Note 567 — ON REGIMEN IN ACUTE DISEASES.

The causes of ardent fever of the ancients was decidedly the same as the bilious remittent fever of modern authors. See Paulus Ægineta, Vol. I., p. 262. We shall find many cases of it related in the Epidemics. In fact the causus is the ordinary fever of Greece and other countries bordering upon the Mediterranean. Galen, in his Commentary on this section, mentions that he had known it generally superinduced by drinking wine after great fatigue in summer. There can be no doubt that this was the fever of which Alexander the Great died. The description of the disease in his case, as given by Arrian from the Royal Journals (βασίλειοι ἑφημερίδες), has so much the air of truth, and withal appears to me so interesting, that I shall be excused introducing it in this place. “And the Royal Journals ran thus: that he drank at a jollification in the house of Medius; then rising up and being bathed, slept, and again supped with Medius, and again drank until the night was far advanced; that giving over drinking he bathed; and having bathed, ate a little, and slept there, because he was already feverish; that being carried on a little to the sacrifices, he performed them according to his daily practice; that the sacrifices being performed, he reclined in the dining-room (ἀνδρὼν) until the dusk of evening, and there gave orders to the commander respecting the march and voyage, that those who had to proceed on foot should be prepared for marching on the fourth day, and those who were to sail on the fifth; that he was carried hence upon a couch to the river, and being placed in a boat was taken across the river to the garden, and then being again bathed, that he rested. Next day, that he again was bathed and performed the appointed sacrifices; and going into a chamber, that he reclined and conversed with Medius, and gave orders to the commanders to meet him in the morning. That having done these things, he took a little supper; and having been carried back to the chamber, that he was in a continued state of fever during the whole night; that next day he bathed, and after the bath performed the sacrifices; that he gave orders to Nearchus and the other commanders respecting the voyage, that it should take place on the third day; that next day he bathed again, and performed the appointed sacrifices; that the religious rites being over, he did not cease to be feverish, but that calling the commanders he gave orders for having every thing in readiness for the voyage; that he was bathed next day, and being bathed was already in a bad state. That next day being carried to the house adjoining the bath, he performed the appointed sacrifices; that he was in a bad state, but yet that he called to him the chiefs of his commanders, and again gave orders respecting the voyage; that the following day he was carried with difficulty to the religious rites and sacrificed, and that notwithstanding he gave orders to the commanders respecting the voyage. That next day, although already in a bad state, he performed the appointed sacrifices; that he gave orders that the commanders should watch in the saloon, and the chiliarchs and pentacosiarchs before the doors; and that being altogether now in a bad state, he was carried from the garden to the palace. That when the commanders came in he recognized them, but did not speak, being now speechless; that he was in a bad state of fever during that night and day, and during another night and day. Thus it is written in the Royal Journals.” Thus far the report is no doubt to be strictly depended upon; the historical embellishments added to it from other sources can have no interest to the professional reader. (Appiani Exped. Alexandr., vii., 37.) It deserves to be remarked, as a remarkable feature in this case, that the mind appears to have been pretty entire during the whole course of the fever. Now, this is one of the characteristics of causus as described by Aretæus (Morb. Acut., ii., 4). It is further one of the most marked features of the yellow fever, which, from all I can learn of it, would appear decidedly to be an aggravated form of causus.