Chapter XIV: Part 14

Aretæus appears to be the first medical author who alludes to contagion in unequivocal terms. He says of elephantiasis, that it is as infectious as the plague, being communicated by respiration. Cælius Aurelianus, who was probably nearly contemporary with him, mentions as contagious diseases the plague, incubus, hydrophobia, and elephantiasis. Galen expresses his sentiments on the contagious nature of certain diseases in the following terms: “That a pestilential state of the atmosphere produces fever, is unknown to no one possessed of good understanding; and, also, that it is dangerous to associate with persons having the plague, for there is a risk of catching it, like the itch and ophthalmy. It is dangerous also to live with those labouring under consumption, and, in a word, with all those having a putrid respiration of such a nature as to render the houses in which they lie fetid.” (De Diff. Febr. i, 3.) Aëtius (xiii, 120) and our author (iv, i) state their decided opinion of the infectious nature of the plague and elephantiasis. Oribasius, Alexander, Synesius, Palladius, Actuarius, and all the Latin medical authors, with the exception of Cælius Aurelianus, have omitted to make any allusion to the contagious nature of diseases.

Of the Arabians, Rhases mentions, as diseases “which are transmitted from one person to another,” lepra (elephantiasis?), itch, consumption, and pestilential fever. These, he says, prove infectious, when one is shut up in a narrow house along with those labouring under them, or when one sits in the wind blowing from them. He states afterwards that ophthalmy and malignant pustules are sometimes contagious. (Ad Mansor. iv, 24; see also Contin. xxxiii, 5.) By malignant pustules he means the smallpox. Avicenna and Haly Abbas give the same list of contagious diseases. Avicenna says that smallpox and measles are of all diseases the most contagious. Of the other Arabians, Avenzoar alone, while treating of elephantiasis, alludes to the doctrine of contagion.

Having now done with the ancient authorities, we shall only give further the declaration of the celebrated Boccacio regarding the plague of Florence: “E fu questa pestilenza di maggior forza, percio che essa dagl’ infermi di quella per lo communicare insieme s’avventava a’ sani non altramenti che faccia il fuoco alle cose secche o unte, quando molto gli sono avvicinate.” (Decameron, Introduzione.)

The result of our investigations into the opinions of the ancients on this subject leads us to the conclusion, that all, or at least the most intelligent of the medical authorities, held that the plague is communicated, not by any specific virus, but in consequence of the atmosphere around the sick being contaminated with putrid effluvia. Hence, they maintained that mild fevers (συνηθεῖς) which show no tendency to putrescency are not communicable from one person to another. See Alexander Aphrodisiensis, (_l. c._) Fracastorius, in like manner, considered putrefaction as the source of all contagion. (De Contag. i); and nearly the same opinion was maintained by the learned Fernel, Franciscus de Pedemont, Ingrassius, Ficinus, and others. (See Prælect. Mar. 77.) Although Galen several times speaks of a poison being formed in the human body, he means that the animal fluids are so altered as to become deleterious, and does not hold that there is any specific virus transmitted from one person to another. (De Loc. Affect. v, 7, vi, 5; Epidem. iii.)

We may take this opportunity of stating that, after a pretty extensive investigation into the histories of pestilential epidemics, we have come to the conclusion that the plague has almost invariably assumed one or other of the following phases: 1st. That of cholera and dysentery. The plague described by Thucydides, and that of Ingrassias, and many other pestilential epidemics described in ancient and modern times, including the Asiatic cholera of the present age, belong to this class. 2d. That of profuse; and, as they have been termed, syncoptic sweats. The celebrated epidemic of the fifteenth century, now so admirably illustrated by M. Hecker, is the best marked instance which we possess of this form of the disease. M. Hecker, indeed, supposes that the Cardiac disease of the ancients was of a similar nature to the sweating sickness. But it strikes us (although we must admit that we have not had time to consider this point maturely), that the syncoptic fever or cardiac disease of the ancients, was not of a pestilential nature. 3d. The other form is the Glandular plague, which many late authorities would consider as the only form of the disease; but as we think erroneously, since the other types are often mixed up with this in the same epidemic. Thus in the plague of Aleppo, during the years 1760, 1761, and 1762, although the ordinary form of the disease was the glandular, a considerable proportion of the cases assumed the first form which we have noticed. And in the plague of Athens, although it commonly put on the appearance of the first form, it would appear probable, from the obscure allusion to cutaneous eruptions in the description of Thucydides, that a certain proportion of the cases were of the second type. The three forms then would appear to us to be as closely allied to one another as diphtherite, ulcerous sore-throat, and scarlatina are; that is to say, that they are all varieties of one species of disease.

SECT. XXXVII.—ON THE TREATMENT OF THOSE WHO ARE SEIZED WITH SYNCOPE FROM CRUDE HUMOURS.

