Book V., 2, Syd. Soc. edit.

I would beg leave to call the attention of my professional readers

to the guarded and judicious manner in which pleurisy is treated by

our author, beginning with hot fomentations to the side, and gradually

advancing to the more active means, namely, purging and venesection.

It will be remarked that Hippocrates holds depletion to be the only

legitimate mode of removing the pain of the side, and that his

commentator, in illustration of his meaning, pointedly condemns the use

of narcotics in this case. Now this is a most important consideration,

as bearing on a mode of practice which has obtained much favor of

late years; I allude, of course, to the treatment by a combination of

mercurials and opium. The experience of some thirty years would seem to

decide in its favor, but how often have certain methods of treatment

in other cases obtained the sanction of professional favor for a

much longer period, and yet in the end been abandoned as positively

prejudicial? In my younger days I knew old practitioners, of the

highest reputation, who administered these medicines in scrofula,--in

cancer,--in every case! One cannot think of the changes in professional

opinions on the mercurial treatment of syphilis, since the days of John

Hunter, without the most painful feeling of distrust in all modes of

treatment where one cannot recognize some reasonable bond of connection

between the remedy applied and the effects produced, or where long

experience and analogy are in favor of them, and where the judgment

runs no risk of being imposed upon by fallacious appearances and

collateral circumstances. In a word, who does not feel disposed, in the

practice of medicine, constantly to recur to the great truth proclaimed

by our author in his first Aphorism? “Experience is fallacious, and

judgment is difficult.”

I am almost afraid further to put the question to the profession of

the present day, whether or not the administration of antimonials in

pleuro-pneumonia be an improvement on the ancient practice, or the

reverse? Shall we say, then, that experience has decided that this

substance (antimony), which, when applied to the cuticle, or to its

prolongation, the epithelium of the stomach and bowels, occasions pain,

heat, and vascular congestion, produces the very opposite effects

on the lungs, when absorbed into the blood and conveyed to them? I

dare not venture to answer these questions myself, but suggest them

as deserving to be reconsidered, with serious impartiality, by the

profession. I trust, however, it will not be supposed that I incline

to stand up for ancient modes of practice, because they are old, or

to condemn modern methods because they are new; I merely state the

reflections which the comparison of ancient and modern usages, on this

important subject, has suggested to me.

Our author, it will be seen, attaches much importance to the

administration of the ptisan, or decoction of barley, in

pleuro-pneumonia. Our modern Hippocrates, I mean, of course, Sydenham,

was equally partial to this practice,[530] which is still very much

followed on the continent.

It will be remarked, that Hippocrates says nothing of counter-irritants

to the skin, in the treatment of pleurisy, all his external

applications being of the soothing kind. The stimulant treatment,

however, is not altogether modern, having been recommended in certain

cases by the Arabians. (See PAULUS ÆEGINETA, Vol. I., p. 501.)

Celsus also approves of sinapisms to the side. (iv., 6.)

The use of the bath and of the _douche_, or affusion of hot water

in febrile diseases, is an important question, which well deserves to

be reconsidered by the profession. (See the annotations on § 18.)

The reader will no doubt have been struck with the remark of Galen,

in the extract given above, that our author’s plan in the present work

is deficient in method, because he himself was the discoverer of the

subject-matters to which it relates. Galen then seems to have been of

opinion that it was too much to expect from any individual, that he

should produce a work which would be remarkable at the same time for

the originality of its materials, and for the methodical arrangement of

them. In confirmation of Galen’s judgment in this case, I would direct

attention to the difference that there is between this treatise and the

“Prognostics;” for all must admit that the matters of which the latter

work is composed are admirably methodized, and we have shown above that

they were derived in a great measure from the previous labors of the

Asclepiadæ.

ON REGIMEN IN ACUTE DISEASES.

Those who composed what are called “The Cnidian Sentences”[531]

have described accurately what symptoms the sick experience in every

disease, and how certain of them terminate; and in so far a man, even

who is not a physician, might describe them correctly, provided he

put the proper inquiries to the sick themselves what their complaints

are. But those symptoms which the physician ought to know beforehand

without being informed of them by the patient, are, for the most part,

omitted, some in one case and some in others, and certain symptoms of

vital importance for a conjectural judgment.[532] But when, in addition

to the diagnosis, they describe how each complaint should be treated,

in these cases I entertain a still greater difference of opinion with

them respecting the rules they have laid down; and not only do I not

agree with them on this account, but also because the remedies they use

are few in number; for, with the exception of acute diseases, the only

medicines which they give are drastic purgatives, with whey, and milk

at certain times. If, indeed, these remedies had been good and suitable

to the complaints in which they are recommended, they would have been

still more deserving of recommendation, if, while few in number, they

were sufficient; but this is by no means the case. Those, indeed,

who have remodeled these “Sentences” have treated of the remedies

applicable in each complaint more in a medical fashion. But neither

have the ancients written anything worth mentioning respecting regimen,

although this be a great omission. Some of them, indeed, were not

ignorant of the many varieties of each complaint, and their manifold

divisions, but when they wish to tell clearly the numbers (species?) of

each disease they do not write correctly;[533] for their species would

be almost innumerable if every symptom experienced by the patients were

held to constitute a disease, and receive a different name.[534]

2. For my part, I approve of paying attention to everything relating

to the art, and that those things which can be done well or properly

should all be done properly; such as can be quickly done should be

done quickly; such as can be neatly done should be done neatly; such

operations as can be performed without pain should be done with the

least possible pain; and that all other things of the like kind should

be done better than they could be managed by the attendants. But I

would more especially commend the physician who, in acute diseases,

by which the bulk of mankind are cut off, conducts the treatment

better than others. Acute diseases are those which the ancients

named pleurisy, pneumonia, phrenitis, lethargy, causus, and the

other diseases allied to these, including the continual fevers. For,

unless when some general form of pestilential disease is epidemic,

and diseases are sporadic and [not] of a similar character, there

are more deaths from these diseases than from all the others taken

together.[535] The vulgar, indeed, do not recognize the difference

between such physicians and their common attendants, and are rather

disposed to commend and censure extraordinary remedies. This, then,

is a great proof that the common people are most incompetent, of

themselves, to form a judgment how such diseases should be treated:

since persons who are not physicians pass for physicians owing most

especially to these diseases, for it is an easy matter to learn the

names of those things which are applicable to persons laboring under

such complaints. For, if one names the juice of ptisan, and such and

such a wine, and hydromel, the vulgar fancy that he prescribes exactly

the same things as the physicians do, both the good and the bad, but in

these matters there is a great difference between them.

