Part 80

Avicenna and the other Arabians make mention of the amulet recommended by Galen.

SECT. XXVII.—ON ANGINA, OR QUINSEY, AND THE COMPLAINTS ALLIED TO IT; IN WHICH THE SUBJECT OF THOSE WHO HAVE BEEN STRANGLED OR OTHERWISE SUFFOCATED IS TREATED OF.

When the parts within the throat are inflamed, the disease is called synanche; when those without it, parasynanche. In like manner, when the parts within the windpipe are inflamed, the disease is called cynanche; and when those without it, paracynanche. All these complaints are attended with orthopnœa and pain, with difficulty of breathing, and in some cases with fever. There is redness of the face and neck, and swelling in some cases, and sometimes the mouth is kept constantly open, and they cannot swallow drink. Cases of cynanche are sometimes attended with a sense of suffocation. This disease attacks children but rarely, and then only from injuries of the spinal vertebræ occasioned by a fall, which case, being incurable, is not to be meddled with. In the others, we must immediately bleed from the arm, and take away not a great quantity at once, but in divided quantities; for from a rapid evacuation there is danger of suffocation, owing to the matters rushing to the affected part, if the patient should faint. Should they not be immediately relieved by it, we must open the veins below the tongue; or make incisions into the tongue itself, if it be swelled and protrude out of the mouth. The bowels are to be evacuated by acrid clysters; hot water is to be poured upon the feet, and the extremities firmly bound with ligatures. The neck is to be wrapped in unwashed wool, or in wool smeared with oil, and a cataplasm of raw barley-meal applied. At the commencement we may use the gargles described for inflammation of the tonsils, or the simple medicine from mulberry, with the decoction of sumach; but the best remedy is that from wild mulberry, and after that the compound application from mulberry, or the parts are to be anointed with the composition from walnuts. When the disease is at its height, we may add a little nitre or sulphur vivum, unless the acrimony prohibit their use. And dog’s dung, dried and powdered, and rubbed in with honey, is a most excellent application, more especially the white kind; also the dung of wild swallows, in like manner. When the complaint is of long standing, we may use the liniment from besasa, or wild rue, sometimes increasing and sometimes diminishing its strength, by the mixture of other medicines. Cupping-instruments or leeches are to be applied to the chin and neck, and the patients must use the stronger gargles from iris, hyssop, gith, southernwood, liquorice, dried figs boiled in honied water, or in the juice of rue with milk, or mustard with oxymel. If irritation arise from the use of them, we must give warm oil of the finest kind, or rose-oil by itself, or with the juice of ptisan or of fenugreek, to gargle with. The food should be honied water until the third day, after which the juice of ptisan, with some of the sweet drinks, and then the yelks of eggs in a liquid state. They may use spoon-meats made from chondrus, when deglutition is unobstructed, and take food suitable to their strength. When the disease is on the decline, we may get them to take exercise and the bath. The parts are to be enveloped in a cerate of the oil of rue; and we must have recourse to the other means of an analeptic nature.

In suspended animation, such as have the foam already at their mouth we must do nothing to, agreeably to the precept of Hippocrates (Aph. ii, 43); but the others may be resuscitated by pouring into their mouths vinegar and pepper, or the fruit of the nettle pounded in the strongest vinegar. It is with difficulty that they swallow it, but they must be compelled; and when the redness about the neck is dispelled, they immediately look up and recover. The same means are to be used towards those who have been wrecked in the sea; and, in fine, towards all those whose respiration has been suspended; for their heat is thereby resuscitated.

