Part 81

A trochisk to be inhaled for a continued cough. Of storax, of pepper, of mastich, of Macedonian parsley, of each, oz. j; of sandarach, scr. vj; two bay-berries; mix with honey; and fumigate by throwing them upon coals, so that the person affected with the cough may inhale the vapour through a funnel. It answers also with those affected by cold in anywise.

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COMMENTARY. All the writers referred to in the preceding Section (with the exception of Aretæus) may be consulted here.

Galen, in the seventh book of his work, ‘de Med. sec. loc.’ has treated of these diseases so fully that he may be said to have exhausted the subject. We can only afford room for a few of his general remarks. He states that the arteriacs, or compositions for affections of the arteria trachea, consist of three different kinds of medicines. First, those called by him obstruents, and answering to those now called demulcents, such as Cretan sweet wine, tragacanth, liquorice, and the like, which act by smoothing the asperities of the parts. Second, the acrid, containing cinnamon, turpentine-rosin, and the like. Third, the intermediate, consisting of the juice of ptisan, almonds, and the like. He gives a great number of compositions from Andromachus, Criton, and others, which might deserve attention. Of their ingredients some are expectorants, such as squills, myrrh, &c.; some demulcents, such as liquorice, tragacanth, &c.; and some narcotic, such as opium, mandragora, hyoscyamus, and hemlock. With the medicinal properties of the last-mentioned article (we mean the conium maculatum), which Dr. Paris commends so highly in diseases of the chest, the ancients were sufficiently well acquainted. For humid coughs Galen recommends a composition of alum, opium, galbanum, and storax. He mentions lumbrici in the stomach as a cause of coughs. (Com. in Epid. iii.) Among the remedies mentioned by our author, by Galen, and by most of the ancient authorities, we may remark the inhaling the fumes of certain acrid medicines, such as yellow orpiment and sandarach, or realgar, i. e. red orpiment. Whether the practice be safe or not we shall not pretend to determine; but, unquestionably, it is recommended upon high authority; and therefore it is not true, as has been often stated, that this practice arose from the mistake of confounding the gum juniper, or vernix of the Arabians, also often called sandarach, with the sandarach of the ancients, or realgar. (See Bree on Asthma, p. 231.) We refer to Aëtius (viii, 61); Pseudo-Dioscorides (Euporist. ii, 33); Pliny (H. N. xxxiv, 55); Alexander (v, 4); Myrepsus (xli, 76); Serapion (ii, 19, and 24); and Rhases (Cont. viii.) The ancient veterinary surgeons used arsenic in fumigations for the coughs of cattle. See Vegetius (Mulom. iii, 67.) Platearius, a modern writer of the thirteenth century, recommends arsenic for chronic coughs, both in fumigations and taken into the stomach, and yet he distinguishes quite correctly the sandarach, or red arsenic, from the gum vernix. (De Simplici Medicina.) Some of the earlier writers on the venereal disease recommend fumigations with arsenic for syphilitic ulcers of the throat. (V. Aphrodisiacus, and Sect. XXIX of this Book.)

At the commencement of a common catarrh, Celsus advises to abstain “a sole, balneo, vino, venere;” but to use “unctione et assueto cibo.” When the lungs become affected he recommends much friction and exercise on foot. He gives the following account of the origin of these complaints: “Destillat autem humor de capite interdum in nares, quod leve est; interdum in fauces, quod pejus est; interdum etiam in pulmonem, quod pessimum est.” The idea of the disease originating in the head and spreading downwards prevails in all the ancient descriptions of the disease, and, we may mention, is now sanctioned by the authority of the illustrious Laennec. See, in particular, Aëtius, who copies, however, in part from Galen.

Alexander devotes a whole chapter to the consideration of these complaints. He forbids diuretics, because they carry off the thin part of the humours and leave the thick behind. Respecting the chalazia mentioned by Galen, and “the smooth, hard, and firm stone” said to have been expectorated by Alexander’s patient, we have a few remarks to make. The passage in Galen’s work where they are described is at ‘de Loc. Affect.’ iv, near the end. These sputa have been described by recent pathologists. Thus Andral calls them small clots, of a dull white, or inclining a little to yellow, from a small pin’s head to a pea in size. (Clinical Medicine, 464, Engl. ed.) The modern authorities agree that they are indicative of phthisis. Aretæus describes by the name of pneumodes, and as a species of asthma, a diseased state resembling that which we are treating of. The symptoms are dyspnœa, cough, and wasting; pulse small, frequent, and feeble; the sputa, if any, small, white, round, and like hail. The disease proves fatal in the course of a year, and often ends in dropsy and anasarca.