3. But it appears to me that those things are more especially

deserving of being consigned to writing which are undetermined by

physicians, notwithstanding that they are of vital importance, and

either do much good or much harm. By undetermined I mean such as these,

wherefore certain physicians, during their whole lives, are constantly

administering unstrained ptisans, and fancy they thus accomplish the

cure properly, whereas others take great pains that the patient should

not swallow a particle of the barley (thinking it would do much harm),

but strain the juice through a cloth before giving it; others, again,

will neither give thick ptisan nor the juice, some until the seventh

day of the disease, and some until after the crisis.[536] Physicians

are not in the practice of mooting such questions; nor, perhaps, if

mooted, would a solution of them be found; although the whole art is

thereby exposed to much censure from the vulgar, who fancy that there

really is no such science as medicine, since, in acute diseases,

practitioners differ so much among themselves, that those things which

one administers as thinking it the best that can be given, another

holds to be bad; and, in this respect, they might say that the art

of medicine resembles augury, since augurs hold that the same bird

(omen) if seen on the left hand is good, but if on the right bad: and

in divination by the inspection of entrails you will find similar

differences; but certain diviners hold the very opposite of these

opinions.[537] I say, then, that this question is a most excellent one,

and allied to very many others, some of the most vital importance in

the Art, for that it can contribute much to the recovery of the sick,

and to the preservation of health in the case of those who are well;

and that it promotes the strength of those who use gymnastic exercises,

and is useful to whatever one may wish to apply it.

4. Ptisan, then, appears to me to be justly preferred before all

the other preparations from grain in these diseases, and I commend

those who made this choice,[538] for the mucilage of it is smooth,

consistent, pleasant, lubricant, moderately diluent, quenches thirst

if this be required, and has no astringency; gives no trouble nor

swells up in the bowels, for in the boiling it swells up as much as it

naturally can. Those, then, who make use of ptisan in such diseases,

should never for a day allow their vessels to be empty of it, if I may

say so, but should use it and not intermit, unless it be necessary to

stop for a time, in order to administer medicine or a clyster. And

to those who are accustomed to take two meals in the day it is to be

given twice, and to those accustomed to live upon a single meal it is

to be given once at first, and then, if the case permit, it is to be

increased and given twice to them, if they appear to stand in need of

it. At first it will be proper not to give a large quantity nor very

thick, but in proportion to the quantity of food which one has been

accustomed to take, and so as that the veins may not be much emptied.

And, with regard to the augmentation of the dose, if the disease be of

a drier nature than one had supposed,[539] one must not give more of

it, but should give before the draught of ptisan, either hydromel or

wine, in as great quantity as may be proper; and what is proper in each

case will be afterward stated by us. But if the mouth and the passages

from the lungs be in a proper state as to moisture, the quantity of

the draught is to be increased, as a general rule, for an early and

abundant state of moisture indicates an early crisis, but a late and

deficient moisture indicates a slower crisis.[540] And these things are

as I have stated for the most part; but many other things are omitted

which are important to the prognosis, as will be explained afterwards.

And the more that the patient is troubled with purging, in so much

greater quantity is it to be given until the crisis, and moreover until

two days beyond the crisis, in such cases as it appears to take place

on the fifth, seventh, or ninth day, so as to have respect both for the

odd and even day; after this the draught is to be given early in the

day, and the other food in place is to be given in the evening. These

things are proper, for the most part, to be given to those who, from

the first, have used ptisan containing its whole substance; for the

pains in pleuritic affections immediately cease of their own accord

whenever the patients begin to expectorate anything worth mentioning,

and the purgings become much better, and empyema much more seldom takes

place, than if the patients used a different regimen, and the crises

are more simple, occur earlier, and the cases are less subject to

relapses.

5. Ptisans are to be made of the very best barley, and are to be well

boiled, more especially if you do not intend to use them strained. For,

besides the other virtues of ptisan, its lubricant quality prevents

the barley that is swallowed from proving injurious, for it does not

stick nor remain in the region of the breast; for that which is well

boiled is very lubricant, excellent for quenching thirst, of very easy

digestion, and very weak, all which qualities are wanted. If, then, one

do not pay proper attention to the mode of administering the ptisan,

much harm may be done; for when the food is shut up in the bowels,

unless one procure some evacuation speedily, before administering

the draught, the pain, if present, will be exasperated; and, if not

present, it will be immediately created, and the respiration will

become more frequent, which does mischief, for it dries the lungs,

fatigues the hypochondria, the hypogastrium, and diaphragm. And

moreover if, while the pain of the side persists, and does not yield

to warm fomentations, and the sputa are not brought up, but are viscid

and unconcocted, unless one get the pain resolved, either by loosening

the bowels; or opening a vein, whichever of these may be proper;--if

to persons so circumstanced ptisan be administered, their speedy

death will be the result.[541] For these reasons, and for others of a

similar kind still more, those who use unstrained ptisan die on the

seventh day, or still earlier, some being seized with delirium, and

others dying suffocated with orthopnœa and râles.[542] Such persons

the ancients thought _struck_, for this reason more especially,

that when dead the affected side was livid, like that of a person who

had been struck. The cause of this is that they die before the pain is

resolved, being seized with difficulty of respiration, and by large and

rapid breathing, as has been already explained, the spittle becoming

thick, acid, and unconcocted, cannot be brought up, but, being retained

in the bronchi of the lungs, produces râles; and, when it has come to

this, death, for the most part, is inevitable; for the sputa being

retained prevent the breath from being drawn in, and force it speedily

out, and thus the two conspire together to aggravate the mischief;

for the sputa being retained renders the respiration frequent, while

the respiration being frequent thickens the sputa, and prevents them

from being evacuated. These symptoms supervene, not only if ptisan be

administered unseasonably, but still more if any other food or drink

worse than ptisan be given.

6. For the most part, then, the results are the same, whether the

patient have used the unstrained ptisan or have used the juice alone;

or even only drink; and sometimes it is necessary to proceed quite

differently. In general, one should do thus: if fever commences shortly

after taking food, and before the bowels have been evacuated, whether

with or without pain, the physician ought to withhold the draught until

he thinks that the food has descended to the lower part of the belly;

and if any pain be present, the patient should use oxymel, hot if it

is winter, and cold if it is summer; and, if there be much thirst, he

should take hydromel and water.[543] Then, if any pain be present, or

any dangerous symptoms make their appearance, it will be proper to give

the draught neither in large quantity nor thick, but after the seventh

day, if the patient be strong. But if the earlier-taken food has not

descended, in the case of a person who has recently swallowed food, and

if he be strong and in the vigor of life, a clyster should be given, or

if he be weaker, a suppository is to be administered, unless the bowels

open properly of themselves. The time for administering the draught is

to be particularly observed at the commencement and during the whole

illness; when, then, the feet are cold, one should refrain from giving

the ptisan, and more especially abstain from drink; but when the heat

has descended to the feet, one may then give it; and one should look

upon this season as of great consequence in all diseases, and not least

in acute diseases, especially those of a febrile character, and those

of a very dangerous nature. One may first use the juice, and then the

ptisan, attending accurately to the rules formerly laid down.

