Chapter XV: Part 15

We must endeavour to remove a cough in fevers, more especially in such as come on with rigors, for it exasperates the fever when it is subsiding. We must give lozenges from boiled honey to hold below the tongue, for these melt and remove the substances which obstruct respiration. The time for using them is at the acme of the paroxysm, and a short time before the attack. Well-boiled hydromel must likewise be given. When there is no suspicion of the nerves being affected, in process of time you may give oxymel with confidence, or if not it, the decoction of hyssop, which is a remedy also for rigors. If the fever is not of the ardent kind, you may give castor, which is also of use to the nervous system. Electuaries may be used, made of the kernels of the common and wild pine, iris, linseed, bitter almonds, and nettle-seed. But the most of these may be mixed with the food. Turpentine-rosin should be given in an egg. To the chest and the parts about the trachea, apply a sulphurated woollen cloth, and oil of rue, or of iris, or of dill. Tight ligatures long applied are excellent for stopping cough, I mean to the middle and extremities. Nor will it be unsuitable to use for the cough stavesacre dried, which may be chewed with dried grapes or mastich. The extremities may be rubbed, chafed, and bound with ligatures, and afterwards the retracted parts unbound. But if the cough annoys, owing to the acrid nature of the fever, we must use a gargle of tepid water. Cold water also is often useful; and, in like manner, gargles of oxycrate, or of the decoctions of dates, roses, or liquorice. Moderately cooling things are also to be laid over the bowels and heart.

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COMMENTARY. Galen gives some ingenious remarks on the causes of coughing. He states that when any substance becomes fixed in the trachea, as it is a cartilaginous and hard tube, and incapable of contraction, nature brings on coughing, by which a violent expiration of air is induced. A cough, then, is nothing but a violent expiration by which nature endeavours to expel any body that obstructs the air-passages; and, when she cannot accomplish this at the first effort, she repeats it once and again until she effect her purpose. He goes on to state, that such fluids as are very watery, instead of being brought up, are merely divided or cut asunder by the current of air, while such as are thick and viscid, adhere so closely to the sides of the windpipe that they cannot be removed, and hence violent efforts are necessary to effect the discharge of them. (De Causis Sympt. ii, 4.) He treats fully of compositions for coughs in his work ‘De Comp. Med. sec. Loc.’ (vii.) See the 28th Section of the Third Book.

Avicenna recommends cough pills and lohocks made with poppies, the cold medulla of fruit, starch, and the like. (iv, i, 2.)

The prescriptions of Serapion contain liquorice, sweet almonds, tragacanth, and the like. (De Antidotis, vii, 17.) Those of Haly Abbas are very similar. (Pract. iii, 22.)

A receipt is given by Rhases for cough pills, the principal ingredients of which are tragacanth, sweet almonds, poppy seed, gum Arabic, and Armenian bole. (Divis. i, 52.) Many such receipts are given by Myrepsus.

SECT. XLIX.—ON SNEEZING.

Sneezing frequently occurring in fevers is troublesome, for it determines to the head and weakens the strength, and, in some cases, it produces a discharge of blood. Such are the bad effects of sneezing, which ought therefore, to be contended against. It is restrained by rubbing the nose, forehead, and eyes; by yawning, frequent friction of the roof of the mouth, eructation, stretching of the loins, raising the head, turning to the side, gently chafing the extremities, anointing the masseter muscles, pouring hot oil into the ears, applying a warm cushion under the chin. It is proper to avoid being roused suddenly from sleep, and also smoke, dust, acrid smells, pepper, castor, mustard, and mint. The smell of apples and polenta is proper, for it blunts the desire of sneezing. The empty sea-sponges do the same. When there is a frequent desire of sneezing without the ability, let the lips be composed, let the patient smell to acrid substances, and let the mind be relaxed.

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COMMENTARY. Galen explains that sneezing is a still more violent effort of nature than coughing, and that its intention is to remove irritating matters from the parts about the nose. (De Caus. Sympt. ii, 4.)

Avicenna gives ample directions for the treatment of sneezing; but they are evidently copied from our author. (iv, 1, 2.) The same may be said of Haly Abbas. (Pract. iii, 22.) Rhases recommends us to give warm gruel internally, to pour warm water on the head, and to apply oil of gourd, of roses, and the like, to the nostrils. (Cont. xxxi.)

Cassius Medicus discusses the question why rubbing the nose and eyes stops sneezing. He supposes that it is by occasioning a discharge from these parts, whereby the exciting cause is removed. (Probl. 45.)

SECT. L.—ON LOSS OF APPETITE.