Some are seized with fever while having a great collection of crude humours, and while the mouth of the stomach is at the same time disordered. In them the hypochondrium is distended with flatulence, the orifice of the stomach is more swelled than natural; in some the complexion is turned to a more white and watery, and in others to a blacker. None of these can bear the abstraction of blood without the most imminent danger; but they require evacuation, although they cannot endure phlebotomy nor purging, for even without them they are disposed to fall suddenly into a state of syncope. They are to be cured, then, by friction. It will be proper, at the commencement of the disease, to begin with rubbing the limbs from above, downwards, with moderately rough linen cloths, and afterwards, the whole arms from above, downwards. But when the limbs have been sufficiently warmed, and there is danger of a sense of lassitude, we must use a relaxing oil, and avoid all astringents. When it is winter, we must also use a sudorific one, such as the Sicyonian oil, or that of chamomile. After rubbing the limbs freely, we must next rub off the oil, and proceed to the spine, which we must rub in like manner, and then immediately return to the legs, and from them to the arms again, and afterwards to the spine again, continuing this practice for a whole day. Honied water, in which hyssop has been boiled, is most beneficial in these cases. And they must neither get farinaceous food, nor soup, nor water, nor be permitted at all to drink freely; but they ought to be contented with honied water alone for the first three days, and be rubbed in succession. If the strength be moderately good, and the contents of the stomach do not pass properly downwards, you may venture with a clyster. But if there is a greater overflow of the superfluities than proper upon the stomach, you must first boil the honied water well, for thus it will be less laxative; but when the belly is looser than proper, you must not thus stop it, but, instead of the honied water, give the juice of ptisan. But if the discharge still continue, we must support with a gruel made from chondrus. But if we ascertain from the weakness of the pulse that the powers of the system are prostrated, it will be proper to give bread out of diluted wine, provided there be no inflammation of the stomach or liver. But should they be inflamed at the same time that the body is loaded with crude humours, the state of the patient is hopeless. If you perceive that the humours are thick, give oxymel always instead of honied water; if it is summer, the patient hot, and fond of cold drink, give him cold oxymel; but when in winter, it must be hot. Baths are most prejudicial to such persons. If, when you are called, syncope has already come on, and the parts which I have mentioned are free from inflammation, give a small bit of bread out of wine, and proceed straightway to the friction in the manner I have described. In those cases in which the syncope is occasioned by yellow bile infesting the mouth of the stomach, we must give cold drink, and administer wine that is thin, of a bright yellow colour, and old.

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COMMENTARY. This Section is taken either from Oribasius (Synops. vi, 27), or Aëtius (v, 97.) These authors, however, merely abridge the account of this subject which is given by Galen. (Meth. Med. xii, 5, and Therap. ad Glauc. i.) Syncope, according to the explanation of Galen, is a sudden prostration of the vital powers, without suspension of the respiration, as in _deliquium animi_. Our author has given a very correct account of Galen’s treatment. He states that, the system labouring under a load, the great indication is evacuation, but that venesection cannot be borne in such cases. In short, he insists that our great dependence must be placed on friction, for the application of which he gives very minute directions. When the pulse suddenly sinks and becomes irregular, he administers wine, unless there be inflammation of the stomach or liver. In cases complicated with crude humours, he pronounces the bath to be most prejudicial, and also disapproves of very cold or very warm air. He is most particular in his directions for the selection of the most proper wine to be used, and gives some interesting observations on the principal Greek and Roman wines used in his time. He concludes his remarks with stating that thick wines ought to be avoided as injurious, and such as are watery and thin as ineffectual, whereas those of a middling kind are to be selected. He particularly praises the Ariusian and the Lesbian. The Falernian he condemns, as being too fragrant and austere, which qualities render it injurious to the head.

Alexander disagrees with Galen as to several of the points of treatment laid down by him. He insists that Galen’s rigid rules for applying strong friction, at the same time that abstinence is enjoined, are such as no ordinary powers of constitution could bear up under; and, therefore, he recommends to rub first, and then to give some light nourishment, such as thin ptisan, oxymel, and bread soaked in wine, when the strength is greatly overpowered. Nay, when the powers of the constitution are in danger of sinking under the weight of the load, he suggests the propriety of having recourse to venesection; and accounts for the benefit derived from this evacuation upon the same principle that a fire which is like to be extinguished by an excessive load of green fuel burns brighter when part is taken off. This is an ingenious explanation of the manner in which bleeding proves useful in cases of congestive fevers. Respecting the use of wine and the bath, his views are similar to those of Galen. He approves very much of administering a light-coloured diffusible wine when the powers of the system are much sunk.

Avicenna adheres closely to the principles of treatment laid down by Galen; and, therefore, says nothing of venesection. (iv, 1, 2, 58.) Rhases treats this complication of fever in like manner. He calls it “Febris syncoptica, ex humorum copiâ et cruditate nata.” (Ad Mansor. x, 14.) He mentions emetics, but approves most particularly of friction. (Contin. xxx.)

Averrhoes contends that, in such a case, it is lawful for a Mussulman to drink wine, although forbidden by the Prophet. He approves also of friction. (Collig. vii, 16.)

Prosper Alpinus informs us that the Methodists, in such cases, gave wine and aromatics, and used every means to rouse the system. (Med. Method, vi, 9.)

SECT. XXXVIII.—OF THOSE WHO HAVE FALLEN INTO SYNCOPE FROM THIN HUMOURS.

Those who have fallen into a state of syncope from thin humours, must be treated quite oppositely to the manner described, for you will find the diagnostic symptoms quite different. They must be supported by taking a little food frequently. And their case is to be thought hopeless when the liver or stomach is inflamed at the same time that the powers are gone. In these affections, the expression of the countenance speedily becomes death-like. It is necessary to support their strength with food, but their skin must be condensed instead of being rarefied as in the former case. The air must be cooled, and they must be rubbed with astringent ointments. They must be furnished with food not very laxative, also bread and gruels from chondrus, with autumnal fruits that are austere, and not apt to spoil; these, either by themselves or with bread. A watery wine taken from the beginning with the food will be beneficial.

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COMMENTARY. This is taken from Galen. (Meth. Med. xii, 6.) See also Oribasius (Synops. vi, 27); Aëtius (v, 98.) In this case Alexander recommends nearly the same plan of treatment as Galen. He recommends for food things which are incrassant and anti-discutient, such as the juice of halica, succory, lettuces, apples, pomegranates, pears, &c. They must be administered, however, in small quantities. He approves of giving a weak watery wine, not very old. He recommends friction with tonic and incrassant oils, such as the oil of apples, and other applications of a like nature.