7. When pain seizes the side, either at the commencement or at a

later stage, it will not be improper to try to dissolve the pain by

hot applications.[544] Of hot applications the most powerful is hot

water in a bottle, or bladder, or in a brazen vessel, or in an earthen

one; but one must first apply something soft to the side, to prevent

pain. A soft large sponge, squeezed out of hot water and applied, forms

a good application; but it should be covered up above, for thus the

heat will remain the longer, and at the same time the vapor will be

prevented from being carried up to the patient’s breath, unless when

this is thought of use, for sometimes it is the case. And further,

barley or tares may be infused and boiled in diluted vinegar, stronger

than that it could be drunk, and may then be sewed into bladders and

applied; and one may use bran in like manner. Salts or toasted millet

in woolen bags are excellent for forming a dry fomentation, for the

millet is light and soothing. A soft fomentation like this soothes

pains, even such as shoot to the clavicle. Venesection, however, does

not alleviate the pain unless when it extends to the clavicle. But

if the pain be not dissolved by the fomentations, one ought not to

foment for a length of time, for this dries the lungs and promotes

suppuration; but if the pain point to the clavicle, or if there be a

heaviness in the arm, or about the breast, or above the diaphragm, one

should open the inner vein at the elbow, and not hesitate to abstract

a large quantity, until it become much redder, or instead of being

pure red, it turns livid,[545] for both these states occur. But if

the pain be below the diaphragm, and do not point to the clavicle, we

must open the belly either with black hellebore[546] or peplium,[547]

mixing the black hellebore with carrot or seseli,[548] or cumin, or

anise, or any other of the fragrant herbs; and with the peplium the

juice of sulphium[549] (asafœtida), for these substances, when mixed up

together, are of a similar nature.[550] The black hellebore acts more

pleasantly and effectually than the peplium, while, on the other hand,

the peplium expels wind much more effectually than the black hellebore,

and both these stop the pain, and many other of the laxatives also

stop it, but these two are the most efficacious that I am acquainted

with. And the laxatives given in draughts are beneficial, when not

very unpalatable owing to bitterness, or any other disagreeable taste,

or from quantity, colour, or any apprehension. When the patient has

drunk the medicine, one ought to give him to swallow but little

less of the ptisan than what he had been accustomed to; but it is

according to rule not to give any draughts while the medicine is under

operation;[551] but when the purging is stopped then he should take a

smaller draught than what he had been accustomed to, and afterwards go

on increasing it progressively, until the pain cease, provided nothing

else contra-indicate. This is my rule, also, if one would use the juice

of ptisan, (for I hold that it is better, on the whole, to begin with

taking the decoction at once, rather than by first emptying the veins

before doing so, or on the third, fourth, fifth, sixth, or seventh day,

provided the disease has not previously come to a crisis in the course

of this time), and similar preparations to those formerly described are

to be made in those cases.

8. Such are the opinions which I entertain respecting the administering

of the ptisan; and, as regards drinks, whichsoever of those about to

be described may be administered, the same directions are generally

applicable. And here I know that physicians are in the practice of

doing the very reverse of what is proper, for they all wish, at the

commencement of diseases, to starve their patients for two, three, or

more days, and then to administer the ptisans and drinks; and perhaps

it appears to them reasonable that, as a great change has taken place

in the body, it should be counteracted by another great change. Now,

indeed, to produce a change is no small matter, but the change must be

effected well and cautiously, and after the change the administration

of food must be conducted still more so. Those persons, then, would be

most injured if the change is not properly managed, who used unstrained

ptisans; they also would suffer who made use of the juice alone; and so

also they would suffer who took merely drink, but these least of all.

9. One may derive information from the regimen of persons in good

health what things are proper; for if it appear that there is a great

difference whether the diet be so and so, in other respects, but more

especially in the changes, how can it be otherwise in diseases, and

more especially in the most acute? But it is well ascertained that even

a faulty diet of food and drink steadily persevered in, is safer in

the main as regards health than if one suddenly change it to another.

Wherefore, in the case of persons who take two meals in the day, or

of those who take a single meal, sudden changes induce suffering and

weakness; and thus persons who have not been accustomed to dine, if

they shall take dinner, immediately become weak, have heaviness over

their whole body, and become feeble and languid, and if, in addition,

they take supper, they will have acid eructations, and some will

have diarrhœa whose bowels were previously dry, and not having been

accustomed to be twice swelled out with food and to digest it twice

a day, have been loaded beyond their wont. It is beneficial, in such

cases, to counterbalance this change, for one should sleep after

dinner, as if passing the night, and guard against cold in winter

and heat in summer; or, if the person cannot sleep, he may stroll

about slowly, but without making stops, for a good while, take no

supper, or, at all events, eat little, and only things that are not

unwholesome, and still more avoid drink, and especially water. Such a

person will suffer still more if he take three full meals in the day,

and more still if he take more meals; and yet there are many persons

who readily bear to take three full meals in the day, provided they

are so accustomed. And, moreover, those who have been in the habit of

eating twice a day, if they omit dinner, become feeble and powerless,

averse to all work, and have heartburn; their bowels seem, as it

were, to hang loose, their urine is hot and green, and the excrement

is parched; in some the mouth is bitter, the eyes are hollow, the

temples throb, and the extremities are cold, and the most of those

who have thus missed their dinner cannot eat supper; or, if they do

sup, they load their stomach, and pass a much worse night than if

they had previously taken dinner. Since, then, an unwonted change of

diet for half a day produces such effects upon persons in health, it

appears not to be a good thing either to add or take from. If, then,

he who was restricted to a single meal, contrary to usage, having his

veins thus left empty during a whole day, when he supped according to

custom felt heavy, it is probable that if, because he was uneasy and

weak from the want of dinner, he took a larger supper than wont, he

would be still more oppressed; or if, wanting food for a still greater

interval, he suddenly took a meal after supper, he will feel still

greater oppression. He, then, who, contrary to usage, has had his veins

kept empty by want of food, will find it beneficial to counteract the

bad effects during that day as follows: let him avoid cold, heat, and

exertion, for he could bear all these ill; let him make his supper

considerably less than usual, and not of dry food, but rather liquid;

and let him take some drink, not of a watery character, nor in smaller

quantity than is proportionate to the food, and on the next day he

should take a small dinner, so that, by degrees, he may return to his

former practice. Persons who are bilious in the stomach bear these

changes worst, while those who are pituitous, upon the whole, bear the

want of food best, so that they suffer the least from being restricted

to one meal in the day, contrary to usage. This, then, is a sufficient

proof that the greatest changes as to those things which regard

our constitutions and habits are most especially concerned in the

production of diseases, for it is impossible to produce unseasonably

a great emptying of the vessels by abstinence, or to administer food

while diseases are at their acme, or when inflammation prevails; nor,

on the whole, to make a great change either one way or another with

impunity.[552]

