Part 61

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.)