Part 52

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COMMENTARY. Hippocrates applies the term hepialus to a fever occasioned by amenorrhœa. He briefly notices the lipyria in several parts of his works, (as Coac, 32, 27.) Galen enters minutely into the consideration of the nature and causes of the hepialus, which appears to be a variety of the quotidian intermittent. He says the fever derives its origin from the putrefaction of a thick phlegm resembling melted glass. Its distinguishing characteristic is, that the patient experiences a sensation of heat and rigor at the same time.

Aëtius, and the other subsequent authorities, treat of the fever in the same terms. They recommend, principally, sudorifics and calefacients.

Rhases, Avicenna, Serapion, and Haly treat of the epiala, and the “frigus quod non calefit,” as varieties of the quotidian. Alsaharavius gives a very distinct account of the epiala. He says it arises from a gross vitreous phlegm, and is attended with internal heat, and cold of the extremities. The pulse is small and weak, the urine white and unconcocted, and the perspiration suppressed, owing to the constriction of the pores and thickness of the humours. He approves of giving emetics, attenuants, and calefacients. The lipyriæ are treated of by Serapion, Avicenna, Rhases, and Alsaharavius. They are said to be the counterpart of the epialæ, being distinguished by internal cold and external heat. Rhases describes the hepialus as consisting of internal heat and external cold. He says it arises from vitreous phlegm. The lipyria, he states, is one of the worst varieties of ardent fevers.

The rigor without heat, or “frigus quod non calefit,” is a febrile affection still met with in warm climates.

The term typhus, now generally applied to the common fever of this country, is used by Hippocrates, in his work on ‘Internal Affections,’ where he describes five varieties of the disease. They are cases of ardent fever, attended with stupor and insensibility. The term typhodes occurs in Galen’s ‘Commentaries on Hippocrates;’ in his work, ‘De Diff. Feb.’ (i, 9); and ‘De Prognost. Puls.’ (ii, 9.) Leo defines a typhous fever to be one in which the heat is weak and concealed. (14.) It would appear that the fevers to which the ancients applied the term typhoid were either intermittents or remittents. Isidorus thus defines typhous fevers: “Typhi sunt frigidæ febres, quæ abusivè typhi appellantur ab herbâ quæ nascitur in aquis quæ Latinè forma atque status dicitur: est enim accessionum revolutio per statuta temporum intervalla.” (Orig. iv, 7.) The word τύφος occurs in Marcus Antoninus (ii, 17), where Gataker remarks, “Est enim τύφος κυρίως idem quod κάπνος, fumus.” Salmasius gives the derivation of the term as follows: “τύφος proprie est fomes, τύφεσθαι enim ἠσυχῆ κάιεσθαι Græci exponunt.” (In Tertulliani Librum de Pallio Annot. 318.)

Prosper Alpinus thus explains the nature of typhoid fevers: “Has febres exterius mites seu obscuras intus turbantes Græci typhodes appellant, quippe quæ naturam multitudine humorum gravatam, ac fere suffocatam, incendium foras transmittere nequeuntem, significent. Hasque vulgus medicorum appellat, foris mites, intus conturbantes; suntque eæ omnes, admodum perniciosæ.” (De Præsag. Vita et Morte Ægrot. i, 10.)

SECT. XXVII.—ON THE CONTINUAL FEVERS.

The continual fevers are allied to each of the intermittents; thus, to the true tertian is allied the causus or ardent fever; to the quotidian, that fever which has a paroxysm every day, but does not terminate in a complete freedom from fever; and, in like manner, to the quartan, that which has an exacerbation every fourth day. For the true causus has all the other characteristics of the tertian, and differs from it only in not commencing with a rigor, nor ending in a complete remission of the fever. The continual fever which has an exacerbation every day, possesses all the other characteristics of a quotidian, except that it does not terminate in a perfect apyrexy. In like manner, the continual fever which has an exacerbation every fourth day, but does not terminate in a complete apyrexy, is allied to the quartan. A continual fever, therefore, is one which does not terminate in any interval from fever until it is altogether resolved. But when it evinces no remission, it is, indeed, of the same class as the ardent fevers, but differs from them in acuteness.

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COMMENTARY. Hippocrates has stated the alliance between the intermittent and continual fevers. (Epidem., Op. Galeni, ed. Basil, v, p. 362.) In his report of the epidemical diseases of a certain season, he mentions that the continual fevers (συνεχεῖς) were distinguished by an exacerbation every alternate day, after the manner of tertians, and that they were attended with ardent symptoms. He also remarks their tendency to terminate in dysenteries, lienteries, and tenesmus.