When loss of appetite is occasioned by depraved humours, we must give those kinds of food and drink which will either clear away such humours by vomiting, or downwards by the bowels, or those that by dilution will render them better. You have the materials of these things treated of in the First Book of this work. Should the loss of appetite be occasioned by debility, since all debility is owing to an intemperament of the parts, we must cure the species of intemperament by its contraries. Wherefore we will give a more particular account of loss of appetite in treating of stomach complaints in the Third Book. But in fevers we must straightway endeavour to bring back the appetite with aromatics, more particularly by giving polenta moistened with water, or oxycrate, or diluted wine, or a decoction of some of the fragrant and astringent fruits; by gentle unction and moderate friction of the whole body, by chafing, by bathing the face, and swallowing a small quantity of water; and, by putting the fingers down the throat, the stomach has been roused to bring up the food, more especially if the fluid discharged be bilious or acid. After the first days, cataplasms of dates, of apples, of the wild wine, of wormwood, and of aloes, ought to be applied over the stomach. Let a variety of simple food be prepared, and from grain, having some difference from the common articles, but not very different from those used in fevers; and among them those fruits which do not readily turn acid, nor are very sweet, but are ripe; however, they are not to be eaten to satiety, but only so as to whet the appetite for other food. While they are eating, the most delicious articles ought to be present, which may have the power to provoke and incite the desire. After the fever is gone, should the want of appetite continue during the recovery, yellow parsnip boiled with oxymel, and lettuces, and pickled olives, and capers, and pickles, the bulbi, and every other stomachic should be thought of; and, in particular, those things should be recollected in which the patient delighted most when in good health. Walking, gestation, vociferation, calefacient plasters, frictions, and exercises ought to be had recourse to. And drinking the propoma from wormwood, or from aloes, or swallowing the vinegar of squills to the amount of a mystrum, have proved excellent remedies.

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COMMENTARY. Galen’s explanation of the philosophy of the sense of appetite is very interesting. He remarks that the appetite is a refined species of touch, the seat of which is the mouth of the stomach, which, therefore, is supplied with nerves direct from the brain. He goes on to remark, that the earth is to plants what the stomach is to animals, supplying them with abundance of food as long as it is moistened by seasonable rains; but, when it becomes parched with drought, the plants in like manner are dried up for want of nutriment. (This comparison is borrowed without acknowledgment from Aristotle.) To animals, then, as not being fixed to the earth (with a few exceptions), nature bestowed a stomach which is to them a repository of food, such as the earth is to plants, and she further gave them a sense of want by which they have the desire of being filled with food and drink in due season. This desire of being filled is called the appetite, which arises from a sense of want, when the veins of the stomach absorb, and, as it were, suck from it, whereby a painful feeling is excited, the proper cure of which is a supply of food. The sensation then of sucking constitutes hunger. The loss of appetite may arise either from the sense of the sucking being lost, or from the process of sucking (absorption?) not taking place, or from the body not being evacuated. (De Causis Sympt. i, 7.) He treats of stomach affections very fully in his work ‘De Med. sec. Locos.’ (viii.)

Treatment similar to our author’s is recommended by Alexander (vii, 7), and by Oribasius (Synops. vi, 35.)

Avicenna evidently takes his plan of treatment from our author, for he recommends emetics, and afterwards fragrant things, with a plaster composed of fruits laid over the stomach, and wormwood, aloes, &c., internally. (iv, 1, 2, 26.) Among the causes of loss of appetite mentioned by him in another place are general disorder of the constitution in fevers, severe thirst, repletion with depraved humours, and insensibility of the mouth of the stomach, so that it does not perceive the suction of the veins. (iii, 13, 2, 7.)

Haly’s treatment is nearly the same. He recommends fragrant food and fragrant wine after the acme of the fever, gentle laxatives, and such modes of exercise as he can bear. (Pract. iii, 21.)

SECT. LI.—ON BULIMOS OR INORDINATE HUNGER.

If want of appetite should pass into the opposite state, I mean an excessive atrophy, called bulimos, we must resuscitate such persons with roasted pork, or kids, and other savoury things; and, in a word, with every strong-scented thing, if the acute stage of the fever be past. We must bind the extremities, and rouse, by pinching the cheeks, and pulling the hair and ears. When recovered, we must give bread that has been dipped in diluted wine, or any other diffusible thing.

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COMMENTARY. According to Galen, bulimos is occasioned by a want connected with atony, and coldness of the stomach. (De Caus. Sympt. i, 7.) Alexander, on the other hand, says, that it arises from inordinate heat and weakness of the stomach. He informs us that the vulgar practice consisted in giving fragrant things, binding the extremities, rousing by pinching, giving bread soaked in wine, and, in short, administering every thing calculated to cool and strengthen the body. Others, he says, give opium in cold water, in order to extinguish the heat of the stomach. However, he disapproves of all these things, and recommends food of difficult digestion. He relates the case of a woman affected with bulimia who was cured by having a purgative powder given to her, which occasioned the discharge of a worm more than twelve cubits long. (vii, 6.)

Aëtius and Oribasius adopt the theory of Galen, and recommend nearly the same treatment as our author. Aëtius also directs us to apply over the stomach cooling cataplasms made of dates, quinces, or polenta, boiled in diluted wine.

Serapion remarks that bulimos is distinguished from the canine appetite, by the desire in the former complaint being for proper articles of food, whereas, in the latter, it is for depraved or improper food. His treatment in most respects is like our author’s. He also recommends a mixture of old odoriferous wine, camphor, and lignum aloes. (ii, 11.)

Avicenna and Haly Abbas agree with Galen in stating that bulimos is connected with a cold intemperament of the stomach, whereby the sensibility and attractive power of the stomach are diminished. Their treatment in principle is quite similar to our author’s. In extreme cases they agree with Galen in recommending the theriac. One of Rhases’ authorities recommends cardamom, cubebs, and the like. (Cont. xi.)

