Aretæus gives a good description of the phenomena attending empyema thoracis. He says that when the abscess points outwardly, it separates the ribs from one another to make room for itself. It is occasioned, he says, by inflammation with a collection of blood. But the most graphic delineation of the phenomena of disease to be found in the whole records of medicine is that which he draws of a patient in the last stage of consumption. We will not mar it by attempting a copy which would fall so short of the original. He does not approve of the common tests, as recommended by Hippocrates; and, instead of forming an opinion of the case by throwing the sputa upon fire or water, he prudently directs us to judge of the case from the general symptoms. Unfortunately only a fragment of the chapter on the treatment has come down to us. It appears from it that he approved of a milk-diet and a sea-voyage. In cases of empyema he states that the matter sometimes forms a communication with the windpipe, and is evacuated in that way, and sometimes it is carried off by the urinary passages.
Celsus recommends in particular a sea-voyage, change of air, gestation in a couch, and a milk-diet. He cautions against the bath and exposure to the sun or cold. When other means do not effect a cure, he directs us to burn the chest in different places with the actual cautery, so as to form issues. See a strong recommendation of this practice in Caillot (Elemens de Physiologie, p. 6.)
Galen has detailed the principles upon which phthisis ought to be treated in the fifth book of the ‘Meth. Med.’ He commends strongly a diet of milk, especially that of goats, which is, he says, of an intermediate consistence between the milk of cows and of asses. The ancients, he says, made consumptive patients suck a woman. Whatever kind be used, he recommends it to be drunk as soon as it is milked from the animal; and he further directs sometimes honey or a little salt to be added to it. According to Galen, portions of the lungs are sometimes brought up in the sputa. (Loc. Affec. iv.) Cælius Aurelianus also confirms this statement. (Tard. Pass. ii, 14.) Aretæus, Alexander, and Leo further say that portions of the bronchia have been brought up with the expectoration.
Alexander gives very judicious directions for the choice of milk, and treats of empyema otherwise very fully. He says, when pus is collected in the chest, the sound of it may be heard in succussions of the body.
Aëtius states, upon the authority of Archigenes, that in certain cases empyema is formed without fever. This is now well ascertained to be the case. He approves of the cautery, like Celsus. His account of phthisis is taken from Galen.
Cælius gives many important observations on the proper treatment of consumption, and strictures on the practice of the other sects. He remarks that in old coughs attended with fever, although the expectoration be at first transparent and not purulent, the complaint often terminates in phthisis. His description of the disease is singularly accurate. The pectoral râle he notices in these words: “Quosdam etiam sibilatio vel stridor thoracis sequitur.” The pulse is said to be “debilis, densus ac deinde formicalis.” He mentions that it usually terminates by a colliquative diarrhœa. His treatment is judiciously suited to the circumstances of the case. He condemns the early use of the bath, hellebore, and the formation of issues on the part affected. Of the varieties of empyema he has treated elsewhere at great length. He appears to consider the operation of paracentesis as dangerous.
Many of the remedies recommended by Marcellus contain a combination of stimulant with narcotic substances, that is to say, of myrrh, storax, and the like, with opium and hyoscyamus.
Pliny speaks of navigation, that is to say, a sea-voyage, as a popular remedy for phthisis in his time. (H. N. xxxi, 33.)
Vegetius, the veterinary surgeon, remarks that tubercles like boils form in the lungs of cattle. (Mulom. ii, 45.)
Avicenna’s treatment is in general like that of Galen and his followers. He speaks of inhaling the vapours of arsenic, pine-fruit, &c. He and his countryman Avenzoar approve of paracentesis and the cautery. Mesue recommends the tepid bath in the decline of phthisis. Serapion approves of opening the abscess in cases of empyema by means of a red-hot iron. In the treatment of empyema Haly Abbas appears to have put great confidence in absorbent earths, such as burnt crabs, gum Arabic, Cyprian earth, &c. He gives the milk of asses in the morning, and at night the syrup of poppies. He also praises goats’ milk. He approves of a milk-diet and demulcents likewise in phthisis. He makes frequent mention of poppies, doubtless with the view of alleviating the cough. In certain cases he prescribes the tepid bath; and, under proper regulations, we are convinced that it might often be of service. Haly approves of the tests of purulent expectoration, which we have stated above that Aretæus condemned. Alsaharavius says that the bath may prove useful in phthisis, but that it ought not to be tried except under the direction of a skilful physician. He seems to direct the patient first to use the tepid bath in a warm place, and afterwards to go for a short time into a cold bath. He does not explain the principles of his practice. He approves in general of a milk-diet, but directs us to change it if a diarrhœa come on. The milk of asses or of goats is what he prefers. He approves of the Hippocratic tests of pus. Rhases describes several species of consumption. One of them he represents as being seated in the trachea. His account of the various modes of treatment is most ample. He strongly commends the milk of asses.
Galen, Rhases, and most of the ancient authorities held that consumption is contagious. See, further, Aristotle (Prob. 7), and Isocrates (Æginet.) Alexander Aphrodisiensis accounts for the propagation of the disease by supposing that putrid matter is conveyed from the lungs of the affected person to others. (Prob. ii, 42.)
The historian Sallust uses the word tabes as synonymous with contagium, in the following sentence: “Tanta vis morbi, uti tabes, plerosque civium animos invaserat.” (Catalin. 36.) Livy does the same in several places. (See ii, 23.)
Pleurisy, properly so called, is an inflammation of the membrane which lines the ribs, and is attended with difficulty of breathing, cough, continual fever, and pain shooting to the clavicle and hypochondrium. You may distinguish pleurisy from inflammation of the liver (for in it there are all these symptoms), by the pain in pleurisy being pungent, and the cough being sometimes without expectoration (when it indicates that the disease is not yet concocted), and sometimes with expectoration, the appearance of which indicates the nature of the humour that occasions the complaint; for it is red and tinged with blood when a fulness of blood is the cause; yellow and palish when caused by yellow bile; white and frothy when from phlegm; and blackish when from the melancholic humour. And the pulse is hard and serrated. But, in inflammation of the liver, the pain is not pungent, nor is the pulse so hard; and the cough throughout is dry and without expectoration, and the face appears paler. Pleurisies from inflammation of the external muscles (which are not, properly speaking, pleurisies) are not accompanied with cough and expectoration, nor is the pulse hard; and if one touch the part affected with his hand, the patients feel pain; and if not resolved, the swelling is converted into pus, which may be evacuated externally by an incision; whereas pleurisy from inflammation of the membrane which lines the chest has not this termination; for if it do not discharge the empyema either internally or externally, it terminates in peripneumonia.