Avicenna, Averrhoes, and Rhases treat the case exactly as our author.

SECT. XXXIX.—ON THE OTHER CAUSES WHICH OCCASION SYNCOPE.

There are four other causes from which men fall into syncope; namely, violent pain, watchfulness, too great evacuation, and sometimes motion when in a state of delirium. To these, if you please, you may add a fifth, namely, an intemperament of the primary organs. Death takes place most quickly when the heart is affected, next, when the brain, but not so when the liver.

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COMMENTARY. See, in like manner, Galen (Meth. Med. xii, 7); Oribasius (Synops. vi, 28); Aëtius (v, 99.)

From the Commentaries on the last three Sections it will be seen that Galen and his followers, whether Greek or Arabian, consider syncope in the light of a symptom or complication of fever. But it is treated of as a distinct disease by Celsus, Cælius Aurelianus, and Aretæus; by the former two under the name of _morbus cardiacus_, and by the last under that of _syncope_. We think ourselves called upon in this place to give a brief exposition of their views.

Celsus treats of _morbus cardiacus_ after phrenitis, because, as he says, persons affected with phrenitis are apt to fall into the other. He calls it a great weakness of the body, which, owing to the languid state of the stomach, is melted by immoderate sweating. It is recognized by a small and weak pulse, immoderate sweats, breaking out from the chest and neck, the feet and legs alone being dry and cold. He adds, it is a sort of acute disease. His treatment consists in applying a repressing cataplasm to the præcordia, and next, in stopping the sweats by friction with sour oil, roses, &c., or with some cerate similarly prepared. If the sweating gains ground, the body is to be anointed with parget, litharge, Cimolian earth, or sprinkled with the powder of them. The patient is to be lightly covered, laid in a place not too warm, with open windows, so that a current of air may reach him. Light food is to be frequently administered, and also, if necessary, wine neither too strong nor too weak, which may be given with barley-meal, if the patient has not taken other food. If he cannot take food, he is to be first treated with the affusion of cold water; and if his stomach have lost its tone, he is to be allowed to vomit before taking food. If the stomach still reject the food, he is first to take a cupful of wine, which is to be repeated after an hour, and then the whole body is to be anointed with pounded bulbi (onions?), which will have the effect of making the stomach retain the wine, and thereby heat will be restored to the whole body and strength to the veins. As a last resource, he recommends an injection of ptisan or gruel. Fragrant things may also be applied to the nose, such as roses and wine; and if the extremities be cold, they are to be chafed with hot hands smeared with oil. If the violence of the sweating be thus checked, and life prolonged, the time thus gained will be of some assistance. Means are afterwards to be taken to prevent a relapse. (iii, 19.)

Cælius, the Methodist, treats so fully of the _cardiac passion_, that we feel at a loss how to give a competent outline of it within our limits. The followers of Asclepiades, he says, held it to be a swelling about the heart, connected with congestion; but, according to Soranus, the great master of the Methodists, the heart is not primarily affected; and he holds it to be an acute and sudden prostration, by which the distribution of particles over the passages of the body is stopped. The causes of it are many; such as protracted indigestion, intoxication, baths after food, vomiting after supper, and depressing passions, by which the body is dissolved into sweats. It takes place most frequently, he says, in continual, ardent, and inflammatory fevers on the sixth day. His description is too lengthy to find a place here. Suffice it to say that when the affection is at its height, the pulse is small, tremulous, and creeping; there is a profuse, viscid, and fœtid sweat over the chest, face, and perhaps the whole body, with failing respiration, pallid countenance, hollow eyes, and so forth. Some of the preceding authorities, such as Asclepiades and Themison, held that it was generally, but not always attended with fever; and with them he pretty nearly agrees. As we have already hinted, he is not disposed to admit that it is a primary affection of the heart, but rather holds it to be a disorder of the general system. Having discussed, in two chapters, the diagnosis, first, between it and affection of the stomach, and then between it and critical sweats, he comes to the treatment. The patient is to be laid in a cool and well-ventilated apartment, to be covered over with light clothes, and to have his face, neck, and chest sponged with cold water and vinegar; and if the sweating continue, astringents and obstruents, such as alum and Samian earth, are to be added; or the body may be anointed with astringent oils; but, in particular, various applications of a fragrant and astringent nature are to be made to the chest. He recommends great caution in the administration of food and drink; directs that the mouth should be rinsed with something cooling; and, in process of time, that various articles of a restorative nature should be given for food, and at last, wine, about the choice of which he is very scrupulous, approving, in general terms, of such as is white, well clarified, and subaustere, and in particular of the Surrentine, the Falernian, the Chian, and the Lesbian. He cautions, however, not to give too much at a time. When there is great prostration of the vital powers, he approves of ligatures to the extremities, and the application of cupping instruments, with great heat to the præcordia. When all other means fail, the patient is to be supported by administering nourishing things in clysters. Such is his own mode of treatment. He afterwards animadverts freely upon the practice of the other sects.

Although Aretæus treats of syncope as a separate disease, he holds that it derives its origin from causus, or ardent fever. He pronounces it to be a loosening of the vital cords, and that its seat is the heart; hence his chapter on the treatment is entitled, on the cure of _cardiacs_. The symptoms, he holds, mark an affection of the heart, namely, small and weak pulse, great palpitation, throbbing of the heart, fainting, unrestrainable sweats, &c.