10. One might mention many things akin to these respecting the stomach

and bowels, to show how people readily bear such food as they are

accustomed to, even if it is not naturally good, and drink in like

manner, and how they bear unpleasantly such food as they are not

accustomed to, even although not bad, and so in like manner with drink;

and as to the effects of eating much flesh, contrary to usage, or

garlic, or asafœtida, or the stem of the plant which produces it, or

things of a similar kind possessed of strong properties, one would be

less surprised if such things produce pains in the bowels, but rather

when one learned what trouble, swelling, flatulence, and tormina

the cake (maza) will raise in the belly when eaten by a person not

accustomed to it; and how much weight and distention of the bowels

bread will create to a person accustomed to live upon the maza; and

what thirst and sudden fullness will be occasioned by eating hot bread,

owing to its desiccant and indigestible properties; and what different

effects are produced by fine and coarse bread when eaten contrary to

usage, or by the cake when unusually dry, moist, or viscid; and what

different effects polenta produces upon those who are accustomed and

those who are unaccustomed to the use of it; or drinking of wine or

drinking of water, when either custom is suddenly exchanged for the

other; or when, contrary to usage, diluted wine or undiluted has been

suddenly drunk, for the one will create water-brash in the upper part

of the intestinal canal and flatulence in the lower, while the other

will give rise to throbbing of the arteries, heaviness of the head, and

thirst; and white and dark-colored wine, although both strong wines,

if exchanged contrary to usage, will produce very different effects

upon the body, so that one need the less wonder that a sweet and strong

wine, if suddenly exchanged, should have by no means the same effect.

11. Let us here briefly advert to what may be said on the opposite

side; namely, that a change of diet has occurred in these cases,

without any change in their body, either as to strength, so as to

require an increase of food, or as to weakness, so as to require

a diminution. But the strength of the patient is to be taken into

consideration, and the manner of the disease, and of the constitution

of the man, and the habitual regimen of the patient, not only as

regards food but also drink. Yet one must much less resort to

augmentation, since it is often beneficial to have recourse to

abstraction, when the patient can bear it, until the disease having

reached its acme and has become concocted. But in what cases this must

be done will be afterwards described. One might write many other things

akin to those which have been now said, but there is a better proof,

for it is not akin to the matter on which my discourse has principally

turned, but the subject-matter itself is a most seasonable proof. For

some at the commencement of acute diseases have taken food on the same

day, some on the next day; some have swallowed whatever has come in

their way, and some have taken _cyceon_.[553] Now all these things

are worse than if one had observed a different regimen; and yet these

mistakes, committed at that time, do much less injury than if one were

to abstain entirely from food for the first two or three days, and on

the fourth or fifth day were to take such food; and it would be still

worse, if one were to observe total abstinence for all these days, and

on the following days were to take such a diet, before the disease

is concocted;[554] for in this way death would be the consequence to

most people, unless the disease were of a very mild nature. But the

mistakes committed at first were not so irremediable as these, but

could be much more easily repaired. This, therefore, I think a strong

proof that such or such a draught need not be prescribed on the first

days to those who will use the same draughts afterwards. At the bottom,

therefore, they do not know, neither those using unstrained ptisans,

that they are hurt by them, when they begin to swallow them, if they

abstain entirely from food for two, three, or more days; nor do those

using the juice know that they are injured in swallowing them, when

they do not commence with the draught seasonably. But this they guard

against, and know that it does much mischief, if, before the disease

be concocted, the patient swallow unstrained ptisan, when accustomed

to use strained. All these things are strong proofs that physicians

do not conduct the regimen of patients properly, but that in those

diseases in which total abstinence from food should not be enforced

on patients that will be put on the use of ptisans, they do enforce

total abstinence; that in those cases in which there should be no

change made from total abstinence to ptisans, they do make the change;

and that, for the most part, they change from abstinence to ptisans,

exactly at the time when it is often beneficial to proceed from ptisans

almost to total abstinence, if the disease happen to be in the state of

exacerbation.[555] And sometimes crude matters are attracted from the

head, and bilious from the region near the chest, and the patients are

attacked with insomnolency, so that the disease is not concocted; they

become sorrowful, peevish, and delirious; there are flashes of light in

their eyes, and noises in their ears; their extremities are cold, their

urine unconcocted; the sputa thin, saltish, tinged with an intense

colour and smell; sweats about the neck, and anxiety; respiration,

interrupted in the expulsion of the air,[556] frequent and very large;

expression of the eyelids dreadful; dangerous _deliquia_; tossing

of the bedclothes from the breast; the hands trembling, and sometimes

the lower lip agitated. These symptoms, appearing at the commencement,

are indicative of strong delirium, and patients so affected generally

die, or if they escape, it is with a deposit, hemorrhage from the nose,

or the expectoration of thick matter, and not otherwise. Neither do I

perceive that physicians are skilled in such things as these; how they

ought to know such diseases as are connected with debility, and which

are further weakened by abstinence from food, and those aggravated by

some other irritation; those by pain, and from the acute nature of the

disease, and what affections and various forms thereof our constitution

and habit engender, although the knowledge or ignorance of such things

brings safety or death to the patient. For it is a great mischief if to

a patient debilitated by pain, and the acute nature of the disease, one

administer drink, or more ptisan, or food, supposing that the debility

proceeds from inanition. It is also disgraceful not to recognize a

patient whose debility is connected with inanition, and to pinch him in

his diet; this mistake, indeed, is attended with some danger, but much

less than the other, and yet it is likely to expose one to much greater

derision, for if another physician, or a private person, coming in and

knowing what has happened, should give to eat or drink those things

which the other had forbidden, the benefit thus done to the patient

would be manifest. Such mistakes of practitioners are particularly

ridiculed by mankind, for the physician or non-professional man thus

coming in, seems as it were to resuscitate the dead. On this subject

I will describe elsewhere the symptoms by which each of them may be

recognized.

12. And the following observations are similar to those now made

respecting the bowels. If the whole body rest long, contrary to

usage, it does not immediately recover its strength; but if, after a

protracted repose, it proceed to labor, it will clearly expose its

weakness. So it is with every one part of the body, for the feet

will make a similar display, and any other of the joints, if, being

unaccustomed to labor, they be suddenly brought into action, after a

time. The teeth and the eyes will suffer in like manner, and also every

other part whatever. A couch, also, that is either softer or harder

than one has been accustomed to will create uneasiness, and sleeping in

the open air, contrary to usage, hardens the body. But it is sufficient

merely to state examples of all these cases. If a person having

received a wound in the leg, neither very serious nor very trifling,

and he being neither in a condition very favorable to its healing nor

the contrary, at first betakes himself to bed, in order to promote the

cure, and never raises his leg, it will thus be much less disposed to

inflammation, and be much sooner well, than it would have been if he

had strolled about during the process of healing; but if upon the fifth

or sixth day, or even earlier, he should get up and attempt to walk,

he will suffer much more then than if he had walked about from the

commencement of the cure, and if he should suddenly make many laborious

exertions, he will suffer much more than if, when the treatment was

conducted otherwise, he had made the same exertions on the same days.