The cure. If the pain shoot to the clavicle, we must straightway open a vein; or if to the hypochondrium, we must purge downwards. Physicians of late, in all cases, have recourse to venesection, apprehending, I suppose, the disturbance occasioned by purging. When the strength prevents us from having recourse to either of these remedies, we must use stimulant clysters; and if the pain is moderate, after the clyster we may give honied water, and the juice of ptisan and of chondrus. When the affection is on the decline, we may add to the juices leeks or calamint, and the patient may get the seeds of pennyroyal and nettle, with honey, as a linctus. When the pains are violent after the evacuation, they must be soothed by the application of hot wool, or of sulphurated wool; or by fomentations of millet and flour in a bag, or by means of hot water or oil in a bladder. Unwashed wool may be applied with oil; and wine, containing an admixture of sea-water, or salt, may be added to it. Or we may apply a cataplasm, formed of the medicine from seeds, with the decoction of chamomile and marshmallows, or of dried figs, iris, wormwood, and some honey, with oil of nard. About the fourth day give spoon-meats for food, with some honey; but after the seventh day we are to give a linctus of almonds and nettle-seeds, triturated in honey, or the linctus of butter and honey pounded together. And we are to use the hypoglottis (electuary) of boiled honey. And we must apply to the affected parts the fetid epitheme—that from sweet marjoram, and the rue-plaster. The bulbi, applied with axunge, are often an effectual remedy, and they may also be administered in a clyster with butter and turpentine. Among the most powerful remedies is the linctus from pine-nuts and bitter almonds, linseed, pitch-fruit, and starch, in equal parts, with honey. When they are troubled with insomnolency, it will be proper to give a linctus of poppy-heads; and we may use the antidote called athanasia, and those prepared for this purpose. When the disease remains after the fourteenth day, we must cup them, and keep them upon a spare diet; and then, when the disease is on the decline, we may make them take the bath (but avoiding the cold), and allow them to use a more nutritious diet. If the inflammation of the pleura be not resolved, but appear to be converted into pus, we must have recourse to the remedies formerly mentioned.
For pains of the sides without fever. Pains of the sides without fever are cured by bdellium and costus, mixed with the ashes of burnt cabbage-leaves and tallow: for this remedy is powerfully discutient.
Commentary. See Hippocrates (de Morbis, ii; de Rat. Vict. in Acut.); Galen (de Med. sec. loc. vii, et alibi); Celsus (iv, 6); Aretæus (Morb. Acut. i, 10; Curat. Morb. Acut. i, 10); Aëtius (viii, 76); Psellus (Op. Medicum); Alexander (vi, 1); Oribasius (Synops. ix, 7, 8); Actuarius (Meth. Med. iv, 4); Nonnus (129); Cælius Aurelianus (Morb. Acut. ii, 13); Octavius Horatianus (ii, 4); Marcellus (de Medicam. 24); Serapion (ii, 21); Mesue (de Ægrit. Pect. 7); Avicenna (iii, 10, 4); Alsaharavius (Pract. xii, 8); Avenzoar (i, 16, 4); Haly Abbas (Theor. ix, 21; Pract. vi, 13); Rhases (Divis. 54; Contin. x.)
Hippocrates gives brief descriptions of pleurisy, and recommends nearly the same treatment that is now practised, namely, bleeding ad deliquium animi, purging, diluent drinks, and fomentations to the side by means of sponges squeezed out of hot water, or of bags filled with salts and millet, or the like. He says, those who have neither been bled nor purged die on the seventh day, either with delirium, or with orthopnœa and a râle. One of his aphorisms is, that pneumonia supervening upon pleurisy is dangerous. (vii, 11.) He was acquainted with pulmonary adhesions, as is remarked by his devoted admirer Laennec.
Aretæus, with his usual accuracy, gives a most complete description of all the symptoms of pleurisy, but, as it is not much different from our author’s, we shall not enter far upon a detail of it. He states distinctly that the disease is an inflammation of the membrane which lines the chest. The sputa are pituitous, bilious, or deeply saturated with blood, or yellowish. He remarks, by the way, that pleurisy is sometimes a sporadic disease, and sometimes epidemical. His directions about the application of the common remedies are dictated by his usual excellent judgment. On the necessity of early and repeated venesection he insists strongly, but recommends it not to be carried the length of producing deliquium animi, as the fluids will thereby be determined inwardly. Archigenes (ap. Aëtium) and other ancient authorities joined him in this rule of practice, although in opposition to Hippocrates. He approves of cupping the side, but not until after the seventh day, and directs us to apply to the scarifications salts or nitre. His internal remedies consist of demulcents, diluents, and narcotics, varied according to circumstances. He forbids the use of cold drink and cold air. Celsus also cautions against cold, and directs sinapisms to the chest. His general treatment is nothing different from that of Hippocrates.
Galen treats of pleurisy cursorily in many parts of his works, but, as he follows entirely the views of Hippocrates, we need not enter into a detail of his practice. We may mention, however, that the worst character of the pulse, according to him, is when it is hard, small, and very frequent. (Diff. Puls. iv, 5.)
Aëtius gives an interesting account of a species of pleurisy arising from indigestion or crudities of the stomach. In this case he forbids venesection, and recommends clysters and calefacient applications.
Alexander gives very minute directions how to distinguish pleurisy from hepatitis. He remarks that, in the latter disease, the patient is yellowish: in the former the pulse is hard and serrated. When the pain is not violent, he recommends us to trust to cupping, which he says was a popular remedy in Armenia. He disapproves in general of opiates. When the discharges from the bowels are bilious, he directs purging with scammony, black hellebore, and the like. According to Actuarius, the urine in pleurisy is first reddish, and afterwards becomes red and of a dark wine colour. (De Urinis, vii, 9.) The sputa, he says, in pleurisy and pneumonia, is of a whitish and bloody colour. (De Diagnos. i, 16.)
Psellus cautions us not to confound pleurisy with abscess of the side. In the latter case, he remarks, there is no cough, and pain is felt upon pressure. He appears to copy from Paulus.
There is nothing particularly original in the accounts given of it by Oribasius, Nonnus, Octavius, and Marcellus. We shall, therefore, proceed to explain the views of the Methodists. The remedies recommended by Cælius Aurelianus are, upon the whole, nearly the same as those directed by the other sects, but he attaches much importance to his own method of applying them. In illustration of his principles, we shall mention a few of his strictures upon the practice of the others. He condemns Hippocrates for carrying venesection the length of producing deliquium animi, which he pronounces to be a very pernicious practice. Indiscriminate purging, he thinks, increases irritation. He disapproves of abstinence for seven days, as enjoined by the father of medicine. Diocles he blames for enjoining the same rules with regard to bleeding and purging, and for allowing cold food in summer. Praxagoras he strongly and properly condemns for giving pepper or southernwood in mulse; and also for recommending the warm bath, and fomentations to the side, which he justly remarks will only occasion cold to the patient; and for prohibiting venesection, when the disease is occasioned by cold, and the patient is old and weak. He finds fault with Asclepiades for saying that venesection is not proper in certain countries, as at Rome and Athens, whereas Cælius properly maintains that venesection is everywhere proper. It is worthy of remark, by the way, that prejudices against bleeding prevailed in Rome when Galen wrote, and to a certain extent do so still. Cælius also justly condemns his too free allowance of mulse, or wine and honey. He blames Themison for using acrid applications to the chest. Of his strictures on the treatment of Heraclides, the most just are his condemnation of the practice of giving mulse with rue, and garlic with vinegar, to remove the nausea; and of his direction to bleed only on the second day after two or three clysters had been given.
Of the practice of the Arabians little need be said, as their views of treatment are entirely conformable to those of the Greeks. Avicenna’s directions are most minute, and would furnish an excellent guide to practice. He forbids cold things, and approves of cupping and sinapisms only when the disease does not yield to the ordinary treatment. When insomnolency continues long, he permits to give the syrup of poppies. Convalescents are directed to avoid saltish and sharp things, repletion, the sun, wind, smoke, loud talking, and the like. Serapion, on the fourth day, adds liquorice to the decoction of barley. Mesue and Avicenna agree in opinion, that fomentations to the side do no good unless in slight cases, and when applied early. Mesue forbids cupping until the seventh day; and, when the stomach and bowels are loaded, he opens the bowels before bleeding. Haly Abbas directs bleeding from the arm opposite the side affected, at first; but, if the disease is protracted, from the arm of the same side. He recommends gentle laxatives, and, after bleeding and purging, warm applications to the side, such as a bladder half filled with hot water. He also speaks of cupping, and of stimulant plasters, sinapisms, and such like. He says, when the body is cleansed, and the disease matured, the patient is to be put into a tepid bath. This practice may deserve consideration.
