It is a peculiar and inseparable symptom of ephemeral fevers, that
concoction of the urine takes place on the first day; and a pleasant
state of the heat is likewise peculiar and inseparable from such fevers.
After the first resolution of the fever, you will have a still more
confident diagnosis; for the motion of the arteries then becomes similar
to that of persons in health, whereas no other fever returns so soon to
the natural state. And it is also a very great mark of this fever that
the patient bears it well. Those persons are readily seized with this
complaint in whom the perspirations are not vaporous, but very acrid, as
if containing something fuliginous. Such are they who are of a hot and
dry temperament, and, in fine, those who are troubled with bitter bile.
Those who are seized with this fever from fatigue should be rubbed softly
with oil and bathed; but those from dryness, are to be rubbed less and
bathed more. Those from cares, grief, watchfulness, or anger, are not to
be bathed often, but slightly rubbed with plenty of tepid oil possessed
of little stypticity; and bathed according to habit. Those who have
been seized with the fever from inordinate heat are to be treated from
the commencement with cooling things and more baths, but by no means
with much oil and friction. The cooling things should be rose oil, or
cold oil of unripe olives, prepared without salts. The same are to be
poured upon the open of the head, and the bath used when the fever has
passed its acme. If a person has a fever from congelation, he is to be
bathed in the decline; but if the fever be attended with catarrh, he is
not to be bathed until concoction takes place; but those who have fever
from exposure to heat are to be bathed while these symptoms are present.
Those from exposure to cold are to be warmed moderately, and have the
head bathed with such applications as the oil of iris and of nard. To
those in whom the fever is occasioned by constriction of the skin, the
proper remedies are, tepid baths of sweet waters, friction to open the
pores, exercises, and an exhilarating diet. Those in whom the fever is
occasioned by want of food are to be led to the bath after the decline of
the first paroxysm, and to have plenty of tepid oil poured upon them; are
to be rubbed most gently, and to remain for the greater part of the time
in the cistern of the warm bath. After coming out and recovering their
strength, they are to be led again to the bath, and afterwards get warm
water to drink, the juice of ptisan, and sometimes of lettuce; and are to
partake of fishes having tender flesh, in white broth. The common diet in
all these cases ought to consist of things which contain good juices, of
easy digestion, and which will not be restrained within the pores of the
skin. Wine should be given which is watery in appearance and strength. It
will sometimes be proper, on the first attack of the fever, to give some
nourishing food, when the fever has been enkindled by an intemperament
inclining to the hot and dry. Those who have this fever from inflammation
of the glands of the groin, do not require a physician to instruct them
what ought to be done; for, attending to the ulcer from the time that the
bubo is formed, they take the bath in the decline of the paroxysm. But
they ought to be restricted as to wine, until the inflammation of the
groin is resolved, and use a spare diet.
* * * * *
COMMENTARY. Among all the remains of ancient medicine which have come
down to us, there is not, perhaps, anything more valuable than the
reports of febrile diseases, contained in the ‘Epidemics’ of Hippocrates,
illustrated, as they fortunately are, by the learned ‘Commentaries’ of
Galen. Many of them are histories of ephemeral fevers, brought on by
certain exciting causes, and terminating in synochus. The procatarctic
causes generally assigned are fatigue, excessive debauchery, grief,
exposure to extreme heat or cold, and the like.
Hippocrates thus defines the duty of the physician in conducting the
treatment of febrile diseases: To be able to tell what had preceded them;
to know the present state and foretel the future; to have two objects in
view, either to do good, or at least to do no harm. (Epidem. i, 7.) His
general rule with regard to regimen in fevers is most important, namely,
that a diluent or moistening diet is proper in all febrile affections.
(Aphoris. i, 16.) See his Comment. (t. ii, p. 283, ed. Dietz.)
Of no disease has Galen treated so frequently and fully as of fever. (See
de Diff. Febrium, Meth. Med. viii and ix; Therap. ad Glauc., de Crisibus
ii, 13, et alibi.) He everywhere inculcates that ephemeral fevers are
affections of the _spirits_, by which he seems to have understood the
heat and gases contained in the blood. The exciting or remote causes of
them, according to him, are want of sleep, indigestion, sorrow, fear,
anger, anxiety, the application of heat and cold, excessive fatigue,
tumour of the groin, and the like. He remarks, that the heat in these
fevers is not offensive on the first application of the fingers, but
conveys an acrid sensation after a short time. He has particularly
stated constriction as a proximate cause of fever; and this, by the
way, is agreeable to what is stated by Cælius Aurelianus: “quidam vero
conclusioni viarum causam febrium ascribentes.” (Acut. Morb. ii, 33.)