In fine, all these things concur in proving that all great changes,

either one way or another, are hurtful. Wherefore much mischief takes

place in the bowels, if from a state of great inanition more food than

is moderate be administered (and also in the rest of the body, if

from a state of great rest it be hastily brought to greater exertion,

it will be much more injured), or if from the use of much food it be

changed to complete abstinence, and therefore the body in such cases

requires protracted repose, and if, from a state of laborious exertion,

the body suddenly falls into a state of ease and indolence, in these

cases also the bowels would require continued repose from abundance of

food, for otherwise it will induce pain and heaviness in the whole body.

13. The greater part of my discourse has related to changes, this way

or that. For all purposes it is profitable to know these things, and

more especially respecting the subject under consideration,--that in

acute diseases, in which a change is made to ptisans from a state of

inanition, it should be made as I direct; and then that ptisans should

not be used until the disease be concocted, or some other symptom,

whether of evacuation or of irritation, appear in the intestines, or

in the hypochondria, such as will be described. Obstinate isomnolency

impairs the digestion of the food and drink, and in other respects

changes and relaxes the body, and occasions a heated state, and

heaviness of the head.[557]

14. One must determine by such marks as these, when sweet, strong,

and dark wine, hydromel, water and oxymel, should be given in acute

diseases.[558] Wherefore the sweet affects the head less than the

strong, attacks the brain less, evacuates the bowels more than the

other, but induces swelling of the spleen and liver; it does not

agree with bilious persons, for it causes them to thirst; it creates

flatulence in the upper part of the intestinal canal, but does not

disagree with the lower part, as far as regards flatulence; and yet

flatulence engendered by sweet wine is not of a transient nature, but

rests for a long time in the hypochondria. And therefore it in general

is less diuretic than wine which is strong and thin; but sweet wine is

more expectorant than the other. But when it creates thirst, it is less

expectorant in such cases than the other wine, but if it do not create

thirst, it promotes expectoration better than the other. The good and

bad effects of a white, strong wine, have been already frequently and

fully stated in the disquisition on sweet wine; it is determined to

the bladder more than the other, is diuretic and laxative, and should

be very useful in such complaints; for if in other respects it be less

suitable than the other, the clearing out of the bladder effected by

it is beneficial to the patient, if properly administered. There are

excellent examples of the beneficial and injurious effects of wine,

all which were left undetermined by my predecessors. In these diseases

you may use a yellow wine, and a dark austere wine for the following

purposes: if there be no heaviness of the head, nor delirium, nor

stoppage of the expectoration, nor retention of the urine, and if the

alvine discharges be more loose and like scrapings than usual, in such

cases a change from a white wine to such as I have mentioned, might be

very proper. It deserves further to be known, that it will prove less

injurious to all the parts above, and to the bladder, if it be of a

more watery nature, but that the stronger it is, it will be the more

beneficial to the bowels.

15. Hydromel, when drunk in any stage of acute disease, is less

suitable to persons of a bilious temperament, and to those who have

enlarged viscera, than to those of a different character; it increases

thirst less than sweet wine; it softens the lungs, is moderately

expectorant, and alleviates a cough; for it has some detergent

quality in it, whence it lubricates the sputum.[559] Hydromel is also

moderately diuretic, unless prevented by the state of any of the

viscera. And it also occasions bilious discharges downwards, sometimes

of a proper character, and sometimes more intense and frothy than

is suitable; but such rather occurs in persons who are bilious, and

have enlarged viscera. Hydromel rather produces expectoration, and

softening of the lungs, when given diluted with water.[560] But unmixed

hydromel, rather than the diluted, produces frothy evacuations, such

as are unseasonably and intensely bilious, and too hot; but such an

evacuation occasions other great mischiefs, for it neither extinguishes

the heat in the hypochondria, but rouses it, induces inquietude, and

jactitation of the limbs, and ulcerates the intestines and anus. The

remedies for all these will be described afterwards. By using hydromel

without ptisans, instead of any other drink, you will generally succeed

in the treatment of such diseases, and fail in few cases; but in

what instances it is to be given, and in what it is not to be given,

and wherefore it is not to be given,--all this has been explained

already, for the most part. Hydromel is generally condemned, as if

it weakened the powers of those who drink it, and on that account it

is supposed to accelerate death; and this opinion arose from persons

who starve themselves to death, some of whom use hydromel alone for

drink, as fancying that it really has this effect. But this is by no

means always the case. For hydromel, if drunk alone, is much stronger

than water, if it do not disorder the bowels; but in some respects it

is stronger, and in some weaker, than wine that is thin, weak, and

devoid of _bouquet_. There is a great difference between unmixed

wine and unmixed honey, as to their nutritive powers, for if a man

will drink double the quantity of pure wine, to a certain quantity

of honey which is swallowed, he will find himself much stronger from

the honey, provided it do not disagree with his bowels, and that his

alvine evacuations from it will be much more copious. But if he shall

use ptisan for a draught, and drink afterward hydromel, he will feel

full, flatulent, and uncomfortable in the viscera of the hypochondrium;

but if the hydromel be taken before the draught, it will not have

the same injurious effects as if taken after it, but will be rather

beneficial. And boiled hydromel has a much more elegant appearance

than the unboiled, being clear, thin, white, and transparent, but I am

unable to mention any good quality which it possesses that the other

wants. For it is not sweeter than the unboiled, provided the honey be

fine, and it is weaker, and occasions less copious evacuations of the

bowels, neither of which effects is required from the hydromel. But one

should by all means use it boiled, provided the honey be bad, impure,

black, and not fragrant, for the boiling will remove the most of its

bad qualities and appearances.

16. You will find the drink, called oxymel, often very useful in these

complaints, for it promotes expectoration and freedom of breathing.

The following are the proper occasions for administering it. When

strongly acid it has no mean operation in rendering the expectoration

more easy, for by bringing up the sputa, which occasion troublesome

hawking, and rendering them more slippery, and, as it were, clearing

the windpipe with a feather, it relieves the lungs and proves emollient

to them; and when it succeeds in producing these effects it must do

much good. But there are cases in which hydromel, strongly acid,

does not promote expectoration, but renders it more viscid and thus

does harm, and it is most apt to produce these bad effects in cases

which are otherwise of a fatal character, when the patient is unable

to cough or bring up the sputa. On this account, then, one ought to

consider beforehand the strength of the patient, and if there be any

hope, then one may give it, but if given at all in such cases it

should be quite tepid, and in by no means large doses. But if slightly

acrid it moistens the mouth and throat, promotes expectoration, and

quenches thirst; agrees with the viscera seated in the hypochondrium,

and obviates the bad effects of the honey; for the bilious quality of

the honey is thereby corrected. It also promotes flatulent discharges

from the bowels, and is diuretic, but it occasions watery discharges

and those resembling scrapings, from the lower part of the intestine,

which is sometimes a bad thing in acute diseases, more especially when

the flatulence cannot be passed, but rolls backwards; and otherwise it

diminishes the strength and makes the extremities cold, this is the

only bad effect worth mentioning which I have known to arise from the

oxymel. It may suit well to drink a little of this at night before the

draught of ptisan, and when a considerable interval of time has passed

after the draught there will be nothing to prevent its being taken.