It is worthy of remark that the Arabians in general bleed from the arm of the opposite side. The Greek and Latin authorities are divided in opinion upon this rule of practice. Hippocrates, Galen, and Celsus recommend us to bleed from the arm of the affected side; but Aretæus, Aëtius, and Cælius Aurelianus, from the opposite. Galen, in one place, mentions that he had abstracted blood in a case of pleurisy by opening one of the arteries of the hand.
When the heart itself is primarily affected, the case is far beyond all medical aid, occasioning sudden death; and so also in the inflammations and erysipelas of it, strong distemperatures in very acute fevers, and hemorrhages when it is wounded, especially in the left ventricle. When it is affected sympathetically with the brain, the liver, the orifice of the stomach, and from sorrow, fear, and many other causes, it brings on the affection called syncope, being a sudden collapse of the vital powers, indicated by prostration of strength, deliquium animi, a small pulse, coldness of the extremities, and copious perspiration. When this affection is of a violent nature, it also is irremediable; but if the strength stands out, it may sometimes be relieved. But strong palpitations of the heart often arise from a fulness or effervescence of its blood. When, therefore, the heart is over-heated, it renders the respiration large and dense; but when it is too cold, the respiration is small and rare. The complete cure of syncope of the heart, when it occurs among the symptoms of fever, we have treated of in the Second Book. This only may now be added, that when the collapse gains ground after friction and ointments have been applied to the extremities, and after purification of the floor, and other cooling means, we must sprinkle upon the parts of the body which are sweating powdered myrtle, Cimolian earth, or amber, or pomegranate-rind with manna, or Samian earth with gum; and cataplasms of mustard or pellitory, or adarce, are to be applied to the cold extremities, as far as to the groins and armpits. The food should be bread out of water, or out of cold diluted wine, swines’ feet and the joints and snout, and fowls; all the things being given in a cold state. On the head and forehead is to be rubbed the juice of unripe olives, or some astringent application, with gum, and the decoction of roses; and a cataplasm is to be applied to the hypochondria and stomach, formed from dates, roses, the flower of the wild vine, acacia, hypocistis, and alum.
On palpitation of the heart. “I knew a certain person,” says Galen, “who suffered an attack of palpitation of the heart every year in the season of spring. Wherefore, having for three years experienced benefit from venesection, in the fourth he anticipated the attack by getting bled, and escaped from it, and did so for many years afterwards, using at the same time a suitable diet. And yet even he died before attaining old age, as every other person in this complaint does, some being suddenly cut off in acute fevers by syncope; but some of them without syncope, being unexpectedly deprived of life, as if by apoplexy. The majority of those who are thus affected do not reach the fiftieth year of age, but pass the fortieth.”
Commentary. See Galen (de Loc. Affect.); Aëtius (viii, 58); Oribasius (Synops. ix, 6); Actuarius (Meth. Med. iv, 3); Leo (iv, 21); Nonnus (134); Avicenna (iii, 11, 12); Serapion (ii, 27); Avenzoar, (1, 12); Mesue (de Ægrit. Pect.); Haly Abbas (Theor. ix, 22, and Pract. vi, 16); Alsaharavius (Pract. xiii); Rhases (Divis. i, 58, and Contin. xvi.)
Most of the knowledge which the ancients possessed of these obscure complaints may be found in Galen (l. c.) In the body of a monkey he had remarked hydrops pericardii, and in that of a cock he had detected a scirrhous tumour, from which he inferred that these diseases occur also in the human subject. One would almost suspect, however, that the ancients were more familiar with inspectiones cadaverum than they chose to avow. As a proof of this, we may mention what is related by Hesychius of Hermogenes the rhetorician: “Hermogenes the rhetorician having died was dissected, and his heart was found covered with hair, and greatly exceeding its natural size.” (See also Suidas.) Respecting persons having hair on their hearts we quote the following note from Fabricius (Bibliotheca Græca, iv, 429): “Plura exempla hominum quorum cor pilosum est repertum collegit elegantissimus. Muretus (xii, 10, Var. Lect.); Pontanus (Bellar. Attic. 301), et Alexander Tassonus in libro Italicè edito cui titulus Pensieri Diversi, (vi, 30.) De Aristomene Messenio idem tradit præter alios Dio. Chrysost. (xxxv, 430) de Leonida Plutarchus in parallelis minoribus (306.)” It is proper to mention, however, that Senac is incredulous as to the truth of these stories (Essai, &c. 62.) On the subject we are treating of the learned Stephen Bernard has the following remark: “Apparet, ni fallor, ex hoc loco Pauli (iii, 68), veteres morborum sedes in cadaveribus rimari non neglexisse quod etiam patet ex illis quæ de hepatis inflammatione habet (181), qui enim scire poterant aliquando partem ejus cavam, nonnunquam vero gibbam inflammatione tentari nisi ex cadaverum inspectione?” (Ad Nonni Epit. 208.) See also Pliny (Hist. Nat. xi, 70), and the note of Harduin.
Since all the writers subsequent to Galen merely copy from him, we need not say more of their opinions. We may state, however, what Actuarius says regarding the characters of the urine in affections of the heart. In hot intemperaments of the organ the urine at first is more acrid and thinner, but as the disorder increases, it assumes an oily colour and consistence. The sediments become grumous, furfuraceous, scaly, and gritty. When it is affected with a cold intemperament, the colour of the urine is whiter, and the sediment at first moderate and crude, but afterwards it becomes black. (De Urin. vii, 4.)
The Arabians, especially Avicenna, treat of these complaints at great length, but without supplying much additional information. Avenzoar speaks obscurely of certain tumours resembling pellicles or cartilages on the pericardium. He mentions also hydrops pericardii, and abscess of the same. Pain of the heart, says Haly Abbas, may arise from an intemperament, organic disease, or a solution of continuity. The last two causes soon occasion death. He mentions that palpitation may be occasioned by dropsy of the pericardium. He recommends bleeding in cases of palpitation, upon the authority of Galen, and also things of a cold nature, such as seeds of cucumbers, citrons, gourds, roses, and camphor. Alsaharavius gives a similar account of these affections. Rhases also approves of venesection and cold applications. He mentions that palpitation is sometimes felt in the region of the stomach, for which he recommends bitters, such as wormwood.
The disease which Galen and his followers describe under the name of palpitation was no doubt that state of the heart now called hypertrophy with dilatation. In confirmation of the truth of Galen’s prognosis, we may quote the words of the celebrated translator of Laennec, as to the issue of the disease of the heart we have mentioned: “Such persons however are marked for destruction. After a certain time the disease obtains the mastery, and brings the strong man down, the sooner, alas! for the bold resistance made to his dominion.” (English Translation of Laennec, p. 62.)
