Chapter XXIII: Part 23

It deserves to be remarked that Dioscorides, Pliny, Galen, Alexander, and Paulus agree in recommending the hæmatite, or bloodstone for hemoptysis. It is a native oxyde of iron.

To the long and accurate account given by Cælius Aurelianus it is impossible to do justice in a short abstract. Passing over entirely his description of the symptoms, and explanation of the sources from which the blood is discharged, we shall merely dwell upon a few points of his practice. He insists with proper earnestness on the necessity of complete rest, coolness, and abstinence from everything of a stimulant nature; and recommends the practice already often mentioned of applying to the part affected sponges or compresses soaked in cold water, or in water and vinegar, or in some astringent decoction. He also approves of the application of ointments or plasters composed of galls, alum, the rind of the pomegranate, and the like. From among his many internal medicines we would point out the composition consisting of gum acacia, alum, and the decoction of poppies. When the discharge does not stop before the third day, he recommends venesection. But if pain, difficulty of breathing, or a dry cough should come on, he approves of bleeding at an earlier period of the disease. He then directs us to give emollient epithemes, electuaries containing frankincense and opium, and the like. When the pain is protracted, he recommends us to apply cupping-instruments or leeches to the part affected. Food of a middle quality, milk, and the like are to be given. From his strictures upon the practice of the others, it appears that some of the medical sects had condemned venesection, but it is satisfactory to know that most of the authorities were agreed about the propriety of it. The Methodist forbids it when there are no symptoms of inflammation present. It seems there were disputes also about the propriety of ligatures to the extremities, but Cælius pronounces in favour of this practice. He informs us further that some questioned the propriety of giving vinegar, but he decidedly approves of it. When there is any inflammation, he disapproves entirely of astringents. He also condemns sudorifics and diuretics. He allows exercise only when the complaint has abated.

Marcellus condemns ligatures to the extremities, but approves of applying to the chest a sponge soaked in cold water or acrid vinegar.

We have not room for many extracts from the Arabians, who, however, supply little additional information, although they treat fully of the disease. We would refer to Avicenna’s account as being particularly full and excellent. He approves of the internal use of vinegar, and when there is a tickling cough, of anodynes, such as mandragora, henbane, and poppy. Rhases and Serapion approve of sponging the chest with vinegar. Averrhoes, who is fond of contradicting preceding authorities, condemns the practice of giving vinegar in hemoptysis. Mesue recommends the use of chalybeate water for drink. He approves in general of astringents. Haly Abbas gives a very full and interesting account of the causes and varieties of the disease, and modifies his treatment accordingly. He recommends bleeding from the basilic vein, to be repeated if circumstances require, purging with gentle laxatives, such as myrobalans and rhubarb, giving demulcents, such as gum arabic and starch, to which poppy is sometimes to be added, for allaying irritation. He directs the bath, strong exercise, and vociferation to be avoided. When the disease arises from a cold cause (he means in cases of passive hemorrhage), he forbids venesection, and recommends stimulants, such as frankincense and myrrh. In certain cases he allows astringents, such as alum, balaustine, galls, sumach, &c. He also directs us to apply to the breast an astringent cerate containing roses, plantain, purslain, &c. Alsaharavius recommends bleeding, cold applications to the chest, opiates, and astringents, according to circumstances. Rhases states that opium, by thickening or congealing the blood, proves useful in hemoptysis. He approves very much of a milk-diet. In general he recommends venesection. He directs the physician to be at pains to ascertain from what part the blood proceeds.

Cold applications to the chest are not now generally resorted to in this disease, although it will be seen that the ancient authorities generally approve of this practice. It will be remarked, however, that Galen condemns the indiscriminate use of this remedy; and Rhases also states that he had seen mischief produced by the unseasonable application of cold to the chest. In short, like every other mode of practice, it ought, no doubt, to be applied with proper caution and discrimination.

SECT. XXXII.—ON EMPYEMA AND PHTHISIS.

Empyema is formed either in the cavities of the chest, or in the pleura, sometimes arising from vomiting of blood, when the ulcer has not healed (in which case phthisis soon comes on, provided the discharge came from the lungs), and sometimes from a precursory inflammation, which has formed into an abscess and burst (as is sometimes the case in pleurisy), or from a defluxion from the head. The symptoms of a confirmed empyema are weight in the chest, an intense dry cough, with pain, and sometimes with a fluid, in which case they seem to experience an alleviation. At the commencement the attacks of fever are weak, irregular, and difficult to perceive; but when the abscess is about to burst, they have more violent fever, attended with rigor, and in speaking their breathing is obstructed. When the abscess bursts, matter is brought up, sometimes pure and sometimes feculent: sometimes it is discharged upwards, when it is attended with more danger; and sometimes downwards, in which case the matter is partly translated to the stomach and bowels; and partly to the bladder, the metastasis taking place by certain vessels. All along they have hectic fever until the ulcer becomes clean; and if this do not speedily take place, the empyema is converted into phthisis from the lungs undergoing ulceration. When this takes place, the cheeks are livid; there are copious sweats about the forehead and neck; the flesh is melted, the nails bent, and they appear glossy, white, or pale. When the disease gains ground, the bowels become loose, the hypochondria are retracted; for the most part thirst and a loathing of food oppress them; and the expectoration is very fetid.