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COMMENTARY. See Hippocrates (de Victu Acutorum, 39; de Prognos.; de Morbis, ii, iii); Galen (de Med. sec. loc. vi; de loc. Affect. iv); Aretæus (de Morb. Acut. i, 7); Alexander (iv, 1); Aëtius (viii, 48); Oribasius (Morb. Curat. iv, 71); Leo (iv, 10); Actuarius (Meth. Med. iv, 14); Celsus (iv, 4); Nonnus (123); Scribonius Largus (16); Cælius Aurelianus (Morb. Acut. iii, 1); Octavius Horatianus (ii, 6); Marcellus (de Med. 15); Serapion (ii, 18); Avicenna (iii, 9); Mesue (de Ægr. Gutturis); Avenzoar (i, 10); Haly Abbas (Pract. i, 26, and vi, 2); Alsaharavius (xi, 2); Rhases (ad Mansor. ix, 54, and iv, 25; and Contin. vii).

The plan of treatment recommended by Hippocrates can scarcely be improved upon: general bleeding, opening the veins below the tongue, giving warm gargles and linctuses, shaving the head, wrapping the neck in soft wool, or applying fomentations to it, giving honey and water, or ptisan not cold, and administering clysters or purgative medicines. According to Le Clerc, he performed bronchotomy in extreme cases. He refers, we suppose, to lib. iii, 11, ‘de Morbis,’ but the language is not so precise as to make it quite certain that bronchotomy was there meant to be described. Sprengel supposes that he only introduced a tube by the nostrils into the trachea. He describes a species of cynanche in which there is no external swelling, and which proves fatal in the course of a day, or at least of a very short time. (Prog.) Cynanche, he says elsewhere, is apt to be determined to the lungs. (Aph.) Fever, again he says, attending ulcerated sore throat is bad. (Prog.) When the tonsils are swelled and red, he says it is dangerous to scarify them. (Ibid.) His commentator Stephanus remarks that when the disease becomes indolent the part may be burned or cut.

Aretæus states that the parts affected with synanche are the tonsils, epiglottis, fauces, uvula, the upper part of the trachea, and, if the inflammation spread, the tongue and jaws. He makes a distinction between cynanche and synanche. The former is attended with swelling of the parts and other well-known symptoms, of which he has given a striking description. In synanche (which he attributes to the pneuma being over-heated and over-dried), the parts, on the contrary, are contracted, and there is a strong sense of suffocation. This disease, he says, generally proves soon fatal, unless swelling and inflammation of the parts supervene, or erysipelas of the breast occur; in imitation of which, he states that a good physician will apply a sinapism or cupping-instrument to the chest to produce revulsion. In treating of the former variety of the disease, he begins with administering two clysters to evacuate the bowels and produce revulsion; he bleeds in the arm from a large orifice so as nearly to bring on deliquium animi, and he approves also of bleeding by opening the veins below the tongue: he recommends applications at first of an astringent nature, but, if suppuration be expected, he directs hot ones from fenugreek, hot fomentations, sponges squeezed out of the decoction of bay or hyssop, and the like, to be used. In the other variety, he recommends us to determine outwardly by all possible means, such as by applications containing nitre, mustard, &c. He says the application of fire would be most suitable in such cases, but as it cannot be applied from the situation of the disease, he recommends medicines which resemble fire (caustics), so as to stop the ulceration from spreading. The caustics and astringents mentioned by him are alum, galls, pomegranate rind, and in particular calcined chalcitis. The last was a vitriol resembling sulphate of copper. (See the preceding Section.) He mentions that in this variety some were said to have opened the windpipe, in other words to have performed laryngotomy. He does not believe, however, that the operation had ever actually been performed, and dissuades from attempting it, as it would only increase the evil; and he apprehended that the wound in the cartilages would never heal. From his account of synanche, Le Clerc concludes that Aretæus belonged to the Pneumatic sect; and although Ackerman is doubtful upon this point, we could point out many passages in his works which have quite satisfied us on this point. By pneuma was probably meant the vital heat in the body, acted upon by a spiritual substance within us, the same being a portion of that principle which the ancient philosophers called nature. It was truly a vis medicatrix. (See Morb. Chron. cur. i, 7.)

