All fevers, regardless of type, are classified as either essential or symptomatic. Essential fevers are further categorized as simple, compound, confused, erratic, pestilent, or malignant in nature. ### Simple Fevers Simple fevers affect either the vital spirits, bodily humors, or solid body parts. They primarily impact the vital spirits, followed by the animal and natural spirits (if such exist). This produces the true ephemeral fever, which typically lasts only one day but may persist longer if the spirits are thick or sluggish. ### Fevers of the Humors Various fevers develop within the bodily humors. Some are continuous while others are intermittent. Among the continuous fevers, some arise from non-putrefied humors while others stem from putrid humors. The putrid variety can result from either equally putrefied or unequally putrefied humors. Fevers from non-putrefied humors originate when blood becomes inflamed in the heart due to abnormal heat (preternatural heat). This inflamed blood spreads through the major veins into the body’s tissues, directly impairing our bodily functions (hurt our actions). ### Non-Putrefied Humor Fevers Fevers from non-putrefied humors originate when blood becomes inflamed in the heart due to abnormal heat. This inflamed blood spreads through the major veins into the body’s tissues, directly impairing our bodily functions. These fevers differ from ephemeral fevers in name and source material but not in their essential nature or treatment approach. One affects inflamed spirits while the other involves unputrefied blood. Both may have identical external causes and respond to the same therapeutic methods and remedies. These are continuous fevers with only one episode, though they are distinguished by three types based on their progression patterns: - **Equal Tenor (Homotonos):** The heat remains constant throughout the fever’s duration. The amount of new inflammation equals the amount dissipated. - **Increasing (Epacmastical):** Recent inflammation exceeds dissipation, causing the heat to intensify and grow stronger over time. - **Declining (Paracmastical):** More heat dissipates than is newly generated, leading to a gradual, noticeable decline until the fever ends. This type of continuous fever (Synochus) may last up to seven days, while ephemeral fevers typically do not exceed three days unless the spirits are particularly thick. Individuals most susceptible to non-putrefied continuous fevers include those with full bodies abundant in blood, those who eat luxuriously and live sedentary lives, and residents of hot, humid, or temperate climates. These fevers usually resolve through sweating or moisture production, similar to ephemeral fevers, though they carry significant risk if bleeding treatment is neglected. ### Putrefied Humor Fevers Fevers arising from putrid humors result from either equal or unequal putrefaction processes. When humors putrefy equally within the major veins, the resulting fevers are continuous and follow the same three-fold classification as non-putrefied continuous fevers: **1. Equal Putrefaction (Homotonos):** Putrefaction remains constant throughout the disease course, with the amount of putrefaction matching the amount eliminated from the body. **2. Increasing Putrefaction (Epacmastical):** Putrefaction progressively increases from onset to resolution. **3. Declining Putrefaction (Paracmastical):** The disease-causing humor gradually diminishes from beginning to end. These three fever types show no apparent remissions or intensifications at regular intervals because the humors are equally putrefied within the major blood vessels. This differs from fevers caused by unequally putrefied humors in the same vessels, which will be discussed in their appropriate section. Unlike true intermittent fevers, these continuous fevers have no complete breaks in symptoms but persist until all putrefaction is resolved. Their symptoms resemble those of non-putrefied continuous fevers but are more pronounced because they stem from putrid matter rather than simple heat buildup. ### Synechis: Continuous Fevers from Unequally Putrefied Humors Later physicians use the term “Synechis” for any continuous fever caused by humors that putrefy unequally within the major veins. This distinguishes it from other continuous fevers, though etymologically the terms share similar meanings. This type of continuous fever receives different names based on the location of the unequally putrefying humor: ### Burning Fever (Causus) When putrefaction occurs in major veins near the heart, a burning fever develops. ### Other Continuous Fevers When putrefaction occurs in veins farther from the heart, continuous fevers develop that are named according to the predominant humor involved: - **Bilious Continuous Fever (Bilious Synechis):** Results from putrefying natural bile. Shows intensifications and remissions every other day, with morning hours typically showing the greatest relief, though without complete intermission. This creates a continuous tertian pattern. (From putrefied natural choler). - **Continuous Quotidian Fever:** Caused by putrefying natural phlegm in the veins. Daily intensifications and remissions occur at set hours. (From putrefied natural phlegm). - **Continuous Quartan:** Results from putrefying melancholic humor. Shows intensification and remission every fourth day but without complete intermission. (From putrefied melancholic humor). ### Intermittent Fevers Among fevers caused by unequally putrid humors, some differ from continuous fevers