But to those who are restricted entirely to drinks without draughts

of ptisan, it will therefore not be proper at all times to give it,

more especially from the fretting and irritation of the intestine

which it occasions, (and these bad effects it will be the more apt to

produce provided there be no fæces in the intestines and the patient

is laboring under inanition,) and then it will weaken the powers of

the hydromel. But if it appears advantageous to use a great deal of

this drink during the whole course of the disease, one should add to

it merely as much vinegar as can just be perceived by the taste, for

thus what is prejudicial in it will do the least possible harm, and

what is beneficial will do the more good. In a word, the acidity of

vinegar agrees rather with those who are troubled with bitter bile,

than with those patients whose bile is black; for the bitter principle

is dissolved in it and turned to phlegm, by being suspended in it;

whereas black bile is fermented, swells up, and is multiplied thereby:

for vinegar is a melanogogue. Vinegar is more prejudicial to women than

to men, for it creates pains in the uterus.

17. I have nothing further to add as to the effects of water when

used as a drink in acute diseases; for it neither soothes the cough in

pneumonia, nor promotes expectoration, but does less than the others

in this respect, if used alone through the whole complaint. But if

taken intermediate between oxymel and hydromel, in small quantity,

it promotes expectoration from the change which it occasions in the

qualities of these drinks, for it produces, as it were, a certain

overflow. Otherwise it does not quench the thirst, for it creates bile

in a bilious temperament, and is injurious to the hypochondrium; and

it does the most harm, engenders most bile, and does the least good

when the bowels are empty; and it increases the swelling of the spleen

and liver when they are in an inflamed state; it produces a gurgling

noise in the intestines and swims on the stomach; for it passes slowly

downwards, as being of a coldish and indigestible nature, and neither

proves laxative nor diuretic; and in this respect, too, it proves

prejudicial, that it does not naturally form fæces in the intestines:

and, if it be drunk while the feet are cold, its injurious effects

will be greatly aggravated, in all those parts to which it may be

determined. When you suspect in these diseases either strong heaviness

of the head, or mental alienation, you must abstain entirely from wine,

and in this case use water, or give weak, straw colored wine, entirely

devoid of _bouquet_, after which a little water is to be given

in addition; for thus the strength of the wine will less affect the

head and the understanding: but in which cases water is mostly to be

given for drink, when in large quantity, when in moderate, when cold,

and when hot; all these things have either been discussed already or

will be treated of at the proper time. In like manner, with respect

to all the others, such as barley-water, the drinks made from green

shoots, those from raisins, and the skins of grapes and wheat, and

bastard saffron, and myrtles, pomegranates, and the others, when the

proper time for using them is come, they will be treated of along

with the disease in question, in like manner as the other compound

medicines.[561]

18. The bath is useful in many diseases, in some of them when used

steadily, and in others when not so. Sometimes it must be less used

than it would be otherwise, from the want of accommodation; for in few

families are all the conveniences prepared, and persons who can manage

them as they ought to be. And if the patient be not bathed properly, he

may be thereby hurt in no inconsiderable degree, for there is required

a place to cover him that is free of smoke, abundance of water,

materials for frequent baths, but not very large, unless this should be

required. It is better that no friction should be applied, but if so, a

hot soap (_smegma_)[562] must be used in greater abundance than is

common, and an affusion of a considerable quantity of water is to made

at the same time and afterwards repeated. There must also be a short

passage to the basin, and it should be of easy ingress and egress. But

the person who takes the bath should be orderly and reserved in his

manner, should do nothing for himself, but others should pour the water

upon him and rub him, and plenty of waters, of various temperatures,

should be in readiness for the _douche_, and the affusions

quickly made;[563] and sponges should be used instead of the comb

(_strigil_), and the body should be anointed when not quite dry.

But the head should be rubbed by the sponge until it is quite dry; the

extremities should be protected from cold, as also the head and the

rest of the body; and a man should not be washed immediately after he

has taken a draught of ptisan or a drink; neither should he take ptisan

as a drink immediately after the bath. Much will depend upon whether

the patient, when in good health, was very fond of the bath, and in the

custom of taking it: for such persons, especially, feel the want of it,

and are benefited if they are bathed, and injured if they are not. In

general it suits better with cases of pneumonia than in ardent fevers;

for the bath soothes the pain in the side, chest, and back; concocts

the sputa, promotes expectoration, improves the respiration, and allays

lassitude; for it soothes the joints and outer skin, and is diuretic,

removes heaviness of the head, and moistens the nose. Such are the

benefits to be derived from the bath, if all the proper requisites be

present; but if one or more of these be wanting, the bath, instead of

doing good, may rather prove injurious; for every one of them may do

harm if not prepared by the attendants in the proper manner. It is by

no means a suitable thing in these diseases to persons whose bowels are

too loose, or when they are unusually confined, and there has been no

previous evacuation; neither must we bathe those who are debilitated,

nor such as have nausea or vomiting, or bilious eructations; nor such

as have hemorrhage from the nose, unless it be less than required at

that stage of the disease, (with those stages you are acquainted:)

but if the discharge be less than proper, one should use the bath,

whether in order to benefit the whole body or the head alone. If then

the proper requisites be at hand, and the patient be well disposed to

the bath, it may be administered once every day, or if the patient be

fond of the bath there will be no harm, though he should take it twice

in the day. The use of the bath is much more appropriate to those who

take unstrained ptisan, than to those who take only the juice of it,

although even in their case it may be proper; but least of all does

it suit with those who use only plain drink, although, in their case

too it may be suitable; but one must form a judgment from the rules

laid down before, in which of these modes of regimen the bath will be

beneficial, and in which not. Such as want some of the requisites for

a proper bath, but have those symptoms which would be benefited by it,

should be bathed; whereas those who want none of the proper requisites,

but have certain symptoms which contra-indicate the bath, are not to be

bathed.

APPENDIX TO THE WORK

ON

REGIMEN IN ACUTE DISEASES.

THE ARGUMENT.