Celsus, like Aretæus, describes the two varieties of the disease, and recommends nearly the same treatment.

Galen, and after him Aëtius, give a similar account with great minuteness and precision. We cannot pretend to do justice to their treatment, and shall merely mention that, in the second variety, they praise mustard for a gargle, and elaterium as a purgative. It is worthy of notice that Galen describes a rare species of this disease, in which the tongue is so swelled that the mouth cannot contain it. (Meth. Med. i.)

Alexander’s directions are most minute and judicious, but we must be content with stating that he approves of opening the ranal and jugular veins, and that his treatment is otherwise similar to that of Galen. This is the first mention of opening the jugulars that occurs in a medical author.

Octavius Horatianus we shall merely mention, in order to state that he has described the two varieties of the disease like the others.

Cælius Aurelianus gives a singularly accurate and circumstantial account of this disease, but it is so long that we can merely afford room to point out a few of his leading opinions. He approves of a fomentation made with a bladder half filled with hot sweet oil. He directs the patient to inhale the steam of hot water, and to have sponges squeezed out of it applied to the neck and throat. He approves of cupping the neck or of leeching it, and also of scarifying the tongue and fauces if they are much swelled. With respect to the treatment of the other sects, he blames Hippocrates for making too rapid a detraction of blood, and also for opening the veins below the tongue, which, he says, will only aggravate the evil, and may be productive of inconvenience, owing to the difficulty of stopping the bleeding. But, in particular, he finds fault with Archigenes for mentioning laryngotomy, and treats the operation as entirely fabulous and the fiction of that physician. His aversion to it is so strong that he pronounces it a crime. Before having done with this author, we may remark that Prosper Alpinus, the modern advocate for ancient Methodism, does not agree with Cælius in condemning the Hippocratic practice of opening the veins below the tongue. In his own case he had experienced the good effects of this practice. (Meth. Med. vii, 10.)

The Arabians, like their Grecian masters, describe the two varieties of the disease, and treat them accordingly. For the variety called synanche by the Greeks, they approve of hot gargles consisting of mustard, pepper, and the like. This resembles the modern practice of using gargles of Cayenne pepper. In the following passage, Rhases evidently points at the contagious synanche: “It happens on certain years in spring that a bad and destructive species of synanche attacks a great many persons. Wherefore at such a time it will be proper to anticipate the disease by venesection, abstracting blood from the legs with cupping-instruments, opening the belly, and gargling with rose-water, or infusions of sumach, mulberries, and nuts.” Haly Abbas likewise states that the disease is sometimes epidemical. Rhases approves of general bleeding, of opening the sublingual veins, and of using astringent gargles at first, and afterwards maturative ones consisting of figs, sweet almonds, and the like. In his ‘Continens’ he seems to allude to bronchotomy. Alsaharavius describes the two varieties of the disease with great minuteness. He agrees with the others as to the danger of that variety in which there is no swelling nor inflammation outwardly. Avicenna and other of the Arabians follow Alexander in recommending bleeding by opening the jugulars. The two kinds of angina, mentioned by the ancients, are described in similar terms by Sydenham, Boerhaave, and Van Swieten. The first variety, or common quinsey, is well known. The second is of less frequent occurrence. The modern authorities have found it as fatal as the ancients gave them reason to expect. The reader will find a very interesting commentary on Aretæus’ description of malignant sore throat in a tract, ‘de Recondita Abscessum Natura.’ (Mangeti Bibl. Chirurg. i, 48.) It is the disease now called laryngitis acuta.

Haly approves of the treatment recommended by our author in cases of suspended animation. In treating those who have been in water, he directs, very improperly we are convinced, the patient to be hung by the heels, to favour the escape of the water by the mouth. It would appear, however, from the late experiments of Professor Meyer, that the ancients were correct in supposing that water is generally found in the lungs of drowned persons. When a person has hung by the neck for a time, and there is any prospect of recovery, Haly directs us, as soon as he can swallow, to make him gargle with oil of violets and tepid water, and to drink barley-gruel and the like.

