A manual of medical diagnosis : being an analysis of the signs and symptoms of disease / by A.W. Barclay.

  • Barclay, A. W. (Andrew Whyte), 1817-1884.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical diagnosis : being an analysis of the signs and symptoms of disease / by A.W. Barclay. Source: Wellcome Collection.

    97/708 (page 63)
    idea ; and we then inquire into the possible causes of the attack, and especially the exposure to local malaria in ague districts. The rigor is generally intense, and the perspiration profuse,—such, indeed, as are never met with except in deep-seated suppuration ; and if there be no history of any serious derangement of health, which would of necessity accompany previously existing disease of any internal organ, there need be little doubt of the nature of the case. These symptoms are soon followed by complete intermission ; and, finally, the recurrence of the attack, after a longer or shorter interva], makes up the entire history of the disease. The completeness of the intermission, the disappear- ance of everything like fever in these cases, deserves especial observation, because it forms the most trust- worthy evidence of the true nature of the disease. Delusive hopes, and perhaps mischievous treatment, are not unfrequently based upon intermissions which have an appearance of regularity, but are incomplete in other characters. The intermittents of the tropics present anomalies which are sometimes very perplex- ing ; but in this country, except the patient be worn down by oft-repeated paroxysms, I think it extremely dangerous in diagnosis to admit that any fever belongs to this class, simply because the remissions assume some regularity of type. The paroxysms in ague may recur at nearly the same time next day, when it is called quotidian; on the third day, tertian ; or on the fourth day, quartan. These are all regular inter- mittents, and an approach to regularity in the period of recurrence is the rule in the greater number of cases. Occasionally an appearance of irregularity is produced by anticipation or postponement of the paroxysm; the former in the commencement, the latter in the decline of the disease; the rigor begins half an hour or an hour earlier or later on each recur- rence. Another cause of an appearance of irregu- larity is the existence of what is called double tertian.