No one can read this piece attentively without coming to the conclusion

that it is not a natural continuation of the subject discussed in the

preceding work, but that it is made up, in a considerable measure, of

materials extracted from it. Expositions of subjects which are there

given methodically are here presented in a disjointed form; and rules

of practice there laid down with precision are here often delivered in

a vague and indefinite shape. Still, however, it must be admitted, that

the reverse is sometimes the case, and that what is presented imperfect

in the former part of the work is here sometimes reproduced very

much improved. It has been therefore a matter of much dispute among

the critics whether this portion be the composition of Hippocrates,

or whether it be altogether the work of a different hand. The most

probable conjecture respecting it seems to be, that as Hippocrates in

the preceding part several times announces his intention of giving

a continuation of the subject, some one of his immediate disciples

undertook the work which he had thus promised, and composed this

treatise from fragments left by the author himself, and from materials

collected from his other works. As stated by Galen in his Commentary,

and as we have explained in our remarks on the “Aphorisms,” in the

second section of the Preliminary Discourse, it was a common practice,

in ancient times, to add appendices to popular works. I can have no

hesitation, then, in following the example of M. Littré, who recognizes

it as an appendix to the preceding work. But I must say that I rather

incline, with Galen, to think that there are many things in it which

cannot have come from Hippocrates, than to hold with M. Littré that it

is nearly or altogether his composition. But however that may be, it

indisputably contains much interesting matter, for which we have every

reason to believe that we are indebted to Hippocrates, either directly

or at second hand. I shall now give a brief abstract of its contents.

He commences with some general observations on the nature and

treatment of causus, the endemial fever of Greece. What is said on this

head is much to the purpose, but incomplete. Then there is given a

general rule for bleeding in diseases which certainly is well deserving

of attention at the present day, when professional opinions on this

point of medical practice are very much unsettled. Nowadays we have

abandoned all general rules of practice, and profess to be guided

solely by experience; but how variable and uncertain are its results

in the present case! I myself--albeit but verging towards the decline

of life--can well remember the time when a physician would have run

the risk of being indicted for culpable homicide if he had ventured

to bleed a patient in common fever; about twenty-five years ago

venesection in fever, and in almost every disease, was the established

order of the day; and now what shall I state as the general practice

that has been sanctioned by the experience of the present generation?

I can scarcely say, so variable has the practice in fever and in many

other diseases become of late years. One thing is remarkable in the

present work with regard to venesection in pneumonia and pleurisy,

namely, that it is directed to be carried the length of inducing

_deliquium animi_, contrary to the practice laid down in the

preceding work, and to the rule which was followed by all the other

ancient authorities. Another of the rules regarding bleeding here

delivered is also deserving of attention, namely, that in inflammatory

diseases it is improper to purge before bleeding, but that venesection

should precede all other means of cure.

The section in which cynanche is treated of appears to me to be highly

interesting and important. I think it may be a question whether the

prognostic spirit of Hippocrates and his followers had not in a great

measure anticipated all the results of modern diagnosis.

After this there follows some additional account of causus, which,

although out of place, contains observations of considerable interest.

To the treatment of pleurisy and pneumonia we have already alluded, but

the subject is so interesting that we cannot dismiss it with so brief a

notice. In the ancient method of treating fevers and febrile affections

three main objects would appear to have been kept in view: 1st, by

depletions, to remove the morbid fluids from the general system, or to

draw them off from a particular spot in which they had fixed; 2d, by

diluents, to supply the waste of fluids occasioned by the preternatural

heat of the body; and, 3d, to support the strength by a suitable supply

of such nutriment as the system is then capable of receiving.

Now with regard to venesection, it will be seen in this and the

preceding work that the practice is regulated by certain well-marked

indications, namely, the seat of the pain, the condition of the

patient, and the characters of the sputa. The purging is regulated by

the state of matters below the chest, it being held as a general rule

that clysters should be administered regularly every day during the

first days of the fever. After purging comes the cooling drinks, such

as oxymel. The administration of farinaceous food in a liquid state,

that is to say, of unstrained ptisan, is to be regulated by the state

of the sputa and urinary sediment, namely, when the sputa have put on a

purulent appearance, and the sediment has become copious and reddish.

Now this certainly seems to be a very intelligible and judicious rule

for the administration of nutritious articles in febrile diseases. I

need scarcely remark that at the present time there is scarcely a rule

of practice in medicine which is worse defined than this respecting

the administration of wine and other alimentary substances in febrile

diseases. In proof of what is now stated, I would beg leave to refer

the reader to what will be admitted to be one of the best authorities

in modern literature on fever, I mean to Dr. Tweedie’s elaborate

article on this subject, in the “Cyclopædia of Medicine.” It will be

seen, at vol. ii., p. 208, that the rules for the administration of

wine and other articles of food are by no means well defined. A cool

skin and a soft pulse, when combined with debility, are the indications

upon which most stress is laid; but the pulse, as long ago it was

pronounced by Celsus to be, is “res fallacissima,” and of this the

excellent author seems to have been sensible; for the injunctions

which he gives to regulate the administration of the wine and other

articles, by the effects they produce, sufficiently show that he was

sensible how deficient in precision our knowledge of the subject is at

present. At the same time he makes it appear that he was well aware

of one important fact in the treatment of febrile diseases, which,

although distinctly recognized by Hippocrates, is still frequently

overlooked by ordinary practitioners, namely, that in convalescence

the stomach partakes of the general debility, and is unable to digest

food in any great quantity at that time.[564] M. Littré further calls

attention to another rule for the administration of wine, lately laid

down by Dr. Stokes, of Dublin, which is certainly a most important

one, provided it is confirmed by time and experience. It is founded on

auscultation, and is to this effect; that when the impulse of the heart

is abnormally weak, and when there is a diminution of the proportion

between the two _bruits_, or when there is a preponderance in the

sound of the second _bruit_, wine may be freely administered.

Now, as I have said, this rule, if sanctioned by ample experience,

is undoubtedly a most excellent one; but I may be allowed to remark,

that my own observations on the heart in fever have led me to the

conclusion that, as I have stated respecting the pulse, its sounds are

very fallacious; and I must say that the rule of Hippocrates appears

more likely to prove a certain guide in this instance. For is it not

a natural view of the subject, that wine and other articles of food

should be withheld while the emunctories are not in a condition to

cast off the recrementitous superfluities of the system; but that when

the secretions are properly established, alimentary substances may be

safely administered?[565]

There is another point connected with the regimen in acute diseases

on which I have a remark or two to make--it is the administration of

animal matters in a fluid state, such as beef-tea, or soups from fowls.

These we see frequently administered in febrile cases by practitioners

of the present day, but by the ancient authorities they would appear

to have been entirely rejected. Which party is the safer guide in this

case? For my own part, I have long thought that animal matters, when

introduced into the system while in a febrile state, have a tendency

to become putrid, and thereby to occasion an increase of the heat and

general disorder.

After some defective observations on dysentery, our author treats of

tetanus; but here Galen objects to the characters which he gives of the

urine, and to his practice as regards the administration of wine. His

views, however, are not very different from those which now prevail.

