain situations, and therefore it is of telluric origin. It is more likely to emanate from marshy situ- ations than from those in which the soil is dry, and hence it has been called marsh miasm. It is contained in the lower strata of the at- mosphere, and is present especially between sunset and sunrise. It is a very remarkable fact that the special cause may remain for a long time latent in the system ; patients some- times do not experience the disease until many months or even years after the morbific agent has entered the body. Persons who have had periodical fever are liable during many years to relapses, without any fresh exposure to the cause. Remittent fever has been called bilious remittent, or simply bilious fever ; but there is no ground for referring the pathology of this fever especially to the liver, as these names would imply. Periodical fever may be combined with continued fever, giving rise to a hybrid disease which of late years, in this country, has been called typho-malarial fever. The view generally held is that the special cause of periodical fever, as well as the special causes of all the essential fevers, produces its morbid manifestations by its presence and the changes which it occasions in the blood. The blood changes have been supposed to be analo- gous to those in fermentation, or those which are chemically called catalytic. The name zymotic (Gr. #7/77, leaven) is based on this hypothesis. The diseases which are supposed to involve fermentation or catalytic changes in the blood have been nosologically distinguished as zymotic diseases. Many cogent considera- tions render it probable that the special causes of different fevers are living germs or entities, but their existence has not as yet been satis- factorily demonstrated. 2. Yellow Fever. This, although included in the class of fevers called periodical, differs essentially from intermittent and remittent fever, and is a distinct species. It has doubtless its own special cause, that is, a cause peculiar to this fever. The disease prevails only in certain portions of the globe, and is rare in any but tropical or sub-tropical regions. As a rule, in these regions it is rarely prevalent in the colder months of the year. The yellow fever zone, as it is termed, is be-