The continual fevers are allied to each of the intermittents; thus, to
the true tertian is allied the causus or ardent fever; to the quotidian,
that fever which has a paroxysm every day, but does not terminate in a
complete freedom from fever; and, in like manner, to the quartan, that
which has an exacerbation every fourth day. For the true causus has all
the other characteristics of the tertian, and differs from it only in
not commencing with a rigor, nor ending in a complete remission of the
fever. The continual fever which has an exacerbation every day, possesses
all the other characteristics of a quotidian, except that it does not
terminate in a perfect apyrexy. In like manner, the continual fever
which has an exacerbation every fourth day, but does not terminate in a
complete apyrexy, is allied to the quartan. A continual fever, therefore,
is one which does not terminate in any interval from fever until it is
altogether resolved. But when it evinces no remission, it is, indeed, of
the same class as the ardent fevers, but differs from them in acuteness.
* * * * *
COMMENTARY. Hippocrates has stated the alliance between the intermittent
and continual fevers. (Epidem., Op. Galeni, ed. Basil, v, p. 362.) In his
report of the epidemical diseases of a certain season, he mentions that
the continual fevers (συνεχεῖς) were distinguished by an exacerbation
every alternate day, after the manner of tertians, and that they were
attended with ardent symptoms. He also remarks their tendency to
terminate in dysenteries, lienteries, and tenesmus.
Galen marks a distinction between the continual fever (συνεχῆς) and the
synochus, which it is necessary that the reader should particularly
attend to. He remarks that there are three varieties of intermittents:
the quotidian, which arises from putrid phlegm; the tertian, from yellow
bile; and the quartan, from black bile. Of continual fevers, arising
from yellow bile, there are two species; the one being called synochi,
and consisting of one paroxysm from beginning to end; and the other,
to which the generic appellation continual (συνεχεῖς) is particularly
applied, and which consists of a number of particular paroxyms. Of the
continual fevers, some assume the tertian type, having a remission of
the fever every alternate day; some the quotidian, and have a remission
every day; and others, of rare occurrence, resemble the quartans, in
having remissions after an interval of three days. (De Diff. Feb. ii, 2.)
In another place he says of synochous fevers that they consist of two
varieties, the one arising from an ebullition of the blood, and being
produced by the conversion of ephemerals; and the other arising from
putrefaction of the blood in persons who are gross and plethoric. (Meth.
Med. ix.)
Aëtius treats of continual fevers (συνεχεῖς) in nearly the same terms as
our author, and distinguishes them from the synochi.
Alexander states that the continual fevers (συνεχεῖς) differ from the
intermittents, solely from the humours which occasion the former being of
a thicker nature.
Our author’s account is nearly copied word for word from Oribasius.
Actuarius remarks that the synochus proceeds from an ebullition of
the blood, and the continual fever (συνεχὴς) from putrefaction of the
different humours.
Nonnus states very distinctly the difference between the synochus and
continual fever. In the latter, he says, there is an incomplete remission
of the febrile symptoms, but in the former there is no remission at all.
Synesius and Constantinus Africanus adopt the distinction between the
synochus and continual fever, as stated by Galen.
Leo says, a continual fever has no intermission, but merely a remission
and abatement of the fever in the decline of the paroxyms.
Celsus, although he does not describe the _febres continuæ_ particularly,
seems to allude to them in the following account of the quotidians:
“Rursus aliæ sic desinunt, ut ex toto sequatur integritas; aliæ sic, ut
aliquantum quidem minuatur ex febre, nihilominus tamen quædam reliquiæ
remaneant, donec altera accessio accedat; ac sæpe aliæ vix quidquam aut
nihil remittant, sed ita ut continuent.”
In the works of Rhases, the distinction between the continual and
synochous fevers is clearly pointed out. He states that the synochus, or
_continens_, is a fever which consists of one paroxysm from beginning
to end; whereas the continual, called συνεχὴς by the Greeks, and _f.
continua_ by the Romans, is allied to the intermittents.
In the barbarous translation of Alsaharavius, there is some difficulty
in recognizing this distinction. He first describes a fever, which he
denominates _synocha_, which arises, he says, from inflammation of the
blood, and is marked by redness of the face, headach, and difficulty of
breathing. Second, nearly allied to it is the synochus or februs continua
(it ought to be _f. continens_), which arises from putrefaction of the
blood. Third, the febris quotidiana, the febris tertiana continua,
and the febris quartana continua, which are distinguished from their
corresponding intermittents by being attended with a partial remission
and not a complete intermission of the febrile symptoms.
Avicenna describes the tertian intermittent by the name of febris
tertiana periodica, and the continual tertian by that of tertiana
continua; the quotidian intermittent by the name of febris phlegmatica
periodica, and the continual quotidian by that of febris phlegmatica
inseparabilis, or latica; the quartan intermittent by the name of
quartana periodica, and the continual quartan by that of quartana
continua. The synochus he calls by the name of febris sanguinis; and, in
treating of it, remarks that Galen is guilty of inconsistency in stating
the proximate cause of it; for that in one place he says it arises from
the blood, and in another from bile. Averrhoes states the same objections
to Galen’s account of the origin of synochous fevers.
Avenzoar marks the distinction between the intermittent and the continual
quotidians, tertians, and quartans.
We have been more than usually minute in explaining the opinions of the
ancients with regard to the Continual fevers, because much confusion has
arisen in modern nosological treatises and works on medicine, from the
distinction between them and the synochi not being properly understood.
After what has been said, the medical reader will readily perceive
that the Continual fevers (συνεχεῖς) of the Greeks are the same as the
Remittent fevers described by Pringle, Monro, and other English authors
of that age who have treated of fevers.