Commentary. Our author’s description of the causus, or ardent fever, is taken from Hippocrates (de Rat. Vic. Acut.), where the commentary of Galen is worth consulting. According to Hippocrates, the causus is generally produced in the summer season, owing to the veins becoming dry and attracting bilious humours. In other parts of his works he gives an account of several varieties of the disease, differing considerably in character from that described in the above-mentioned work. For example, one variety mentioned in his ‘Epidemics’ was distinguished by the absence of thirst and delirium, and by the paroxyms occurring on the even days. (See Galen’s Commentary, Opera, ed. Basil. t. v, 424; also, de Morbis, i, 27; and Coacæ, 130.) He further describes, under the head of causus, various cases of febrile complaints after childbirth and abortion, which would now be called puerperal fevers. (Epidem. iii.)
Aretæus delivers a most striking description of ardent fevers, which we regret that our limits prevent us from giving at full length. The following are some of the most important symptoms: the heat acrid and subtile, especially in the internal parts, desire of cold air and of cold things, the extremities cold, the pulse dense and small, the eyes clear, bright, and reddish; and, if the fever go on increasing, delirium, oblivion of every thing, lividity of the nails, frequent respiration, profuse perspiration about the forehead and neck, coldness of the body, and at last a complete collapse marked by a return of the powers of reason and certain indications of a prophetic spirit. This is but a meagre outline of his matchless delineation of the phenomena of causus.
As all the Greek, Latin, and Arabian writers treat of causus in nearly the same terms as Hippocrates, we shall be very brief in noticing their descriptions. According to Alexander, there are two varieties of causus, the true and the spurious, the former being marked by intense thirst, bilious stools, tongue rough and black; and the latter by the thirst being moderate, the tongue not black, and the stools consisting not of bilious matters, but rather of corrupted food. The former kind is said to be occasioned by a bilious, and the latter by a pituitous humour. Aëtius describes the disease in the same terms as our author. He says that it is produced by putrefaction of yellow bile. Palladius says that ardent fevers are occasioned by an erysipelatous inflammation of the lungs, or by the putrefaction of bilious humours which have become immoderately heated. The Arabians describe it exactly as the Greeks. According to Avicenna, there are two varieties of the disease, the bilious and the pituitous. The inseparable symptoms of the disease are, he says, concealed heat, roughness, and, at last, blackness of the tongue. There is no perspiration until after the crisis. For the most part the heat is not strong in the external parts, but is particularly so in the internal. Rhases states that the ardent fever called καῦσος by the Greeks belongs to the class of tertians, only that in the former the heat is more intense, and the paroxysms do not terminate in a complete intermission of the febrile symptoms. The symptoms, he adds, bear a considerable resemblance to those of the tertian intermittent, but are more strongly marked. According to Alsaharavius, the causus, or ardent fever, is occasioned by heated bile collected in the veins adjoining to the heart, stomach, or liver, and its symptoms resemble those of tertians, but are more intense.
From the above exposition of the opinions of the ancients regarding the causus, or ardent fever, the medical reader will readily recognize its identity with the bilious remittent fever of Sir John Pringle and other English authors. If there were any doubt on this head, it would be set aside by the description of the symptoms of ardent fever which is given by the late Dr. Robert Jackson, as they were manifested in his own person during a severe attack of it. (On Fever, 403.)
Some late writers have confounded the causus of the ancients with synocha, or inflammatory fever. But, as we have said, and as was correctly stated by Baccius, the causus was decidedly of the continual or remittent type, and nearly allied to the tertian intermittent. (De Thermis.) Hoffman remarks that it seldom appears in the more temperate parts of Europe, but is very common in Asia, Greece, and Italy; and hence the frequent mention of it in the works of Hippocrates, Galen, and Aretæus. (Oper. t. ii, § 2, c. 2.)
Homer says that the dog-star brings many fevers upon unhappy mortals (Iliad, xxi, 31); and his commentator Eustathius remarks that the poet correctly refers the origin of ardent fevers to the heat of the dog-days.
SECT. XXX.—THE CURE OF ARDENT FEVERS.
Either of the following things must take place, that this fever may terminate completely; the bilious humours must either be evacuated or extinguished. They are evacuated then by sweating, vomiting, or purging downwards; but they are extinguished by cold drink, with which we have entirely cured ardent fevers. For diet, those in causus should not take water alone, nor mead alone, but boiled mead much diluted with water; for the food of such persons ought to consist entirely of drinks. The bath will suit with those only affected with causus who are free from all inflammatory and erysipelatous swelling. And if they exhibit signs of concoction, it will suit still better with them; but not so if the fever be occasioned by a saltish humour. These should be supported with the juice of ptisan.
Commentary. Our author’s directions respecting the treatment are mostly taken from Hippocrates (de Rat. Vict. Acut.) Hippocrates allows venesection only when the attack is violent. He approves of the application of cold water to the surface. Archigenes, as Aëtius informs us, sponged the head and chest with cold water during the acme of ardent fevers. (iii. 159.) His own treatment, which is borrowed from Philumenus and Galen, consisted of cooling remedies internally and externally, such as drinking cold water and other things of a refrigerant nature, using cold applications, and the cold bath, (v, 28.) Alexander, Oribasius, Synesius, and Constantinus Africanus treat the causus upon the same plan as our author. They say nothing of bleeding. Celsus likewise omits to make mention of venesection, but recommends refrigerants, and especially cold water to be given, even to satiety. He forbids it, however, when there is any affection of the internal viscera, and when there is a cough. He informs us that Asclepiades, of Bithynia, strongly recommended gestation for the cure of this fever.
Averrhoes abstracts blood when there are symptoms of plethora, gives gentle purgatives, such as tamarinds, and allows the patient cool drink and cool air. Haly Abbas treats the causus entirely upon the refrigerant plan, with cold drink, cooling fruits, fresh air, gentle laxatives, such as prunes, and by cold applications to the skin. Alsaharavius conducts the treatment upon much the same principles. When the patient is troubled with protracted watchfulness, he directs us to rub the temples with the juice of poppies, lettuces, and coriander. Avicenna also speaks favorably of these soporifics, but does not in general approve of bleeding. The treatment recommended by Rhases is altogether refrigerant. He directs us to clear away the asperities of the tongue, and then to give cooling and acid drinks. When there is no inflammation of any internal viscus, he permits water cooled with snow. He says nothing of venesection. However, some of his authorities, as quoted in his ‘Continens,’ recommend bleeding. They seem in general to have approved of keeping the patient in a cool room perfumed with aromatic and fragrant herbs. One of them approves of applying over the stomach a robe moistened with a fluid prepared from camphor, rose oil, &c.