The vitreous phlegm being the coldest of all, if it accumulate in the
body, and remain free from putrefaction, it occasions the rigor without
heat, which is not attended with fever. In those fevers which are kindled
by the humours, it is putrefaction for the most part which kindles
febrile heat. If it become putrid, and that through its whole substance,
which is rarely the case, owing to its great coldness, it occasions
quotidian fever. But when it is half putrid, and not equally through its
whole substance, but some parts of it being putrid, and others not, it
gives rise to the fever called hepialus, in which those affected have
rigors and fever at the same time; for the parts of the humour which are
not putrid being scattered through the veins all over the body, occasion
rigor; but the putrid parts kindle fever. The word hepialus is either
derived from ἡπίας ἁλος, i. e. the sea, which is mild in appearance,
although formidable in reality; or from ἡπίως ἁλεάζειν, i. e. warming
gently. And, as this fever is of the quotidian kind, being formed by
phlegm, it is to be treated in the same manner; only that it requires
remedies as much hotter and more incisive than the quotidian, as its
phlegm is colder than that of the other. The rigor without heat stands
in need of heating things still more than the hepialus. Wherefore, the
composition of three peppers, that from calamint, and still more that
from Cyrenaic juice are particularly suitable to this complaint, as also
the remedies prepared from castor and the like. You will find a fuller
account of these matters in the 46th section, “on immoderate rigor and
cold.” The fevers called lipyriæ, and the typhoid or smoky, and whatever
others are mentioned besides those described, being all of the same kind
as the above mentioned, will require the same methods of cure as those
which have been mentioned, or will soon be described.
* * * * *
COMMENTARY. Hippocrates applies the term hepialus to a fever occasioned
by amenorrhœa. He briefly notices the lipyria in several parts of his
works, (as Coac, 32, 27.) Galen enters minutely into the consideration
of the nature and causes of the hepialus, which appears to be a variety
of the quotidian intermittent. He says the fever derives its origin
from the putrefaction of a thick phlegm resembling melted glass. Its
distinguishing characteristic is, that the patient experiences a
sensation of heat and rigor at the same time.
Aëtius, and the other subsequent authorities, treat of the fever in the
same terms. They recommend, principally, sudorifics and calefacients.
Rhases, Avicenna, Serapion, and Haly treat of the epiala, and the
“frigus quod non calefit,” as varieties of the quotidian. Alsaharavius
gives a very distinct account of the epiala. He says it arises from a
gross vitreous phlegm, and is attended with internal heat, and cold
of the extremities. The pulse is small and weak, the urine white and
unconcocted, and the perspiration suppressed, owing to the constriction
of the pores and thickness of the humours. He approves of giving emetics,
attenuants, and calefacients. The lipyriæ are treated of by Serapion,
Avicenna, Rhases, and Alsaharavius. They are said to be the counterpart
of the epialæ, being distinguished by internal cold and external heat.
Rhases describes the hepialus as consisting of internal heat and external
cold. He says it arises from vitreous phlegm. The lipyria, he states, is
one of the worst varieties of ardent fevers.
The rigor without heat, or “frigus quod non calefit,” is a febrile
affection still met with in warm climates.
The term _typhus_, now generally applied to the common fever of this
country, is used by Hippocrates, in his work on ‘Internal Affections,’
where he describes five varieties of the disease. They are cases of
ardent fever, attended with stupor and insensibility. The term _typhodes_
occurs in Galen’s ‘Commentaries on Hippocrates;’ in his work, ‘De Diff.
Feb.’ (i, 9); and ‘De Prognost. Puls.’ (ii, 9.) Leo defines a typhous
fever to be one in which the heat is weak and concealed. (14.) It would
appear that the fevers to which the ancients applied the term _typhoid_
were either intermittents or remittents. Isidorus thus defines typhous
fevers: “Typhi sunt frigidæ febres, quæ abusivè typhi appellantur ab
herbâ quæ nascitur in aquis quæ Latinè _forma_ atque _status_ dicitur:
est enim accessionum revolutio per statuta temporum intervalla.” (Orig.
iv, 7.) The word τύφος occurs in Marcus Antoninus (ii, 17), where Gataker
remarks, “Est enim τύφος κυρίως idem quod κάπνος, fumus.” Salmasius gives
the derivation of the term as follows: “τύφος proprie est fomes, τύφεσθαι
enim ἠσυχῆ κάιεσθαι Græci exponunt.” (In Tertulliani Librum de Pallio
Annot. 318.)
Prosper Alpinus thus explains the nature of typhoid fevers: “Has febres
exterius mites seu obscuras intus turbantes Græci _typhodes_ appellant,
quippe quæ naturam multitudine humorum gravatam, ac fere suffocatam,
incendium foras transmittere nequeuntem, significent. Hasque vulgus
medicorum appellat, foris mites, intus conturbantes; suntque eæ omnes,
admodum perniciosæ.” (De Præsag. Vita et Morte Ægrot. i, 10.)