The classical reader is referred to Callimachus for a grand poetical description of Bulimia. (Hymnus in Cererem.)

SECT. LII.—ON THE CANINE APPETITE.

Although this symptom seldom occurs during fevers, it sometimes does afterwards; and, since it is allied to loss of appetite, as being the opposite extreme, it will not be improper to treat of inordinate appetite, both of them being in excess. Since, therefore, this affection is generally occasioned by an acid phlegm, we must use those things which will divide and dissipate it. Such, in particular, are all sweet and saline things, and those which are called heating detergents. We must, therefore, give largely of the heating wines. Such are the yellow in colour, and those which are red without being styptic. We must also give them the sweeter kind, although they should not be thirsty. When they come to dinner, we must give them first all fatty things, and everything beside which is prepared with much oil, and has no austere or astringent property. These, although they should not overcome the cause of the complaint, at all events, destroy the insatiable desire of food; but abstinence from them lessens the collection of phlegm in the stomach. We must also give pickles, and after them, plenty of the afore-mentioned wines to be drank. By persevering with these things for some time, the complaint subsides.

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COMMENTARY. According to Galen, one of the causes of the canine appetite is an acid cacochymy, and another is an immoderate evacuation of the whole body, occasioned either by strong heat or weakness of the retentive faculty. (u. a.) Hippocrates recommends the liberal use of wine, in one of his Aphorisms (ii, 21); and Galen, in his Commentary on the same, states that the wine should be tawny-coloured or red, and devoid of astringency. In another place, he directs us to purge away the offending humour with the hiera of aloes. (De Med. sec. Locos. viii.)

Our author borrows part from Oribasius. (Synops. vi, 34.)

Alsaharavius recommends the same plan of treatment as the Greeks, when the disease is connected with a cold intemperament; but when with a hot, he directs us to have recourse to bleeding, cold fruits, and cooling applications over the stomach. (Pract. xvi, 11.)

Rhases and Avicenna approve in general of our author’s plan of treatment, to which, however, they suggest some improvements: when the cause of the complaint is an acid phlegm, they direct us to give fatty things, with mustard, pepper, garlic, and the like. When connected with black bile, they approve of bleeding. When it arises from worms, they, of course, approve of anthelmintics. Sarac, one of Rhases’ authorities, recommends emetics and purgatives, with a cupping instrument applied over the stomach. (Contin. xi.)

Serapion’s treatment is entirely like our author’s. (ii, 10.)

SECT. LIII.—ON THIRST.

A protracted thirst may be supposed to be occasioned by dryness, or heat of the parts, by which liquids pass from the mouth to the stomach; and the natural cure of dryness is sleep, and of heat, watching. Some become thirsty from wine, or the heating nature of their food, in which case, the proper cure is cold drink. But some desire drink of a bad quality, as they do food corresponding to the prevailing cacochymy. I have known persons seized with unquenchable thirst, of which they died, who had eaten of the vipers called dipsades, and others who had got drunk upon old wine; and also persons on board of a ship, who, when their fresh water failed them, had drunk of sea-water, have all died. Febrile thirst may be mitigated, by pouring upon the head the coldest oil, or rose oil. But the best remedy for thirst is the seed of the black lettuce, chewed, or the liquorice; or, seed of the cucumber may be retained in the mouth. Give also the following pill, called adipson: Of garden cucumber, dr. viij; of tragacanth, dr. iv; dissolve the tragacanth in the white of fresh eggs, and when dissolved, add to the pounded seeds of the cucumber; and when softened, form pills, which dry in the shade. Give one of these pills to hold below the tongue, and drink the fluid of it as it dissolves. Give also, to swallow, the decoction of quinces, or of pears, or of medlars, or of the tendrils of the vine, or the juice of the pomegranate.

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COMMENTARY. The greater part of this Section is taken from Galen (de Caus. Symp. l. c.), who, as usual, handles the subject very philosophically. Oribasius treats of it in nearly the same terms as our author. (Synops. vi, 37, 38, 39.) Aëtius remarks that there are two causes of thirst, a want of humidity, or a redundance of heat. In fevers, then, both these causes cooperate to occasion thirst; for there is excess of heat originally, and dryness comes on owing to the fluids of the body being consumed by the febrile heat. (v, 119.)

The question was keenly agitated in the ancient schools of medicine, whether cold drink might be safely given in fevers. Hippocrates was a great advocate for this practice, giving his patients barley-water and acidulated draughts very freely at all periods. Asclepiades, on the other hand, as Celsus and Alexander inform us, forbade even to wash the patient’s mouth with water during the first stage of a fever. Celsus is disposed to hold a middle course between these opposite methods of practice. He particularly approves of washing the mouth and fauces frequently with cold water, because, as Erasistratus had properly remarked, these parts often required cold liquids, while the internal parts are not in want of them. Philumenus (ap. Aëtium) also strongly recommends gargles, but forbids cold drink freely until after the acme of the fever. Alexander informs us that the celebrated Archigenes allowed his patients the free use of cold water and acidulated drinks. He himself does not speak very decidedly for or against this practice, but, upon the whole, is disposed to think well of it, unless there be inflammation, hardness, or swelling anywhere. He approves, however, of cold applications externally: and, accordingly, directs us to apply to the region of the stomach a bladder filled with cold water, ice, or some cooling decoction.

