[655] Galen, in illustration, states that epilepsy is sometimes carried off by an attack of quartan fever.
[656] The semitertian was always looked upon as a very formidable form of fever. See Paulus Ægineta, Book II., 34. Galen gives a prolix, but not a very distinct account of it.
[657] Galen, in his Commentary, states that he had often seen persons in consumption attacked with tertian and quotidian intermittents, but admits that he had no more experience of quintans than he had of septans and nonans. Avicenna. however, is not so sceptical as to the occurrence of these rare forms of intermittents. Indeed he says, he had often met with quintans, and that a trustworthy physician of great experience had assured him that he had met with nonans. (iii., 1, 3, 67.) Rhazes also would appear to acknowledge the occurrence of all these varieties of intermittent fever. (Contin., xxx., 10, 1, 409.)
[658] The text is much improved in Littré’s edition, so that the meaning is pretty intelligible without any commentary. Galen states in explanation, that the three varieties of fever are thus marked and distinguished from one another: in the first, the fever attains its height at the commencement, and gradually diminishes until the crisis; in the second, it begins mild, and gradually reaches its height at the crisis; in the third, the fever begins mild, gradually attains its height, and then gradually subsides until the crisis.
[659] These are all febrile diseases, and for the most part of the ardent type. In order to enter properly into the spirit of them, the reader will find it necessary to revert frequently to the Prognostics, and compare the parallel passages. See also the Argument.
[660] Galen, in his Commentary, remarks that the fatal issue of this case might have been anticipated after the return of the fever on the third day, with a complication of bad symptoms, such as great thirst, dry tongue, black urine, delirium, coldness of the extremities, and so forth. The modern reader will be struck with the description of the respiration, namely, that the patient seemed like a person who forgot for a time the besoin de respirer, and then, as it were, suddenly recollected himself. Such is the meaning of the expression as explained by Galen in his Commentary, and in his work On Difficulty of Breathing. By “rare” is always meant “few in number.” The reader will remark that this is a striking case of a fever having regular exacerbations on the even days, and slight remissions on the uneven.
[661] This, it will be remarked, is a case of fever induced from obvious causes, namely, excessive fatigue and dissipation. We must take into account, however, the febrile constitution of the season. According to Galen, the fatal result could have been confidently foreseen from the seventh day. The distention in the hypochondriac region here described would appear to have been meteorism. The throbbing in this region was no doubt owing no the same cause. The rash was most probable miliary. It is described as resembling vari (ἴονθοι), by which was probably meant acne. See Paulus Ægineta, Vol. I., p. 454. Upon reference to the Prognostics, it will be remarked that the characters of the urine are all bad, that is to say, it was either suppressed, or the sediment was either wanting or black and farinaceous. See Prognost. 12. By “black,” as applied to the urine, is to be understood “a dark-red color,” like that of wine.
[662] There is nothing in this case very remarkable, or which stands in need of elucidation; but yet the reader may feel interested in Galen’s reflections upon it. The recovery he holds to have been unexpected, as a different result might have been anticipated from the characters of the alvine discharge, and of the urine at the commencement. The favorable change he attributes to the swelling of the spleen, whereby the peccant humors were attracted to it; and he further remarks, that as the swelling of the spleen diminished, the humors are described as having passed down to the extremities, after having first affected the groin of the side on which the spleen is situated. He further calls attention to the improved characters of the urine when the swelling of the spleen and pains of the limbs supervened. Still, however, he adds, there was a remnant of the cacochymy in the system which gave rise to the relapse on the fourteenth day, so that the complete crisis did not take place until the seventeenth day.
[663] This is evidently a well-marked case of puerperal fever, or of fever complicated with the puerperal state. There is nothing particularly interesting in Galen’s commentary on it. He states that the application made in order to remove the suppression of the lochial discharge may either have been a pessary or a suppository. It seems most likely to have been the former. On the composition of the ancient pessaries, see Paulus Ægineta, Book VII., 24. He remarks that the symptoms first stated are unfavorable, but not necessarily fatal, until we come to the coldness of the extremities, which is an extremely mortal symptom in the beginning of a disease when combined with a very violent fever. The modern reader will be struck with the expression that “the attendants seldom put her in mind” to make water; it is very descriptive, however, of the state of stupor the patient was in when she was so insensible that she did not attend to the calls of nature.
[664] Galen remarks that it was reckoned very extraordinary for a rigor not to be followed by febrile heat. See Comment. et de Rigore; de Diff. Febr., ii.; and Foës’s long annotations on this passage.