The treatment recommended by the great Methodist Cælius Aurelianus is not much different from the practice of the other sects, only he enjoins a more rigid abstinence from wine and food of a heating nature. He also condemns the practice of inhaling the vapours of red arsenic (sandaracha), and the like. In protracted cases he recommends a change of place.

There is nothing original in the practice of the Arabians. Avicenna prudently forbids preparations of poppies after expectoration has commenced. For coryza Haly Abbas recommends, if the patient’s age and temperament permit, bleeding, a spare diet, abstinence from wine, fumigations with the vapours of camphor, lignum aloes, vinegar, &c.; avoiding to lie on the back, and so forth. He treats at great length of coughs, distinguishing them according as they are seated in the throat, gullet, or lungs, and whether they be sympathetic or not. For hoarseness, he directs gargles from the seed of anise or fennel, or a decoction containing radishes, parsley, fennel, mastich, spikenard, iris, figs, &c. Alsaharavius treats fully of these complaints in much the same terms.

SECT. XXIX.—ORTHOPNŒA, ASTHMA, AND DYSPNŒA.

Those who breathe thick without fever, like those who have run fast, are said to be asthmatic, that is to say, to pant for breath; and from their being obliged to keep the chest erect for fear of being suffocated, they are called orthopnoic. The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs. Dyspnœa is a common symptom which accompanies these and many other complaints. The indication of cure in asthmatic complaints is to consume the viscid and thick humour by attenuant and detergent medicines. Wherefore the vinegar of squills will answer well with them, and the oxymel prepared from it; the baked squill itself when triturated with honey; the antidote called hiera, continued purging with drastic medicines, and vomiting from radishes. And, in like manner, the round birthwort may be drunk, the root of the great centaury, the fruit and root of cow-parsnip, the fruit of calamint, hyssop, iris, and gith. Put a sextarius of slaters, into an earthen vessel, roast upon the coals; when whitened, pulverize, and, mixing with boiled honey, give a mystrum thereof before and after food. If there be any urgent necessity, before doing all these things, open a vein and evacuate proportionably to the patient’s strength; and stimulate the belly by clysters. Externally to the chest we may apply cataplasms from figs, the flour of iris, and of barley, containing rosin, wax, and honey; and iris and manna may be sprinkled upon them. Some benefit may also be derived from raw barley-flour, with rosin, wax, iris, and manna. We may use the more heating ointments, such as those of iris, dill, and rue. But the following application is particularly proper: Of pumice-stone, p. j; of burnt lees of wine, p. iv; of arsenic, p. j; of the schenanth, p. ij; of alcyonium, p. j; of aphronitrum, p. ij; pound, sift, mix with the ointment, and with it rub the parts about the chest, and use emollient ointments for attracting the humours.

A draught for asthmatics. Of poley, of southernwood, of castor, of ground pine, of ammoniac perfume, equal parts; mix with honey, and give.—Otherwise: Some give a spoonful of aphronitrum in three cyathi (cupfuls) of honied water.—Another: Of aphronitrum, dr. ix; of pepper, dr. j; of laserwort, dr. ss; give a spoonful in water.—Another: Of castor, of ammoniac perfume, of each, dr. vj; of pepper, xl grains; mix with must, and give to the size of a bean in honied water.—Another: Of mustard, dr. j; of the spuma nitri, three oboli; of elaterium, a diachylon (i. e. half an obolus): form the whole into eight trochisks, and give two every two days; for they will evacuate upwards gently. To those who are choked for want of breath, give, of aphronitrum, dr. iij, with three cyathi of hydromel, and sometimes with cardamom, and it will relieve them immediately. It is also useful in ischiatic disease.

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COMMENTARY. The following ancient works may be consulted: Hippocrates (Aphoris.); Galen (de Comp. Med. sec. loc. vii); Celsus (iv, 4); Aretæus (Morb. i, 11); Cælius Aurelianus (Morb. Tard. iii, 1); Aëtius (viii, 63); Oribasius (Loc. Affect. iv, 79); Actuarius (Meth. Med. iv, 4); Marcellus (de Med. 17); Nonnus (127); Octavius Horatianus (ii, 2, 12); Serapion (ii, 24); Avicenna (iii, 10, 1, 38); Mesue (de Ægrit. Pect.); Haly Abbas (Pract. vi, 8; Theor. ix, 20); Alsaharavius (Pract. viii, 5); Rhases (ad Mansor. ix, 56; Contin. viii.)