Galen marks a distinction between the continual fever (συνεχῆς) and the synochus, which it is necessary that the reader should particularly attend to. He remarks that there are three varieties of intermittents: the quotidian, which arises from putrid phlegm; the tertian, from yellow bile; and the quartan, from black bile. Of continual fevers, arising from yellow bile, there are two species; the one being called synochi, and consisting of one paroxysm from beginning to end; and the other, to which the generic appellation continual (συνεχεῖς) is particularly applied, and which consists of a number of particular paroxyms. Of the continual fevers, some assume the tertian type, having a remission of the fever every alternate day; some the quotidian, and have a remission every day; and others, of rare occurrence, resemble the quartans, in having remissions after an interval of three days. (De Diff. Feb. ii, 2.) In another place he says of synochous fevers that they consist of two varieties, the one arising from an ebullition of the blood, and being produced by the conversion of ephemerals; and the other arising from putrefaction of the blood in persons who are gross and plethoric. (Meth. Med. ix.)

Aëtius treats of continual fevers (συνεχεῖς) in nearly the same terms as our author, and distinguishes them from the synochi.

Alexander states that the continual fevers (συνεχεῖς) differ from the intermittents, solely from the humours which occasion the former being of a thicker nature.

Our author’s account is nearly copied word for word from Oribasius.

Actuarius remarks that the synochus proceeds from an ebullition of the blood, and the continual fever (συνεχὴς) from putrefaction of the different humours.

Nonnus states very distinctly the difference between the synochus and continual fever. In the latter, he says, there is an incomplete remission of the febrile symptoms, but in the former there is no remission at all.

Synesius and Constantinus Africanus adopt the distinction between the synochus and continual fever, as stated by Galen.

Leo says, a continual fever has no intermission, but merely a remission and abatement of the fever in the decline of the paroxyms.

Celsus, although he does not describe the febres continuæ particularly, seems to allude to them in the following account of the quotidians: “Rursus aliæ sic desinunt, ut ex toto sequatur integritas; aliæ sic, ut aliquantum quidem minuatur ex febre, nihilominus tamen quædam reliquiæ remaneant, donec altera accessio accedat; ac sæpe aliæ vix quidquam aut nihil remittant, sed ita ut continuent.”

In the works of Rhases, the distinction between the continual and synochous fevers is clearly pointed out. He states that the synochus, or continens, is a fever which consists of one paroxysm from beginning to end; whereas the continual, called συνεχὴς by the Greeks, and f. continua by the Romans, is allied to the intermittents.

In the barbarous translation of Alsaharavius, there is some difficulty in recognizing this distinction. He first describes a fever, which he denominates synocha, which arises, he says, from inflammation of the blood, and is marked by redness of the face, headach, and difficulty of breathing. Second, nearly allied to it is the synochus or februs continua (it ought to be f. continens), which arises from putrefaction of the blood. Third, the febris quotidiana, the febris tertiana continua, and the febris quartana continua, which are distinguished from their corresponding intermittents by being attended with a partial remission and not a complete intermission of the febrile symptoms.

Avicenna describes the tertian intermittent by the name of febris tertiana periodica, and the continual tertian by that of tertiana continua; the quotidian intermittent by the name of febris phlegmatica periodica, and the continual quotidian by that of febris phlegmatica inseparabilis, or latica; the quartan intermittent by the name of quartana periodica, and the continual quartan by that of quartana continua. The synochus he calls by the name of febris sanguinis; and, in treating of it, remarks that Galen is guilty of inconsistency in stating the proximate cause of it; for that in one place he says it arises from the blood, and in another from bile. Averrhoes states the same objections to Galen’s account of the origin of synochous fevers.

Avenzoar marks the distinction between the intermittent and the continual quotidians, tertians, and quartans.

We have been more than usually minute in explaining the opinions of the ancients with regard to the Continual fevers, because much confusion has arisen in modern nosological treatises and works on medicine, from the distinction between them and the synochi not being properly understood. After what has been said, the medical reader will readily perceive that the Continual fevers (συνεχεῖς) of the Greeks are the same as the Remittent fevers described by Pringle, Monro, and other English authors of that age who have treated of fevers.

SECT. XXVIII.—THE DIAGNOSIS AND CURE OF SYNOCHOUS FEVERS.

Synochous fevers are produced sometimes by effervescence of the blood alone, and sometimes by putrefaction of the same, arising from obstruction, and have, therefore, but one paroxysm from beginning to end. The symptoms are, pulse very great, strong, quick, dense, equable; but they are not pungent; and the urine is little different from the natural. The cure of them consists in bloodletting ad deliquium. And those who are affected with these fevers, and are not bled, run the most imminent danger. But if anything should prevent us from having recourse to phlebotomy, we must use such other remedies as are calculated to remove obstructions, those which evacuate, and such as will allay the effervescence of the blood. But when in these cases you remark symptoms of concoction of the humours, and there is neither inflammation, œdematous swelling, nor scirrhus in any important part, nor any part cold, so as that the evil may be determined to it, you may boldly give cold water, more especially if the patient has been accustomed to cold drink.

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