Part 18

COMMENTARY. There is a short treatise on this subject, among the minor works of Theophrastus. He states that, as the excess of motion in this case has produced a preternatural dryness of the body, the indication of cure is to humectate, that is to say, to dilute, by baths and drinks. The work contains many ingenious observations; but our limits do not admit of our giving a proper outline of it.

Our author copies from Oribasius (Synops. v, 15); see, also, Aëtius (iv, 55 et seq.) They all, however, are indebted to Galen. (De Sanit. tuend. iii, 7.) The ulcerose lassitude, he says, arises from a collection of excrementitious superfluities, which are produced by the melting of fat and muscle. In the second species, called the tensive, there is no collection of humours, but the muscular fibres are excessively stretched. The third species, or the inflammative, is characterized by a sensation, as if the parts affected were bruised or inflamed, and happens when the muscles, being excessively heated, attract the superfluities from the surrounding parts. From the pain being deep seated, it has been called ostalgia. He adds a fourth species, being a case somewhat different from all those we have been describing. It is the contrary state to that of the inflammative, the body appearing squalid and contracted. The first case, as it is connected with redundance of humours, is to be cured by discutients; and hence the proper remedy for it is much friction, with emollient oils wholly devoid of astringency. He also approves of the gentle exercise called the restorative. The second species, or the tensive, is to be cured by gentle friction, with emollient oils heated in the sun; by complete quietude, and the frequent repetition of the tepid bath. In particular, unction with oil is proper. The third species, as it is occasioned by violent motions, and is attended with excruciating pains, is to be cured by the gentlest friction, with the most emollient oils; by the most perfect rest, and the tepid bath. The fourth species, characterized by squalor and constriction of the skin, is to be treated by the hot bath, to warm and invigorate the skin, then by soft and slow motions and friction; and then again by the hot bath. But, he adds, the patient must straightway leave the cistern of the hot bath, and plunge into that of the cold, but not remain long in it. The diet, in all these cases, is to be restricted and cooling, especially in the Inflammative.

As all the subsequent authorities, whether Greek or Arabian, adopt the views of Galen, we need not enter into the detail of their plans of treatment. See Psellus (Opus Medicum); Avicenna (i, 3, 2); Rhases (Contin. xxxi); Alsaharavius (Pract. xxxi, 11); Averrhoes (Collig. vi, 8; Collect. ii, 15.) The bath, emollient friction, diluent food, and quietude are the remedies generally recommended by all the ancient authorities; and they are directed with a nice discrimination that cannot be too much admired. Syrasis, one of Avicenna’s expositors, gives the rules of treatment with great judgment.

Prosper Alpinus gives a fair account of the ancient doctrines on this subject. (Meth. Med. iv, 16, and de Præsag. Vita et Morte, ii, 21.)

SECT. XXI.—ON CONSTRICTION OF THE SKIN.

Constriction is occasioned either by obstruction or contraction of the pores. Obstruction is produced either by the quantity or thickness of crude and indigested humours, and contraction by such things as are cold or astringent, or desiccative. Upon stripping the body, the affection is at once recognized by the paleness, hardness, and contraction of the skin, and by the body’s being heated with difficulty during exercise. Calefacient remedies are the proper cure for this state of body, and therefore we must have recourse to the strongest exercise and the hottest baths, and the time of remaining in the cold bath must not be long, nor must the water be very cold. And when about to put on their clothes, let their bodies be anointed with a sweet and thin oil, of a moderately heating quality. Obstructions of the skin are also properly cured by the oil of dill, (more particularly if the dill had been green,) and by the oil of black poplars.

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COMMENTARY. This Section is taken from Oribasius. (Synops. v, 16.) But a somewhat fuller account is given by Galen. (Hyg. iii, 10.) Like our author, he states, that this affection is occasioned, either by a collection of thick viscid humours in the body, or by contraction, that is to say, spasm of the cutaneous pores. It is generally brought on, he says, by exposure to cold, or going into an astringent bath. He gives very minute directions about the treatment, recommending hot baths, and friction with oils of a calefacient and attenuant nature. See also Aëtius (iv, 46); and Actuarius (Meth. Med. iii, 16.)

