As a tertian paroxysm commences with a rigor, and a quotidian without
one, the fever composed of both brings on a degree of shivering, which
is less than a rigor, and greater than chillness, as being a mixture
of these two extremes. Whence, this fever has not improperly got the
name of semi-tertian. These fevers are formed in two ways, either
the two paroxysms uniting into one, or being mixed together from the
commencement. When, therefore, the tertian prevails, the fever is
attended with a strong shivering, and has even a certain degree of rigor
at the attack. Such a fever also soon becomes hotter and more ardent,
and brings on some vomiting of bile, or a discharge of it downwards, or
by a sweat. When the other, the pituitous, prevails, there is coldness
of the extremities, but little shivering; neither are they accompanied
with thirst, nor are they ardent. But when the tertian intermittent and
continual quotidian are equal in magnitude, the commencement of the
paroxysm is with shivering; and when that from phlegm prevails, there
are contractions and shiverings; but if the hotter species prevail,
they soon acquire heat. This is the true semi-tertian, being a fever
formed from an equal combination of both, a tertian intermittent, and
a continual quotidian. But that which is not the true semi-tertian has
either more of the bilious, or of the pituitous character; which species
is of easiest cure, the smaller humour being readily overcome by the
prevalence of the greater, or by the aid of art. When the pituitous
state prevails, we must use especially the remedies mentioned for the
quotidian; or, if yellow bile, those for the tertian, always bestowing
most attention upon that which is most urgent, but not neglecting the
other entirely.
* * * * *
COMMENTARY. The reader may find histories of the semi-tertian in the
Epidemics of Hippocrates, where see the Commentary of Galen. Our author’s
account is condensed from Galen (de Diff. Febr. ii, 2, and de Typis, 4.)
See Aëtius (v, 81); Actuarius (Morb. Dig. ii, 1); Nonnus (142); Celsus
(iii, 8); Palladius (21.) Celsus describes it as the second species of
tertian in the following terms: “Alterum longe perniciosius, quod tertio
quidem die revertitur, ex octo autem et quadraginta horis fere sex et
triginta per accessionem occupat, interdum etiam vel minus, vel plus;
neque ex toto in remissione desistit, sed tantum levius est. Id genus
plerique medici ἠμιτριτᾶιον appellant.” He approves of bleeding at the
commencement, and of a diet that is nutritive without being heating.
Palladius says that the semi-tertian is compounded of a tertian
intermittent, and a continual quotidian, the quotidian paroxysm taking
place every day, and the tertian every alternate day. He ascribes
their origin to a mixture of putrid bile and phlegm. (21.) Haly Abbas
gives a similar account of it. He calls it a fever compounded of a
tertian and quotidian, and remarks that it has a tendency to pass into
hectic. He treats it with diluents and refrigerants. (Pract. iii, 17.)
Avicenna gives a very detailed account of the symptoms and cure of the
semi-tertians. He remarks that the fever is apt to be protracted and
to pass into the hectic. (iv, 1, 4.) See Rhases (Cont. xxxi.) All his
authorities agree in describing it as a compound of the tertian and
quotidian, having a severe paroxysm the one day and a slighter the
following. It is said to be generally protracted to the fortieth day.
Platearius, and the other earlier modern writers, describe the
semi-tertian in nearly the same terms as the ancients. It is a species
of fever still occasionally met with in warm climates. (See Littré’s
Hippocrates, t. ii, 569.)