Intermittent Fever

Intermittent Fever or malaria is a febrile condition characterised by the paroxysmal symptoms with chill, heat and sweating stages which alternate with a pyretic periods. Headache, vomiting, diarrhoea, rigor, or convulsions are the usual symptoms along with a temperature which at times reaches 40.5°c or more.
The exciting cause of the disease is a protozoa called Plasmodium. The three species of this protozoa cause varying periodicity, namely Plasmodium vivax causes tertian malaria or quotidian malaria, Plasmodium malariae causes quartan malaria and Plasmodium Falciparum causes the most serious form of malaria with constitutional symptoms.
Tertian malaria, in which the febrile paroxysms occur every third day (every other day)
Quotidian malaria. Malaria in which the febrile symptoms occur every day.
Quartan malaria,  Malaria in which the febrile symptoms occur every fourth day. (every three days) 
The malaria parasite is carried by Anopheles mosquito which transmitd the same from a malaria carrier to the health person by its bite. This disease is often found during warm weather and in people who live in marshy and swampy places.
Besides the above types of malaria, some are reported to be suffering from congenital malaria, in which the Plasmodium is transmitted to the child by its mother during intrauterine life. The affection becomes evident soon after the birth.
Symptoms
A typical attack of malaria runs a cyclic course and consists of the following stages,,,
Chill stage It is sometimes feeble in other cases it is very intense. There is rigor, headache and nausea which sometimes results in vomiting. The skin is dry and cold and the patient wants to be covered heavily. There may be thirst or not during this stage.
Fever stage  This stage follows chill stage and is characterised by high fever up to 41°c, headache, nausea and sometimes pain in abdomen and region of spleen. The patient generally throws off the covers. The skin is burning hot. The children often develop convulsions during this stage.
Sweating stage . This is third stage follows the fever stage. During this,  the temperature drops and profuse sweat follows, all the unpleasant symptoms disappear and the patient sleeps.
The entire attack generally lasts from 4 to 48 hours. It is often observed that most attacks occur in the afternoon and the highest temperature peak occurs from evening to early morning hours. The temperature curve often varies with type of the parasite.
The associated symptoms generally found in benign types of malaria are enlargement of spleen and sometimes of liver. In blood picture, besides the presence of different stages of the parasite, marked reduction in the leucocytes count occurs.
The malignant form of malaria which is also known as tropical malaria sometimes exhibits the symptoms of encephalitis or meningitis and mainly leads to malaria coma, owing to considerable concentration of the parasites in the cerebral capillaries.
During the a pyrexia period, the patient generally recovers his strength  but weakness, anaemia and other complications may occur if the attacks follow each other for a prolonged period.
Generally, self cure takes place following the reduction in the fever paroxysms and cessation of chill and sweat.
Chronic malaria may occur if there are frequent relapses,  which results in malaria cachexia and anaemia with Symptoms of tendency to haemorrhage, diarrhoea, oedema and deep changes in spleen and liver. The spleen may be stony hard and very enlarged with pain and discomfort.
In children below two years, the course of disease may not be so cyclic and typical but may show the symptoms of excitement, pallor of face, convulsions and vomiting. The temperature and the attacks are irregular and sweating is mild.
The incubation period of the disease is 10-15 days, however the attack and fever may occur several weeks or even months after infection.
Diagnosis
The diagnosis of the disease is fairly simple as the stages are generally well marked. If the temperature is taken every two hours, the cure will often make the picture clear.

The blood test often provides a confirmed proof of malaria which shows ring like annular bodies at the beginning of the attack, minor rings chill and initial heat stage, mature forms during the fever.
There is a demonstrable enlargement of spleen or liver or both. The patient also complain of pain in the spleenic region.
Certain degree of anaemia may be present especially in advanced cases. Besides, herpes in lips and face may be present.
Effects
Some of the effects of malaria in children are herpes of nose, eyelids and corner, anaemia, malaria hepatitis, especially after quartan infections  splenomegaly, loss of memory and malaria cachexia.
