After recovery from ague, the patient should carefully avoid further exposure to miasmata; he should go warmly clothed; avoid damp and cold, and especially night air; he should observe a temperate and regular mode of life, endeavouring to complete his restoration to perfect health, by occasional mercurial laxatives, or mercurial alteratives, and gentle tonics, such as bitters with soda or potash. REMITTENT FEVER. Remittent fevers are closely allied to Intermittents; they arise from the same cause; they present in many respects the same phænomena; and, require a very analogous mode of treatment. A Remittent fever varies in its mode of attack. A person may experience a feeling of general indisposition for some days previous to the development of any very urgent symptoms. It is more usual, however, for the disease to come on somewhat suddenly, with languor, lassitude, yawning and stretching, dejection of spirits, loss of appetite, chilliness, especially in the course of the spine, and occasionally amounting to actual shivering; pains or aching in the back and limbs, and a dull pain or sense of confusion in the head. To these symptoms a reaction presently succeeds, characterized by heat and dryness of the surface, flushing of the face, thirst, increased pain or confusion in the head, hurried respiration, a frequent, full, and often hard pulse, and a dry, white, and furred tongue. At this period too, the patient experiences not only a sense of load and oppression at the scrobiculus cordis, but also a feeling of constriction or perhaps actual pain, extending from thence to the back and into the hypochondriac regions. This pain at the scrobiculus cordis is for the most part, considerably increased by pressure, and is often attended with nausea, or even vomiting of an unhealthy bilious-looking matter. The urine is high-coloured but without sediment; the bowels sometimes constipated, but occasionally relaxed; the stools under such circumstances, being generally dark, bilious, and offensive. Having persisted, during a variable period of from eight or ten, to, perhaps, fourteen or sixteen hours, these symptoms begin gradually to subside; a perspiration more or less copious breaks forth; the skin cools; the tongue becomes moist; the thirst abates; the headache diminishes or ceases altogether; the respiration gets more free and less hurried; the pulse softer and slower; the urine deposits a lateritious sediment; and the patient probably feels himself comparatively well. He is never, however, as in an intermittent, altogether free from some degree of febrile excitement or local disorder, and sooner or later experiences a recurrence of the symptoms enumerated as characterizing what may be considered the two latter or hot and sweating stages of the original paroxysm; for, it very often happens that the cold stage is either very slight or altogether imperceptible in the paroxysms that follow. It is by no means uncommon, however, for subsequent paroxysms to commence with a distinct chilliness; or even, though more rarely, with a strongly marked shivering. Such are the symptoms, and such the progress of a paroxysm of a Remittent fever, as it usually occurs in this country. It nevertheless presents many varieties, according to the state of the patient's constitution, the season of the year, and the intensity of the predisposing and exciting causes. It is now and then so mild, that the paroxysms are very imperfectly developed, consisting, perhaps, of merely a chilliness or creeping, felt once or twice in the twenty-four hours, followed by a slight and vague reaction; at other times, especially when the miasmata proceed from an offensively putrid source, when the heat of the weather is intense, or when the abdominal viscera are much deranged, the disease takes on so aggravated a form, and the remissions become so extremely indistinct, that it is almost impossible to distinguish it from a severe case of genuine Typhus or Continued fever. Between these extremes, we meet with every variety. As Remittent fevers, like Intermittents, arise from miasmata, and as Remittent and Intermittent fevers mutually pass into each other, they can only be regarded as modifications of the same disease; the real difference between them depending upon the accidental presence in Remitting fever, of some general or local source of disturbance, which has the effect of keeping up such excitement in the system as to prevent the return of a perfect apyrexia after each paroxysm; instead of which, the symptoms only undergo a mitigation or remission. Of the causes which act upon the system at large, so as to have this effect, the most frequent are, cold, vicissitudes, long-continued exposure to great heat, and perhaps a concentrated state of the miasmata. With respect to the local sources of that general excitement which interferes with the intermission or apyrexia in Remittents, it may be safely affirmed, that in almost every instance they are to be found in the abdominal viscera, and especially in the liver and alimentary canal. The derangement of these organs varies both in kind and degree; it may consist in mere irritation and disordered function, or it may amount to actual inflammation; the aspect and violence of the disease varying accordingly. Hence, the greater prevalence and more aggravated forms of Remittent fevers in the autumn of temperate climates; hence probably the greater malignity and rapid mortality of Remittents within the tropics; and hence the frequent conversion of a Remittent into an Intermittent by the judicious use of remedies calculated to correct the morbid condition of the irritated or inflamed organs. Diseases set up in other organs than those mentioned, may undoubtedly produce a similar effect, but they are of comparatively rare occurrence; whilst, the derangements of the abdominal viscera constitute a most important, if not an essential part of almost every Remittent fever. Diagnosis. The difference between an Intermittent and a Remittent fever has been already shown, and it is for the most part sufficiently obvious; but it is not at all times so easy to distinguish certain modifications of a Remittent from an ordinary Continued fever; a distinction too, of infinite importance, in as much as it most materially influences both our prognosis and our practice. In autumn, when the sun acts with great power, when the miasmata are concentrated, and especially when the abdominal viscera are much disturbed, a Marsh or Remittent fever often puts on all the appearances of a severe form of common Continued or Typhus fever; presenting, a hot and parched skin, a flushed face, a rapid pulse, violent headache or delirium, a dry brown or almost black tongue and great prostration of strength; together with great bowel irritation, as shown by flatulency, distension and pain, and by frequent loose dark and bilious-looking stools. Such a fever is by no means very uncommon, and certainly at first sight is not by the symptoms to be distinguished from Continued fever. It is chiefly therefore by attending to the history of the case, and by carefully watching its progress, that we can arrive at a correct diagnosis. If it occur in autumn, and if the person is ascertained to have been exposed to miasmata, we ought at all times to suspect the true nature of the case; and if, whilst attentively observing it, we discover that at some uncertain time of the day or night, the patient experiences a chilliness or shivering, followed by a decided aggravation of febrile disturbance, and this again, by sweating, or by a manifest and considerable mitigation, little doubt will remain: or, should such indications prove too slight to decide the question for a day or two, it will very commonly happen, when by the use of proper remedies we have subdued the general excitement, and removed any source of local irritation, that the remissions and exacerbations will become sufficiently distinct to enable us to decide without either doubt or difficulty for, we pretty uniformly find, that as the general excitement and local irritations are corrected, in the same proportion does the disease assume a more decidedly Remittent, or even, on some occasions, an Intermittent type. It must also be remembered, that when fever is produced by miasmata emanating from sewers, cesspools, stagnant ditches, and suchlike offensive sources, it sometimes assumes all the virulence and malignity of typhus; and is scarcely to be distinguished from it, except by a knowledge of its origin, by the effect of remedies, and by its not proving contagious. Whether fever so produced ever does become true and genuine typhus, the disorder being altogether similarly affected by the same remedies, and proving equally contagious, remains to be demonstrated, and is not very probable. When, in a common Continued fever, the mucous membrane of the ilium is considerably involved, that disease |