Those affected with quartans are to be treated gently, without any
powerful medicine or evacuation, unless a great fulness of blood prevail,
in which case it may be necessary to bleed. The diet should be good
and not flatulent, and the belly ought to be loosened by the customary
things; and, if these are not sufficient, clysters may be used, at first
emollient, and afterwards acrid. They must be prohibited from swine’s
flesh, and everything that is viscid and slowly evacuated, and also from
all cooling and diluent articles of food. Let them use a thin white wine
moderately warm, also pickles and mustard. And after an interval of some
days, they should take the composition consisting of three peppers, or
that called Diospoliticus. And if they take every day of pepper alone
in water, they will do well. But if the patient is at the acme of the
complaint, his diet ought to be very light, he should be enjoined to
take protracted rest, and to take care of his bowels by using emollient
and laxative things. Next, let him use diuretics; and if the symptoms of
concoction appear manifest, then he may boldly have recourse to such as
evacuate black humours, and that not once only, but frequently. After a
powerful evacuation give also the medicine from vipers, and such others
as are recommended for these fevers, among which is the well-known and
most celebrated of all containing the Cyrenaic juice.
* * * * *
COMMENTARY. This Section is copied from Oribasius (Synops. vi, 13.)
Galen, however, is the great authority upon this subject. With respect to
venesection, he directs us to have recourse to it only when there is a
plethora of blood; but recommends, when a vein has been opened, and the
blood found to be black and thick, especially in the case of diseased
spleen, to abstract blood until it change its colour. He approves of
laxatives, and clysters, at first emollient and afterwards acrid. He
forbids those things which were supposed to engender black bile, and
recommends a thin white wine. He speaks favorably of pepper. When the
disease is come to its acme, he recommends the state of the viscera
to be rectified by fomentations and cataplasms, and by administering
melanogogues, especially hellebore, in such quantity as to operate
powerfully upwards and downwards. He speaks favorably of vipers, and also
of assafœtida. (Therap. ad Glauc. i.) The Commentary of Stephanus on this
work, lately published by Dietz, contains very sensible remarks on the
practice here recommended.
Alexander delivers his opinions regarding the treatment of quartans at
so great a length that it is impossible to do justice to them in an
abridgment. As usual, he animadverts freely upon the doctrines of Galen,
whom he finds fault with for recommending desiccants and calefacients in
every species of quartan fever; whereas he maintains that when it arises
from adust bile, refrigerants are indicated. He strongly commends emetics
at the beginning of a paroxysm. He approves of peppers combined with
opium, henbane, and other articles. Synesius and Constantinus Africanus
admit the distinction made by Alexander, and nearly follow his principles
of treatment. Synesius makes mention of wormwood, which, however,
had been recommended by Ruffus. (Ap. Aëtium.) Serenus Samonicus also
recommends wormwood: “Mira est absinthi cum simplice potio lympha.”
Celsus gives minute directions for conducting the treatment in all
the stages of the complaint. He thus sums up the remedies which he
recommends: “In ejusmodi valetudine medicamenta sunt, oleum, frictio,
exercitatio, cibus, vinum.”
Serapion mentions black hellebore, agaric, and the lapis lazuli, as
medicines which purge black bile. (De Antid. vi, 15.) Averrhoes, however,
cautions against using black hellebore for the cure of quartans;
expresses himself in dubious terms respecting venesection; and, upon the
whole, seems to place his principal reliance in things of a diffusible,
attenuant, and penetrating nature. Haly Abbas, Avicenna, and Rhases
speak of venesection in much the same terms as Galen, that is to say,
they recommend it when symptoms of plethora are present, but say that
it may prove prejudicial in any other circumstances. They approve of
emetics at the commencement, and of wormwood in the decline of the fever.
Avicenna appeals to Galen in favour of the black and white hellebore.
Several of Rhases’ authorities in his ‘Continens’ recommend bleeding.
They in general approve of the early use of the bath, and of diuretics
and sudorifics; and recommend, in the decline of the fever, things of a
heating nature, such as pepper, anise, spikenard, ginger, &c.
It remains to be mentioned that _amulets_ were very much used in ancient
times for the cure of quartans. Alexander Trallian had great confidence
in them. Galen supposed that they owed their virtues to the physical
properties of the substances which were appended. Ælius Spartianus, one
of the writers of the Augustan History, says, that the emperor Caracalla
wished to punish those who made use of amulets. On the περίαπτα,
περίαμματα, vel amuleta of the ancients, see Andreas Laurentius (de
Mirab. Strum. sanat. p. 83); Rendtorfius (Notæ in Anatolii Fragment. ap.
Fabricii Biblioth. Græc. iv, 305); and Wolfius (ap. Act. Lips. 1690.) The
practice of using amulets for the cure of diseases must have been very
ancient, for it is alluded to by Pindar (Pyth. iii), and Theophrastus (H.
P. ix, 10.) The facts recently stated in support of the system of Animal
Magnetism have been supposed to give some countenance to the ancient
belief in the efficacy of amulets.