In the true tertian, as arising from yellow bile, we must dilute and
cool, evacuate the defluxions upon the stomach by emetics, and downwards
by the belly, and carry them off by urine and perspiration. The bowels,
therefore, are to be moved by emollient clysters, and the secretion of
mine promoted by infusions of parsley and dill in the drinks. And if
symptoms of concoction appear, you may confidently give wormwood. Apply
also baths of warm common water, and let neither nitre, nor salts, nor
mustard be sprinkled upon the body in the bath; but let the patient
enter it after having had warm oil poured over his body. There will
be no mistake if those who are fond of baths be bathed twice; and, if
symptoms of the diseases being concocted appear, there will be no harm
even if they be bathed oftener. Until the disease is concocted, wine is
to be entirely prohibited; but when concoction commences, first some thin
and watery wine may be given, and food of a diluent and cooling nature
will be proper; but honey, mustard, pickles, and everything heating must
be abstained from. Such was the practice of the ancients; nor is it to
be wondered at, as these men were more habituated to exercises and a
restricted diet; but now, when order is perverted, the bile is, for the
most part, found mixed with phlegm. Wherefore, now-a-days, most tertians
are either without a rigor, or it is very slight. And the mode of cure is
also changed; for, neither does the bath suit with tertians now before
concoction, nor yet a full diet, except crumbs of bread, eggs, or the
like.
* * * * *
COMMENTARY. Hippocrates recommends generally purgatives at the
commencement, and afterwards the hot bath, and trefoil, assafœtida, and
wine, to promote perspiration. (De Morbis, ii, 39.) He lays it down as a
general rule applicable to all intermittent and remittent fevers, that
the administration of food should be restricted during the paroxyms.
(Aphor.) See the Comment of Theophilus (ed. Dietz, t. ii, 268.)
Celsus informs us that Cleophantus treated tertians by pouring warm water
upon the patient’s head, and giving him wine before the accession of a
paroxysm. This, however, he considers to be precarious practice. Upon
the whole, his great dependence is upon these three remedies: vomits,
purgatives, and wine; of which the first is to be tried on the third day,
the second on the fifth, the third on the seventh.
Galen’s practice is exactly detailed by our author. He evacuates the
bile upwards and downwards at the commencement, and also, with the same
intention, administers diuretics and sudorifics. After these he reposes
great confidence in wormwood, which, indeed, all the ancients held to
be a powerful cholagogue. He also approves much of the tepid bath of
common water. He directs the physician not to neglect venesection, if
it be indicated; upon which his commentator Stephanus remarks, that the
circumstances commonly indicating bloodletting are the condition of the
patient, if he be young and plethoric, and the season of the year, if it
be spring. (Ed. Dietz.) He forbids wine until the fever is concocted, but
afterwards allows a small quantity of thin watery wine. The food is to be
refrigerant, and diluent. Everything of a heating and acrid nature is to
be abstained from.
Aëtius, Oribasius, and Nonnus conduct the treatment upon the principles
laid down by Galen. Actuarius directs bleeding at the commencement.
Alexander discusses the established principles of treatment freely and
fully. He disapproves of Galen’s practice of giving the decoction of
wormwood in the genuine or true tertian, after the seventh day, and
confines the administration of it to spurious tertians, when he mixes it
with oxymel. His own remedies are of a diluent and refrigerant nature. He
approves very much of the bath. He speaks highly of the good effects of
grapes and peaches, and still more of water-melons given with cold water
before the fit. He approves of gentle, but not of strong purgatives. He
praises very especially a rhodomel prepared from the juice of roses,
honey, and scammony; and another, consisting of the same ingredients,
along with agaric and pepper.
Synesius recommends cooling articles, such as damascenes, gourds, &c.
but says nothing of wormwood. Constantinus Africanus also omits to make
mention either of wormwood or the tepid bath. He, however, pours water on
the head and puts the feet into hot water.
Serapion directs emetics, if the matters are determined to the stomach,
and clysters, or gentle purgatives, if to the bowels. He recommends
myrobalans afterwards, and then wormwood, but not until the morbific
matter is concocted. (Tr. vii, 13.)
Rhases recommends gentle and cooling purgatives, with refrigerant and
diluent drinks, containing sorrel, cucumber, camphor, &c. (Ad Mansor. x,
4.)
Avicenna’s directions are exceedingly minute, and seemingly very
judicious. He cautions against using drastic purgatives, and expresses
himself doubtfully of the effect of venesection. His practice consists
principally in the administration of gentle purgatives, diluent
and refrigerant medicines. He approves of pomegranates, plums, and
water-melons. Averrhoes lays down the same principles of practice.
(Collig. vii, 11.) Haly Abbas states that, as it is the nature of these
fevers to occasion heat and dryness of the body, they are to be treated
with diluents and refrigerants. Agreeably to these principles, he directs
us to give clysters and gentle laxatives, to use the tepid affusion, and
the like. (Pract. iii, 12.) Alsaharavius recommends similar treatment.
Rhases, like Haly, recommends refrigerants and diluents. He approves of
cooling purgatives, such as a combination of myrobalans and scammony, or
a draught made from prunes and manna. He speaks favorably of emetics.
Several of his authorities recommend the bath, and others approve of
wormwood. (Contin. xxx.)
It will be remarked that many of the ancient authorities recommend the
tepid bath for the cure of tertian intermittents. Prosper Alpinus informs
us that he had seen this practice successfully pursued by the Egyptian
physicians. (De Med. Ægypt.)