Constitutional causes.
Not all persons bitten by the Plasmodium vector Anopheles mosquito develop malaria. It is only some persons including who have a malaria constitution that are affected by this malady,(sycotic)  constitution and have an excess of hydrogen and consequently water in the blood and tissues are victims of this malady. The children who feel worse in cold or damp weather, and in rain and are aggravated by everything which in any way increases the atoms water by baths, eating of aquatic animals etc, and which increase the attraction of the organic molecules of oxygen, carbon and hydrogen for water. Thus the intermittent fevers, vaccinosis, gout, etc are some of the disease peculiar to this type of constitution which provides a rich soil to the germs or protozoa to grow and multiply in the human organism. Until this constitutional defect is treated, the tendency to this and a score of the maladies will remain in a child for ever. And as Von Grauvogl stresses, if a patient with intermittent Fever even before his sickness, was always affected by damp weather, he is not cured, even though the last paroxysm occurred years ago,  so as long as he does not feel quite as well in damp as in dry weather.
Preventive
It is essential that children should be protected from mosquito bites by providing mosquito nets screen at night. Stagnant water in and around the house should be removed or sprinkled with kerosene, to kill the mosquito larvae. Spraying of walls and premises with DDT is generally recommended.
The children who get ill on exposure to cold damp or rainy weather should be treated on constitutional level to cure their predisposition to the hydrogenoid constitution. Transfusion of blood donated by a person with latent malaria are highly unsuitable and may cause cause severe constitutional disturbances in a child. The transfusion should,  therefore, preclude such a possibility by the necessary antibodies tests of the blood..
Certain factors such as chill, wetting, exposure, exhaustion, blood loss, anesthestic, surgical trauma and high altitude flying may predispose a child to recurrence and relapse of the intermittent Fever.
Dr. J. H. Clarke recommends the use of Chin Sulph night and morning 30 "potency as a prophylactic measure for children who go in to malaria districts.
During the cold stage, child should be well covered with plenty of blankets which should be dry. During hot stage, cold drinks and tepid sponging as given under fever should be given to lower down the temperature. During sweat stage, the child may not be covered too warmly and after it is over, the bed clothes and pajamas should be changed...

Homoeopathic Therapeutics.
In malaria the medicines require frequent repetitions. It is necessary to pay more attention to symptoms and observe how chill  heat and sweat follow one another, as well as the occurrence of thirst and periodicity.
Dr. Hering cautions in the treatment of malaria, thus,  In commencement of the disease, it is better not to suppress it by Cinchona or quinine, it it should be done only in cases of great necessity, at the same time it can be best cured by homoeopathic remedies. Later when the attacks are more violent and the patient feels well in the intervals, the disease is more difficult to cure and in these cases it may sometimes be suppressed by quinine, though it often has bad consequences. At a still later period when the spleen and liver are swollen, take care not to use much quinine, it will in most cases only hasten dropsy and other succeeding diseases. He further advises, if you cannot find the suitable remedy, give a dose of Ipecacuanha after the attack and repeat it every three to four hours until the next day, a few hours before the time last attack came on,  if no attack comes on, give nothing else on that day, but give a dose on the following day, a few hours before expected attack. If it returns watch the symptoms and give another remedy. If you have selected one, give it first, after the attack is over and second repeat it a few before time the next attack is expected to return. If the fever had been stopped, but return again, give a first remedy for the cause of the relapse, and then the remedy, after the administration of which it stopped. Some of the important medicines frequently required during different stages of malaria are discussed here below,,,,,
Apis  A useful remedy, in intermittent Fever when the characteristic chill at 3 pm is present and the child complains of great thirst. The chill is worse on motion and heat,. But the stages of heat and sweat are thirstless with scanty and high coloured urine. Feeling of oppression in chest. Sweat is often wanting. Whining tearfulness is a useful symptom often accompanying the ailment. After the cold stage, the patient breaks out in profuse urticaria and is very drowsy.
