Malaria Anhang

[P.P. Wells]

INTERMITTENT FEVER

By this term we mean a disease, the nature of which is to appear in paroxysms which recur at intervals with intervening periods of freedom from the paroxysmal phenomena, these periods being of various duration in different cases. The paroxysms, when perfectly expressed, are made up of four elements: the phenomena of the circulation, chill, heat, and perspiration, appearing in succession, the three last in the order named, and have, in the complete form we are now contemplating, a certain symmetry of proportionate duration and intensity in relation of each to the other. This disease is the result of the action of a specific poison on the human organism.

It attacks all classes and conditions of men who are exposed to its action with perfect impartiality. The duration of its effects is not subject to any self-imposed limitation, but continues till the life of the patient is destroyed or the action of the poison is conquered by appropriate means. But the manifestations of the presence and action of this poison are not always met in the perfect, symmetrical paroxysms. On the contrary, these are oftener than otherwise very irregular, either in the comparative duration or intensity of the different paroxysmal elements, or any one or two of these may fail of appearance in any given case, or these may change the order of their appearance in any possible order of succession, or any two of these elements may be mixed, appearing at the same time, or may be alternated in repeated succession for a longer or shorter time. Or instead of the fever as described, there may be, as a result of this poison, a variety of affections, more or less painful and annoying, appearing as rheumatism, neuralgia, dysentery, etc. But in whatever form the effects of this poison may appear, it is a peculiarity of each that it is, characterized by this one feature of periodicity.

The origin of this poison was formerly charged to the presence of stagnant water in the infected locality (in swamps and marshes). But it chanced there were many of these localities where there were no cases of ague. Then decomposing vegetable matter was added as another factor in its production, and these two combined were credited with the origin of the whole evil. But observation has fully established the fact that there are many localities where these are both present, and yet there are no malarial fevers. And more than this, some of the localities where the fever is met in its most malignant form have neither of these elements present as a generating cause.

Such are the Walcheren District, in Holland, and the high, arid desert in Central Spain, and many others. So that, while it is known and admitted that these two are active agents in producing this poison in some localities, there are others where they are absent, and yet the fever is there met at its worst. It follows, then, that there are other factors producing this poison, of which at the present time but little is known beyond the facts which result from its action. And more than this, there are localities where, after the absence of agues from time immemorial, they suddenly appear, while all external circumstances, so far as these can be appreciated, remain the same as

they have ever been. And then it has happened, where agues have so suddenly appeared, the generation of the poison has extended in a given direction, say from west to east, as of late years on the north shore of Long Island Sound, each year adding new territory to the dominion of the disease, till large districts of country are invaded which but lately were wholly exempt from the plague.

Such facts plainly declared that, as to the etiology of ague, there is much still remaining unknown. It is not uncommon to refer the facts just stated to telluric influences of some sort, which only leaves the whole subject in the same darkness as before, in which notwithstanding this attempted explanation, it is likely to remain till it can be further shown what is the kind and nature of this influence so charged. At present, certainly, we know nothing about this branch of causation, and we should know nothing of the existence of the poison so mysteriously produced but that its existence is revealed to us by its effects. The prevalence of the poison is more common in warm latitudes than in cold, and yet in these there are many localities where there is no ague. Where it is present, its production and the intensity of its action are favoured by increase of heat, as well as in swampy districts, by drying the surface, which is usually wet, and by its being wet again after being dried. In such localities the fall of rain is often followed by increase of agues. It is notable that though in these cases water seems to play so important a part in the production of the cause of these fevers, yet they prevail in others where there is little or no water, and where this agent can be supposed to have had little to do in the production of their cause.

A notable example of this is met in the high sandy plains of Spain. In this and the dry localities of Italy and Greece the fall of rain is followed by abundant malaria. This has been attributed to the ammonia present in the water of the rainfall, which is, of course, merely hypothetical. It is also worthy of remark that in many localities, notably in mountainous regions, in spite of frequent exposure to chills, and of extreme changes of temperature from hot days to cold nights, and the greatest exposure of persons, there are no intermittent fevers, while, on the contrary, localities where the greatest evenness of temperature prevails, the sickliest months are those which show the least variation. The production of the poison is modified by the quantity of water present in the infected locality. Where the water is deep it is less, and more where it is shallow.