Avicenna treats of it in the same terms as Galen. (i, 3, 3, 15.)

SECT. XXII.—ON SPONTANEOUS LASSITUDE.

Since the Ulcerose lassitude is occasioned by the ill digestion of acrid superfluities, if the cacochymy be small, the restorative exercise will be sufficient; but if it be greater and deeper-seated, we must not permit such a one either to exercise or to take any motion whatever, but he must for one day remain without food, in a state of quietude and sleep; and then in the evening, when he has been rubbed with emollient unguents, and bathed in tepid water, we must give him wholesome food and some soup. And we must also not restrict him from wine, for nothing contributes so much to the digestion of half-digested humours as wine. Should the symptoms be removed by means of the aforesaid treatment, we may allow the man to return to his usual employments; but if on the following day they should still remain, we must bethink ourselves of a more potent remedy. If his strength be good, we must have recourse either to phlebotomy or purging, having first determined which of these remedies we shall try. If he be weak, we must not bleed, but may purge him moderately. If there be many crude humours in the system, we must neither bleed, nor purge, nor exercise, nor move at all, nor try the bath; but we must keep him in a state of perfect quietude, and give him food, drink, and medicines of attenuating and incisive qualities, without being of a manifestly heating nature. We may give vinegar and honey, and occasionally some ptisan or honied water. And since, in such persons, the lower belly is apt to become swelled and distended with wind, and whatever food is taken to be converted into flatulence, it will be better to give some pepper along with the food. It will be better, too, to use the composition called Diospoliticus, and that simple medicine which consists of three kinds of peppers. Oxymel is also most proper. Let them likewise use a drink made from honey, particularly when it begins to become acid; and such wines as are gently acid, and such articles of food as are attenuant without being heating, as capers, if taken with vinegar and honey, or vinegar and oil. When the Tensive species of lassitude takes place without exercise, it indicates that a plethora distends the solid parts of the body. If the fulness be occasioned by blood, it will be best to open a vein, or scarify the ankles. If the Inflammative lassitude be spontaneous, it will not endure a delay of a few hours, much less of two or three days, for it straightway induces a strong fever, unless one anticipate by letting blood. It will be best, if possible, to abstract blood twice in one day; for if care be taken that the first bleeding do not occasion swooning, it will be of less consequence whether or not it occur after the next. Those who are not bled will be fortunate indeed if they escape with the life.

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COMMENTARY. These judicious observations are taken from Oribasius (Synops. v, 21.) See also Galen (de Sanit. tuendâ, iv); Aëtius (iv, 41); Avicenna (i, 3, 3, 16); Alsaharavius (Pract. xxxi, 2, 11); Rhases (Contin. xxxi); Averrhoes (Collig. vi, 14.)

All the authorities recommend nearly the same methods of treatment. Galen’s account of the subject is full, complete, and satisfactory, but so lengthy, that we cannot venture even upon an abstract of it. He gives proper directions for the physician to endeavour to find out the cause of the lassitude, and to remedy it accordingly. It is often connected, he says, with retention of the menstrual or hemorrhoidal evacuation, or the stoppage of some customary discharge. When attended with inflammatory symptoms, he is very urgent in recommending immediate venesection, without which, as he remarks, the patient cannot escape with his life, unless he is saved by a critical evacuation, such as bleeding from the nose, or profuse sweating.

When, in the inflammative lassitude, the head is affected, Aëtius directs us to open the cephalic vein; when the chest or back, the basilic; and when the whole body equally, the median. He recommends also cooling herbs, such as beet, mallows, lettuce, and the like, with ptisan and tepid water. He forbids the use of cold water. After the third day, if the patient is convalescent, he allows a thin weak wine, much diluted.

Averrhoes approves very much of Galen’s directions respecting the treatment, except that the peppers recommended by him had not been found to answer in his climate (Cordova). Instead of them, he directs cinnamon, amber, cassia lignea, and similar aromatics to be given.

Avicenna joins Galen in cautioning the physician to be guarded in allowing his patient to take much food, as the veins being emptied by the remedies applied for removing the lassitude, greedily absorb the chyle before it is properly concocted.

SECT. XXIII.—ON THE REGIMEN OF OLD PERSONS.

