FEVERS. 535 



" The QUARTAN is, next to the Tertian Intermittent, the most 

 general form of intermittent fever, and like the Tertian, it has 

 been subdivided into the Intermittent and Remittent ; but re- 

 mittent Quartans rarely occur. 



" I. Intermittent Quartan fevers vary, First, With respect to 

 the form or type, or the period of recurrence : 1. The Quartan 

 which is pure and legitimate, ' Quartana paroxysmis quarto 

 quoque die singulis, aliis diebus nullis,' that which has a fit 

 every fourth day and none upon the intermediate days ; 2. The 

 Quartana duplicata, 6 paroxysmis quarto quoque die binis, 

 aliis diebus nullis,' that which has its fits too upon the 

 fourth day, but has always two fits on one day ; 3. 4 Quartana 

 paroxysmis quarto quoque die tribus, intermediis diebus nullis,' 

 that form in which three fits recur each fourth day. This form 

 is admitted as a fact by Sauvages, who quotes it from a brother 

 physician in Montpellier that had the disease himself. I cannot 

 refuse the fact, but I am extremely doubtful of it, as it is the 

 only fact on record of this kind of Quartan. I doubt all singular 

 facts, contrary to the usual order of nature, and this one the 

 more, because Sauvages has not described it with sufficient ac- 

 curacy ; further, it is contrary to the whole analogy of fever, for 

 a triple fit was never observed in any other of the tertian fevers. 

 4. A more frequent form of Quartan is what has been called 

 the ' Quartana duplex,' 6 quae ex quatuor diebus tertium tan- 

 turn a febre vacuum habet, paroxysmis quarto quoque die si- 

 milibus,' where the paroxysm returns upon the first and second 

 day, and there is none upon the third, but there is the usual re- 

 turn again upon the fourth day. 5. The last form is what 

 we call the Quartana triplex, c quotidie accedens, paroxys- 

 mis quarto quoque die similibus,' where there is a fit every 

 day, but it is known to be a quartan by the fits corresponding 

 every fourth day. With regard to both these double and 

 triple quartan fevers, the difference is commonly in this way : 

 The principal quartan fit, in the double quartan, comes on early 

 in the afternoon, from three to five o'clock, whereby it is dis- 

 tinguished from the paroxysm of a Tertian Intermittent, which 

 comes on at noon or before it, or at latest soon after. The 

 triple quartan again has these fits still later in the evening. 