The facts stated above and many others show conclusively that while water, decomposing organic matter, and high temperature are active factors in the genesis of ague poison in many instances, in others, where these are mostly or wholly absent, the poison is present and active in a notable degree.

From this it may be accepted with confidence that there are other factors which originate the poison in question, either conjointly with these, or, in some localities, apparently independent of them. As to just what these last factors are, we may speculate as much as we please, and at the end remain in ignorance.

[Dr. Von Bœnninghausen]

1st. The examination of the patient as to the time and periodicity -the various stages of paroxysm- the concomitant symptoms of each stage and the symptoms predominating during the apyrexia.

2nd. The selection of the remedy. The truly curative remedy may be indicated by the time and periodicity:

10 h. Nat-m.

16 h.: Lyc.

Morning: Nux-v.

Afternoon: Apis

Periodical: Lach. Cact. Nit-ac.

At the same hour every day: Sabad. Aran.

Thirstless: Puls. China. Sabad.

Thirst before the chill: Eupat-per. Ars. Chin. Puls.

Thirst only during the chill: Caps. Carb-v.

Thirst between chill and fever: Chin. Sabad.

Thirst during the fever paroxysm for large quantities of cold water at a time: Bry.

Thirst for small quantities at a time: Ars. Lyc.

Paroxysm + headache: Nat-m.

Headache after paroxysm: Apis.

Fever + sleep as under: Apis. Gels. Cact. Dr. von Bœnninghausen's excellent essay on "Intermittent Fever" for more minutiæ.

3rd. The remedy properly chosen should be administered very soon after the paroxysm is over and only during the apyrexia, never during the paroxysm. If the next paroxysm is not changed in any way either as to time or in its concomitant symptoms, and if no new symptoms belonging to the remedy have been developed, our choice of the remedy may be supposed to have been faulty. If the paroxysm changes as to time and the next attack comes on earlier, we may reasonably expect an improvement and should not repeat the remedy ; if the next attack is accompanied by symptoms characteristic of the remedy, or if the attack is lighter we should not repeat the remedy If the attacks continue but are lighter each time, we may safely wait on the effects of the medicine given. If the attacks continue and the symptoms having guided us in the selection of the remedy cease, then we must choose another remedy. We must follow implicitly Hahnemann's rule - not to repeat the dose or give a new remedy until the effect of the former dose is exhausted.

[Dr Constantine Hering/Sylvain Cazalet]

In marshy places: Arn. Ars. Carb-v. Chin. Cina. Ferr-met. Ip. Nat-m. Rhus-t. Verat.

In damp, cold seasons: Calc. Carb-v. Chin. Lach. Nux-m. Puls. Rhus-t. Sulph. Verat.

In spring and summer: Ant-t. Ars. Belladonna, Capsicum, Carb-v. Cina. Ip. Lach. Nat-m. Nux-v. Puls. Sulph. Verat.

In autumn: Bryonia, Chin. Nux-v. Rhus-t. Verat.

Mismanaged with by large doses of quinine: Arn. Ars. Bell. Calc. Capsicum, Carb-v. Cina. Ferr-met. Ip. Lach. Merc. Nat-m. Nux-m. Nux-v. Puls. Sulph. Verat.

An attack every day: Acon. Ars. Bell. Bry. Calc. Capsicum, Carb-v. Chin. Ignatia, Ip. Lach. Nat-m. Nux-v. Puls. Rhus-t. Sulph. Verat.

An attack every other day: Ant-t. Arn. Ars. Bell. Bry. Calc. Caps. Carb-v. Cham. Chin. Ip. Lach. Nat-m. Nux-m. Nux-v. Puls. Rhus-t. Verat.

An attack every 4th day: Acon. Arn. Ars. Carb-v. Ignatia, Nux-m. Puls. Verat.

An attack every 2 weeks: Ars.

An attack every year: Ars. Carb-v. Lach.

Coming on in the evening: Acon. Arn. Ars. Bell. Bry. Calc. Carb-v. Ign. Ip. Lach. Merc. Nux-v. Puls. Rhus-t. Sulph.

Coming on in the night: Ars. Bell. Calc. Caps. Carb-v. Cham. Hep. Merc. Nux-v. Puls. Rhus-t. Sulph. Verat.

