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.)
SECT. XXI.—THE CURE OF SPURIOUS TERTIANS.
It does not suit with spurious tertians to bathe at the commencement, nor until symptoms of concoction have made their appearance. Neither does it answer to give food every day, but every alternate day will be sufficient. Rest and warm applications to the hypochondriac region agree with them, also broths of easy digestion, and clysters not very emollient. And if detraction of blood be expedient, it ought by no means to be omitted. The nature of the diet ought not upon the whole to be cooling and diluent, but things of a more incisive nature ought to be added. They are particularly benefited by the juice of ptisan, to which have been added pepper, hyssop, sweet marjoram, and spikenard. Also, add pepper to honied water, boil, and give it to drink, and likewise everything which will promote the secretion of urine, except those things which are of a very heating and desiccant nature. In particular, after the seventh day, give wormwood; and many have been benefited by drinking oxymel, and taking gentle laxatives. A vomit taken with food is very beneficial to those in whom the affection is of long continuance.
Commentary. Galen explains that tertians are called spurious or bastard, when the symptoms assume an anomalous character. He states correctly that they are generally connected with disease of the spleen. His practice, which is consistent with his views of the nature of the attack, is similar to our author’s, that is to say, he recommends venesection and fomentations at the commencement, and afterwards things of a hot penetrating nature, such as wormwood and pepper, which he, no doubt, gave with the intention that they should act as deobstruents. Here, again, Alexander cautions against the indiscriminate adoption of Galen’s practice, affirming that these calefacient medicines sometimes prove dangerous, by increasing the inflammatory action. Almost all the other authorities, however, adopt the views of Galen. See, in particular, Oribasius (Synops. vi, 11); Aëtius (v, 81); Nonnus (de Febribus, c. v.) From the characters of the urine Actuarius infers that the spurious tertians are still more intensely bilious than the true, and consequently require longer time to reach their acme. (De Urinis, v, 15.) Avicenna recommends at first venesection and clysters; and afterwards deobstruent medicines, such as wormwood and pepper. Haly Abbas treats spurious tertians like true, at the commencement. After their acme, he strongly recommends wormwood, but forbids it earlier. It acts, he says, by increasing the strength of the stomach, opening the pores, increasing the urine, and promoting the secretion of bile. He approves of wine in the decline of the fever, with the view of supporting the strength, and of promoting the urinary and cutaneous secretions. He therefore directs that the wine be white, and not too old. (Pract. iii, 13.)