Old age is dry and cold; and its correctives are calefacients and diluents compounded with them. Friction is to be applied to the aged, but so as not to occasion lassitude. To such as are weak, some such course of diet as the following is to be prescribed: about the third hour, a small bit of bread with Attic honey; and afterwards, about the seventh hour, after having undergone friction, and taken exercise and baths suitable to old men, they must first get such things as are of a laxative nature, and afterwards fish or fowls; and then for supper, such things as are wholesome, and not apt to spoil in the stomach. I also do not forbid them to use wines prepared with honey, particularly such persons as are suspected of being threatened with the stone or gout, and in that case, a little parsley may be added. If phlegm be gendered in the stomach, we must of necessity apply such remedies as will remove it, and return immediately to a diluent diet: we must give them ripe figs in preference to every other kind of food, and if during the winter, dried figs, unless they complain of unpleasant symptoms in the right hypochondrium. When serous and pituitous recrements collect in the bodies of old men, we must promote the discharge of urine every day, and soften the belly, principally by giving oil before a diet. It is obvious, that all pot-herbs ought to be eaten before all other food, with oil, pickles, or olives and damascenes seasoned with salt. When the belly is bound, the herb mercury and the bastard saffron will relieve it. Turpentine also is proper in such cases. It may be given sometimes to the bulk of a Pontic walnut, and sometimes of two or three. Oil also in a clyster is most useful to those who are constipated.

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COMMENTARY. This Section is copied from Oribasius. (Synops. v, 18.) See also Aëtius. (iv, 30.) These directions are all borrowed from Galen (Hyg. v), who has treated of the subject with his characteristic elegance and good sense. The following is a brief exposition of his views of practice in such cases: “Old age is cold and dry, and is to be corrected by diluents and calefacients, such as hot baths of sweet waters, drinking wine, and taking such food as is moistening and calefacient.” He strenuously defends the practice of allowing old persons to take wine, and gives a circumstantial account of the Greek and Roman wines best adapted to them. In the case of old persons he approves of three meals in the day. He recommends the bath to be taken before dinner, which should consist of sea fish. He properly expresses his disapprobation of giving them aloetic pills to remove constipation of the bowels, and advises rather that they should be kept open with laxative herbs and oily clysters, in the manner stated by our author. Aëtius remarks, in like manner, that old men are much hurt by strong purgatives, which only increase the disposition to costiveness. All that is required in such cases, he remarks, is to lubricate the rectum with an injection of oil. The Arabians follow closely in the same strain. Alsaharavius recommends old persons to drink strong diuretic wines. He also approves of the tepid bath, and friction with emollient oils. He disapproves of much exercise and of taking aloetic pills, instead of which he directs oily clysters and laxative herbs. (Pract. xxvii, 10.) See more particularly Averrhoes’ Commentary on the Cantica of Avicenna (tr. i.) They agree that if an old man had been accustomed to be frequently bled, the practice is not to be wholly laid aside. Avicenna particularly approves of a milk-diet. He recommends old red wines, but forbids such as are new and sweet. (i, 3, 3.) Even Plato, the philosopher, permits old men to take a liberal allowance of wine, which he pronounces to be the restorative of youth, and the corrective of the austerity and despondency of old age. (leg. ii.) See also Athen. (Deip. x, 54, ed. Schweigh.)

According to Hippocrates, old men bear abstinence better than those of any other period of life. (Aphorism.) The reason of this assigned by his Commentators, Theophilus and Damascius, is, that their innate heat is lower than at any other age, and consequently requires less pabulum to support it. (Ed. Dietz. t. iv, 277.)

SECT. XXIV.—FOR A WRINKLED STATE OF THE BODY.

A wrinkled state of the body may be removed by the farina of bitter tares, mixed with white vine.

Another abstergent composition (smegma), to be frequently rubbed into the skin: fat figs bruised with bryony, and the burned powder of tares, the shells of the cuttle-fish (sepia), mixed with a small quantity of honey.

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COMMENTARY. This Section is taken from Oribasius. (Synops. v, 20.)

SECT. XXV.—TO MAKE THE PERSPIRATION FRAGRANT.