His treatment is little different from that of Alexander in syncoptic fever. Thus he begins with venesection, unless otherwise contra-indicated, justifying this practice by the pithy remark that the powers of the system may be reduced by suffocation as well as by want. He recommends, however, that blood should be taken in moderation, and that some wine should be given immediately afterwards, unless inflammation be present. Wine, he remarks, in inflammations, adds to the disease, but, in ordinary cases, to the strength. When general bleeding cannot be borne, he advises cupping in a guarded manner. He approves of bathing the head with cooling things, of cool air, and of all things that are grateful to the senses. When the system is quite sunk, and the extremities cold, he recommends wine guardedly with light soups. The wine, he says, should be fragrant and not very astringent, but should be given with moderation, unless the sweats are very profuse and the skin cold, when he advises wine to be given to any extent, wine in such cases being the last hope of life. He directs further that the patient should be kept up with encouraging words, and the application of fragrant and astringent things, such as alum, rose-water, and the like. He is to be exposed to fragrant and cool air, and, if the sweats persist, obstruent substances, such as Samian earth, &c., are to be added to the applications, and a sponge soaked in cold water is to be applied to the face. Stimulants and rubefacients are to be applied to the extremities. He concludes with remarking that convalescence is often prevented by latent inflammations, which end in marasmus, in which cases the physician must endeavour by gestation, friction, baths, and the administration either of a woman’s milk or that of an ass to support the strength. (De Cur. Acut. ii, 3.)

Aëtius also has a separate chapter on _cardiacs_, although he holds syncope to be symptomatic of acute fever. We need not enter upon an exposition of his views further than to mention that he is of opinion that the part originally affected is the cardiac orifice of the stomach. (ix, 1.)

By _cardiac disease_ in fevers the ancients would seem to have meant to describe a febrile affection, attended with congestion and great nausea. Such a variety of remittent fever is described by the late Dr. Robert Jackson as still occurring in warm climates. The symptoms are great nausea, sluggishness, obscure, weak pulse, and deep respiration. He recommends bleeding, and afterwards stimulant applications to the extremities. (On Fever, p. 193.)

Since writing the above we have had an opportunity of consulting Hecker’s ‘Epidemics of the Middle Ages,’ and beg to refer our readers to it (p. 306) for an ingenious disquisition on the cardiac disease.

SECT. XL.—ON PAIN.

A torpid pain is occasioned by a cold affection; a throbbing is characteristic of a strong inflammation. But, if a person feel as if pierced by a sharp-pointed instrument, or bored by a wimble, this kind of pain is peculiar to the thick intestine, i. e. the _colon_. The pungent is seated in the membranes. The darting pain attends the most vehement attacks, not only of hemicrania, but also of cephalæa. It is said to be darting when it commences in the seat of the affection, as from a root, and spreads quickly to the surrounding parts. Stretching pains take place in the nerves, when they are affected and stretched towards both extremities. But the nerves are not liable to be affected with lateral distensions. The membrane under the skin when distended occasions tensive and torpid pains; those between the flesh, as it were, divellent. For they are many, have irregular insertions, and surround the flesh. But the pains proceeding from the membranes which surround the bone, are deep-seated, and seem to proceed from the bones themselves. Wherefore, when no external cause of the pain is apparent, you must consider the patient’s preceding regimen. If it has been more inactive than usual, or if he has been taking more nutritive food than common, or if any evacuation has been suppressed,—if any or all of these circumstances be observed, plethora is the cause of the pain, and you must evacuate him as quickly as possible; for, by this means you will be enabled with all safety to use such remedies as are fitted to repel the defluxions from the affected parts. If the part be distended with a fulness of blood, open a large vein near it immediately; but when bad humours alone are the cause, you must purge; and, when both meet together, you must use both evacuations, beginning with the bleeding. If, after both these remedies have been tried, the pain continue, it is clear that the offending matter has become fixed in the part affected; and it is also clear, that the cure will be accomplished by discutient remedies. In like manner, we may cure pains from flatulence, by soothing them with attenuant food and injections, and opening the pores of the containing part with cataplasms, irrigations, and fomentations. If a swelling bearing down and pressing upon the part be the cause of the pain, it must be removed; but, if it proceed from a pungent humour, attenuant and calefacient things are most improper. Dill boiled in oil is anodyne and soporific, and the green more than the dry.

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COMMENTARY. This Section is taken from Oribasius (Synops. vi, 29), or Aëtius (v, 100.) All these authors, however, merely abridge the account given by Galen. (Meth. Med. xii, 8, and de Locis Affect. ii.) In the latter work he gives a most ingenious dissertation on the different kinds of pain, and the states of the body in which they occur; but, as our author has given a summary of his observations, we think it unnecessary to go over the same ground. We shall, therefore, merely notice some of his remarks on the treatment, as delivered in the other work. When the pain is connected with flatulence, it is to be removed by food, drink, cataplasms, and fomentations of an attenuant nature. When pungent humours are the cause of the pain, they are to be treated by evacuants, diluents, or narcotics. When occasioned by thick and viscid humours, he forbids narcotics, the action of which, being frigorific, renders them thicker, and the containing parts more compact. In all such cases, therefore, he holds that opium and hyoscyamus, although they afford a temporary relief from pain, act prejudicially. He also proscribes things of a very hot nature, both internally and externally, and recommends to give attenuants, or things of an incisive nature. He in particular commends garlic, which he calls the theriac of rustics. As to external applications, he directs, in febrile cases, first a dry fomentation of millet-seeds, and, if it is not successful, friction with subtile or attenuant oils, and the fat of fowls.

Aëtius defines pain to be a sensation produced by a sudden change of temperament, or a solution of continuity. In illustration of the former cause, he remarks that all sudden changes from heat to cold, or _vice versa_, occasion severe pains. To the latter he refers rupture, contusion, and erosion of the parts. Rupture is produced by tension, contusion by weight, and erosion by some pungent quality. These causes of pain ought to be particularly attended to, and the treatment modified accordingly. His subsequent account is exactly the same as our author’s.