Of the Arabians, Serapion expresses himself most decidedly in favour of cold drink. Avicenna forbids much to be given at a time. See also Haly Abbas (Pract. iii, 22); Alsaharavius (Pract. xvi, 14); Averrhoes (Collig. vii, 24); and Rhases (Contin. xxx.)

The pill mentioned in the end of the Section is from Dioscorides.

Prosper Alpinus represents the Methodists to have disapproved of the free use of cold water in fever. (Med. Meth. vi, 7.)

The highest of the ancient authorities, as for example, Galen, Avicenna, and Averrhoes, agreed in allowing wine, much diluted with water, in fevers. Galen says, the wine should be attenuant and of a light colour. According to Avicenna, wine thus plenteously diluted with water is preferable to plain water, as it promotes perspiration.

Fabius Paulinus gives an admirable exposition of the philosophical doctrines of the ancients on this subject. He remarks that there are three distinct species of thirst. The first is occasioned by the fauces and œsophagus being drier or hotter than natural. This state, if it supervene upon sleep, is to be cured by watchfulness, or _vice versa_. In the second, the veins over the whole body are filled with hot and acrid humours. In the third, the mouth of the stomach, lungs, or heart are preternaturally hot or dry. (Marc. Prælect. 315.)

SECT. LIV.—ON THE ROUGHNESS OF THE TONGUE.

We may moisten asperity of the tongue, by making the patients retain in the mouth a decoction of linseed. But it will be more efficacious if sebesten plums be boiled with the linseed. Having immersed the finger in this liquor, and rubbed the tongue with it, let them rinse the mouth with clear water, or let them clean it with a sponge, and then anoint it with rose oil. And the oil of roses mixed with honey also answers well. Likewise the juice of the purslain retained in the mouth, and the sumach used for condiments, when mixed with honied water, have a good effect. Damascenes, also, and the bones of the sebesten plum retained in the mouth, and rolled on the tongue, and the stem of the lettuce, answer well. Archigenes says, that the Indian salt, which, in colour and consistence is like the common salt, but which resembles honey in taste, when chewed to the size of a lentil, or, at most, of a bean, moistens greatly. They should lie upon the side (for lying upon the back dries greatly), and they ought to keep the mouth shut, because keeping it open allows the moisture to dry up. Sneezing properly produced, moistens the tongue more effectually than any other means.

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COMMENTARY. This Section is taken from Oribasius. (Synops. vi, 43.)

Aëtius recommends nearly the same treatment. He also states, that when the roughness of the tongue is difficult to remove, it may sometimes be accomplished by rubbing it with the fat of fowls or with fresh butter. (v, 118.)

Cælius Aurelianus directs the tongue to be cleaned with a sponge squeezed out of hot water. Avicenna recommends for this purpose an instrument called _chaizaran_, and also directs us to use sugar, or a sponge with a small quantity of salt and rose oil. He likewise makes mention of the salt brought from India, possessing the colour of salt and the taste of honey. (iv, 1, 2, 22.) The Pseudo-Dioscorides recommends mint triturated with honey, red sumach, and rose oil with honey, or by itself. (Euporist. ii, 18.)

Prosper Alpinus held that the Indian salt, mentioned by our author and Avicenna, was the same as our sugar. But this opinion was controverted by Carolus Arantius, (Baptista Fieræ Cœna.) Sprengel, accordingly, maintains that the Greeks and Romans were utterly unacquainted with our sugar. (Rei Herb. Hist., and Notæ in Dioscoridem, ii, 104.) The mel arundinum appears, in fact, to have been a natural concretion, and it was most probably the same as the Indian salt. See Dr. Milward’s Letter to Sir Hans Sloane. The cane from which the ancient sugar was procured is now called by botanists the _bambusa arundinacea_, or bamboo cane. See Book First, 96.

SECT. LV.—ON NAUSEA.

When nausea comes on without being produced artificially, it is a clear inference that noxious humours are vexing the stomach. Some feel uneasy, but vomit nothing, the humour being retained in the coats. When the humours are pituitous, we must get them concocted by rest, spare diet, and sleep. But the thinner may be ejected by vomiting, produced either with the juice of ptisan, or with honied water. But those which are viscid and thick, stand in need of attenuant remedies, such as oxymel, and the like. But, when a noxious fluid is detained in the coats, the powder from aloes, called picra, is beneficial, but astringents are pernicious; whereas, if there be much fluid, but not of a noxious kind, astringents will be beneficial, but the aloetic medicine will bring on marasmus. When cold is joined to humidity, we must mix calefacients with astringents. The symptom of the affection being of a cold nature is that there is no thirst, nor sensation of heat.

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COMMENTARY. Oribasius recommends the same treatment. (Synops. vi, 40.) Our author appears to have condensed the lengthy account given by Galen and Aëtius. (ix, v.)

Alexander also treats of the subject at great length, but we can only afford room for a few extracts. When the nausea arises from plethora, he directs bleeding; and when the plethora is connected with vitiated humours, he recommends both bleeding and purging. When bilious or melancholic humours occasion the nausea, he recommends dilution at first by giving tepid water or the like, and then evacuations of them by purging or emetics. When the humour is an acrid or sweet phlegm, he recommends oxymel, radishes, and the like. When a serous and thin humour is impacted in the stomach, he evacuates it by procuring vomiting with tepid water or ptisan. (vii, 13.)