Aranea  periodicity, coldness and great susceptibility to dampness are some of red line symptoms of this remedy. It is suited as a constitutional remedy for malaria poisoning when the patient complains of continued chilliness. Dr. Von Grauvogl greatly praises this remedy for hydrogenoid intermittent, when the spleen is greatly enlarged and the patient is unable to live near sea, lakes, rivers etc. Suitable for quotidian and tertian type of malaria. Coldness with pain in long bones and feeling of stone in abdomen at the same hour daily. The chill almost freezes the patient, and the stages of heat and sweat are either feeble or absent. Chill starts at 7pm and lasts till 8 in the morning, every day at the same hour, with cough loss of appetite, sleeplessness and great exhaustion. This valuable remedy of the animal kingdom tops the list of all similar remedies which have great sensitiveness to damp and cold places.
Ars alb. Suitable when the different stages are not distinctly marked or when the paroxysm is imperfectly developed. Arsenic is the remedy of choice in pernicious malaria due to Plasmodium falciparum when vomiting, purging and weakness are present. Heat stage is well marked in this remedy giving a feeling as if hot water is circulating in Veins, the chill stage is usually feeble or absent. One of the important symptoms of the remedy is the thirst for large quantities of water during the sweating stage. The sweat is cold, clammy and prostrating. Besides, burning pains in stomach, in supportable pain in limbs, anxiety and restlessness, oppression of chest, bitter taste in the mouth, buzzing in the ears during sweating and headache continuing after hot stage are some of the additional dy, also suitable for malaria cachexia when the sallow pallor, clean red tongue are present as after abuse of quinine. Again, the longer the disease has lasted more is Ars generally indicated, because the more deeply have the organs, and tissue been affected. Especially is the case where the liver and the spleen have swollen.
This remedy is also suitable for typho malarial fevers.
Bryonia 
Suitable for ordinary intermittent Fever, when due to exposure, there is great inflammation and irritation of mucous and serous membranes. The chill is attended with external coldness, great thirst, violent dry racking cough and stitching pains in chest and region of spleen. Lips parched, dry and cracked with dryness of mouth, tongue and throat especially during heat stage. Bursting, splitting headache suitable for tertian malaria..
Caps 
Chilliness preceded by thirst, followed by heat without thirst. The child knows that chill is coming as he feels thirsty, but extremely chilly and shivers after each drink becomes ill humoured during cold stage. The chill is violent and long continued, begins in back, between shoulder blades and extends to the whole body. Suitable for tertian and quotidian type of malaria.
Carbo veg
Attack is preceded by or attended with pains in the teeth and limbs, thirst only in the cold stage with redness of face and sick stomach during hot stage.
Ceanothus
Useful in malaria when spleen is enormously enlarged and is painful. Violent dyspnoea owing to spleenitis and constant urging to urinate.
China
Suitable for tertian type of malaria ailments worse every other day with all stages well marked. Most suitable for endemic and epidemic type of malaria, which return every week. Thirty before the chill and during sweat, but is thirst less during heat stage.
Chin Sulph  Suitable for tertian type of malaria when the chill starts at 10_11 am or 3pm with violent shaking and pain in dorsal vertebrae on pressure or lying down. All the stages are well marked and the child is thirsty during chill lips and nails turn blue ringing noise in ears.
Cina
Suitable for malaria when there is vomiting and voracious appetite before, during or after fever and during heat stage, face cold hands warm. Thirsty during cold or heat stage and very cross, does not want to be touched or covered.
Eup perf
Useful in tertian or double tertian type intermittent Fever when accompanied by soreness of all parts and bone pains. The child anticipates the chill as he develops insatiable thirst and bone pains before the chill. Vomiting after chill, which comes on the morning of one day and the evening of the other day and begins in the back. The paroxysm generally begins at 7_9 am
Gelsemium
An excellent remedy against intermittent Fever when the chill is so violent that patient is to be held so that he may not shake so much. Thirst less and profuse urination during the cold stage.