The different kinds of pain are fully treated of by Avicenna (i, 2, 3, 20), and by Haly Abbas (Theor. vi, 16.) Averrhoes has delivered the treatment of this complication of fever in nearly the same terms as Galen. When the pain is occasioned by warm air or flatulence, he particularly commends cupping applied with great heat. He agrees with Galen in condemning narcotics, when the exciting cause is of a cold nature. He also joins him in condemning hot fomentations and clysters, when the pain of the bowels is occasioned by a hot humour. (Collig. vii, 18.) See Rhases (Cont. xxxiii.)

SECT. XLI.—ON COLLIQUATIVE DIARRHŒA OR MELTING.

When anything is discharged from the bowels which was not part of the food or drink that was taken, but of the fluids of the body which had flowed to them, (resembling the yellow bile which is continually discharged by vomiting and purging, but differing from it in fetor; and in this, that the alvine discharge is of a darker yellow, of the consistence of the sordes balneorum, oily, and adipose,) the disease is called colliquation or melting. At first the fat and newly-made flesh are dissolved and melted by the heat of the fever; but as the evil is protracted, some of the solid parts themselves are melted down. In this most unfavorable state of fever, a draught of cold water from the coolest fountain is the most proper remedy; likewise cold cataplasms and epithems ought to be applied to the chest and hypochondriac regions, and cooling food to be given.

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COMMENTARY. Galen mentions that a colliquative discharge from the bowels was a common symptom of the fatal plague which prevailed in his time. He adds that the fæces were generally of a deep yellow colour, and always fetid. (Comment. in Hippocrat. Epidem. iii.) In another place, he states that it is a fatal practice to bleed or purge in cases of fever complicated with diarrhœa. (Therap. ad Glauc. i.)

Our author borrows from Oribasius (Synops. vi, 30), or Aëtius (v, 91.)

The Arabians treat febrile melting upon general principles, as explained under the head of Diarrhœa.

On the colliquative diarrhœa in fevers, see, further, Prosper Alpinus (de Præs. Vita et Morte Ægrot. vii, 11), and Fabius Paulinus (Prælect. Marc. p. 343.)

SECT. XLII.—ON WATCHFULNESS IN FEVERS.

Those who are much troubled with insomnolency, we are to direct to have their legs and hands bound with ligatures at the time when they were accustomed to go to rest; and make them keep their eyelids open, or wink, until they are sufficiently fatigued; then we suddenly loosen the ligatures, remove the lamp, and order complete stillness to be preserved. But, when the insomnolency is obstinate, we must bathe the forehead during the decline of the paroxysm with the decoction of the heads of the black poppy, and direct the patient to snuff up the dried and powdered husk of the white poppy; or from the root of the mandragora pounded with wine and rose oil in equal quantities, we make an emollient ointment (_malagma_), and smear the forehead with it. Or we use, during the paroxysms, wild thyme boiled in must with melilot. Or, taking the pounded heads of poppies, we make a cataplasm of it with bread and rose oil, or cerate. And the greatest attention ought to be paid to the food. Let about three spoonfuls of the seeds of the white poppy be added to the patient’s gruels; and let his pot-herbs be prepared by adding to them as many of the leaves of the black poppy, if green, as can be contained within three fingers; or otherwise, three or four dried heads may be boiled with them and taken. If, even by these means, sleep cannot be procured, let him be smeared with the juice of poppy or of mandragora. But the electuary composed from the heads of poppies, and, particularly that which is drunk with sodden wine, to the amount of a spoonful, or a spoonful and a half, often disposes to sleep. Those who are not troubled with fulness of the head may use the following fumigations in the decline: Of Indian leaf, of amomum, of costus, of arnabo, of each ℥ j, of the fruit of the balsam tree lb. j, of storax, of ammoniac perfume, of Scythian bdellium, of the root of the mandragora, and juice of poppy, as much; use as a fumigation with cypress-wood.

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COMMENTARY. We are informed by Celsus that Asclepiades trusted almost entirely to gentle friction in such cases. (iii, 18.)

Our author, as usual, copies freely from Oribasius. (See Synops. vi, 31.) Nearly the same directions are given by Aëtius. (v, 116.) Those in the beginning of the Section are from Galen; the remaining part is from Herodotus and Philumenus.

Nonnus gives a correct account of the established rules of treatment in such cases. Thus, he directs us to use ligatures, and apply friction, to the extremities; and, if this treatment have not the desired effect, to have recourse to soporific decoctions, or liniments prepared with poppies, opium, mandragora, &c., or even to give internally an infusion of poppy heads. (Epitome, 145.)

The directions given by Avicenna are so like our author’s that we must suppose them copied from him. He directs us first to try the effect of fatiguing the patient by talking loud to him, placing many candles in his chamber, and applying ligatures to his extremities. When this method does not succeed, he recommends the soporific applications mentioned by our author. When there is nothing to forbid the use of it, he permits the syrup of poppies. (iv, i, 2, 20.) Haly Abbas likewise recommends poppies externally and internally. (Pract. iii, 23.) Averrhoes briefly directs food and applications of a soporific nature. (Collig. vii, 2.) Rhases mentions our author’s plan of treatment, and further seems to approve of liniments made of mandrogora, opium, henbane, and the juice of lettuces. (Cont. xxxi.)

Cælius Aurelianus remarks that the indiscreet use of soporifics may bring on lethargy. According to Prosper Alpinus, the Methodists approved of fomentations, consisting of soporific medicines, such as lettuces, opium, and the like. (Med. Meth. vi, 8.)