Serapion appears to have copied from our author. (iii, 5.) See Avicenna (iii, xiii, 5, 8.) Rhases applies over the stomach a cold plaster with snow. When the nausea is oppressive, he promotes vomiting with tepid water. (Cont. xi.)

SECT. LVI.—ON VOMITING OF BILE.

To those who vomit bile, a cataplasm must be applied, made of dates, the rind of pomegranate, and gall, boiled in wine or oxycrate, along with pounded bread. And acacia, hypocystis, and the flowers of the wild pomegranate and sumach, ought to be added to the cataplasm. A cupping-instrument also, when applied with a strong heat, is of great service. Food ought to be given frequently in small quantities. To those who vomit black bile and have the stomach inflated, apply sponges soaked in hot vinegar of the most acrid qualities, or a cataplasm of the leaves of the ivy boiled in wine.

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COMMENTARY. This is taken from Oribasius (Synops. vi, 41.)

Alexander states that the proper remedies for vomiting occasioned by a redundance of bile are diluents and refrigerants. He recommends internally ptisan, lettuces with a small quantity of vinegar, &c. For drink, he particularly approves of cold water, but forbids much to be given at a time. When the strength fails, he permits a small proportion of hydromel, wine, or the like, to be added to the water. In certain cases, when the patient is troubled with insomnolency, he directs us to add the heads of poppies to his drink. He also recommends external applications possessed of tonic, cooling, and repellent properties. (vii, 17.)

Serapion recommends us not to interfere with a critical vomiting. When it is continued, he directs us to give clysters and gentle purgatives at first, and afterwards vegetable acids and astringents. When these remedies fail, he directs us, if the strength be good, to bleed from the arm. He also makes mention of external applications, possessed of astringent and refrigerant properties. (iii, 15.) Haly Abbas, in like manner, cautions against stopping a critical vomiting. (iii, 24.) Alsaharavius prescribes draughts of tepid water at first, and afterwards the infusion of wormwood or of aloes. He also recommends external applications of a strengthening nature. (Pract. xvi, 20.) Avicenna’s plan of treatment appears to have been copied from our author’s. (iv, i, 2.) Rhases recommends acid drinks, such as the decoction of pomegranates and the like. (Cont. xi.)

According to Prosper Alpinus, the treatment of the Methodists consisted in administering sub-acid fruits, the juice of wormwood or of mint in wine, and in applying externally tonic epithemes, containing sumach, galls, mastich, and the like. (Med. Meth. xii, 11.)

SECT. LVII.—ON HICCOUGH.

Singultus is occasioned either by fulness, or emptiness; or by the presence of acrid and pungent humours in the stomach, and when they are vomited, it ceases. And many, if they only take the medicine composed of the three kinds of pepper, and drink wine immediately after, have hiccough. And it is well known that many people hiccup when the food spoils on the stomach. Many also hiccup from rigors. We will find an emetic a proper remedy in cases which are occasioned by fulness or pungency, and warmth in those from cold; and, when the complaint is occasioned by a plethora of humours, there is need of strong evacuation. This may be accomplished by sneezing, but when emptiness is the cause, sneezing will not cure it; for in such cases, we must give rue with wine, or nitre in honied water, or hartwort, or carrot, or cumin, or ginger, or calamint, or Celtic nard. These are the remedies for such cases as are occasioned by corruption of the food, cold, or plethora. When a redundance of cold and viscid humours is the cause, give castor to the amount of three oboli to drink in oxycrate, and the same thing will be of use when applied externally to the skin, along with old Sicyonian oil. The vinegar of squills or oxymel may also be drunk with advantage. Retaining the breath is likewise of great use.

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COMMENTARY. This Section is copied from Oribasius (Synops. vi, 42.)

According to Galen’s explanation, hiccough is occasioned by any exciting cause which rouses the stomach to violent emotions. He states that sneezing proves a cure to it. (De Caus. Sym. iii, 6.) Celsus says, in like manner, ‘Singultus sternutamento finitur.’ He states that frequent and unusual hiccuping is symptomatic of an inflamed liver. (ii, 7.) Aëtius, in like manner, says that singultus in fevers often arises from inflammation of the stomach and neighbouring parts. He treats of the complaint at great length. When it arises from pungent humours, he gives first emetics, and afterwards narcotics, such as opium, &c. He also applies a cupping instrument with great heat to the breast, stomach, and back, in certain cases. (ix, 5.)

Alexander gives an interesting account of this affection, for which he recommends various remedies. When connected with inflammation of the stomach or liver, he begins with bleeding. When it is occasioned by thick and viscid humours, he recommends an oxymel of squills, the composition of which he minutely describes. He also speaks favorably of emetics. When the humours are of a pungent nature he approves of diluents and the drinking of tepid water. Sometimes, he adds, he has known a draught of cold water prove effectual. (vii, 15.)

When singultus is connected with a cold cause, the author of the ‘Euporista,’ ascribed to Dioscorides, recommends us to put the feet into hot water, to take tepid draughts, and apply hot fomentations to the stomach. (ii, 4.)

