The tertian fever being occasioned by yellow bile set in agitation, has
a considerable rigor in the beginning, which differs, however, from the
rigor of a quartan in this, that the skin feels as if it were pierced
and wounded; but, in quartans, the attack is accompanied with a strong
chill; and quotidians have no preceding rigor, they are only accompanied
with a chill. But in tertians, the order of the pulse is regular, and the
fever is attended with strong thirst towards the acme, and burns up the
man; but shortly afterwards the acme takes place, and the heat is equally
diffused everywhere. If you apply your hand, at first it is met by a
strong and pungent heat, which seems as if carried upwards in the form
of vapour, but it is soon extinguished under the hand, if it is allowed
to remain. And when the person drinks, a hot vapour in great quantity
immediately issues from the skin, announcing sweat. But vomiting of bile
supervenes, or the belly is purged, and bilious urine is passed. With
these the fever goes off, having comprehended not more than twelve hours
in one paroxysm. When, therefore, it abates within twelve hours, we call
it true tertian; when the paroxysm is more protracted, we name it simply
tertian; and when the paroxysm is prolonged to the utmost, so as to have
but a small interval, we call it prolonged tertian.
* * * * *
COMMENTARY. Hippocrates relates many interesting cases of tertian fevers
in his ‘Epidemics.’ He attributes their origin to bile. (De Nat. Hum. 29.)
Celsus describes two kinds of the tertian, the one beginning with
shivering, and being succeeded by heat, the paroxysm returning every
alternate day; and the other constituting the semi-tertian, of which we
will have to treat afterwards.
Galen treats of these fevers in different parts of his works. (In
Hippocrat. Epidem. Comment., Therap. ad Glauc., de Different. Feb. ii,
3, de Typis, 3.) The symptoms of the tertian are thus described by him:
It is attended with intense thirst, heat, acrid and bilious vomitings,
loss of appetite, and restlessness. For the most part these symptoms
are preceded by rigors, or sometimes by extreme coldness. The pulse in
tertians is small and dense. At first, the night preceding an attack
is passed in a restless state, but after the disease is prolonged this
is not the case. The urine is yellow. In many parts of his works he
announces it as his decided opinion that the quotidian intermittent is
produced by phlegm; the tertian by yellow bile; and the quartan by black
bile. This theory of intermittents was adopted, in a word, by all his
successors. See Oribasius (Synops. vi, 9); Aëtius (v, 80); Nonnus (de
Febr. 6); Palladius (de Febr. 6); Alexander (xii, 6); Synesius (iii);
Avicenna (iv, 1, 2); Haly Abbas (Theor. viii); Serapion (vi, 13);
Avenzoar (iii, 1, 2); Averrhoes (Collig. iv, 28.)