SECT. XX.—ON THE CURE OF TERTIAN FEVER.
In the true tertian, as arising from yellow bile, we must dilute and cool, evacuate the defluxions upon the stomach by emetics, and downwards by the belly, and carry them off by urine and perspiration. The bowels, therefore, are to be moved by emollient clysters, and the secretion of mine promoted by infusions of parsley and dill in the drinks. And if symptoms of concoction appear, you may confidently give wormwood. Apply also baths of warm common water, and let neither nitre, nor salts, nor mustard be sprinkled upon the body in the bath; but let the patient enter it after having had warm oil poured over his body. There will be no mistake if those who are fond of baths be bathed twice; and, if symptoms of the diseases being concocted appear, there will be no harm even if they be bathed oftener. Until the disease is concocted, wine is to be entirely prohibited; but when concoction commences, first some thin and watery wine may be given, and food of a diluent and cooling nature will be proper; but honey, mustard, pickles, and everything heating must be abstained from. Such was the practice of the ancients; nor is it to be wondered at, as these men were more habituated to exercises and a restricted diet; but now, when order is perverted, the bile is, for the most part, found mixed with phlegm. Wherefore, now-a-days, most tertians are either without a rigor, or it is very slight. And the mode of cure is also changed; for, neither does the bath suit with tertians now before concoction, nor yet a full diet, except crumbs of bread, eggs, or the like.
Commentary. Hippocrates recommends generally purgatives at the commencement, and afterwards the hot bath, and trefoil, assafœtida, and wine, to promote perspiration. (De Morbis, ii, 39.) He lays it down as a general rule applicable to all intermittent and remittent fevers, that the administration of food should be restricted during the paroxyms. (Aphor.) See the Comment of Theophilus (ed. Dietz, t. ii, 268.)
Celsus informs us that Cleophantus treated tertians by pouring warm water upon the patient’s head, and giving him wine before the accession of a paroxysm. This, however, he considers to be precarious practice. Upon the whole, his great dependence is upon these three remedies: vomits, purgatives, and wine; of which the first is to be tried on the third day, the second on the fifth, the third on the seventh.
Galen’s practice is exactly detailed by our author. He evacuates the bile upwards and downwards at the commencement, and also, with the same intention, administers diuretics and sudorifics. After these he reposes great confidence in wormwood, which, indeed, all the ancients held to be a powerful cholagogue. He also approves much of the tepid bath of common water. He directs the physician not to neglect venesection, if it be indicated; upon which his commentator Stephanus remarks, that the circumstances commonly indicating bloodletting are the condition of the patient, if he be young and plethoric, and the season of the year, if it be spring. (Ed. Dietz.) He forbids wine until the fever is concocted, but afterwards allows a small quantity of thin watery wine. The food is to be refrigerant, and diluent. Everything of a heating and acrid nature is to be abstained from.
Aëtius, Oribasius, and Nonnus conduct the treatment upon the principles laid down by Galen. Actuarius directs bleeding at the commencement.
Alexander discusses the established principles of treatment freely and fully. He disapproves of Galen’s practice of giving the decoction of wormwood in the genuine or true tertian, after the seventh day, and confines the administration of it to spurious tertians, when he mixes it with oxymel. His own remedies are of a diluent and refrigerant nature. He approves very much of the bath. He speaks highly of the good effects of grapes and peaches, and still more of water-melons given with cold water before the fit. He approves of gentle, but not of strong purgatives. He praises very especially a rhodomel prepared from the juice of roses, honey, and scammony; and another, consisting of the same ingredients, along with agaric and pepper.
Synesius recommends cooling articles, such as damascenes, gourds, &c. but says nothing of wormwood. Constantinus Africanus also omits to make mention either of wormwood or the tepid bath. He, however, pours water on the head and puts the feet into hot water.
Serapion directs emetics, if the matters are determined to the stomach, and clysters, or gentle purgatives, if to the bowels. He recommends myrobalans afterwards, and then wormwood, but not until the morbific matter is concocted. (Tr. vii, 13.)
Rhases recommends gentle and cooling purgatives, with refrigerant and diluent drinks, containing sorrel, cucumber, camphor, &c. (Ad Mansor. x, 4.)
Avicenna’s directions are exceedingly minute, and seemingly very judicious. He cautions against using drastic purgatives, and expresses himself doubtfully of the effect of venesection. His practice consists principally in the administration of gentle purgatives, diluent and refrigerant medicines. He approves of pomegranates, plums, and water-melons. Averrhoes lays down the same principles of practice. (Collig. vii, 11.) Haly Abbas states that, as it is the nature of these fevers to occasion heat and dryness of the body, they are to be treated with diluents and refrigerants. Agreeably to these principles, he directs us to give clysters and gentle laxatives, to use the tepid affusion, and the like. (Pract. iii, 12.) Alsaharavius recommends similar treatment. Rhases, like Haly, recommends refrigerants and diluents. He approves of cooling purgatives, such as a combination of myrobalans and scammony, or a draught made from prunes and manna. He speaks favorably of emetics. Several of his authorities recommend the bath, and others approve of wormwood. (Contin. xxx.)
It will be remarked that many of the ancient authorities recommend the tepid bath for the cure of tertian intermittents. Prosper Alpinus informs us that he had seen this practice successfully pursued by the Egyptian physicians. (De Med. Ægypt.)