Ipeca
Suitable for tertian type of malaria worse in warm room, and from external heat feels better in open air and by drinking though there is no thirst during chill. Useful in cases of relapses of intermittent Fever.
Lycopodium
Paroxysm between 4_8 pm may come between 8_9 am or between 6_7 pm.
Nat mur
Chill commences between 10_11 am beginning in back and feet,  with hammering headache, weakness and blue nails and lips. Long continued chill followed by moderate heat. The child feels extremely thirsty in heat stage, which is followed by profuse sweat which relives all pains, except headache. This remedy is more useful in inveterate and chronic malaria cases with weakness, weariness, anorexia, constipation, etc.
Nat Sulph
Suitable in marsh malaria owing to living in damp and cold dwellings. Children of hydrogenoid constitution who are chilly and are best in warm dry air and suffer by rainy weather or by eating aquatic animals, plants, etc.. Paroxysm generally comes between 6_9 pm
Pulsatilla
Suitable in all types of malaria that is quotidian, tertian and quartan when the nature, severity and period keep changing. No two attacks are alike. The attack is preceded by stomach disorder and is accompanied by thirstlessness in all stages. Chill starts around 4 pm with vomiting and feeling of heat and chilliness in different parts. During heat stage, the child feels intolerably warm and searches for a cold spots in the room which he feels too hot and stuffy, wants doors and windows open. The child has one cheek red and the other pale, the Veins are distended and look of anxiety writ on his face. The child may feel thirsty during heat stage but it decreases as the heat increases. Sweat stage with great thirst.
Pyro.  Suitable for quotidian type malaria or chronic malaria threatening to develop into malarial cachexia. The periodicity of the attack is regular and distinct with wiry pulse. The chills usually comes in the evening around 7 pm, begins in the back and is violent, shaking the patient. Hyperpyrexia with temperature shooting upto 41 °c. The pulse and temperature ratio is disturbed, pulse is abnormally rapid, and out of proportion to the temperature. Great heat with profuse hot sweat, but sweating does not cause a fall in temperature. Wants to move as he feels relief.
Rhux tox
Suitable for quotidian and tertian type malaria, when the attack comes in the later part of the day and consists of heat preceded and followed by chill. The chill comes at 7 pm, begins in the high and is usually attended with a dry cough and restlessness. Chilly as if cold water were poured over him followed by heat and inclination to stretch the limbs and yawn incessantly. Excessive heat as if hot water running through blood vessels the child is extremely restless and changes position continually, one moment it is on the back, the other moment it is on the sides. The other concomitant symptoms calling for this remedy are heat accompanied by rash, pain in bowels and diarrhoea pressure at the pit of the stomach, urticaria and the tongue thickly coated except the red and triangular tip.
Sepia
Suitable for chronic, spoiled or masked cases of malaria. The chill normally comes at 11am and is attended with great shivering and thirst. Violent heat followed by profuse perspiration. Feet cold and wet.
Sulphur
Suitable for chronic cases of intermittent Fever when the attacks relapse and when the carefully selected remedies fail to act. Sulphur clears the disease picture or helps in complete cure by itself. Chill creeping from sacrum to back worse by open air or slightest movement. During shivering there is extreme coldness of nose, hands, feet, chest, back, abdomen and genitals. The chill and rigor, strangely enough, is not followed by heat but during the heat stage there are flushes of heat in face with shivering over body. Burning heat of palms and soles, cold feet,  with burning soles the patient puts out of bed to cool them off. The flushes of heat may end in moist skin and faintness.
Tarentula his
Suitable for chronic, spoiled and masked cases of intermittent Fever. The chill which shakes the patient is followed by long lasting heat and is often accompanied by restlessness. The child must be in in constant motion though the motion aggravates all the symptoms. The child is sensitive to music, averse to company but want some one to be with him.