The earlier of the modern writers on medicine approve of applying to the nose a sponge soaked in a soporific liniment prepared from opium, henbane, mandrake, cicuta, lettuce, and the like. (See Theodoricus, iii, 8.)

SECT. XLIII.—THE CURE OF CATAPHORA OR SOMNOLENCY.

Sponge the forehead with oxycrate of the temperature of new milk; put tight ligatures round the extremities; and apply to the nose strong-smelling things of an incisive quality. In the remissions, apply cupping instruments between the shoulders along the spine. When the disease is protracted, errhines must be tried during the remission. Let the food consist of things having incisive and dividing properties, as recommended by us in our general directions regarding the health.

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COMMENTARY. The treatment mentioned by our author is recommended by almost all the other authorities both before and after his time. See, in particular, Oribasius (Synops. vi, 33); Aëtius (v, 117); Nonnus (Epitome, 146); Avicenna (iv, 1, 2, 18); Haly Abbas (Pract. iii, 23.)

Prosper Alpinus gives an excellent account of the practice of the Methodists. It consisted of painful friction, tight ligatures, rubefacients applied to the extremities or head, sternutatories, and, in short, everything calculated to rouse. (Med. Meth. vi, 7.)

SECT. XLIV.—THE CURE OF HEADACH IN FEVERS.

When headach proves troublesome in fevers, after the accustomed evacuations, in the decline of the paroxyms, the head ought to be anointed, first with the common oil from unripe olives, or with rose oil, to which a very small quantity of vinegar has been added; which, if it be the summer season, and the fever of the ardent type, may be used cold; but, in winter, if the fever be not ardent, it must be hot or tepid. In the oil may be boiled the juice of wild thyme and knot-grass (_polygonum_); and in summer, the heads of the poppy, or the poppy itself may be added, as in winter, a moderate quantity of the hogs-fennel may be substituted in place of it. When the pain continues in the forehead, if the open of the head be bare, a poultice may be applied to it, made of old barley-meal and knot-grass; or, in like manner, of bread and roses, or of some myrtle or wild thyme. Some are rather benefited by an admixture of pennyroyal, and others, when the affection was of a hot nature, have rather been remedied, by having flea-wort (_psyllium_) added to the barley-flour, or even by this substance alone, when boiled to the consistence of bird-lime. It must be frequently changed. Coriander with barley-meal may be used in like manner. Aloes with vinegar are also to be rubbed in, or myrrh and ammoniac in like manner, and crocomagma. Pulsatory pains are dispelled by rue and mint, with bread, to which a little rose oil has been added. When the pain does not yield to the afore-mentioned remedies, we must first cut the hair close by the skin, and then rub some of the oily embrocations over it all; after which cupping-instruments are to be applied to the hind-head, and the extremities to be bound with ligatures, and chafed. Leeches also are a proper application. But if a catarrh or defluxion raise the pain in the head, we must apply the remedies which will afterwards be described in the proper place. But if exhalations from the stomach have been carried upwards, and hurt the head, we must attend to them, as is stated below.

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COMMENTARY. Part of the directions delivered by Celsus for the treatment of headach deserves to be given in his own language: “Si capitis dolores sunt, rosam cum aceto miscere oportet, et in id ingerere: deinde habere duo pittacia, quæ frontis latitudinem longitudinemque æquent: ex his invicem alterum in aceto et rosâ habere, alterum in fronte: aut intinctam iisdem lanam succidam imponere. Si acetum offendit purâ rosâ uterdum est, si rosa ipsa lædit, oleo acerbo.” If this does not succeed, he recommends other more refrigerant applications prepared with iris, poppies, ceruse, litharge, &c. (iii, 10, 112.)

When headach occurs towards the beginning of fever, Galen bleeds once and again, if there be nothing to contra-indicate depletion, and more especially if the patient be plethoric. He then attends whether it arise from fumes proceeding from the stomach, or constipation of the bowels, and corrects these conditions accordingly. If it make its attack after the seventh day, he first evacuates the bowels by clysters, then cups the back part of the head or neck, or uses paregoric applications, such as rose oil, with some vinegar, if in summer; but, if in winter, especially in persons of a cold temperament, the oil of chamomile, with a fifth part of vinegar. See further ‘De Med. sec. Locos.’ (ii.)

Alexander recommends attention as to whether the headach be connected with the crisis, and in that case he cautions against meddlesome interferences, which may do more harm than good. When any applications are admissible, he recommends that they be of a cooling and soporific nature. (i, 10.)

Aëtius likewise recommends bleeding, purging, and vomiting, when not contra-indicated; and gives very proper directions about the local applications. He directs us to soak a handful of wool in some cooling fluid, and, holding it above the head, to squeeze out the fluid, so that it may fall upon the head from a height. (v, 100.)

Palladius says that headach in fevers is occasioned by repletion and distension of the veins, owing to fumes arising from the stomach. (De Febribus, 13.) Nonnus merely abridges our author’s account. (Epit. 147.)

Avicenna’s directions about the local applications are brief, and similar to those of the Greeks. (iv, i, 2, 19.) Haly Abbas recommends bleeding and attention to the state of the stomach, for the relief of which he in certain cases permits the use of wine. (Pract. iii, 20.) Rhases joins preceding authorities in recommending vinegar and rose oil to be poured upon the head. They are to be used cold in summer, but hot if in winter. (Cont. xxx.)

We have seen that Celsus approved of cold and astringent applications to the head. The Methodists condemned this practice, and recommended hot water to be poured upon the open of the head. Hippocrates seems to allude to this practice, when he says: “Much hot water poured upon the head removes fever.” (Aphor. vii, 42.) Prosper Alpinus gives an excellent account of the Methodical treatment. (Med. Meth. ii, 6.)

