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.
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.