Our author’s theory of the disease is borrowed from Galen, and seems very plausible. It being admitted by our best modern pathologists, that there is no organic alteration of structure in ordinary cases of convulsive asthma, it seems likely that the paroxysm is occasioned by thick and viscid humours infarcted in the lungs; or, most probably, in many cases from the system being loaded with such humours which nature casts off by the lungs. We need scarcely add, that it is now well ascertained that asthma is frequently produced by engorgement of the lining membrane of the bronchi, thus forming what is called the dry catarrh. Galen, like our author, maintains that the use of attenuant and detergent medicines is indicated. His internal remedies are squills, pepper, wormwood, opopanax, storax, sulphur, oxymel, millepedes, &c. He forbids all things which are either of a very hot or cold nature, as in either case they tend to thicken the humours.

Aëtius gives nearly the same account as our author, both having evidently borrowed from Galen. He strongly praises vinegar of squills, myrrh, pepper, and the like. In certain cases he advises the application of the actual cautery to the head (see Book Sixth, Sect. I) under the impression that the disease is occasioned by a defluxion from it. He also speaks of burning the chest in several places for the purpose of making issues; and further recommends strong rubefacients.

Among the articles recommended by Marcellus, the Empiric, for difficulty of breathing, we remark vinegar of squills, natron (soda), opium, horehound, &c. The first article, it will be perceived, among his remedies for asthma is vinegar of squills. Almost all the ancient authorities praise the virtues of squills in this disease.

Aretæus gives a good description of the symptoms of the disease, which he attributes to a humid, thick, and glutinous matériel in the lungs. He says, the lungs are primarily affected, and through them sympathetically the diaphragm, and parts about the chest which assist in respiration. But if the heart be affected, he adds, the issue is speedily fatal. Among the incipient symptoms he mentions flatulence of the bowels, restlessness, and latent heat by night. As the paroxysm proceeds, the cheeks become red, the nose sharp, the eyes prominent as if from strangulation, there is a râle even when awake, and still more so when asleep; the voice is humid and devoid of resonance, with an insatiable desire of cold air, panting, and orthopnœa. To these symptoms are added, paleness of the countenance, with the exception of the cheeks; profuse sweats about the face and chest; constant and difficult coughing, with little expectoration. His chapter on the treatment is lost.

As Oribasius, Actuarius, and Nonnus follow the principles laid down by Galen, we need not give any account of their opinions.

Octavius Horatianus adopts Galen’s theory, which he thus explains: “Pingui autem et frigido phlegmate pulmonibus adhærente, cavernæ, vel meatus, quibus naturaliter spiritus redditur et accipitur, concluduntur; et ex hoc impedimento suspirium, vel anhelitus molestissimus, nascitur, ut sedendo magis quam jacendo respiret.” He recommends bleeding, if not contra-indicated; but, if that is the case, frequent abstinence. Among his internal remedies we remark oxymel, gum ammoniac, castor, and vinegar of squills. He approves also of emetics. He recommends stimulant applications to the chest, also fomentations and sinapisms. A long journey, he says, is beneficial.

Cælius Aurelianus disapproves of burning the head and of strong purging. He approves of bleeding, if the patient’s strength permit, of clysters, cupping the breast, gestation, friction, vociferation, emetics from radishes, or even from hellebore, and of giving the vinegar of squills. He speaks favorably of the cold bath. His description of humid asthma is very striking, and has been commended by late authorities on the subject. The sounds within the chest are thus described: “stridor, atque sibilatio pectoris, cum vocis debilitate.”

Cassius discusses the question why there is a sibilant murmur in cases of orthopnœa, and decides that it is because the affection is a contraction and falling-in of the cells of the lungs, and the breath rushing through a narrow passage produces this murmur. (Prob. 82.)

Serapion recommends friction, exercise, squills, fumigations with arsenic, &c. Mesue also recommends arsenic in various forms. Avicenna’s account is particularly full and judicious. He properly remarks that asthma is sometimes connected with derangement of the heart, liver, and stomach. Like the others, he approves of arsenic, both in pills and in solution.