SECT. XXVIII.—ON CORYZA, CATARRH, AFFECTIONS OF THE TRACHEA, AND COUGH.

All these complaints have this in common, that they are occasioned by the defluxion of a redundant humour from the head to the parts below. When, therefore, it seats in the nostrils, the disease is called coryza; when in the pharynx and roof of the mouth, simply catarrh; but when it attacks the larynx and arteria trachea, so as to occasion a roughness of the membrane which lines them, the voice becomes hoarse, and the disease is called branchus, or morbus arteriacus: these terms being applicable not only to the inflammatory roughness occasioned by a defluxion from the head, but also to that arising from vociferation and inhaling cold air. When the complaint is protracted, and the defluxion is carried down to the chest and lungs, it gives rise to bad coughs. And a cough often arises from an intemperament; sometimes a hot one, as in fevers, and sometimes a cold, as in northerly states of the weather, which is rather a dry one. Cough is also sometimes symptomatic of some other disease, such as pleurisy, hepatitis, phthisis, or peripneumonia. Wherefore Galen relates that, in certain chronic cases of cough, chalazia (hail-stones) have been brought up from the chest. But Alexander relates that a certain heavy stone, like that which forms in the urinary organs, was brought up in a chronic cough, upon which the cough ceased. We ourselves have seen a discharge of stones with vomiting of blood, as we will describe more accurately when we come to that part. Those who have coryza and catarrh from exposure to heat have a sensation of heat about the parts, and a running of acrid and thin humours from the nostrils and mouth, and there is redness about the face and nose. When they are occasioned by cold, there is distension about the head and forehead, and obstruction of the ethmoid pores, so that the voice does not resound through the nose; and when they are protracted, cough supervenes, and expectoration of phlegm, which is sometimes unconcocted and fluid, and sometimes green. In some cases fever comes on, which does not alleviate the complaint when it proceeds from heat, but when from cold it promotes concoction.

The cure of catarrh and of coryza. When a hot intemperament prevails, those remedies will apply which suit with headachs from the same cause. They must have recourse to baths, and have a large quantity of hot water poured upon the head. The food most befitting are spoon-meats and eggs in a state to be supped, starch, sweet cake, sesame, rice, almonds, the fruit of the cones of pine, and all confections from milk. The wines which are drunk should be sweet and not old. The lohoch from poppy-heads, called diacodium, and other compound medicines for these complaints, are to be taken. When a cold intemperament prevails, and the disease is difficult to remove, a restricted diet is to be observed, and the head anointed with some heating and attenuating ointment, such as that of nard or rue. But the ointment of iris is not only to be rubbed in, but is also to be injected into the nostrils; and, internally, they are to be rubbed with frankincense and myrrh, with oil; and this more especially when the coryza arises from cold. But these are remedied by odoriferous substances with burnt linen, or by gith and cumin burnt and bound up in a linen rag. Let them also smell to the cyphi seleniacum, and let it be rubbed into the forehead; and to it let there be added one of the antiphlogistic plasters, such as the Icesian, the Oxera, the Barbarum, and the Athena. For catarrh from cold it will be expedient to drink of cyphi, and to rub into the chest the juice of balsam by means of unwashed wool; or to apply calefacients to it, along with storax, the ointment of iris, or that of dill. Let them also use hot and concocting food. But when the matter is already concocted, a masticatory will answer well with them, and detergent ointments (smegmata) to the head, such as the soap of Constantine, and the like.

