Ague (Febris intermittens) is the common name for an intermittent fever accompanied by paroxysms or fits. Each fit is composed of three stages—the cold, the hot, and the sweating stage. Before a fit, the patient has a sensation of debility and distress about the epigastrium; feels weak and disinclined for exertion; the surface of his body becomes cold, and the bloodless skin shrivels up into the condition termed goose-skin (eutis anserina). A cold sensation creeps up the back, and spreads over the body; the patient shivers, his teeth chatter, his knees knock together; his face, lips, ears, and nails turn blue; he has pains in his head, back, and loins. This condition is succeeded by flushes of heat, the coldness gives place to warmth, and the surface regains its natural appearance. The warmth continues to increase, the face becomes red and turgid, the head aches, the breathing is deep and oppressed, the pulse full and strong. The third stage now comes on; the skin becomes soft and moist, the pulse resumes its natural force and frequency, and a copious sweat breaks from the whole body.
These paroxysms recur at regular intervals. The interval between them is called 'an intermission.' When they occur every day, the patient has quotidian ague; every second day, tertian; and when they are absent for two days, quartan. There is a double quotidian in which two paroxysms occur daily; in the double tertian there is a daily attack, but the paroxysms of successive days differ in some respects, while those of alternate days agree in character. Quintan, sextan, hepton, and octan cases are extremely rare. All ages are liable to this disease.
The exciting causes of this disease are unknown, but are thought by some to be effluvia from the surface of the earth (marsh miasmata). Others, again, such as Klebs, Tommasi-Crudelli, Cecchi, Laveran, and Osler, believe that a bacillus of some kind causes the disorder. Their researches show this to be very probable, although absolute proof is still wanting. A certain degree of temperature—higher than 60° F.—seems necessary for the production of the poison. It does not exist within the arctic circle, nor does it appear in the cold seasons of temperate climates, and seldom beyond the 56° of N. lat. (Watson). It also requires moisture. In England, ague is almost exclusively confined to the eastern coast; and the extension of drainage has rendered agues far more rare than before. James I. and Oliver Cromwell died of ague contracted in London. The Pontine Marshes to the south of Rome have long been notorious as a source of aguish fevers. Peat bog, or moss, is not productive of malaria, as is seen in parts of Ireland and Scotland. Neither is ague ever seen among the inhabitants of the Dismal Swamp—a moist tract of 150,000 acres on the frontiers of Virginia and North Carolina in North America.
The treatment of ague must be considered under two heads—during the paroxysm, and in the 'interval.' It is carried out generally as follows: As ague is a specific disease, little can be done during the paroxysm, save by applying external warmth to the body during the cold stage, and by administering restoratives, should collapse occur at the end of the hot stage. During the 'interval,' after purgatives have been administered, quinine must be given with the object of breaking the recurrence of the paroxysm, and thus, if possible, preventing grave degeneration of the organs and malarial cachexia. Arsenic is also sometimes used to attain this object.