After childbirth, the milk frequently being converted into cheese in the breasts, produces inflammations. Wherefore at first we may use these applications: Having squeezed a soft sponge out of tepid oxycrate, apply it to the breasts, and bind it on in the proper form; or use dates triturated in oxycrate with bread, or a whole egg with rose-oil and some cerate; or alum, fleawort, with coriander and purslain, may be applied in the form of a cataplasm; or apply the firestone triturated with cerate, and bind it on. When there is distension or thrombus in the part, apply a cataplasm of bread with water and honey, or with wine and honey; or bread with the green herb perdicias (pellitory of the wall?), along with cerate twice a-day; or bean-flour with hydromel, or sodden must. But if they cannot bear the weight we must use an embrocation of hot sweet oil by means of soft wool. But we must foment them with the steam of hot water, or a decoction of fenugreek, or of marshmallows, or of linseed. And we are to apply to them a cataplasm made of fine flour with linseed, or fenugreek with hydromel, or sesame with honey, or pounded butter. But we must interdict sucking of the breasts, because it only attracts more milk to them. When the inflammation is on the decline we may apply the following cerates: Boil beet in oil until it is softened, throw it away, but add to the oil a moderate quantity of wax, and use.—Another: Mix the red parts of ten raw eggs in a cerate consisting of wax, oz. iiss, and of rose-oil, oz. iv; stir with a spatula, and add as much salt water as it can receive, and then again stir with a spatula, and use. For hardness of the breasts, the composition from honey is applicable, and all emollient applications. When the swelling is converted into pus, we must use those applications which have been mentioned for parotis, and those that will be mentioned afterwards for apostemes.
From Archigenes, for spreading ulcers of the breasts attended with malignity. Of good Adriatic wine, xx sextarii; of the sumach, lb. j; of cypress balls, lb. j; of black galls, called omphacitæ, oz. vj; of cassia, oz. vj; when bruised, macerate in wine for ten days, then boil down to one half, stirring with a cypress spatula; then throw away the herbs; and when the juice is boiled to the consistence of honey, lay it up in a glass vessel. Use it for spreading ulcers, undiluted, or, if it is too thick, let it be diluted with wine. It is so made as to apply to spreading ulcers in the breasts, to runnings of the ears, foul defluxions from the gums, and dysentery. When diluted with milk it acts as a paregoric in soothing pain. Other kinds of ulceration of the breasts must be treated like ulcers in general.
Preservatives of the breasts. Having pounded cumin with water, apply to the nipples, then lay upon the breasts a sponge squeezed out of oxymel, and bind it with a bandage. After three days, having taken away the cumin, put on a cataplasm of the bulbous roots of the lily upon the nipples, and having bandaged it let it remain again for three days, and do the same three times a month.—Another: Apply powdered hemlock for nine days, and the sponge externally, as mentioned above; and after an interval of a few days repeat the same. The rubbings from the Naxian whetstone act as a preservative of the breasts of virgins.
Commentary. See Oribasius (Synops. ix, 9); Aëtius (xvi, 35); Nonnus (151); Scribonius Largus (102); Avicenna (iii, 12); Haly Abbas (Theor. ix, 40; Pract. viii, 29); Alsaharavius (Pract. xiv); and Rhases (Contin. xv.)
A considerable part of this Section is copied from Oribasius. Aëtius, however, has treated of these complaints more fully than any other author. He gives from Philumenus various prescriptions for inflamed breasts, the most important ingredients in which seem to be ceruse and litharge, with wax or honey. One of them also contains the recent leaves of henbane, evidently for the purpose of allaying pain. For indurated mammæ he directs linseed, or the seed of fenugreek with hydromel to be applied. In short, his applications and our author’s are very similar. He describes a certain induration of the mamma under the name of chondriasis. This affection is alluded to by Aristotle (H. A. vi, 20.) When an abscess forms, he recommends us to open it and evacuate the pus. Nonnus, as usual, copies from our author.
Avicenna treats fully of these complaints, but his remedies are mostly borrowed from the Greeks. The most simple of his applications for apostemes of the breasts is a sponge squeezed out of tepid vinegar and water. Haly Abbas recommends the same, or a plaster of the oil of roses, bread, and the yelk of an egg. When suppuration is expected, he directs us to apply a cataplasm of figs. Alsaharavius treats minutely of this subject. When pain of the breast arises from coagulated milk, he recommends a piece of cloth soaked in warm water or vinegar. When milk cannot be extracted from the breasts, he directs them to be sucked by means of a suitable instrument shaped like a nipple. To dispel coagulated milk Rhases recommends a mixture of hot vinegar and rose-oil. He also recommends a composition of mint and common salt.
Of liquid alum, p. ij; of myrrh, p. j; dissolve in wine, and use.—Another: Plunge heated Molybdæna into fragrant wine, triturate with the wine, adding a little myrrh until it become of the thickness of the sordes in baths, then use. Another: Of litharge, dr. xvj; of myrrh, dr. ij; of amomum, dr. j; mix with wine.—Another: Of liquid alum, dr. viij; of amomum, of myrrh, and of spikenard, of each, dr. iv; triturate with wine, and use.
Commentary. See in particular Oribasius (Synops. viii, 36); Nonnus (155); Geopon. (xii, 26); Alsaharavius (Pract. xv); Rhases (ad Mansor. v, 51, and Contin. xxxvi.)
All the authorities concur in recommending for the cure of this complaint, a combination of astringents with aromatics. They therefore direct us to mix alum with storax, myrrh, and the like. Rhases recommends tutty with rose-water and camphor, and also various astringent and odoriferous liniments. The plan of treatment directed by Alsaharavius is deserving of attention. He recommends purging with the hiera picra. Alsaharavius further recommends a bath in which mint, marjoram, centaury, spikenard, and the like have been boiled. The part is afterwards to be rubbed with an ointment, consisting of litharge or tutty, mixed with alum, myrrh, &c. in fragrant wine.
The ancients believed that living freely upon figs rendered the perspiration fetid. Eustathius, the commentator on Homer, makes mention of two Sophists, called Anchimolus and Mochus, who lived solely upon figs for food, and water for drink; and he adds that their perspiration was so fetid, that when in the bath everybody shunned them. (Ad Iliad. xiii, 6.)
Those complaints which occur in fevers, such as loathing of food, bulimia, the canine appetite, atony of the stomach, deliquium animi, thirst, hiccough, nausea, and syncope, have been treated of sufficiently in the Second Book, and it would be out of place to say more about them. But inflammations of the orifice of the stomach and of the liver require the admixture of astringents; for, if treated by the relaxant method alone, it will prove dangerous. It will be necessary, then, whether oil be affused on the part or a cataplasm be applied, to add some of the astringents to it, such as wormwood or the nard ointment; or that of apples, or of quinces may be boiled in it. The following is a cerate which we frequently use: Of white wax, oz. j, (but if in summer, dr. vij); of aloes and mastich, of each, dr. j; add of the oil of unripe olives, or of apples and of nard, when going to use it, as much as will be sufficient to give it consistence. Or, if the stomach require greater astringency, as not being able to retain the food, mix also of oil of unripe olives, dr. j; or of the juice of wormwood an equal quantity; and, thirdly, of the juice of hypocistis, of wild vine, and of sumach. We must make the quantity of the cerate proportionate to the number of the other medicines. When the inflammation becomes protracted and hard, we must apply more complicated remedies, containing aromatic, emollient, and discutient ingredients, such as that prepared from melilot, the philagrianum, and the fragrant. And a necklace of green jasper appended from the neck, so as to touch the stomach, is of great use. In hot intemperaments of the stomach, or ardent affections of it with prostration or deliquium animi, or anorexia from any other cause than fever, give cold water with the juice of unripe grapes, or the decoction of quinces, or of vine shoots, or the powdered seed of cucumber with cold water. Apply to the stomach a bladder filled with cold water, or the shavings of gourd. And the pills called Adipsa are to be given, as described when treating of thirst. The following medicine is proper for cooling and strengthening a watery stomach: Of green rose-leaves, dr. vj; of liquorice juice, dr. iv, mix with sweet wine, and make into an electuary, to be allowed to melt under the tongue. When, on account of a gross phlegm, medicines are required to heat and incise it, the following one will be useful: Of the rind of fennel-root, oz. ij; of vinegar, a sextarius and a half; of aloes, oz. iij; of honey, lb. iv; the roots being boiled in the vinegar, are to be squeezed out and thrown away, and honey being added, it is to be boiled to a proper consistence, and then powdered aloes sprinkled upon it. Give three spoonfuls of it with water. Some prepare it without the aloes. The composition from calamint is also proper for such cases. When the food turns acid on the stomach, give in water for drink a drachm of coriander seed sprinkled upon it like polenta, or one spoonful of mastich, or two spoonfuls of the seed of the white lettuce. The following is a compound medicine: Of pepper, dr. j; of the seeds of dill, dr. iij; of cumin, dr. iv; triturate, and give at bedtime one spoonful in diluted wine. Those who form black bile, and have the stomach inflated, may, during the exacerbations, apply to it sponges soaked in the strongest vinegar, after which, if the complaints continue, alum with pulverized copper may be added to honey, and applied. Let them drink the juice of endive, or let mint be sprinkled upon the draught. When the stomach is inflated and distended, mix a moderate quantity of honey and pepper with the decoction of calamint, and give. For subversion of the stomach, take of the juice of the kernels of the unripe pomegranate, p. iij; of the juice of mint, p. j; boil until it thicken, and give a mystrum (two spoonfuls?) of it before a meal.