The cure of affections of the trachea, or hoarseness. For the complaint called arteriacus and branchus, those things already mentioned will apply; but, in particular, when an inflammatory affection of the trachea and larynx prevails, we must, at the commencement, use the emplastic remedies, until the inflammation become more moderate; such as those from Cretan sweet wine, tragacanth, gum, and starch, and a decoction of the fatty dates and that of liquorice, with rob, until it become of the consistency of honey. And we must use that class of electuaries called hypoglottides. But, above all things, the patient at this period must abstain from drinking wine; but when the inflammation becomes moderate, he may take some sweet wine. And let him use those spoon-meats which are made from honey and milk, with starch, and bread of fine flour, and almond emulsions; and let him take butter. When a humour remains fixed in the parts, he must have recourse to detergent remedies, such as the porridge of beans, and those things which are prepared from honey, cabbage, and well-boiled leeks. He may also take the hotter medicines, and those used for the cough, in the rob of dried figs, of frankincense, iris, turpentine, storax, galbanum, pepper, cinnamon, cassia, and the like.

On cough. Coughs are to be cured by the same method, attending only to this, whether they be occasioned by sympathy with other parts, such as a defluxion from the uvula or head, and whether they be symptomatic of other diseases; in which case, they are to be disposed of in the manner already mentioned, or as will be described afterwards. An exposition of the compound remedies follows.

Pills for catarrh and cough. Of storax, of myrrh, of opium, of galbanum, equal parts; mix with must, or pound by themselves in a mortar, and make into pills the size of a tare. Give three, four, or five at bedtime, and swallow with some must. These things are for an acrid and thin rheum.—Another: Of the seed of henbane, dr. xij; of pine-nuts, dr. vj; of saffron, dr. ij. Mix with rob or with must, and use.

An electuary. Of honey, oz. j; of butter, oz. ss. Boil together and give; and let the decoction of hyssop, of figs, of pine-nuts, and of iris, be swallowed.

Pills for more inveterate coughs. Of storax, dr. vj; of myrrh, dr. iiss; of turpentine, of galbanum, of opopanax, and of iris, of each, dr. ij; of white pepper, of nitre, of henbane-seeds, of the juice of poppy, of each, dr. j. Beat in a mortar without any liquid, form into pills, and use as formerly directed.

For roughness of the windpipe, cough, and bloody expectoration. Of bitter almonds whitened, xxv in number; of toasted linseed, dr. iv; of tragacanth, dr. ij; of pine nuts, xxx grains; the yelk of an egg roasted in dough. The tragacanth is macerated with water, and the whole mixed with must. If the sound of the voice be broken, mix honey instead of the must, more particularly when there is anything to expectorate.

An arteriac to be kept below the tongue for those who have lost the voice, for hoarseness, and bloody expectoration. Of tragacanth, dr. vj; of gum, dr. vj; of myrrh, dr. iss; of white pepper, xx grains; of saffron, dr. j; of liquorice-juice, dr. vj; the flesh of three dates; of Cretan sweet wine, q. s. The juice of the tragacanth alone placed under the tongue answers very well. Instead of the juice of liquorice, its decoction boiled down to the proper consistence may be substituted in quadruple quantity.

An arteriac for loss of voice, suiting also for strengthening the voice. Boil six leeks to a third part; throw them away, but with the decoction mix the juice of alica and honey; boil with them the yelks of three eggs previously boiled, stirring with a branch of dill.

For coughs. Of pennyroyal, oz. ij; of pine-nuts, of bastard saffron, of linseed, of each, oz. j; of white pepper, oz. iv; mix with boiled honey.—Another: Of hyssop, of pennyroyal, of pepper, of each, oz. j; of Macedonian parsley, oz. ss; of honey, a hemina.

For concocting an inveterate cough. Of honey, dr. xvj; of turpentine, dr. ij; of galbanum, dr. xiv. Having boiled them together, and having formed to the size of beans or of walnuts, let them be sucked.—Another: A dry cough is cured by the arteriacs, and also by the drinking of hot water; for, not being able to expectorate, owing to the thickness of the phlegm, they are assisted in so far by diluents. A decoction from hyssop, and iris, and pine-nuts, also answers with them.