The diagnosis of fevers from putrefaction is formed from observing that
none of the procatarctic or exciting causes had preceded; and it is
peculiar to fevers from putrefaction, that they do not commence with
rigors, and have not been preceded neither by strong heat or cold; and
compression of the pulse is also peculiar to them. This is the name
given to the pulse, when in the commencement of the paroxysm it is very
small and irregular. This is a well-marked peculiarity of such fevers.
But the strongest characteristic of putrid fevers is, the quality of the
heat; for it is fuliginous so as to prove pungent to the touch. Want of
concoction in the urine and feeble digestion are also peculiar to them;
for, in such fevers, a strong and distinguished appearance of concoction
in the urine is never to be seen at first.
* * * * *
COMMENTARY. This Section is mostly taken from Oribasius (Synops. vi,
7.) Many of the histories in the Epidemics of Hippocrates are synochous
fevers, accompanied with putrefaction of the fluids. Galen remarks that
they occur principally in persons of a plethoric and gross habit of body.
(Meth. Med. viii.) According to him, putrid fevers may either arise
from the conversion of ephemerals, or originally from putrefaction of
the fluids within the vessels. (De Diff. Feb. i, 9.) Aëtius states that
they arise from constriction of the skin, or viscidity of the humours,
whereby the perspiration is stopped, and the quality of the vital heat
so altered as to give rise to putrefaction, first of the fluids, and
afterwards of the fat and solid parts. When these corrupted fluids are
contained within the vessels, they occasion synochous fevers; but, when
distributed over the body, they give rise to intermittents. (v, 74.)
Synesius and Constantinus Africanus give a similar account. Alexander
gives an interesting and ingenious disquisition on the origin and nature
of putrid fevers, one of the most common causes of which he holds to be
the conversion of ephemeral fevers, and the inseparable symptoms being
want of concoction in the urine and quickness of the pulse with systole.
This is the account of them given by most of the other authorities, both
Greek and Arabian, so that we need not enter into any very circumstantial
exposition of their views. We shall merely give the brief account of
them furnished by Palladius. There are, he says, two kinds of synochous
fevers, the one being occasioned by effervescence, and the other by
putrefaction of the blood; of these, the latter are the more protracted
and dangerous. In them the pulse is contracted, the heat pungent, and
the urine white and putrid. Among the Arabians, see, in particular,
Alsaharavius (xxxii, 6); Haly Abbas (Theor. viii, 5); and Rhases (Cont.
xxx.) Rhases states that putrid fevers are often engendered by eating too
much fruit, such as peaches. He says they generally begin with depression
of the pulse, horripilation, torpor, and somnolency.