Coming on in the morning: Arn. Ars. Bell. Bry. Calc. Carb-v. Cham. Chin. Hep. Lach. Merc. Nat-m. Nux-v. Sulph. Verat.

Chill and coldness only: Bry. Caps. Chin. Coff. Hyos. Ip. Nux-v. Puls. Verat.

Chill and heat, but no sweat: Acon. Arn. Ars. Bell. Bry. Caps. Carb-v. Cham. Ign. Ip. Merc. Nux-v. Puls. Rhus-t. Sulphur.

Chill and sweat, but no heat: Ars. Bry. Puls. Rhus-t. Sulph. Verat.

Heat only, little or no chill and sweat: Acon. Ars. Bell. Bry. Calc. Coff. Ip. Lach. Nux-v. Op. Puls. Sulph. Verat.

Heat and sweat, but no chill: Acon. Ars. Bell. Bry. Caps. Carb-v. Cham. Chin. Cina. Coff. Hep. Ign. Ip. Nux-v. Op. Puls. Rhus-t. Verat.

Sweat prevailing: Acon. Ars. Bell. Bry. Calc. Carb-v. Cina. Hep. Merc. Nat-m. Puls. Rhus-t. Samb. Sulph. Verat.

Chill, heat and sweat, all of the same degree: Acon. Ars. Bell. Bry. Caps. Cham. Chin. Cina. Hep. Ign. Ip. Nux-v. Puls. Rhus-t. Sulph. Verat.

Chill then heat: Acon. Arn. Bry. Bell. Caps. Carb-v. Chin. Cina. Hep. Hyos. Ign. Ip. Nat-m. Nux-v. Puls. Rhus-t. Sulph. Verat.

First heat then chill: Bell. Bry. Calc. Caps. Nux-v. Puls. Sulphur.

Heat and chill, alternating: Ars. Bell. Bry. Calc. Chin. Merc. Nat-m. Nux-v. Sulph. Verat.

Heat and chill at the same time: Acon. Ars. Bell. Bry. Calc. Cham. Chin. Ign. Ip. Merc. Nux-v. Puls. Rhus-t. Sulph. Verat.

Heat and chill at the same time, heat externally, chill internally: Acon. Ars. Bell. Calc. Coff. Ign. Lach. Nux-v. Sulph.

Heat and chill at the same time, heat internally, chill externally: Arn. Bry. Chin. Merc. Puls. Rhus-t. Verat.

Sweat coming on with the chill: Ars. Calc. Nux-v. Puls. Sulphur.

Chill then sweat without heat: Bry. Caps. Rhus-t. Verat.

Sweat and heat together: Acon. Bell. Bry. Caps. Cham. Chin. Cina. Hep. Ign. Ip. Merc. Nux-v. Op. Rhus-t. Verat.

Sweat after the heat: Ars. Bry. Carb-v. Cham. Chin. Cina. Coff. Hep. Ign. Ip. Op. Puls. Rhus-t. Sulph. Verat.

Thirst before the attack: Arn. Chin. Puls. Sulphur.

Thirst during the chill: Acon. Ant-t. Arn. Ars. Bry. Calc. Caps. Carb-v. Cham. Chin. Cina. Hep. Ign. Ip. Nat-m. Nux-v. Rhus-t. Sulph. Verat.

Thirst after the chill, but before the heat: Ars. Chin. Pulsatilla.

Thirst and heat together: Acon. Bell. Bry. Calc. Caps. Cham. Chin. Hep. Hyos. Lach. Merc. Nat-m. Nux-v. Puls. Rhus-t. Sulph. Verat.

No thirst during the heat: Ars. Bell. Caps. Carb-v. Chin. Ign. Ip. Lach. Merc. Nux-m. Nux-v. Puls. Rhus-t. Samb. Sulph. Verat.

Thirst after the heat: Chin. Nux-v. Op. Pulsatilla.

Thirst during the sweat: Ars. Cham. Chin. Hep. Merc. Nat-m. Puls. Rhus-t. Verat.

Thirst after the sweat: Nux vomica.

Complaints accompanying intermittent fever

Pains in the limbs: Ars. Chin. Nat-m. Nux-v. Rhus-t. Verat.

Great Weakness: Ars. Chin. Ferrum, Hyos. Lach. Nat-m. Nux-v. Rhus.

