The ague commences in the following manner, viz. by reason of extreme laxity in the heart and arteries, they become unable to propel on the blood towards the surface; at this instant the blood recoils upon the heart, and round about the heart in the arteries, forming a kind of extraversion of the blood; the heart and arteries in the chest, labour with an excessiveredundancy, greatly distended and irritated, and finally highly inflamed. The subject of it is insatiable with drink during this stage of it. But the surface experiences a very different sensation: this reflux of blood upon the seat of the circulation, has left the coldness of death upon the surface: this will remain until the internal heat shall have, by its time and degree, induced a sufficient degree of tensity, or stricture on the heart and arteries, that will enable them to propel on towards the extreme parts that excessive redundancy that inflamed them. As soon as this sufficient tensity is formed, the blood comes forward towards the surface with fever heat; and that inflammation which was first internal and local, now becomes external and universal.

This appears to be the true circumstance of the case, so far. And it will follow, that this acquired morbid tension will, according to the degree of it, resist another paroxysm: if the internal heat continue long, the fit will be resisted a length of time, in proportion thereto; but if the internal fever heat be of short duration, the resistance to another paroxysm will be proportionably short. Hence the quotidian and tertian agues are more violent and of longer duration in their paroxysms, than those that occur daily; and this longer continuance determines the duration of that resistance to the next paroxysm. This acquired tension may, however, be lost by some accident, by bodily or mental fatigue, by unusual abstinence from suitable nutriment, &c. all which may shorten the term of resistance to the next ague. A trifling cold will infallibly induce an ague very suddenly, which is a circumstance that people but little notice, and which is a very common cause of this disease remaining so long.

The cause of those fevers continuing so short a time, is partly owing to the brevity of the existing cause, and partly to the less comparative degree of tension on the surface, with that which exists internally. The internal energy of the arteries, forms an exertion towards the surface, and the resistance by suppression of perspiration through tension on the surface, being little or nothing, a diaphoresis is quickly induced, and the inflammation must subside. The pores being very open at the close of every paroxysm, renders it very necessary that people should observe a steady degree of warmth in this disease, even when they are not electrified.

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