Some cases treated.

A delicate 9 years old boy had quotidian type malaria for 3 days. On fourth day at about 10 am when chill shook the boy so violently his mother held him, heavily wrapped brought to me considering the above symptom and the time of occurrence of the chill as well as the thirstlessmes (as I was told that the child never asked for water during any of the stages on previous days)
I prescribed Gelsemium 200 two doses 10 minutes apart. The effect was rapid. The violence of the chill was reduced and heat with prostration supervened. The temperature rose to 39°c and the child lay down quietly. He complained of pain in forehead. A dose of Gelsemium 200 was repeated in heat stage as well. No more medicines was needed. Surprisingly, the child had no further attacks of the intermittent Fever. Though it is often recommend that medicine should better be given after the attack and in repeated doses, I chose to administer the medicine during the chill and heat stages in frequent doses and the rapid recovery followed.

M,  had tertian fever for five or six weeks. Pulsatilla 200 was given which seemed to aggravate, changing the fever to a quotidian type symptoms. Paroxysm  commenced at 8 am. Hard and shaking chills, last one hour, after which great thirst followed by fever with no thirst, headache flushed face dry red eyes and after the fever, sweating with thirst, but very profuse perspiration at night, particularly upon the parts on which he lies. Great debility after perspiration. China 200 ten doses one every three hours. Speedy recovery followed.

Miss C,  15 years old school girl consulted me for her severe headache over eyes in temples and occupit which according to her had lingered on after a bad attack of malaria about six months ago. She had been treated with quinine after positive blood tests for Plasmodium. The dull pain remained almost throughout the day and was worse from studies or mental exertion. She also complained of coryza with thin watery discharge and sneezing in the noon. She had grey hair which reported had started appearing 5 years ago. Sometimes she had severe earache and sweeling of lymphatic glands.
On these symptoms, I prescribed two doses of Nat mur 1m apart from one hour. After about, 10 days she had great relief in headache and coryza. Later one dose of Nat mur, 10 m completely cured her. Her hair also started regaining normal colour.

One of the most puzzling cases of intermittent Fever I have ever cured is that of a, 13 years of old boy who lacked most of the routine symptoms but had some striking symptoms which I missed owing to my absence at a time of the occurrence and going according to narration of the parents.
The child had paroxysms on alternate days around 8 am. The chill was violent and was preceded by intense thirst and pain in the whole body. Vomiting of water during chill. During heat,  the temperature rose sharply to 40°c and the child went into convulsions and had considerable difficulty in breath (as was narrated to me by parents) . The heat stage was followed by scanty sweating. When I saw the boy the paroxysms was over. Any way,  considering the above dy, I prescribed a dose of Eup perf 200 with the instructions to immediately call for me as soon as the next paroxysms started. I was told that the child felt prostrated during the apyrexia period and complained of bitter taste in the mouth. I was called when the paroxysms struck the child again on the third day. The chill had just started after the child had taken two glasses of water and it was heavily covered with blankets. Eup perf 200 was administered every ten minutes without any difference in the intensity of the chill which then was followed by great heat. I was baffled by the apparent inefficiency of Eup perf inspite of being well indicated and being given after the earlier attack and during the present attack. Soon I observed that the heat stage brought the frightening convulsions and terrible dyspnoea. On examination, I observed terrible swelling of spleen. During the convulsions, the child became very rigid, bending backward. The mother of the child started weeping as she thought the child was going to die. The convulsions and rigidity immediately brought the to my mind the drug picture of Cicuta vir which was immediately administered in, 30 c potency, two doses 10 minutes apart. The picture immediately changed for the better. The child straightened up,  the convulsions disappeared, and breathing became free, which brought great relief to me and the child's parents. It seems the dyspnoea of Cicuta is connected with enormous swelling of spleen. The child had no more attacks of fever, but as a safeguard, a dose of Cicuta vir 200 was administered to the child to check the recurrence of cerebral symptoms.