It does not suit with spurious tertians to bathe at the commencement,
nor until symptoms of concoction have made their appearance. Neither
does it answer to give food every day, but every alternate day will
be sufficient. Rest and warm applications to the hypochondriac region
agree with them, also broths of easy digestion, and clysters not very
emollient. And if detraction of blood be expedient, it ought by no means
to be omitted. The nature of the diet ought not upon the whole to be
cooling and diluent, but things of a more incisive nature ought to be
added. They are particularly benefited by the juice of ptisan, to which
have been added pepper, hyssop, sweet marjoram, and spikenard. Also,
add pepper to honied water, boil, and give it to drink, and likewise
everything which will promote the secretion of urine, except those things
which are of a very heating and desiccant nature. In particular, after
the seventh day, give wormwood; and many have been benefited by drinking
oxymel, and taking gentle laxatives. A vomit taken with food is very
beneficial to those in whom the affection is of long continuance.
* * * * *
COMMENTARY. Galen explains that tertians are called spurious or bastard,
when the symptoms assume an anomalous character. He states correctly
that they are generally connected with disease of the spleen. His
practice, which is consistent with his views of the nature of the attack,
is similar to our author’s, that is to say, he recommends venesection
and fomentations at the commencement, and afterwards things of a hot
penetrating nature, such as wormwood and pepper, which he, no doubt,
gave with the intention that they should act as deobstruents. Here,
again, Alexander cautions against the indiscriminate adoption of Galen’s
practice, affirming that these calefacient medicines sometimes prove
dangerous, by increasing the inflammatory action. Almost all the other
authorities, however, adopt the views of Galen. See, in particular,
Oribasius (Synops. vi, 11); Aëtius (v, 81); Nonnus (de Febribus, c. v.)
From the characters of the urine Actuarius infers that the spurious
tertians are still more intensely bilious than the true, and consequently
require longer time to reach their acme. (De Urinis, v, 15.) Avicenna
recommends at first venesection and clysters; and afterwards deobstruent
medicines, such as wormwood and pepper. Haly Abbas treats spurious
tertians like true, at the commencement. After their acme, he strongly
recommends wormwood, but forbids it earlier. It acts, he says, by
increasing the strength of the stomach, opening the pores, increasing the
urine, and promoting the secretion of bile. He approves of wine in the
decline of the fever, with the view of supporting the strength, and of
promoting the urinary and cutaneous secretions. He therefore directs that
the wine be white, and not too old. (Pract. iii, 13.)
From the account of the ancient practice in cases of tertians, as
given in this and the preceding chapter, it will be seen that the
use of bitters in these diseases was well understood formerly. The
administration of pepper in such cases, it will also be remarked, was an
ancient practice.