Haly Abbas, like Galen, refers asthma to a collection of gross phlegm about the cells of the lungs. His remedies are of an attenuant and incisive nature, and he particularises the vinegar of squills. He cautions asthmatics to beware of indigestion, and, therefore, forbids exercise after food, but recommends it before a meal. After exercise he enjoins hard friction, no doubt with the intention of favouring the cutaneous perspiration. Rhases commends squills and the tepid bath. Like the others, he approves of inhaling the vapours of arsenic.

Vegetius, the veterinary surgeon, recommends squills with wine, assafœtida, and oil, for these complaints in cattle.

Respecting the use of arsenic in asthma, Prosper Alpinus remarks: “Præterea audent aliqui arsenicum summè exitiale venenum illis exhibere. Narrant quidam nepotem patris fratri decrepito orthopnoico, ut cum interimeret, clam in ferculo ex cucurbitâ parato porrexisse arsenicum, coque non modo non interimisse decrepitum, verum et ab asthmate prorsus sanasse.” (De Meth. Med. x, 13.) He states further, by the way, both in that work and in the one “de Medicina Ægyptiorum,” that the Egyptians were in the practice, for the cure of asthma, of applying cones of cotton to the breast, and setting them on fire. Fracastorius, who recommends this practice of imbibing the fumes of arsenic, for contagious phthisis, speaks of it in the following terms: “Nonnulli antiquorum jubent Sandaracæ nidorem per anhelitum in pulmones trahi: quum autem Sandaracam dico non eam intelligi volo quæ vernix vulgo vocatur, sed quæ auripigmentum a nobis dicitur: porro nec per auripigmentum velim a te accipi priorem illam speciem quæ citrina est sed alteram, quæ est ruffa, et propriè Sandaraca vocatur.” (Morb. Contag. iii.)

Dr. Hill, however, properly remarks that the arsenic of the ancients, or orpiment was a much more innocent substance than the factitious arsenic of the moderns. See also Cleaveland (Mineralogy p. 680.) The arsenic of the ancients, in fact (as will be shown in the proper place), was the mineral substance called yellow orpiment, consisting of sixty-two parts of arsenic and thirty-eight of sulphur, according to the analysis of Klaproth. The sandarach was realgar, which consists of seventy-five parts of arsenic and twenty-five of sulphur.

SECT. XXX.—ON PERIPNEUMONIA.

Peripneumonia is an inflammation of the lungs, supervening, for the most part, upon violent catarrhs, cynanche, asthma, pleurisies, or other complaints, but being sometimes the original affection. It is accompanied with difficulty of breathing, an acute fever of the ardent type, weight and tightness of the chest, a râle, a seizure of the face with great fulness, the morbific matter being determined upwards like fire. Wherefore the cheeks appear red, the eyes swelled, with falling down of the eyebrows, and the cornea appears somewhat glossy. When the symptoms incline to a more ardent type, it is to be apprehended that the inflammation is of an erysipelatous nature. When the disease originates from the conversion of other diseases into this, we must not have recourse to venesection, more especially if the diseases be of a chronic nature, and if blood had been previously let. But, in the remissions, clysters are to be injected into the bowels, which are moved with difficulty; or, when nothing contra-indicates, large cupping-instruments with scarifications may be frequently applied to the breast and sides. But if the peripneumonia was the original affection, and the strength permit, we must open a vein; or if not, we may cup, proportioning the evacuation of blood to the powers of the patient. Let draughts of the juice of ptisan, or of chondrus with honey, be taken, or from bitter almonds with semilago, or chondrus having some sweet potion mixed with it, such as hydromel, apomel, or hydrorosatum. Fresh butter to the extent of three spoonfuls is also proper. The patient must also drink the propoma of the decoction of figs with hyssop, or of iris boiled in honied water, or of powdered iris, to the amount of two spoonfuls sprinkled upon honied water. This also evacuates downwards. To keep up the strength, he should be made to drink frequently of honied water alone, and with pine-nuts, and the seed of cucumbers. And cupping-instruments and the cerate of privet, having some iris sprinkled upon it; or the cerate of the oil of rue and dried iris; or that made of wax, and rosin, marrow, butter, hyssop, dried iris, and nard ointment, may be applied to the whole chest and sides.