For salivation of the stomach. Rinse the mouth with vinegar of squills, the sauce of pickled olives, or the decoction of the green leaves. Or a very small quantity of the same may be swallowed. A still more effectual remedy is aloes dissolved in water. For those who cannot retain their food (who were particularly called stomachics by the ancients), mix with honey the flour of fenugreek and the dried seed of mallows in powder, and apply. The cerate consisting of wax, the lees of oil of iris, and castor, is also proper.
On anorexia. Anorexia is a loathing of food, either from the prevalence of an intemperament in the stomach, or a collection of humours. You may know a hot intemperament by the thirst, by the fetid and feculent eructations if compelled to take food, and from the circumstance that cold and intractable substances are most easily digested; and a cold by the opposite, for they neither have thirst, nor can they endure cold things, and they have sometimes acid eructations. Of those who have anorexia from humours, they who suffer from thin and sharp humours, have gnawing pain at the stomach, and are more affected with nausea and thirst. When the humours become putrid, they sometimes have fever. When they suffer from thick and viscid humours, these for the most part neither occasion acute pain nor thirst, but the common symptom of all these cases is nausea. Wherefore, if the humours are contained in the cavity of the stomach, they vomit them up; but, if they are absorbed and infarcted in its coats, they have nausea only, but do not vomit, unless it be when they have taken food. Those, therefore, who have anorexia from a hot intemperament, should take cooling things for diet, more especially such as are prepared from vinegar. Wherefore give them bread that has been soaked in oxycrate, or oxycrate itself to drink, and oxygal (vinegar and milk), and that which is called melca by the Romans (it is a condiment from milk), endive, lettuces, and sometimes cold water: all these moderately, according to the degree of the prevailing intemperament; for the immoderate use of them is not only not beneficial, but often renders the complaint utterly incurable. When the affection is connected with coldness, it is to be cured by the opposite remedies; wherefore give to drink old wine and prepared wine, hydrogarum, and the decoction of anise, rue, and Macedonian parsley, and pepper, in hot common water; or the composition from the three peppers, or that from calamint. You may give also the theriac from vipers, which is also not inapplicable to those who loathe food from a collection of humours. Garlic, both as food and as medicine, is applicable to them. When the anorexia proceeds from a collection of humours, you may evacuate such as are thin and sharp, either by vomiting or purging downwards, and they may readily be made to vomit, by drinking beforehand tepid water, or hydromel diluted with a large quantity of water. But it will be better to give previously some moistening food, such as the juice of ptisan, or the yelks of eggs. How to produce easy vomiting has been explained in the First Book. But if the patient be hard to make vomit, it will be better to determine the matter downwards, having previously diluted their system by means of plenty of mild food. The cathartic medicine may either be the picra from aloes, that from quinces, which also admits of scammony, or that from rhodomel. If it be possible without the scammony to evacuate by a large dose of aloes, it will be better, because the scammony is bad for the stomach. When the anorexia proceeds from thick and viscid humours, you may cure them by attenuating and incisive remedies, such as oxymel, and the preparations from it and brine, as capers, olives, mustard, and the like. The remedies recommended for anorexia from a cold intemperament are not inapplicable to these, and more particularly after evacuation. You may evacuate them by the oxymel called Julian. Externally you must use those unguents and emollient ointments which have power to warm and strengthen the stomach, such in particular as that from the unripe grape, that called Marciatum, and all the common ointments; also such epithemes as the Baium, the fragrant, and the like. They ought particularly to have recourse to exercises and friction. When dyspepsia and anorexia arise from a cold and liquid humour, or such an intemperament, the medicines composed from quinces will be applicable to them, I mean that called meloplacuntion, that from the juice of apples, and that from the flesh of them, and that which is prepared from the citron. Also the malagmata or emollient unguents, such as the Marciatum, that from the juice of the unripe grape, the Baium, Polyarchium, and such like. When there is an ulcer in the stomach or bowels, the patient must abstain from all acrid food and drink, and use remedies of a soothing nature, such as draughts without oil, and those from starch, Samian earth, Lemnian earth, and milk, or a small quantity of honey, so as to purge without griping. A convenient epitheme is prepared from dates, the flour of quinces, and a cerate from quince-ointment, or rose-oil with ammoniac and frankincense; and also the epitheme of Nileus, the plaster from willows, and the Icesian may be used. You may know that an ulcer exists by blood, pus, or the scabs of a sore being vomited up.
For those whose stomachs are enervated and in a state of atony, and who, for that reason, do not digest their food, or vomit it up. Of aloes, of masucha, of mastich, of storax, of each, oz. ij; of wormwood, oz. iv; of the flowers of the wild vine, oz. iij; of Gleucine oil, oz. vj; of quince-ointment, oz. iij; of wine, q. s. Some also add of cyphi and roses, of each, oz. ij. These things, being powdered, are received upon purple or wool, and applied to the stomach. But some, by adding of wax, oz. vj, make an epitheme of it.
For iliac affections of the stomach, that is, strong and spasmodic pains. The trochisk of the Amazonians is the best medicine in this case. An account of it, and of the ingredients which enter into the composition of other compound remedies for the stomach, you will find in the last Book, where Compound Medicines are treated of.
Commentary. See Aretæus (Morb. Chron. ii, 8); Cælius Aurelianus (Pass. Tard. iii, 2); Celsus (iv, 5); Galen (de Med. sec. loc. vi); Oribasius (Synop. ix, 10); Aëtius (ix, 1); Alexander (vii, 5); Actuarius (Meth. Med. iv, 5); Octavius Horatianus (ii, 16); Marcellus (de Med. 20); Avicenna (iii, 13, 1, 2, 3); Serapion (i, 1); Avenzoar (i, 15); Averrhoes (Collig. v, 54); Haly Abbas (Pract. vii, 2, Theor. ix, 24); Alsaharavius (Pract. 16); Rhases (Divis. 59, Contin. xi.)
