§ 86. Intermittent fever. Fever and ague.* It is very difficult to establish general rules for the treatment of intermittent fever. The type of the fever, the peculiarities of the chilly and hot stages, of the sweat and thirst, are not the only indications for the selection of a remedy ; the character of the apyrexia has likewise to be considered and will differ in different patients. This is one reason why we should only be able at the bed-side of the patient to determine what remedy we shall use in the case. A second reason why the indication of specific remedies for intermittent fevers is difficult, is that they rouse, more readily than any other affection can do, the dyscrasia which may be latent in the system; this then combines with the fever and impresses upon it a peculiar character. There are other diseases which either set in with or acquire an intermittent type (diseases where no vascular erethism is present, but the intermittent character of the disease is evident); in these diseases the remedy has likewise to be chosen at the bed-side of the patient. These and similar difficulties shall not deter us from communicating the following remarks relative to the treatment of intermittent fever; they will perhaps aid the beginner in homoeopathy in selecting proper remedies for the cases which he may be called upon to treat.

§ 87. Intermittent fevers might be considered syno-chal fevers, inasmuch as great vascular irritation is present in every case of fever and ague. The difference between those two classes of fevers is simply this, that a synochal fever has only one paroxysm, whereas an intermittent fever consists of a succession of synochal paroxysms with intermitting type. This statement only refers to pure intermittent fevers; if such a fever should possess some of the characters of syno-chus or typhus, it belongs to the class of complicated intermittent fevers, for which it is much easier to discover a specific remedy than for simple fevers of that class.

* See the excellent treatise on the treatment of intermittent fever, by Dr. Hartlaub in Hartlaub and Trink's Annals, Vol. III. (This treatise will be published in one of the next numbers of the Examiner.)

See also Boenninghausen's treatise on the treatment of intermittent fever, translated by Charles J. Hempel, M.D. This is a practical essay and absolutely necessary to a physician who wishes to treat intermittent fever with success.

An intermittent fever is recognised and its character determined by the periodicity of the paroxysms and the intermissions, the only two essential and characteristic phenomena in intermittent fever. The paroxysms and the intermissions themselves are so various that it is impossible to give a detailed account of the symptoms. In some fevers the paroxysms consist merely of heat; in others of coldness, with or without subsequent sweat; there are fevers with coldness all over the body, the patient nevertheless feeling hot to himself, or he experiences chilliness although the skin is hot to the touch; there are fevers where one paroxysm consists of a mere chill or coldness followed by a feeling of health, the other of heat followed by sweat or without sweat; in some fevers the heat comes first and the chilliness afterwards; in others the chilliness and heat are followed by a long intermission, after which sweat breaks out, which may be considered in the light of a second paroxysm; there are fevers where no sweat is present, others again where sweat constitutes the paroxysm without heat or chilliness, or where the sweat is only present during the heat. There are many more peculiarities, especially as respects the accompanying symptoms, headache, bad taste, nausea, vomiting, diarrhoea, absence of thirst or else violent thirst, pains in the bowels and limbs, sleep, delirium, temper, spasms, etc., before, during, or after the chilliness, heat, or sweat, not to speak of a number of other characteristic differences. The characteristic appearances of the intermission should not be neglected by the physician, particularly if the paroxysm should not be well marked, in which case the apyrexia will be characterized by symptoms which do not generally exist after a paroxysm.

The general symptoms of fever and ague are: chilliness, heat, and sweat, recurring at regular or irregular periods, followed by the appearance of a red, brick-dust sediment in the urine; during the apyrexia the patient feels more or less comfortable and the pulse is normal. Most frequently the paroxysms recur at regular periods, every twenty-four hours (quotidia-nae),forty-eight (tertianae), seventy-two (quartanae),etc.

We know very well that modern pathologists do not number intermittent fevers among the febrile diseases. Various affections may be distinguished by a regular intermittent type without having a febrile character. Such intermittent diseases originate in the peripheral nerves, not the vascular system, which is affected secondarily on account of the intimate relation existing between those nerves and the blood-vessels; hence it is that intermittent diseases are now termed ganglionic, cerebral or spinal intermittent. Nevertheless we have preferred treating this class of diseases as usual, pointing out their characteristic peculiarities as much as was necessary and occupying ourselves principally with their homoeopathic treatment.

The duration of an intermittent fever is very uncertain, from one week, to several weeks or even months. In no disease there is a greater disposition to relapses than in intermittent fevers; in a quotidian a relapse takes place on the seventh day, in a tertian on the fourteenth, in a quartan on the twenty-eighth after the cessation of the last paroxysm. A relapse may be anticipated if a feverish feeling should remain in the system; if the feverish colour should remain on the cheeks; if the strength of the patient should not increase with his appetite; if the last paroxysm should be like the first; if at the time when the paroxysms used to occur, slight chills, a drawing and stretching of the limbs, continual yawning, irritated pulse, changeable urine, should make their appearance. Relapses are frequently brought on by moral causes, slight errors in diet, by eating milk, eggs, fish, etc.; by changes of temperature, walking along the water, continual use of cold drinks, etc.