Part 59

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SECT. XLVII.—ON SWEATS.

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

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

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

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

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

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