Though there is perhaps nothing original in the views of the Arabians, they treat of hiccough very fully and accurately. Among the causes of it, mentioned by Alsaharavius, is inflammation of the stomach and liver, in which case he recommends venesection. When connected with excessive heat of these parts, he approves of cold air, cold drink, and refrigerant draughts, containing prunes, tamarinds, camphor, &c. (xvi, 18.) The causes of hiccough, according to Serapion, are evacuation, repletion, pungent and cold humours. His remedies are emetics, calefacients, and attenuants, which are to be directed according to the nature of the exciting cause. (iii, 17.) See also Avicenna (iii, 13, v, 25); Rhases (Divis. 62, ad Mansor. ix, 65, Cont. xi.) Rhases recommends calefacients, such as cumin, pepper, rue, and the like, in vinegar. He also approves of emetics and laxatives.

Prosper Alpinus says that the ancient Methodists approved of oily emetics. (Meth. Med. vi, 8.) It will be remarked, that our author states that many persons are seized with hiccough if they take peppers with wine. Prosper Alpinus mentions that they had this effect on him (de Præs. V. et M. ægr. iii, 9); and I have further to state the same of myself.

Rogerius, probably copying from Rhases (for the practice of the earlier modern physicians is mostly borrowed from the Arabians), recommends principally calefacient, attenuant, and carminative medicines, mixed with gentle laxatives, such as prunes. (iii, 21.)

SECT. LVIII.—ON CONSTIPATION AND LOOSENESS OF THE BOWELS IN FEVERS.

Those things which remedy a dry state of the bowels are treated of in the First Book sufficiently. But since a humid or loose state of the bowels may prevail in fevers, this also must be treated of; for many are cut off not by the fever itself, but by this symptom alone. In the commencement, we must not interfere with the discharge when it proceeds from corruption of the food and indigestion; but when the evacuation becomes immoderate, it must be restrained. If the discharges are of an acrid nature, that which is given should consist of good juices, and be otherwise thick, such as spoon-meats from pearl-spelt (chondrus) and ptisan. Baths are also befitting after the complaint has become concocted. But when the discharges consist of phlegm and are watery, on the other hand, the food ought to be of a more dry and heating nature, as far as the fever will permit. Of this kind, are those things which are prepared from heating condiments. But they must abstain from baths, unless otherwise required. When the digestive faculty is in an atonic state, we must give food and applications of an astringent nature; the food consisting of things in particular, to which pomegranates, apples, pears, or medlars have been added, or these fruits themselves, and thin fragrant wine of an astringent quality; and the applications are to be cataplasms made of polenta, and dates, and wormwood, roses, myrtles, and such like things. It must be considered also, to what part these cataplasms are to be applied, I mean the region of the stomach, the lower belly, or perhaps the loins. Bloody discharges are restrained and dried up by remedies containing fine flour of polenta, with frankincense, or manna mixed with wine, or oxycrate. When the watery discharge is acrid, it must be sweetened by a _lavement_ either with water alone, or the juice of ptisan, or of chondrus, or rice, or tragum, not once, but often; and afterwards there are to be added dried roses, or myrtles, and sometimes galls; and an egg with rose oil, and a thin astringent wine, or the decoction of roses, may be injected or applied to the anus, which will blunt the desire of going to stool. But when the calls are frequent, a clew formed of warm threads may be applied to the anus.

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COMMENTARY. Galen forbids venesection when the fever is complicated with diarrhœa. (Therap. ad Glauc. i.)

When the body is constipated, Celsus recommends laxatives, diuretics, and sudorifics. He adds, it may also be proper to let blood, practise gestation, enjoin abstinence from food and drink, and keep the patient from sleeping. He likewise recommends the bath, both of tepid water and of oil. When the bowels are loose he enjoins rest and sleep, gives medicines to restrain sweating, and forbids all exercise except gentle gestation. He also directs us to excite vomiting by copious draughts of tepid water, unless the complaint be of long standing, or there be pain of the throat, præcordia, or side. (iii, 6.)

Alexander forbids narcotics, unless in cases of extreme urgency. Avicenna joins him in laying down this injunction, and otherwise directs us to treat the diarrhœa febrilis upon general principles. (iii, 16, 1, 4.) Haly Abbas treats fever, when complicated with constipation, by giving gentle laxatives, such as prunes and tamarinds, or, if these prove injurious to the stomach, by administering clysters. When the diarrhœa is complicated with a discharge of blood, he approves of adding to the other medicines Armenian earth, purslain, sumach, or such like astringents. (Pract. iii, 24.) See Serapion (iii, 17); Rhases (Divis. 67.)

According to Prosper Alpinus, the ancient Methodists approved of astringent applications and astringent clysters for febrile diarrhœa. (Med. Meth. vi, 10.) Sydenham and Van Swieten agree with Alexander and Avicenna in forbidding to stop diarrhœa in fevers by means of opiates, unless in extreme cases.

SECT. LIX.—ON TRICKLING OF BLOOD AND HEMORRHAGE FROM THE NOSE.