In this variety, he approves of venesection, unless the patient be a
child or a very old man. In the other cases, his most approved remedy
is the bath; but his treatment is judiciously varied, according to
circumstances. For example, when the fever arises from the depressing
passions, he forbids hard friction and frequent baths, and merely directs
us to pour tepid oil over the patient’s body. When it is produced by
exposure to heat, he forbids us to use much oil, or to have recourse
to hard friction, and directs us to pour upon the head water which has
been cooled by means of ice, and to put the patient into a cold bath.
Alexander, however, finds fault with him for giving heating medicines,
such as pepper, and using hot applications over the stomach in such
cases. Alexander’s account of the nature and treatment of these fevers
cannot be perused with too much attention. He mentions as characteristics
of ephemerals, that the urine is properly concocted from the first;
and that the pulses have a quick and elevated diastole, with a shorter
systole; the vessels, he adds, requiring refrigeration, rather than
purification. They arise, he says, from many and various causes, such
as repletion, want, watchfulness, fatigue, disorder of the belly,
apostemes; and, in a word, from all the procatarctic causes. When the
fever is occasioned by excessive fatigue, the indication, he states,
is to supply moisture to the body, rather than to take from it. Hence,
all friction with discutient oils ought to be avoided; and what is used
for rubbing the body should be mixed with much water. But the principal
dependence is to be put upon the tepid bath. Here, again, he thinks
that Galen erred, in not directing that the oil used for rubbing the
body should be diluted with water. He adds, that it will often have an
excellent effect after the patient has come out of the tepid bath, and
been anointed as directed, to make him take a warm bath and remain in
it for a considerable time. When ephemerals arise from indigestion, he
gives very minute directions for the treatment, according to the nature
of the exciting cause. When connected with constriction, he approves of
bleeding, if, as generally happens, it be attended with fulness.
Oribasius and Aëtius treat of ephemeral fevers in much the same terms as
our author.
Palladius says that ephemerals are affections of the _spirits_, arising
from some external exciting cause, such as fatigue, intoxication,
anxiety, watchfulness, or from a tumour of the groin. Celsus gives a
similar enumeration of the causes, but in briefer terms: “Febris ex
inguine, vel ex lassitudine, vel ex æstu, aliâve simili re est.” Almost
all the authorities, from Hippocrates downwards, mention enlargement of
the glands, especially those of the groin, among the causes of fever.
Agathias, the historian, remarks, that pestilential fever is attended
with enlargement of the inguinal glands, but does not terminate favorably
in one day, like the ephemerals. (Hist. v.) Stephanus, the commentator,
accounts for the enlargement of the glands in fever, as being a
collection of the impurities of the system in its weakest points. (Ed.
Dietz, p. 244 and 256.)
Nonnius enumerates nearly the same causes of these fevers as our author,
whom he appears to have followed closely. He remarks, that ephemerals are
sometimes protracted to the third or fourth day, from which it appears
that the term is not to be taken in too strict a sense. Leo, also,
expresses himself in like terms.
Synesius treats of ephemeral fevers with great accuracy, so that we have
reason to regret that the text of this author should be so corrupt. Like
preceding authors, he enumerates, among the exciting causes, abscess
of the glands of the groin, neck, and armpits, the heat of which, he
says, being determined to the heart, kindles a fever. In this case he
recommends discutient and emollient applications, such as mallows,
linseed, and the like. The account given by Constantinus Africanus is
exactly similar to his.
Actuarius mentions the same causes, and briefly recommends the same
treatment as our author.
Alexander Aphrodisiensis says expressly, that the ephemeral fever may
pass into the putrid and the putrid into the hectic. (De Febribus, 28.)
