Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    91/976 (page 71)
    intermittent aided probably by high temperature. When a -Remit- tent follows exposure to Malaria, it is reasonable to suppose that tire morbific agent has been absorbed in a high degree of concentration. I attribute some effect to the agency of high temperature, because remittents are more common in hot malarious countries than where the same poison exists in temperate regions, and because, as already mentioned, I have, in a great many instances, observed intermittents pass at once into a severe type of the remittent form, apparently fiom. no other cause than the descent from comparatively cool and elevated regions into the heated plains, and this under circumstances when there was no reason to believe that the sufferers had been again ex- posed to malaria. The period of incubation is also, I think, much influenced by tem- perature—being shorter in hot, longer in cold climates,—and doubtless also by the degree of concentration of the poison. I have already given an example of a fatal miasmatic fever being developed within a few hours after exposure to the cause in a notoriously malarial locality. From a week to ten days or a fortnight have in my experience been the most common periods of incubation. Symptoms.—These in an uncomplicated remittent fever, occurring in an adult of a tolerably vigorous constitution, are as follows: The most constant, as well as the most urgent, of the premonitory symp- toms, already described, is oppression at the epigastrium. The cold stage is neither so complete nor so long continued as in ague ; in some of the worst remittents I have ever seen, no rigors were observed at all, a passing sensation of chilliness, alternating with flushes of heat, being all that the patients complained of, as regards temperature. In other cases rigors are present, but they are seldom severe; here, as in ague, these sensations of cold are merely subjective, the thermometer indicating already a temperature perhaps 2° above the natural stand- ard, which, as the hot stage develops, mounts to 7° or 8°, and, according to some observers, even 10° above that standard. As the hot stage advances, vomiting often begins, and continues throughout the disease a distressing and embarrassing symptom. The sense of fulness and oppression at the epigastrium is not relieved by the vomiting, although the amount of fluid thrown off is out of all proportion to the quantity taken. The tongue is furred, and, as the temperature of the body rises, dry. The pulse, which in the premoni- tory stage was slow, small, and irregular, now rises rapidly to 100 or 120 ; in men of sthenic habits it is full; in adynamic cases from the first, although very frequent, it is small and compressible. llie countenance is flushed, the eyes suffused, and the patient com- plains of rending headache, with pain in the limbs and loins; the skin is red and distended; the heat ardent and stinging; the sufferer is restless, and tosses in his bed in the vain search for an easy posture Wlien the above symptoms have lasted for from six to twelve hours, they begin to abate : a slight degree of moisture breaks out on the brow