Since a trickling of blood indicates a fulness in the whole body, or in the head, being occasioned either by expression or contraction, and as a free evacuation would relax them, and diminish the quantity, it may be proper to evacuate where nature points. With this view, I have ventured, in cases of quartan epistaxis, to open the vessels in the nostrils with the reed called typha. We must not be contented with a small evacuation, but must take away blood in proportion to the strength. Spontaneous hemorrhages from the nose in fevers, when critical, are not to be interfered with; but yet, if the flow of blood be immoderate, it ought to be restrained. In the first place, tight ligatures ought to be applied to the patient’s extremities, and his head elevated. It would appear that a ligature to the privy parts, is particularly adapted for restraining bleeding from the nose. The nostrils ought not to be wiped, nor the part irritated, so that a clot of blood may be allowed to form. Let the nose be cooled by a sponge soaked in oxycrate, and the nostril plugged up with a pledget dipped in some of the astringent applications. The composition of them, and the rest of the treatment, we will deliver more fully in the following Book, “on topical affections.”

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COMMENTARY. Hippocrates declares that profuse bleeding at the nose indicates a disposition to convulsions, which venesection is calculated to remove. (Prædict. i, 21.) Galen, in his Commentary, remarks that the convulsions are brought on by the unseasonable use of cold applications to stop the hemorrhage. He strongly recommends bleeding from the arm of the side from which the blood flows. In another place, he states that epistaxis in acute fevers is an unfavorable symptom. (In iii, Epidem. Comment.)

Aëtius mentions that Hippocrates had declared a bleeding from the nose on the fourth day of a fever to be a very bad symptom. He recommends encouraging the bleeding by irritating the nostrils with a stalk of grass. Our author, it will be observed, directs this operation to be performed until the _typha_, a species of grain several times mentioned by Theophrastus (Hist. Plant.); by Galen (de Aliment. i, 13); and by Alexander Trallian (vii, 5.) Sprengel makes it to be a species of secale or rye; but Stackhouse, the English editor of Theophrastus, is of opinion that it was the _triticum spelta_, or spelt.

When it is judged proper to restrain the hemorrhage, Avicenna recommends ligatures to the extremities and cold and styptic applications to the nose and adjoining parts, (iv, i, 2, 14, and iii, v, 1.) Serapion agrees with most of the ancient authorities in commending a mixture of frankincense and aloes, when applied on the down of a hare. He also directs us to apply a sponge soaked in cold water to the temples and forehead. (ii, 13.) When bleeding at the nose occurs in a fever, Rhases forbids us to stop it, unless it prove excessive; in which case, he directs us to apply a cupping instrument, without scarification, to the hypochondrium; to tie ligatures about the testicles; to pour cold water on the head; and to drink cold water. (Divis. 40.)

Considering how full and accurate our author and the others are in treating of the complications of fever, it is singular that they should all have passed by a profuse discharge of blood per anum, although it had been noticed by Hippocrates. In one of his Aphorisms he says: “When, in cases of fever, there is a quantity of blood discharged, the bowels get into a loose state.” His commentators Theophilus and Damascius say, in explanation, that the natural heat of the intestines being wasted by the discharge of blood, they lose their power of retention. (Ed. Dietz, ii, 401.)

SECT. LX.—ON DELIQUIUM ANIMI OR SWOONING.

When the fainting is occasioned by cholera, diarrhœa, or other repeated and copious evacuations, we must sprinkle water upon the patient, twist his nose, rub over the orifice of the stomach, and encourage vomiting; and we should also irritate the throat with our fingers or the introduction of a feather. Several strong ligatures are likewise to be applied; when the evacuations are downwards, to the arms; and, when upwards, to the legs. The patients are also to be placed in an easy, erect posture, and a cupping-instrument applied, so as to produce revulsion to the opposite part of the body. Wine and water relieves prostration of strength occasioned by frequent evacuations, provided there be no inflammation of any visceral part, nor violent headach, nor delirium, nor ardent fever unconcocted, to contra-indicate it; for in such cases wine will do much mischief. And if it be summer, and the patient of a hot temperament, and addicted to drink cold things, we may give cold drink; but if the contrary, warm. When the deliquium is occasioned by profuse sweats, we are to constrict the skin, as formerly said, and allow a free current of cool air. In defluxions on the stomach, none of these things is fitting, unless the application of strengthening things to the belly and stomach, and bathing them; for baths are most beneficial in cases of stomach defluxions, but greatly aggravate hemorrhages and sweatings. Those who have fainting fits from plethora, must abstain from wine, and food, and from baths too, if there be fever. And we must give them honied water having thyme, marjoram, pennyroyal, or hyssop boiled in it. Oxymel also is beneficial to them. But if the faintings proceed from depraved humours contained in the stomach, we must prescribe a vomit with water and oil—at the same time tickling the throat with the finger or a feather. But if vomiting cannot be thereby procured, we must give pure oil, which will often evacuate downwards. And wormwood is applicable in such cases. But if the faintings are occasioned by weakness of the stomach, we must use tonic medicines, as formerly stated in the Section which treats of this affection, and rub the extremities. When they proceed from exposure to immoderate heat, we are to prescribe the bath; or, when from excessive cold, we must use the medicine containing the three peppers, and pepper itself. Those who fall into fainting fits owing to great heat, or insolation, or from remaining long in the bath, may be cured by being sprinkled with cold water, and exposed to the wind; by having their stomach rubbed, and getting wine and food. But if the swooning be occasioned by the greatness of the inflammation, or bad nature of the fever in the attacks, and if the patient is cold, we ought to rub his limbs strongly, chafe him, apply ligatures, force him to keep awake, and abstain from food. And these things are to be done previous to the paroxysm. But those who have faintings from dryness, should get for food two or three hours before the paroxysm either the juice of chondrus, or bread out of water, along with the kernels of the pomegranate, or apples, or pears. But if great danger be anticipated, we must also give wine. Those who have sudden attacks of fainting are to be thus treated. And in all cases we are to find out the cause of the deliquium, and direct our attention to it. And sometimes the greatest care must be bestowed upon this symptom, which threatens danger, or death itself.