Haly Abbas gives a most distinct and accurate account of the phenomena
of ephemeral fevers, according to the nature of their remote causes. The
first class are produced by external causes, such as exposure to the heat
of the sun, hot baths, or astringents which occasion constriction of the
pores of the skin. He also inculcates that these causes may likewise
give rise to synochous or putrid fevers. The second class are produced
by calefacient food and medicines. The third class are occasioned by
immoderate exercise, or violent passions, such as anger, fear, and the
like. The fourth are sympathetic affections proceeding from inflammatory
swellings of the glands. He remarks, that in certain kinds of fever the
increase of heat is not felt upon the first application of the hand,
owing to constriction of the pores. (Theor. viii, 3.) His treatment
merits attention. When the fever arises from a hot cause, he directs us
to pour refrigerant liquids, such as vinegar, rose oil, and the like,
upon the head, and to apply to the forehead a cloth moistened with the
same. When the fever is produced by cold, he recommends the warm bath,
with friction, in order to promote perspiration; after which calefacients
may be given; but he forbids wine, if the exciting cause be great, lest
it should occasion a conversion of the complaint into a putrid fever,
which, as he remarks, Galen states not to be an uncommon occurrence. To
prevent this he recommends venesection and the liberal administration of
diluents. The next class of ephemerals of which he treats are intestinal
fevers originating in errors of food and drink. For these he recommends
cooling drink, cooling articles of food, clysters, eccoprotics, and the
like. When the fever is brought on by violent labour, he prescribes the
tepid bath, gentle friction with emollient oils, light food, and a spare
allowance of wine, provided the patient has been habituated to it. When
the fever is produced by violent emotions of the mind, he recommends the
tepid bath, refrigerant food, camphor, and the like. When it arises from
sorrow, he directs us to have recourse to treatment of an exhilarating
nature, the bath, wine, and so forth. For fever brought on by want of
sleep, he recommends soothing treatment, the affusion of tepid water and
wine, if the patient has been accustomed to it. In fevers arising from
glandular swellings, he approves of venesection, and forbids the use
of the bath and of wine. This is somewhat different from our author’s
treatment. The account of the causes and treatment of ephemerals given
by Alsaharavius is so like that of Haly Abbas, that we shall not enter
particularly upon it. Serapion, Averrhoes, and Avenzoar give sensible
expositions of the causes and cure of these fevers; but there is little
in them worthy of attention that is not derived from the Greeks. Avenzoar
states distinctly, that, if neglected or mismanaged, they are apt to be
converted into putrid, or synochous fevers. For ephemerals occasioned
by labour, he recommends the tepid bath, and friction with the pulp
of melons. Avicenna remarks, that if, in ephemerals, the blood become
inflamed, the fever is apt to be converted into synochous, or, if it
become putrid, into putrid fever. This, he says, is particularly the
case, when the ephemeral fever is connected with obstruction of the pores
of the skin. For the cure of this species, he approves of venesection.
He recommends the same remedy when the disease arises from drinking
too much wine, or from aposteme of the groin, armpits, or neck. His
expositor Syrasis particularly commends the tepid affusion in ephemerals.
Rhases joins in enforcing the same practice as Avicenna. He gives a
most comprehensive account of the causes of these fevers. Like all the
other authorities, he decidedly inculcates this important fact, that,
although ephemeral fever be in itself neither serious nor fatal, it may
be converted into a vehement and acute fever, when any error is committed
in the regimen or method of cure. Constriction, he says, may take place,
either in the pores of the skin, or in the internal parts, and is
generally occasioned by cold or astringents. This is one of the causes of
fever. The others are, immoderate exercise, the application of heat, food
of a heating nature, and putridity.
According to Prosper Alpinus, the Methodists held that the proximate
cause of fever is constriction. Galen, as we have stated, held this to be
one of the causes, but not the sole one. The Methodists, like our Cullen
and Hoffman, seem to have generalized too much. Their most approved
remedies were the warm bath and friction with emollient oils. (De Med.
Method. v.)
The earlier modern writers on medicine give the same account of
ephemerals as their ancient masters, whose views in all cases they
servilely adopt. See Rogerius (Tract. iii), and Platearius (de Febribus.)
Rogerius correctly remarks, that ephemeral fever, from enlargement of the
glands, is merely symptomatic. The causes of ephemerals, as enumerated
by him, are exposure to extremes of heat and cold, food and drink of a
heating nature, strong exercise, violent passions of the mind, and the
like. Platearius remarks that if an ephemeral be prolonged beyond the
third or fourth day, it is apt to be converted into a putrid fever.