To all these authors, almost every one of whom has treated of these complaints more fully than Paulus, or upon a different plan, it is quite impossible for us to do justice within the narrow limits to which we confine ourselves in these annotations. We shall, therefore, direct our attention principally to Celsus, and merely add a few remarks from the others. The stomach, he says, is affected by great heat, inflation, inflammation, and ulceration; by phlegm or bile; and by resolution, which is a common and fatal complaint. Heat is to be cured by cold external applications, such as vinegar and roses, along with cold drink. Inflation we shall see treated of in the next Section. Inflammation which is attended with pain is to be treated by rest, abstinence, sulphurated wool, and wormwood, when fasting. If attended with ardor, he prescribes cold and repellent applications, occasionally exercise, and a fuller diet. Ulceration is to be cured by exercise, friction of the extremities, smooth and glutinous food, and avoiding every thing that is acid and acrid. Redundance of phlegm is to be treated by emetics, exercise, friction, hot drink, and hot food. When bile prevails he recommends laxatives, potions of wormwood, gestation, or a sea-voyage; emetics, if they can be conveniently borne, and suitable food, so as to avoid indigestion. Resolution, he says, is a severe affection of the stomach, when it cannot retain the food, and the body wastes. The bath, he says, is useless, but exercise of the upper parts of the body peculiarly proper. He recommends pouring cold water on the stomach, swimming in the same, and living on cold food, rather such as is difficult to digest than what will readily spoil on the stomach. Hence, he says, some digest beef. Undiluted austere wine, either cold or very hot, is proper. If there is vomiting with pain, he directs us to apply over the stomach, wool or sponge soaked in vinegar, or cold cataplasms; or, if the pain be more severe, a cupping-instrument; then bread which has been steeped in cold diluted wine is to be given. If this is not retained, some smooth article of food not disagreeable to the stomach is to be administered; and, if this be not retained, a cupful of wine is to be taken every hour until the stomach becomes settled. He also praises an acid mixture, containing pomegranate, endive, &c.
Aretæus gives a lively description of the feelings of a dyspeptic. The student who, heedless of the allurements of the senses and of the ties of nature, follows his divine pursuits with indiscreet ardour, and neglects to take proper food and exercise, is said to be particularly liable to affection of the stomach. The cure, he says, is to be effected by gestation, vociferation, a suitable diet, and indulgence of the patient’s caprices as far as possible. Wormwood, ginger, aloes, and mastich are also proper.
Alexander properly remarks that disorder of the stomach affects sympathetically the heart and brain. He treats fully of inflammation of the stomach, for which he directs us to give relaxants and tonics, such as wormwood and mastich. He further recommends the application of a plaster, composed of emollient and stimulant ingredients, such as wax, turpentine, ginger, opopanax, &c. It is singular that he and most of the ancient authorities have omitted to mention venesection for this complaint. We therefore entertain some doubts whether they meant by it the gastritis of modern Nosologists, which, by the by, is of so rare occurrence, that some late writers of high name are of opinion that it never occurs spontaneously. (See Christison on Poisons.) Some of the ancient authors, however, do recommend venesection in this complaint, as for example, Serapion, Rhases, Avicenna, and Haly Abbas. Horatianus recommends the same for sudden pains of the stomach. Cælius Aurelianus, while treating in general terms of stomach complaints, recommends bleeding, “si in vehementiam passio venerit.” He also prescribes cupping and leeching. His account of these affections is highly interesting, but so circumstantial that we dare not venture even upon an abridgment of it. Haly Abbas speaks of the inflammation ending in suppuration. To Alsaharavius we particularly invite attention. Rhases gives a copious statement of the opinions of all preceding authorities on this subject.
The formation of flatus in the stomach arises from the juices or food being dissolved into vapours by a gentle heat. For cold, as it is not of an attenuating and dissolving nature, does not engender flatulence; whilst a violent heat not only attenuates, but likewise dissipates, and thus prevents the formation of flatulence. But a lesser degree of heat dissolves and changes the food, but not sufficiently, and hence flatus is gendered. Wherefore we must attenuate them by calefacient medicines—boiling in oil the seed of cumin, of parsley, of cow-parsnip, and of carrot. When the affection partakes of cold, you may boil rue, bay-berries, gith, and fennel in the oil, and mix bitumen and oil of bays. But if the pain be attended with inflammation, instead of calefacients, you may use relaxants, making a decoction of dill, and mixing with it the fat of a cock and of a goose. Those who have flatulence may be relieved by the decoction of a fasciculus of poley, or a decoction of calamint, having a small quantity of honey and a drachm of pepper mixed with it. These remedies must be applied when the pain is violent; but if it is moderate, fomentations from millet will be sufficient. But a large cupping-instrument that will comprehend the navel often removes the symptom at once. Castor also is of use to them, when taken in a draught with oxycrate, and when applied externally with Sicyonian oil; and it also cures flatulence when attended with tormina. But the ankles of a swine burnt, and taken in a draught, cure tormina and flatulence; and the round birthwort does the same. Pains from obstructions of the bowels, or flatulence arising from thickness of the humours, or from cold, are relieved by drinking undiluted wine after food; and, if sleep follow, it completely removes these complaints.
Commentary. See all the authors referred to in the preceding Section.
Our author’s treatment, which consists of dry cupping, dry fomentations, and the internal use of calefacients and wine, is what Celsus also recommends. He likewise speaks favorably of exercising the upper parts of the body, of friction, and of using purgatives occasionally, and sometimes, though rarely, the bath. Serapion, Rhases, and Avicenna, recommend similar treatment, namely, purgatives and aromatics, such as aloes, anise, calamint, cumin, and the like. Haly Abbas forbids all flatulent food, such as pulse, milk, and grapes; recommends the bath after much exercise, and before dinner, and the stomach to be rubbed, and a cataplasm of salt and cumin applied to it. He also prescribes many calefacient and carminative articles, such as anise, rue, castor with old wine, also the peppers, theriac, mithridate, hiera picra, &c. Alsaharavius recommends aromatics and carminatives, and afterwards that the pit of the stomach should be rubbed with calefacient oils. Averrhoes directs us to give all solid food, as flesh, puddings, &c. quite cold; but spoon-meats may be eaten as warm as the blood or somewhat warmer. This method, he adds, will clear the head and stomach of wind, beget finer blood, brisker spirits, and cause a lively circulation of all the humours.
Rhases and Avicenna describe ulceration of the stomach very accurately, and also thickening of its coats.
Avicenna mentions rupture of the stomach, but does not say whether he alludes to spontaneous rupture or rupture from accident.
Actuarius has given a more distinct account of hæmatemesis than any other of the ancient authorities. He says the blood may be brought up either pure or of a dark colour, and it may be occasioned either by external injuries or proceed from constitutional causes. The constitutional causes are commonly either general plethora or atony of the liver. In certain cases, he says, it proceeds from rupture of the vessels, and in others from relaxation of them, in others again from corrosion. In melæna, he says, the skin is pale. (De Diagnos. i, 39.)