_The cure._ Our first object, therefore, ought to be to assist the concoction of the abscess, which may be attempted by fomenting with sponges, and applying cataplasms made of barley-flour, with dried figs boiled, some rosin, pigeon’s dung, nitre, and mallows. The rupture of the abscess is promoted by lying upon the side which is not affected. Let them drink at intervals honied water, and the juice of ptisan with honey. Those who are stronger may likewise drink the decoction of hyssop and thyme with honey. Eating pickles also forwards the breaking of the abscess, and likewise the pills from the colocynth hiera, taken at bedtime. When the pus begins to be discharged, give again the decoction of hyssop, iris, and liquorice boiled in honied water, or liquorice triturated with sesame; and apply a cataplasm of fine flour, boiled in honied water and oil. When the ulceration is difficult to cleanse, we must use the compound remedies, such as that from horehound, either the simple or the compound one; that from tares; and those called dodecatheon, and the medicine named from Philoxenus. When it is converted into phthisis, we may give the headed leek, dissolved in draughts of chondrus or ptisan, and let them be twice boiled, and given by themselves. Let the water which is drunk be rain, and honied water made from it. At the beginning of the remissions apply cataplasms of linseed and fine flour, with the decoction of fenugreek, or mallows, oil, honey, and the leaves of marshmallows. In process of time we may have recourse to cerates, such as those from butter, oil of privet, oil of bays, and iris. The plaster of Mnasæus is also to be used. When there is a defluxion upon the chest, that made of willows may be applied to it. They may also take the simple propoma, mentioned already for empyema, and some of the compound ones. When a violent cough prevails, mix thyme and hyssop along with the juice of liquorice, in well boiled honey; and, having formed them properly, give to be retained under the tongue. The antidote of Mithridates, at intervals, will likewise suit with them, as also that from vipers. But the best remedy is the Armenian bole taken in a draught, and the antidote _esdra_ is not at all inferior to those aforesaid.

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COMMENTARY. See Hippocrates (de Morbis, ii, 45; Coacæ Prænot. et alibi); Galen (Meth. Med. v); Aretæus (Morb. Chron. i, 8); Aëtius (viii, 75); Oribasius (Synops. ix); Alexander (vii, 2, 3, 4); Leo (iv, 10); Actuarius (Meth. Med. iv, 4, and i, 17); Nonnus (123); Cælius Aurelianus (Morb. Tard. ii, 14, and v, 8); Celsus (iii, 22); Octavius Horatianus (ii, 8); Marcellus (17); Avicenna (iii, 10, 5); Mesue (de Ægrit. Pect. ii, 12); Serapion (ii, 27); Alsaharavius (Pract. xiii, 3); Haly Abbas (Pract. vi, 12, Theor. ix, 20); Avenzoar (i, 16, 4); Rhases (ad Mansor. ix, 69; Contin. x.)

Hippocrates states, as tests of the nature of the sputa, that, if they possess a fetid smell, or sink to the bottom of salt water, they indicate great danger. When a collection of pus is suspected, he directs us to shake the patient, when a peculiar sound will be heard if there be fluid in the chest. And here, by the way, we may mention that Laennec gives Hippocrates great credit for his diagnostic talent in this case. It is in pneumothorax that succussion is applicable as a test of fluid being confined in the chest. In that case, he directs us to make an incision into the chest; in other words, he recommends paracentesis thoracis, an operation revived of late years, but with very equivocal results. Hippocrates, however, restricted the operation to those cases in which there is protrusion of the collected fluid. (Aff. Int. xxv.) It would appear, from one of his Aphorisms, that the pus was let out either by a cutting instrument or the cautery. (vii, 43.) In his Prognostics, he pronounces a falling out of the hairs and a diarrhœa to be fatal symptoms in phthisis. He gives a very striking description of confirmed empyema. (Prognost. 17.) His account of the formation of hydrothorax (Affect. Int. xxv.) has also been highly commended by the great master of auscultation. According to Hippocrates, phthisis is most common between the ages of eighteen and thirty-six. (Aphor. v, 9.)

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.)

SECT. XXXIII.—ON PLEURISY.

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.

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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.

SECT. XXXIV.—ON AFFECTIONS OF THE HEART.

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.”

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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.)

SECT. XXXV.—ON AFFECTIONS OF THE BREASTS.

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.

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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.

SECT. XXXVI.—FOR FETID SMELL AND SWEATING AT THE ARMPITS.

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.

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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.)

SECT. XXXVII.—ON AFFECTIONS OF THE STOMACH, OF THE HYPOCHONDRIA, AND OF THE BELLY.

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.