The prejudices against the bark, on its first introduction, led to a variety of substitutes for it in these diseases; and all the bitters and astringents were occasionally employed, joined sometimes with alkaline and neutral salts, at others with aromatics, more simple stimulants, or antispasmodics; the abrotanum, the various species of wormwood, the carduus, the centaury, the camomile flowers, the columbo root, orange and lemon peel, gentian, quassia, tansey, rue, St. Ignatius' bean, with almost every medicine which contains a bitter juice. It is a doubt whether the bitter is the same in all. When the bitters are pure, as in the gentian and camomile flowers, the principle is apparently the same; but the wormwood, for instance, contains an essential oil totally different from its bitter juice; the orange peel not only an essential oil, but an astrin gent principle. This may have perhaps occasioned the preference of the latter, since the bark also contains an astringent portion; and whatever aversion physicians had to the bark, in their substitutes they came as near it as possible. The action of bitters and astringents we have already noticed. See Amara and Astringentia.

The astringents employed have been the alum, the galls, the tormentil, and the oak bark: each, it is said, has been successful; but their success has not been so decided as to lead to their general employment instead of bark.

The additions to the bitters and astringents, though chiefly to the former, have been, we have said, alkalis, neutral salts, stimulants, or antispasmodics. Boerhaave was fond of the bitters with alkalis as producing a saponaceous medicine, in his opinion a powerful deob-struent; though he sometimes preferred the neutrals. These are undoubtedly of great utility as antifebrile medicines, though seldom sufficiently powerful to stop the paroxysms of an intermittent. The aromatics usually added are nutmeg and ginger; the antispasmodics, the animal oil of Dippel, or, sometimes, the less elegant form of candle snuffings. The latter, with nutmeg, is said to have often effected a cure. Similar additions sometimes render the bark more effectual.

The other substitutes have been the metallic tonics, copper, arsenic, and iron. We know not that copper has been employed in the pure intermittents, though used with success in the intermittentes larvatae, which we shall notice in the following article. Arsenic was employed many years since in this disease, and lately has been in general use, from the success of Edwards's ague tincture (see Arsenicum). It is undoubtedly a very active and powerful medicine; nor have we found any disadvantages from its use. It has succeeded, when the bark in every form, and with every addition, has failed. Fowler's arsenical solution is made in the following manner: take arsenic very finely powdered, and fixed alkaline salt, of each sixty-four grains (some ordered half the quantity); distilled water, half a pint; these are to be put into a Florence flask, and placed in a sand heat: the water is then to boil slowly till the arsenic is perfectly dissolved: when the solution is cold, half an ounce of compound tincture of lavender is to be added, and of distilled water, another half pint, more or less, so that the whole of the solution shall yield by measure a pint, or rather weigh fifteen ounces and a half. Patients from two to four years of age may take from two to four drops; from five to seven years, from five to seven drops; from eight to twelve years, from seven to ten drops; from thirteen to eighteen and upwards, twelve drops at a dose, in any proper vehicle, two or three times a day.

Iron is sometimes added to the bark and bitters to increase their virtue; but it has, we believe, been seldom trusted alone. All these medicines seem to act by increasing the general tone of the system, and thus counteracting the debility in which the disease apparently consists. The mineral acids, though powerful tonics, have not been used, we believe, in this disease.

The general management of patients, who labour under intermittents will not detain us long. It is in the first place necessary to remove them from the infected air; but the activity of modern husbandry has lessened the number of marshes, and the disease is comparatively rare. In parishes where the number of intermittents was not annually less than two hundred respectively, the disease is not found, or only in a few-instances in its disguised state. The diet should be light, easy, and digestible. The ancients seldom admitted of food in the first days of fever; and in the early periods of intermittents, when the disease has seldom any regular interval, the less nourishment that is taken, the sooner will the fever assume its proper type. In general, when the fits are more distinct, animal food should be avoided unless there is sufficient time to complete the digestive process before the expected return. This precaution must be continued after the fits have disappeared.

The intermittentes comitatae and perniciose of Torti are more nearly allied to the remittents, and are Indeed often of the remittent kind. They will therefore be considered with advantage under that article. See Re.mittentes.

See Torti Therapeutice Specialis, Sydenham's Works; Cleghorn on the Diseases of Minorca; Hunter on the Diseases of the Army; Senac de Recondita Febrium Natura; Fordyce on Fevers, second Dissertation.

Intermittentes larvatae. A fever of a truly intermittent nature is often disguised under the appearance of a very different complaint, or seems to the inexperienced practitioner a fever of a different kind. In the first, the real disease may generally be suspected from the appearance of regular paroxysms, or more certainly by perfect intermissions, since these more often occur in such disguised intermittents than a regular recurrence of the disease. Intermitting pains of every kind, where the paroxysm is completely terminated, are of this kind; and the most common and most troublesome instance is the haemierania. The distinction of the complaint is not easy, for pains in the head, from whatever cause, are not constant: even the dolor faciei crucians, q. v. the tic doloureux, has its remissions (see Cephalalgia). Haemicrania, therefore, is distinguished from its situation, occupying often with such minute precision one half of the head, that the patient can place the point of a pin between the part pained and that unaffected; frequently from its regular attack, at least a regular continuance; in many instances from its being ushered in by rigor, followed by feverish heat; almost always from soreness in the bones of the cheek of the side affected during the paroxysm only. It is a disease of the most distressing kind, for its obstinacy is equalled only by the violent degree of the pain.