in both substance and location, called intermittent fevers: #### Key Differences: - **Continuous fevers**: Natural matter located in major blood vessels. - **Intermittent fevers**: Excremental matter located outside major vessels (liver, stomach, spleen, intestines, mesentery, and body tissues). ### Types of Intermittent Fevers: - **Intermittent Tertian** (from putrefied excremental choler): - Recurs every third day - Begins with rigidity and sometimes vomiting - Twelve-hour duration (varies by choler quantity) - Ends with sweats, followed by complete fever-free period _(apyrexy or perfect infebrication)_ - Primary source: the liver **Intermittent Quotidian** (from putrefied excremental phlegm): - Eighteen-hour duration due to coldness, clamminess, and thickness - Begins with coldness in nose, ears, hands, and feet - Ends with moisture rather than sweat - Source: the stomach (when glassy phlegm putrefies) ### Special Fever Type There exists another fever type the Greeks call by a term derived from “mild” and “sea” – like the ocean that appears calm to sailors but suddenly becomes violent with storms. This fever begins gently, takes root, then quickly throws patients into desperate dangers. Alternatively, as Aegineta would have it, the name derives from an adverb meaning “gently” and a word meaning “heats.” This category includes fevers from catarrh (mucous discharge) and those accompanying “green sickness” (though these will be discussed in their proper place). - **Note:** This may be a reference to Paul of Ageina (Paulus Aegineta) a 7th century Greek physician who wrote a Medical Compendium in Seven Books. - While the Greek terminology is missing from the translation, it would be interesting to find out if this fever was associated with Familial Mediterranean fever (FMF). - **Quartan Fever** (from putrefied melancholic excremental humor): - Begins with horror and sometimes vomiting (like tertian) - Duration is twelve hours (more or less, depending on the quantity of humor) - Recurs every fourth day - Longest-lasting of all fevers - Primary location: the spleen ## Summary of Fever Classifications This completes the discussion of fevers caused by unequally putrefied humors, whether continuous or intermittent. ## Extended Fever Cycles Although Hippocrates and Galen mention quintan, sextan, septan, and nonan fevers, we should not assume these arise from any distinct type of humor. Rather, they should be classified as variations of quartan fever and treated by the same methods. The only difference is: - **Quintan fever**: Caused by atrabilious humor (black bile) – according to Galen’s Commentary on the third section of the first book of Epidemics, this is “the worst of all, most dangerous, and of the greatest severity” - **Other extended cycles** (sextan, septan, nonan): Caused by melancholic humor ### Simple Fevers - A **hectic fever** (even when it affects solid organs) is classified among the simple fevers. It differs from pestilential fever in that it lacks any poisonous or malignant qualities, and differs from humoral fever in that it is free from putrefaction. - A **pestilent fever** is also numbered among the simple fevers, though it differs from them by its poisonous, contagious, and harmful nature, which contaminates our bodily substance. ## Malignant Fevers - Among malignant fevers may be counted those arising from bilious humors of various types (yellowish, greenish, and leek-colored bile), according to Galen, Hippocrates, and Avenzuar in his _Theisir_. - **Leipyria** is also classified among malignant fevers by Hippocrates in his _Epidemics_ and _Prognostics_ (Book 3), and by Galen in his commentaries on those works. It differs from typical fever by its malignancy and is invariably fatal, according to Galen’s commentary on Aphorism 48, Section 4, and chapter 4 of his _Book of Unequal Distempers_. It kills on the fourth day or sooner and follows severe inflammation of the internal organs. ### Compound Fever A **compound fever** is formed either from two intermittent fevers mixed together (such as a double tertian or double/triple quartan), or from a continuous and intermittent fever combined (such as a hemitertian), or when a hectic fever combines with a putrid fever to create a compound fever. Many other combinations are possible. ## Confused Fever A **confused fever** occurs when two or three humors putrefy simultaneously, whether in the major blood vessels or outside them, beginning and ending together in the same location. This mixture creates not a compound but a confused fever, where one type cannot be distinguished from another because the symptoms are so mixed—hence the name. For example, if bile and phlegm putrefy together in the major vessels, there will be two continuous fevers in the same location, creating a confused (not compound) fever. Similarly, if these same humors putrefy with melancholy in the smaller vessels altogether in the same place, there will be two or three intermittent patterns which, when mixed, likewise produce a confused rather than compound fever. Thus a double continuous tertian fever will be confused, not compound, because the putrid matter is contained in the same location. ### Symptomatic Fever A **symptomatic fever**, though it may be continuous, differs from the above types because its causative matter is not contained in the major blood vessels, nor does it have periods of worsening or improvement. Instead, it depends on inflammation of the specific organ it affects, from which it takes its name, as described in Chapter 2.