SECT. XLV.—ON THE CURE OF STOMACH AFFECTIONS.

If the stomach be weak, we must apply strengthening cataplasms to it, such as those made of dates and wine, and of barley-meal and saffron, and of mastich and aloes; and use embrocations from wormwood, the oil of apples, and of mastich, nard, and wine; and if hot, we must add cooling things, such as the juices of gourd, lettuce, purslain, nightshade, endive, and unripe grapes. But if the bowels appear to be inflamed, it will be proper to add to the embrocations some of the relaxing medicines, such as oil of chamomile and of privet, the grease of a cock or goose and bdellium, ammoniac, or the like; and to the cataplasms, the seed of parsley and fenugreek, the flowers of the marshmallows and chamomile; and, in a word, let the application be a compound of relaxing, attenuant, bitter, and astringent properties.

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COMMENTARY. Celsus notices these affections. When there is pain and inflammation about the præcordia, he recommends us to use at first repellent cataplasms, and, when the inflammation abates, to exchange these for hot fomentations, whereby the remains of the complaint will be removed. Pain without inflammation requires no application, as it will be carried off by the fever itself. (iii, 10.)

Galen treats of all sorts of applications for affections of the stomach in his work, ‘De Med. sec. Locos’ (viii.) Our author follows Aëtius. (v, 95.)

For atony of the stomach, Alexander recommends the applications mentioned by our author. When there is ardor of the stomach, a seasonable draught of cold water, he says, may do much good, whereas, if unseasonably given, it will prove highly dangerous. For atony of the stomach, he also recommends hot wine, if not contra-indicated; and most especially friction of the extremities. When it can be borne, the bath, he says, proves beneficial in cases of atony. When there is a sense of cold, he recommends poppies and wormwood. When the stomach is loaded with offensive humours, he directs an emetic of oil and water to be given. This remedy, he adds, sometimes operates downwards with the best effects, and he directs its purgative operation to be promoted by giving suppositories. He concludes, with recommending the stomach to be strengthened by giving a decoction of wormwood with wine, but forbids this medicine until the fever be abated. (xii, 3.)

Of the Arabian authors, Serapion’s account is the fullest, but it is taken almost word for word from Alexander. (vi, 19.) Rhases states that he had often seen bad consequences arise from evacuation having been practised before attending to the stomach. (Contin. xxv.)

SECT. XLVI.—ON INORDINATE CHILLS AND RIGORS IN FEVERS.

When rigors are critical, we must not interfere with them, nor attempt to put an end to the struggle; and a chill succeeding to a sweat will readily pass away and give no trouble. But when the rigor and chills are protracted, and more particularly, if occasioned by a collection of cold phlegm, we are first to apply ligatures round the limbs in various ways, and then anoint them with the oil of chamomile, or of privet, or of iris; or, if a stronger application be required, we may add to the oil some pepper, or the seed of the rosemary, or adarce, or castor, and the whole body is to be gently rubbed with these things. And in order that the oil may not readily run off, a small quantity of wax may be melted with it. Or, if it is the rigor not attended with heat, we must use the most powerful restorative ointments (acopa), and also dropaces and sinapisms. Proper fomentations ought likewise to be got ready. The acrid-scented things are likewise proper, such as calamint, pennyroyal, and hyssop. Before the attack, we should likewise give for drink honied water, in which pepper and rue have been boiled. And we should likewise give of the Cyrenaic juice, to the size of a millet, two hours before the paroxysm, mixing it up with boiled honey; and we are to give the juice of the laserwort in like manner. And the composition for quartans, made from the Cyrenaic juice, has proved beneficial to many. And some, by going into a bath of hot oil, have shaken off obstinate rigors, as Archigenes affirms. But Galen recommends, before the attack, rubbing the skin with southernwood, or dried calamint, or the leaves and flowers of flea-bane (conyza), or with costus, or pellitory, these two last with oil. By these means the rigors will nearly or altogether cease.

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COMMENTARY. These febrile symptoms are treated of by Celsus at considerable length. (iii, 11, 12.) He properly recommends fomentations of a hot and dry nature, and friction with calefacient oils. When produced by a bilious defluxion upon the stomach, he gives saltish water so as to operate as an emetic. He makes mention of the bath, and in certain cases allows wine. For Galen’s sentiments, see ‘de Diff. Febr.’ (ii), ‘de Causis Sympt.’ (ii, 5), ‘de Inequali Intemp.,’ ‘de Tremore, Palp. et Rigore.’ The last-mentioned work, in particular, contains some ingenious speculations on the nature of rigors. Our author has mentioned Galen’s treatment. Hippocrates pronounces a rigor occurring in continued fever, when the patient is become weak, a mortal symptom. (Aphor.)

Aëtius states that tremors take place in fevers for the most part owing to errors in eating and drinking. Holding them to be connected with disorder of the spinal marrow, he directs us to apply to the back wool soaked in some stimulant oil, or to put the patient into a bath of oil. He recommends castor, both when taken by the mouth and applied externally with the embrocations. (v, 130.)

According to the explanation of Palladius, rigors and tremors are occasioned by fumes or vapours arising in the internal parts, and being diffused over the body. (24.)

The treatment recommended by Haly Abbas is simple and judicious. He directs us to give draughts of hot water, to put the patient’s feet into hot water, and to rub the feet, and, if necessary, the other parts of the body, with calefacient oils and the like. (Pract. iii, 20.)