Cholera is an immoderate disorder of the belly, with discharges upwards and downwards, arising from continued indigestion of the food. Persons are affected with indigestion sometimes from the badness of their food, and sometimes owing to a redundance of depraved humours. Wherefore, if the patient be seized with nausea and lancinating pains, while the food remains in the stomach undigested, we must order him to drink tepid water, and to produce vomiting by putting his fingers or feathers down the throat. We must also encourage the discharge by the bowels. After the evacuation of the superfluities, he must take rest, and apply warmth to the hypochondrium, by means of sweet oil, with some wine; or by the oil of mastich, or of spikenard, if it is winter: and he must be allowed to sleep. After digestion has been accomplished, let him have recourse to baths and wholesome food. When the discharge is immoderate, it will be sufficient at first to try those things which are mentioned in the Second Book for disorder of the belly. But when the discharge continues, and the belly loses its tone, and the pulse gets small and dense, we must apply a cataplasm of dates, with flowers of wild vine, acacia, the juice of hypocistis, and pomegranate rind. For drink, give a cupful of moderately cold water to swallow; or, what is still better, a decoction of roses, of the flowers of wild vine, of sumach, or of vine-shoots; or we may give the juice of an acid-sweet pomegranate, sprinkling upon it a little mint. When the excretions are more acrid, and heat and thirst come on, we must give the seed of cucumber, with three cupfuls of water; and succory and lettuces boiled in oxycrate are to be used for food. When the discharge cannot be stopped, we must administer some of the austere wines; if the patient be free of fever, the Palmatian, the Aminæan, or palm wine, or that from unripe grapes, with honey; but when he has fever, pomegranate wine, or myrtle wine, or Cibyratic hydromel for drink, and along with crumbs of bread, alica, or chondrus. If he loathes food from grain, he may chew some summer fruit, or medlars, pears, quinces, or pomegranates, but he must spit out the fleshy and hard parts. When he cannot retain the food, let a large dry-cupping instrument be fastened over the stomach, and while it is on let some of the afore-mentioned food be taken. For the spasmodic contractions apply to the muscles hot rags dipped in oil, and liquid cerates, containing some castor and Sicyonian oil; but before applying them let hot water be poured upon the legs. If he cannot get sleep, we must have recourse to the remedies recommended for watchfulness; and if his strength permit, he may take a potion from poppy-heads. When the disease is on the decline, he may be put into a bath, and recruited with chickens, pigeons, the feet of swine, or the like. Diarrhœa, being a corruption of the food, for the most part ceases spontaneously, if no more food be taken until after the complete digestion and evacuation of the corrupted matters; but if it continue, we must use the remedies applicable to cholera.
Commentary. Consult Hippocrates (Epidem. v, 4, et alibi); Galen (Comment., de Fac. Part., de Rat. Vict., de Med. sec. loc. viii); Aretæus (Morb. Acut. ii, 5; de Curat. M. A. ii, 4); Celsus (iv, 11); Alexander (vii, 16); Aëtius (ix, 12); Oribasius (Morb. Curat, iii, 11); Leo (v, 5); Actuarius (Meth. Med. iv, 5); Nonnus (164); Cassius Medicus (Problem.); Scribonius Largus; Cælius Aurelianus (Morb. Acut. iii, 19); Octavius Horatianus (ii, 16); Marcellus (30); Avicenna (iii, 16, 1); Serapion (iii, 14); Avenzoar (ii, 1); Alsaharavius (xvi, 20); Haly Abbas (Pract. vii, 14; Theor. ix, 25); Rhases (Divis. 60, Contin. xi; ad Mansor. ix.)
Hippocrates in his ‘Epidemics’ has given several well-detailed cases of cholera. In one, the patient drank hellebore in the juice of lentils, and vomited; he became cold, and was put into the hot hip-bath, where he regained his heat and recovered. In another place, he says that the disease is, for the most part, occasioned by unwholesome food, such as pork improperly boiled, pot-herbs, summer fruits, &c.
Aretæus defines cholera to be a retrograde movement of the matters in the body upon the stomach and intestines, consisting of a discharge upwards and downwards of bile, which, if the disease proves fatal, becomes black; and, at the same time, the extremities are cold, with profuse sweats, pulse small and dense, constant straining to vomit, and tenesmus. He also makes mention, among the symptoms, of spasms and contractions of the muscles in the legs and arms, borborygmi, tormina, and syncope. The complaint, he says, is occasioned by continued indigestion, and proves fatal by superinducing convulsions, suffocation, and retching. With regard to the treatment, he cautions us not to stop the discharge at first, but to encourage it by giving frequently some tepid water; and when attended with tormina and coldness of the feet, to apply to the belly hot oil of rue, and rub the legs to restore heat. When the fæces are all evacuated, he recommends some cold water to compose the stomach; and when the pulse sinks and becomes frequent, while at the same time there are profuse sweats and deliquium, he approves of adding a small quantity of wine to the water. It is to be of a fragrant and astringent kind, so as to strengthen the powers of the system. When all the symptoms get worse, when spasms of the legs occur, and the pulse becomes insensible, he advises us to give more wine and water. Should the vomiting continue, we must return to very hot drink and hot food, for, he remarks, the transition often proves beneficial. When all these fail, a cupping-instrument is to be put on between the shoulders or below the navel. He afterwards speaks of such applications as those recommended by our author, namely, calefacients applied to the belly, chest, and legs. He concludes with saying, that, if the symptoms, instead of improving, should get worse after this treatment, it will be proper for the physician to accelerate his retreat.
When cholera is not attended with fever, Galen approves of giving a piece of bread soaked in diluted wine, of cold drink, and of applying cupping-instruments to the belly. When the patient is strong, he even recommends the cold bath. He directs afterwards astringent food, and also speaks of clysters, old wine, and asses’ milk. He mentions with seeming approbation that Asclepiades gave tepid water at the commencement.
Celsus depends most upon tepid water, dry cupping, and sinapisms to the belly. In extreme cases, he prescribes a light fragrant wine diluted with water.
Alexander’s account is very minute, but little different from that of Aretæus. In certain cases, he permits poppies to remove insomnolency and wine to support the strength. Like Hippocrates, he describes correctly dry cholera. In this variety, which he attributes to a bilious humour, he recommends purging with scammony or the picra of aloes. But in particular he approves of friction and the application of strong ligatures to the extremities; to the arms and hands, when the evacuations are by the belly; and to the feet and legs, when by vomiting from the stomach.
Aëtius, Oribasius, Actuarius, and Nonnus treat of the disease in nearly the same terms as our author.
For cholera, Marcellus recommends various astringent remedies, both externally and internally. Myrtle-wine, he says, will stop the vomiting. He also commends opium.
Octavius Horatianus calls cholera “omnibus acutis ægritudinibus velocior.” Like the others, he recommends draughts of tepid water at the commencement, and wine and aromatics in extreme cases.
Cælius Aurelianus, with his accustomed accuracy, gives a complete history of the symptoms of this disease. The bile which is vomited, he says, is at first yellow, afterwards green, and at last black. His treatment is very similar to that of Aretæus, namely, tepid water at the commencement to facilitate vomiting, sponges out of cold water applied over the stomach, or else cupping-instruments with much heat; aromatics, bread soaked in wine, and the like. He condemns Hippocrates for sanctioning the giving of hellebore. He blames Diocles for recommending southernwood, which, he remarks, is a very harsh medicine; and also for allowing milk, which, he says, is apt to grow acid. He finds fault with Heraclides Tarentinus for trusting to opium and henbane.
Cassius Medicus accounts for the coldness of the extremities and contractions thereof upon the supposition that they are occasioned by the vital spirits having left them and been determined to the stomach.
