COMMENTARY. Galen explains that tertians are called spurious or bastard, when the symptoms assume an anomalous character. He states correctly that they are generally connected with disease of the spleen. His practice, which is consistent with his views of the nature of the attack, is similar to our author’s, that is to say, he recommends venesection and fomentations at the commencement, and afterwards things of a hot penetrating nature, such as wormwood and pepper, which he, no doubt, gave with the intention that they should act as deobstruents. Here, again, Alexander cautions against the indiscriminate adoption of Galen’s practice, affirming that these calefacient medicines sometimes prove dangerous, by increasing the inflammatory action. Almost all the other authorities, however, adopt the views of Galen. See, in particular, Oribasius (Synops. vi, 11); Aëtius (v, 81); Nonnus (de Febribus, c. v.) From the characters of the urine Actuarius infers that the spurious tertians are still more intensely bilious than the true, and consequently require longer time to reach their acme. (De Urinis, v, 15.) Avicenna recommends at first venesection and clysters; and afterwards deobstruent medicines, such as wormwood and pepper. Haly Abbas treats spurious tertians like true, at the commencement. After their acme, he strongly recommends wormwood, but forbids it earlier. It acts, he says, by increasing the strength of the stomach, opening the pores, increasing the urine, and promoting the secretion of bile. He approves of wine in the decline of the fever, with the view of supporting the strength, and of promoting the urinary and cutaneous secretions. He therefore directs that the wine be white, and not too old. (Pract. iii, 13.) From the account of the ancient practice in cases of tertians, as given in this and the preceding chapter, it will be seen that the use of bitters in these diseases was well understood formerly. The administration of pepper in such cases, it will also be remarked, was an ancient practice. SECT. XXII.—THE DIAGNOSIS OF QUARTANS. The quartan makes its attack with much coldness, as having its origin from a cold humour, namely, the black bile; but it is not attended with ardour and febrile heat like the tertian, neither does a vomiting of bile accompany. If, in addition to these, the urine be thin, white, and watery, the fever certainly is a quartan; but the characteristic of a true quartan is a small and rare pulse. They have their beginning most frequently in autumn, supervening upon wandering fevers. At that season, intermittents generally assume the quartan type, although sometimes the paroxysm observes a longer interval of days. * * * * *