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COMMENTARY. Nearly the same account of deliquium animi in fevers is given by Aëtius (v, 101 et seq.), and by Oribasius (de Morb. Curat. iii, 7.) But all these authors are, in fact, indebted to Galen. (Therap. ad Glauc. i.) Aëtius thus states the distinction between syncope and deliquium: “Deliquium makes its attack suddenly, depriving the person of sense and motion, but is not necessarily accompanied with sweats; but syncope seizes upon persons both when asleep and when awake, and is necessarily attended with sweats, called syncoptic.”

Alexander delivers a full account of the subject; but his principles of treatment scarcely differ in any respect from those of Galen. (xii, 13.)

Haly Abbas directs us, when the deliquium proceeds from a defluxion of humours upon the stomach, to apply ligatures to the extremities, to dash water on the face, to fan it, and to give vinegar and pepper. He recommends us to prevent sleep, which has a tendency to extinguish the powers of the primary viscera, by occasioning a determination inwardly. When it proceeds from dryness, he directs us to give wine, the decoction of quinces, of apples, and the like. If it happen at the commencement, he recommends a piece of bread soaked in wine to be given. (Pract. iii, 25.)

The Arabians in general do not acknowledge the distinction between syncope and deliquium. See Averrhoes (Colliget. vii, 16); Serapion (vi, 19); Rhases (ad Mansor. x, 13.)

Avicenna seems to point at the distinction, but it is not perceived by his translator. Rhases recommends the same treatment as Haly Abbas. He approves of hot wine, food of easy digestion, sprinkling of the face with cold water, and the application of ligatures to the extremities. (Contin. xxxi.)

SECT. LXI.—ON THE TREATMENT OF ULCERATION UPON THE OS SACRUM.

This affection occurs most frequently in protracted fevers, owing to the patients having been long confined to bed. When, therefore, the part begins to appear red, we make a circular piece of wool, of the proper magnitude, and lay it below the part, and afterwards prepare a rose or myrtle cerate, containing litharge or ceruse, and apply it. When there is inflammation, we may use a cataplasm of bread, with nightshade, or knot-grass, or plantain, or tender cabbage. But if the ulceration be spreading, we are to use a cataplasm of dried lentils, along with the inner rind of the pomegranate.

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COMMENTARY. This Section is taken from Oribasius (Synops. vi, 44.)

Aëtius remarks that, in prolonged fevers, the fleshy parts of the body being wasted, ulceration takes place in those parts upon which the patient lies. These sores, he adds, spread deep, and have hard thick edges. When the back becomes red and painful, he directs us to surround the adjoining parts with a circle of wool, so as to relieve the affected part from the effects of pressure; and then a cerate of rose or myrtle oil, containing litharge, ceruse, and burnt barley is to be applied. He particularly commends a composition consisting of litharge, oil, wax, and honey, mixed with rose-oil. In short, his plan of treatment, like our author’s, is borrowed from Oribasius. He concludes with directing the use of milder applications when the ulceration has stopped spreading. (v, 127.)

Alsaharavius directs us to treat the redness of the back occasioned by lying long in bed with the flower of millet, barley, or lentils. When pustules form and break, he recommends an ointment containing ceruse to be applied. (Pract. xxix, 1, 26.)

_Appendix to the Commentary on Book Second._

ON SMALLPOX AND MEASLES.

The reader, we are sure, would be disappointed, if we were to quit the subject of Fever without touching upon the history of Smallpox and Measles. We will, therefore, conformably with our general plan, give a brief abstract of the descriptions of these diseases which we meet with in the works of the ancient physicians. In the first place, then, we may mention that, after having read, we may say, every word of every ancient writer on medicine that has come down to us, we can confidently affirm that the Greeks and Romans are altogether silent on the subject, and that we are indebted to the Arabians for the earliest accounts which we have of these diseases. Rhases, indeed, pretends (provided the Introduction to his ‘Treatise on Smallpox’ be not spurious) that Galen had delivered some imperfect descriptions of smallpox; but he would appear to have been led into this mistake by following some inaccurate translation of the works of Galen into the Syriac language; for no passages which would justify the interpretation which Rhases puts upon them are now to be found in the original. Lately, Dr. Bateman attempted to show that allusions to measles and smallpox are to be met with in the works of several of the Greek authors; but we entirely agree with Drs. Mead and Freind, who maintain the contrary. In an Arabian MS. preserved in the University of Leyden, it is stated that the smallpox and measles first appeared in Arabia about the year 572, P.C. See Reiske (Opuscula Medica, p. 10.)