There is nothing very original in the works of the Arabians. Haly remarks that cholera consists of a discharge of bile. He inculcates as a settled principle of treatment, that, when the strength continues good, and the discharge not immoderate, the vomiting is to be encouraged by giving tepid water with oil of sweet almonds to drink. When there is great prostration of strength and tendency to deliquium, he directs us to sprinkle water on the patient’s face, to apply ligatures to his limbs, and to rub his feet and legs with a calefacient oil. When the discharge cannot be got otherwise stopped, he advises us to apply a cupping-instrument over the stomach. Alsaharavius, like the others, directs us to promote the vomiting at first by giving tepid water. Among his other remedies, he recommends an infusion of aloes and wormwood, Rhases recommends draughts of tepid water, the application of snow over the stomach, ligatures to the extremities, wine, and astringents. He, Avicenna, and most of the authorities direct us to encourage sleep. Avicenna’s plan of treatment is exactly the same as that of Rhases.
With respect to diarrhœa, Celsus recommends us to give an emetic; to anoint next day with oil; to give moderate food and undiluted wine; and to apply over the belly a cerate with rue. Cælius Aurelianus enjoins at first rest and abstinence, then astringent applications to the belly, next day astringent food, and then wine and the hath. Haly Abbas remarks that a diarrhœa is not to be rashly stopped unless it become excessive, in which case astringents are to be given, such as galls, roses, pomegranate fruit, &c. Serapion and Rhases mention an emetic as a remedy for diarrhœa.
For the cure of diarrhœa, the veterinary surgeons recommend at first bleeding and hot water, and then astringents, such as sumach and pomegranate rind. (Geopon. xvi, 8.)
There are two varieties of lientery: the one arising from superficial ulceration of the intestines, and (according to some) from a cicatrix occasioned most frequently by dysentery or other defluxions; and the other from an atony of the retentive faculty of the bowels: the second variety being in our opinion connected with the cæliac affection; for in it the stomach being unable to concoct and distribute the food, it is discharged downwards in a smooth, undigested, and liquid state, the stomach in all cases labouring under a defluxion. But in lientery the passage of the food is quick, and the indigestion more intense; so that the appearance of the food which has been taken is preserved, and by these circumstances it is more especially distinguished from cæliac affection. Wherefore we must apply cataplasms of linseed with dates. And lentisk and bramble boiled with oxymel is a very effectual remedy; but, when there is flatulence of the bowels, we must mix some cumin, dill, and rue. If the defluxion increase, we may add quinces, moist alum, acacia, hypocistis, galls, some or all of these. Cerates also made of myrtle-oil with some astringent wine are useful, and the caleficient epithemes from the bay-berries, or from seeds. But that from the flowers of wild vine, that from grape-stones, and that ascribed to Antyllus are more astringent. But the one called Erythrian is wonderfully efficacious. When the disease is protracted, we must have recourse to a dropax (calefacient plaster) along the abdomen, and the cerate from mustard, or mustard itself. The drinks which are taken should be simple, containing plantain-seed, or the seed of dock, or the rind of pomegranate, or dried services, or dried unripe grapes from the Aminæan vine, to the amount of three oboli; which things, when there is no fever, are to be taken in six cupfuls of an austere wine, but when there is fever in rain water. It will injure the stomach less if the dried crop of hens be sprinkled upon the drink. But diuretics, such as parsley, maiden-hair, and the like, occasion a metastasis of the fluid; and, in like manner, the compound ones, as that of Polyides (it is the sigillum), the trochisk from amber, that from Egyptian thorn, the one called clidium, and that from seeds. The following one is most excellent: Of the seed of the wild dock, oz. iss; of plantain-seed, oz. j; of the juice of the hypocistis, dr. vj; of gum or acacia, dr. iij; add to a decoction of the juice of quinces boiled to a third part.—Another: Of cumin, of pepper, of Syriac sumach, of the flowers of the wild pomegranate, of each, oz. iss; of pomegranate-rind, oz. j; of laserwort, oz. ss; either sprinkle a drachm of it dried upon the drink, or mix with oxymel, and give morning and evening.—Another: Of black myrtle, a spoonful and a half; of anise, of dried roses, of the flower of wild vine, of each, half a spoonful; of dates, xx in number; make trochisks, and give a drachm with water or diluted wine. And the theriac from vipers is also an excellent remedy for them. When the discharge is acrid and bilious, the food should be from chondrus, rice, alica, and the like; but some of the astringents should be boiled along with them, such as pears, apples, quinces, medlars, and such like. Boiled milk is also proper. The drink should be either a light watery wine, or some of the sweet potions. If the discharges consist more of phlegm, we may change the diet to the opposite kind, mixing the seeds of some of the stomachic vegetables, anise, cumin, or the seed of parsley. The dried lentil twice boiled is often of use to them, when eaten with a little vinegar or oxymel, and cabbages likewise twice boiled; but it is better to make the second boiling in oxycrate. They should drink some of the older and more heating wines.
Commentary. Hippocrates (Aphor., de Affect.); Galen (in Hipp. Aphor. Comment. vi, 1; de Med. sec. loc. vii); Aretæus (Morb. Chron. ii, 10); Celsus (iv, 16); Nonnus (166); Theophilus (de Alvi Retrim. 2); Actuarius (Meth. Med. i, 42); Aëtius (ix, 37); Oribasius (Morb. Curat. iv, 88); Leo (v, 5); Psellus (Opus Medicum); Scribonius Largus (xi); Marcellus (de Medicam. 27); Avicenna (iii, 16, 1); Serapion (iii, 18); Haly Abbas (Theor. ix, 25, Pract. vii, 16); Alsaharavius (Pract. xvii, 1); Rhases (ad Mansor. ix, 72; Contin. xiii.)
In lientery, says Hippocrates, the food passes through the bowels in a liquid state and without change. Galen remarks that the affection may be defined to be a loss of digestion, the food having undergone no change in consistence, smell, or quality, while in the bowels. The intestines, he says, are either in a state of ulceration and great tenderness, or they have lost their retentive faculty.
Aretæus calls it a disease arising from broad ulcers of the intestines when the food passes through the bowels not at all altered. With respect to the treatment, he merely says that an emetic after food will remove it.
Celsus recommends astringent food, stimulant and rubefacient applications externally; and afterwards exercise, friction, insolation, and vomiting, which, he says, Hippocrates directed to be produced with white hellebore when other things fail.
Dioscorides states that when the inner membrane of a cock’s stomach has been dried and reduced to powder, it may be given triturated in wine with great advantage in stomach complaints. Our author, it will be remarked, makes mention of this medicinal article.
Archigenes and Aëtius describe cæliac affection as an atony of the intestines, so that the food is not retained until it is digested. They treat of it at great length, their principal remedial measures being purging, vomiting, and astringent applications. According to Psellus it arises from superficial ulceration of the intestines. Psellus defines lientery to be a loss of the retentive faculty of the bowels, so that the food passes undigested in a liquid state.
Serapion for lientery directs us to give astringent decoctions, and to apply to the belly an astringent epitheme containing galls, roses, pomegranate-flowers, &c. the food to consist principally of millet and the like. He also recommends a mixture of goat’s milk and water boiled until the water evaporate. When the stomach is loaded he prescribes an emetic. In cæliac affection he directs us to strengthen the intestines by astringents internally and externally. Haly Abbas defines lientery to be a quick discharge of the food in an unchanged state. It arises, he adds, from immoderate debility of the retentive faculty of the intestines, or from excess of the expulsive. It is said to be generally caused by ulcers which, being irritated by the food, stimulate the intestines to expel it. He recommends a variety of remedies, most of which are either astringents or acids, such as balaustine, rind of acorns, mastich, sumach, galls, roses, &c.