SECT. XXVI.—ON THE FEVER HEPIALUS, AND THE RIGOR WITHOUT HEAT.
The vitreous phlegm being the coldest of all, if it accumulate in the body, and remain free from putrefaction, it occasions the rigor without heat, which is not attended with fever. In those fevers which are kindled by the humours, it is putrefaction for the most part which kindles febrile heat. If it become putrid, and that through its whole substance, which is rarely the case, owing to its great coldness, it occasions quotidian fever. But when it is half putrid, and not equally through its whole substance, but some parts of it being putrid, and others not, it gives rise to the fever called hepialus, in which those affected have rigors and fever at the same time; for the parts of the humour which are not putrid being scattered through the veins all over the body, occasion rigor; but the putrid parts kindle fever. The word hepialus is either derived from ἡπίας ἁλος, i. e. the sea, which is mild in appearance, although formidable in reality; or from ἡπίως ἁλεάζειν, i. e. warming gently. And, as this fever is of the quotidian kind, being formed by phlegm, it is to be treated in the same manner; only that it requires remedies as much hotter and more incisive than the quotidian, as its phlegm is colder than that of the other. The rigor without heat stands in need of heating things still more than the hepialus. Wherefore, the composition of three peppers, that from calamint, and still more that from Cyrenaic juice are particularly suitable to this complaint, as also the remedies prepared from castor and the like. You will find a fuller account of these matters in [the 46th section], “on immoderate rigor and cold.” The fevers called lipyriæ, and the typhoid or smoky, and whatever others are mentioned besides those described, being all of the same kind as the above mentioned, will require the same methods of cure as those which have been mentioned, or will soon be described.
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.)