Avicenna gives a very accurate account of the different modes of treatment, but they are much the same as our author’s. He approves of ligatures to the extremities, of rubbing them with stimulant oils, or even with liniments prepared with assafœtida and mustard. He says the bath of hot oil is very beneficial. He also recommends draughts of hot water, and potions containing opium, which, he remarks, will procure sleep and perspiration. In certain cases he allows hot wine, which had been recommended by Hippocrates. (Aph. vii, 56.) He directs us to open the bowels with the hiera, or pills of assafœtida. (iv, i, 2.) Rhases particularly commends a draught of hot water. (Cont. xxx.)

SECT. XLVII.—ON SWEATS.

We must allow critical sweats to go on until they produce the necessary evacuation, and assist by means of moderate heat and rest, and by not wiping away the sweat (for one brings on another), by washing the mouth with warm liquids, by warm drinks, and by sleep. The sweats which occur in the decline of a fever are to be treated like the critical. Sudorific remedies are sufficiently treated of in the 48th section of the First Book. But when the sweats exceed in quantity, they must be wiped off, and the covering of clothes lightened, so as to cool the patient. For, by exceeding, they occasion lassitude, and often bring on syncope. Let, therefore, the covering be light and moistened; let the air be cooled; and let ventilation be used during sleep. Let the black myrtle, pounded, be sprinkled on the body, and gall, and the bark of the pine, in like manner. Let amber and polenta, with astringent wine, be applied to the proper parts; and let the face be sponged with oxycrate. Archigenes uses quicklime and the burned lees of wine in these cases, and for the rigor not succeeded by heat; for both, he says, when heated, become dry. He also orders us to bathe the middle parts of the body with the juice of plantain, or coriander, or purslain, or cabbage, that they may obstruct the passages of the sweat. In sleep, pieces of cloth smeared with Cimolian earth, dissolved in water, are to be applied to the back and chest; and the whole body should be anointed with the oil of roses, or of apples, or of lentisk, or of myrtle, or with the cerates from them. But fatty substances are particularly adapted to them; for, by shutting up the insensible pores, they prevent the passage of the fluid. It is clear that dry food and moderately astringent wines are befitting to them; but much drink should be avoided, and, in particular, all things of a very liquid nature, and likewise frequent washings of the mouth. But, if possible, gestation should be taken in a cold state of the air. The extremities in particular are to be cooled by these means. For those sweats which are extorted by spasms and pains, tight ligatures, or fomentations, are to be applied to the extremities, and they may be relieved by gently rubbing with woollen cloths.

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COMMENTARY. Hippocrates has delivered many interesting remarks on sweats which occur in fevers. (See Epidem., Aphor., Prognost. _passim._) Febrile sweats, attended with miliary eruptions, are held to be unfavorable. “In general,” he says, “sweats proceed either from resolution of the body, or the intensity of the inflammation.” (Prog.) In general he holds that febrile sweats, unless they occur on critical days are unfavorable. (Aphor.)

Galen remarks that profuse sweats are occasioned by rarity (i. e. relaxation) of the body, or redundance of the superfluity, or thinness thereof. The perspiration is checked, on the other hand, either because the superfluity is small in quantity, thick, and viscid; or because the pores of the skin are constricted. Either state, he adds, may arise from atony of the natural powers of the flesh. (De Causis Sympt. iii, 9.) He says, in another place, that for the removal of copious sweats astringent and refrigerant remedies are indicated, and that everything of a relaxing nature ought to be avoided. He recommends cold wine, and forbids all hot things, also ligatures to the extremities, emetics, and motion. He approves of cool air medicated by sprinkling the apartment of the sick with austere things, such as myrtles, vine shoots, and roses. (Therap. ad Glauc. ii.)

Celsus directs us, when the febrile sweats are slight, to rub the body with oil, and, when more profuse, with roses, quince ointment, or myrtle oil, to which austere wine is to be added. (iii, 6.)

Constantinus Africanus and his prototype Synesius concur in directing colliquative sweats to be checked by rubbing the body with oil of myrtles, of roses, &c. They commend an epitheme made of a decoction of roses, the flowers of the wild pomegranate, galls, and myrtle leaves, to which a proper proportion of oil is to be added. They also direct us to place beside the patient vessels filled with water, to sprinkle the apartment with myrtles, roses, &c. to give him the syrup of roses, in cold water, and to avoid exercise.

Actuarius takes notice of the miliary eruption which sometimes accompanies profuse sweats. He reckons it an unfavorable symptom. (Meth. Med. i, 58.) He also makes mention of other cutaneous eruptions, some resembling those produced by nettles, or the bites of gnats, and others of a red or black colour. (Ibid.)

Serapion recommends styptic and desiccative applications, such as galls, frankincense, alum, the flowers of vine, myrtles, and the like. (De Antidotis, vi, 20.)

Haly Abbas briefly recommends friction with styptic oils, and to remove the patient to a cool apartment. (Pract. iii, 24.)

Alsaharavius, in like manner, recommends friction with astringent oils, such as those prepared with roses, pomegranates, and the like. (xxxi, 2, 8.)

Avicenna and Rhases adopt the same plan of treatment as our author. The latter directs us to rub the body with rose oil, or myrtle oil, to sprinkle the patient with rose water in the decoction of myrtles, to fan him, and to lay in his chamber the tops of cooling herbs and trees. (Contin. xxxi.)

Prosper Alpinus informs us that the Methodists approved of cool air, of sprinkling the face with cold fluids, of rubbing the body with styptic oils, and of giving astringent wines internally. He also mentions the application of snow over the arteries of the extremities, and pouring cold water over those of the wrist. It is to be regretted, however, that this author too frequently omits to quote his ancient authorities. (See Medic. Method., vi, 18, and vii, 3.)

SECT. XLVIII.—ON COUGH IN FEVERS.