Ague

Intermittent Fever. Chills and Fever.

Malaria (bad air) is responsible for the great number of cases of ague^[1]. The precise nature of the specific poison which causes ague is not fully known; but it is generally believed to be a vegetable spore^[2], the breathing of which into the lungs causes the poison to enter the circulation and produce disease — the nervous system, the liver and the spleen suffering most. Under the title of Malaria more will be found concerning this specific poison.

Ague proper, or intermittent fever, is a disease which, during its course, manifests itself in paroxysms which occur at regular intervals. The disease is most common in the fall, though when once the poison saturates the system ague may manifest itself at other times.

Symptoms. — Before a paroxysm of ague commences there are usually signs to warn of its approach. These are: A general feeling of lassitude, constipation, loss of appetite and perhaps nausea or sensitiveness of the stomach, a dull headache and dull aching pains in the lower part of the back and possibly in the joints, and a yellow colored fur on the tongue^[3]. These symptoms may last several hours or perhaps several days, and be followed by the paroxysm characteristic of the disease, which may be described as follows:

1. Cold Stage. — A creeping feeling along the back, increasing to decided chilliness, which no amount of heat or clothing overcomes, finally ending in a shaking chill, the teeth chattering, the hands and feet like ice, and the lips and finger tips blue, the face pinched and the whole skin seeming to be shrivelled. Great thirst and headache are present and sometimes nausea and vomiting. Breathing becomes difficult, and the pulse small and rapid and sometimes irregular. Altogether the condition seems to the patient a most deathly one. Its duration varies greatly from ten minutes to four or five hours, when gradually (sometimes suddenly) reaction commences.
2. Hot or Fever Stage. — Usually this starts in with alternate flushing and coldness over various parts of the body, soon developing into intense general fever. The face becomes red and hot and the lips dry and parched; thirst is intense and headache is violent, often causing delirium or convulsions in children; the urine is scanty and the pulse full and strong, the arteries of the neck seeming about to burst. This condition of high fever may last from two to eighteen hours, usually four or six hours.
3. Sweating Stage. — Gradually the skin becomes moist, and, commencing on the forehead, a warm perspiration breaks out and extends over the whole body, becoming very profuse and occasionally possessing a peculiar odor; the urine is passed freely and often has a reddish sediment; all the symptoms of fever subside and the patient usually falls asleep to awaken feeling comparatively well and with a good appetite. With the exception of a general feeling of weakness an intermission (varying in duration in different forms of ague) is enjoyed without any indications of disease.

The length of the intermission designates the class of the paroxysm.

1. Quotidian ague gives a paroxysm every twenty-four hours.
2. Tertian, every forty-eight hours, or every other day (the most common form).
3. Quartan, every seventy- two hours, or every third day.
4. Irregular ague, in which the paroxysms seem to have no definite time of attack.

Treatment. — Ague and quinine or other salts of Peruvian bark^[4] are usually associated in the minds of most people. In households where ague prevails the bottle of quinine will usually be found on the pantry shelf, and sole reliance is placed in from five to thirty grains daily, in small doses, during a "spell of ague." There is no question but that quinine or its equivalent form of Peruvian bark will aid in treatment of ague; but many can not take it, and there are better methods to be adopted. During a first paroxysm little can be done. Always during the cold stage rest and warmth should be provided, and, if the surface is very blue, composition should be given. During the hot stage, hot lemonade with ginger essence or infusion of pleurisy root will hasten the sweating stage of relief. Commencing as soon as the fever is gone tonics should be given in anticipation of another attack. The following will be found a prescription far superior to any salt of Peruvian bark.

Take:

• Fluid Ext. Gentian ... four drachms.
• Fluid Ext. Goldenseal - four drachms.^[5]
• Fluid Ext. Cascara ... two drachms.^[6]
• Salicin ... twenty grains.
• Comp. Tinct. Myrrh ... one drachm.
• Simple Syrup ... eight ounces.

Mix. Take one teaspoonful every three hours during the intermission, and every hour in the day of the paroxysms before the chill commences.

This is bitter, but can be relied upon. Complications may occur during ague, but they must be appropriately treated. Nourishing diet, fresh air and frequent baths should be provided. Removal from a malarial region is of course desirable. Under all circumstances keep the bowels from constipation.

Dumb Ague. — Occasionally a form of ague is met with where the chill or cold stage is not especially marked and the other stages perhaps but feebly manifested. Great depression and dull aching being pronounced in regular paroxysms. Such forms of the trouble require the same treatment as the regular forms.

Ague Cake. — Very often the spleen becomes enormously enlarged in those persons subject to ague, due to the crowding of blood upon the organs^[7], driven inward by the repeated chills and consequent contractions of the surface. In nearly every sufferer from ague the spleen will be found hardened and the liver enlarged.

Anemia following Ague. — Improper condition of the blood and excessive proportion of white corpuscles^[8] may follow ague; giving a pronounced and continued paleness to the countenance. Persons afflicted with ague and coming from a warm to a cold climate, perhaps to escape malaria, are very liable upon exposure to be attacked with pneumonia of a serious nature and often rapidly fatal. Such persons cannot be too cautious in guarding against such a difficulty.

^[1] Ague is an archaic term for the acute, intermittant fever typically associated with malaria.
^[2] Malaria is caused by parasitic micro-organisms. Mosquitoes were suspected to be the transmission vector for these parasites in the late 19th century, with the theory proved in 1987 by Sir Ronald Ross, who received the Nobel Prize for Physiology or Medicine for the discovery.
^[3] The "yellow colored fur" is probably a symptom of dehydration caused by the fever.
^[4] "Peruvian bark" refers to the Cinchona species, a source of quinine, which is still utilised in the treatment of malaria (and has been for almost 400 years).
^[5] Goldenseal, or tumeric root, contains berberine, which has been used in treating malaria.
^[6] Cascara is a common laxative - here used to prevent constipation.
^[7] The spleen is enlarged in chronic sufferers due to the destruction of red blood cells (hemolysis) carrying the parasite within the spleen.
^[8] Hemolytic anemia, again caused by the destruction of red blood cells carrying the parasite.