Dropsical symptoms: Ars. Chin. Ferrum.

Drowsiness and sleepiness: Bell. Carb-v. Hyos. Lach. Op. Puls. Rhus.

Sleep during the chill: Nat-m. Nux moschata.

Sleep during the heat: Ignatia.

Sleep after the chill: Ars.

Great nervous and mental excitement: Acon. Ars. Bell. Bry. Cham. Coff. Ign. Nux-v. Puls.

Rush of blood to the head (with giddiness, delirium, stupor): Acon. Bell. Bry. Carb-v. Glon. Hyos. Lach. Nux-v. Op. Puls. Rhus.

Violent headache: Arn. Ars. Bell. Chin. Glonoine. Ign. Lach. Nat-m. Nux-v. Puls. Rhus.

Deranged stomach: Ant-t. Ars. Bell. Bry. Cham. Chin. Ign. Ip. Nat-m. Nux-v. Puls. Sulph.

Vomiting: Ant-t. Ars. Bry. Chin. Cina. Ign. Nux-v. Puls.

Vomiting during the chill: Bry. Ignatia.

Vomiting after the chill: Ars. Nux-v.

Vomiting during the heat: Nux-v.

Vomiting of bile: Bry. Ign. Nux-v.

Vomiting of mucus: Chin. Ign. Puls.

Vomiting of victuals: Ignatia.

Tongue coated white: Ant-t. Bry. Nux-m.

Tongue sticky, dry, during the chill: Bry.

Diarrhœa: Arn. Ars. Cham. Chin. Ip. Puls. Rhus-t. Verat.

Constipation: Ars. Bry. Calc. Merc. Nux-v.

Spleen, hardness of: Nux-m.

Spleen, pain in: Caps.

Liver, pains and swelling of: Ars. Chin. Merc. Nux-v.

Catarrhal symptoms (cough, etc.): Acon. Bell. Bry. Chin. Hep. Lach. Merc. Nux-v. Puls. Rhus-t. Sulph.

Oppression of the chest and difficulty of breathing: Acon. Ant-t. Arn. Ars. Bry. Chin. Ferr-met. Hep. Ip. Lach. Nux vomits, Puls. Sulphur.

The above accompanying complaints are present particularly :

Before the attack: Arn. Ars. Bell. Calcarea carbonica, Carb-v. Chin. Cina. Ign. Ip. Nat-m. Nux-v. Puls. Rhus-t. Sulph.

During the Chill: Arn. Ars. Bry. Calc. Caps. Carb-v. Chin. Cina. Hep. Ign. Ip. Lach. Merc. Nat-m. Nux-m. Nux-v. Puls. Rhus-t. Verat.

During the heat: Acon. Ars. Bry. Bell. Calc. Caps. Carb-v. Cham. Chin. Coff. Hyos. Ign. Ip. Lach. Merc. Nat-m. Nux-v. Op. Puls. Rhus-t. Sulph. Verat.

During the sweat: Acon. Ars. Bry. Cham. Lach. Merc. Nux-v. Op. Puls. Rhus-t. Sulph. Verat.

After the attack: Ars. Bry. Carb-v. Coff. Ign. Lach. Nux-v. Puls. Rhus-t.

Pulse, intermittent: Ars. Chin. Lach. Merc. Nat-m. Nux-v. Op.

Pulse, apparently wanting: Acon. Ars. Carb-v. Hyos. Op. Verat.

Pulse hard: Acon. Bell. Bry. Hyos. Nux-v. Sulph.

Pulse small: Acon. Ars. Bell. Hyos. Lach. Merc. Nux-v. Op. Verat.

Pulse slow: Bell. Chin. Merc. Op. Puls. Rhus-t. Samb. Verat.

Pulse hurried: Acon. Ars. Bell. Bry. Hyos. Merc. Puls. Sulph.

Pulse irregular: Acon. Ant-t. Ars. Bry. Chin. Hep. Lach. Merc. Nat-m. Rhus.

Pulse full: Acon. Bell. Bry. Ferrum, Hyos. Lach. Nux-v. Op. Puls. Samb. Sulph.

Pulse soft: Carb-v. Chin. Verat.

Pulse trembling: Ars. Merc. Rhus-t.

Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.