Having made some general remarks on the administration of hellebore,

to which he was very partial, he proceeds to point out the bad effects

resulting from any change in regimen. His views here are very similar

to the observations contained in the preceding portion of the work, and

in the treatise “On Ancient Medicine.”

The account of dry cholera is confused and vague. By it he would seem

to mean flatulent colic, or _dry belly-ache_. See Opera, ed.

Littré, tom. ii., p. 388.

The paragraph on dropsy is interesting, although the views taken of

the subject are incomplete. Tympanitis is recognized as a variety of

dropsy. Then follow some detached observations on persons whose bowels

are heated, and on the regulation of the diet, with some remarks on

the different states which counter-indicate purging. At § 23 there are

some practical observations on various conditions of the constitution,

which it would no doubt be proper for the physician to make himself

acquainted with. The contents of all the remaining paragraphs would

seem to have nothing to do with the subject of this treatise.

From what is now stated the reader will readily perceive that this

treatise abounds in interesting matters, which, even at the present

day, may prove suggestive of important views in the theory and practice

of medicine. And although the style, in the judgment of Galen, be very

different from Hippocrates, and the mode of thought deficient in that

precision for which he is so remarkable, the treatise is unquestionably

a work of great ability, and contains what we have reason to regard

as the results of his experience and meditations on many important

subjects. I should have thought it quite unwarrantable, therefore, to

have rejected this piece from a volume which professes to give all

the genuine remains of our great author. And moreover, at the risk,

perhaps, of being set down as an antique devotée, I do not hesitate

to declare that in my opinion this and the preceding portion, taken

together, contain more original information on the important subject

to which they relate than is to be found in any medical work which has

been written from the days of our author down to the present time.

I shall conclude the present Argument by giving from Cælius Aurelianus

the criticisms of Soranus on the opinions of our author, as delivered

in these two treatises. It is to be borne in mind that Soranus was

the chief of the ancient sect of physicians called _Methodici_,

which was very inimically disposed towards all the others, and more

especially to Hippocrates. Though most of the strictures are evidently

overstrained, it cannot fail to be interesting to the reader to have an

opportunity of considering them, such as they are.

After giving an elaborate analysis of our author’s views, Cælius

Aurelianus proceeds as follows: “His Soranus respondens ait. In

calefactionibus acres esse sales, ac necessario tumorem provocare,

febremque accendere, poscam etiam constringere et stricturam passionis

augere. Item milium frixum graveolens et nidorosum, atque capiti

grave, maximè acutè fabricitantium esse perspicimus. Spongiis etiam

erat melius quenquam in dimissione patientes partes vaporare, atque

oleo calido perfundere. Est præterea improprium, ac sine ratione, tunc

uti phlebotomo quoties ad superiora dolor tetenderit; prohibere autem

quoties ad inferiora descenderit. Oportet ergo sub hoc argumento neque

difficultate tumorum partibus inferioribus impeditos phlebotomare:

neque etiam podagricos si quidem inferiora tumere videantur, sed

necessariò quoties dolor ad superiora tetenderit, phlebotomiam

adhibendam videmus. Siquidem sæpe pejorante ventris fluore, hoc

adjutorii genus prohibetur. Neque etiam (ut ait) oportet interiorem

venam dividi. Siquidem et exteriori et media divisa corpora releventur.

Quippe quum e contrario interiorem prohibeant, propter magnitudinem,

ne tumor augeatur. Item sanguinis mutatio iners est detractionis

moderationi, sicuti de adjutoriis scribentes demonstrabimus. Sese

denique idem Hippocrates impugnat in consequentibus, dicens usque

ad animi defectum faciendam detractionem, quod magis vehementer est

nocens: siquidem est pericolosa defectio, et neque si sit temporaliter

defectionis causa, sensu carens ægrotans, dolore relevatus, videbitur

(quum resumptus fuerit) rursum non dolere, quum magis atque magis

ejusdem passionis debilia corpora vehementius officiant. Item

purgativa medicamina (quæ Græci καθαρτικὰ vocant) acrimoniæ causa,

stomachum tumentem, atque hypezocota membranum acuunt in tumorem; et

in periculum ventris effusionem provocantia, magnificam passionis

ingerunt vehementiam. Nutrire etiam cibo post medicamen non oportebat.

Pugnat enim purgationi faciundæ illatum cibi nutrimentum. Quippe quum

medicamine corruptum, officii sui careat viribus. Mitto etiam quod ex

initio acescere facile ptisanæ succus perspiciatur, confectus quippe ex

ordei succo, qui sit digestione difficilis. Dehine ægrotantis corpus

non valet tantum sustinere nutrimentum, quantum sanitatis tempore

solitum videbatur. Item mulsum ex aceto (quod oxymeli appellavit)

sine discretione accipimus. Est etiam immodica usque ad septimum

diem cibi abstinentia, quam custodiendam ordinavit.[566] Quippe cum

nullus vehementiam passionis sustinere valet, nisi nutrimento quamvis

parvo toleratus: et neque in declinatione passionis aliquid humanius

cibo largitur, sed in iisdem sorbilibus perseverandum existimat

succis. At cum fuerint sputa segniora, tunc ut existimat, erit primo

æger nutriendus, quomodo necessariò declinante passione occurrunt

intolerato. In cæteris relinquendum temporibus absque nutrimento

ægrotantem apertissimè indicavit, quum semper plurimum utilitatis

adjutorium cibi, quam cætera possunt adjutoria, largiatur. Omne etiam

corpus erit unctione coæquandum, et non ejus particula. Quippe cum

totum cibo nutriatur, ipsa quoque unctio non exerta, anxietatem ingerit

ægrotanti, quæ latentem difficultatem, atque accessione veniente,

corporis provocat incendium.”

APPENDIX TO THE WORK

ON

REGIMEN IN ACUTE DISEASES.

Ardent fever (causus)[567] takes place when the veins, being dried up

in the summer season, attract acrid and bilious humors to themselves;

and strong fever seizes the whole body, which experiences aches of the

bones, and is in a state of lassitude and pain. It takes place most

commonly from a long walk and protracted thirst, when the veins being

dried up attract acrid and hot defluxions to themselves. The tongue

becomes rough, dry, and very black; there are gnawing pains about the

bowels; the alvine discharges are watery and yellow; there is intense

thirst, insomnolency, and sometimes wandering of the mind. To a person

in such a state give to drink water and as much boiled hydromel of a

watery consistence as he will take; and if the mouth be bitter, it

may be advantageous to administer an emetic and clyster; and if these

things do not loosen the bowels, purge with the boiled milk of asses.

Give nothing saltish nor acrid, for they will not be borne; and give

no draughts of ptisan until the crisis be past. And the affection is

resolved if there be an epistaxis, or if true critical sweats supervene

with urine having white, thick, and smooth sediments, or if a deposit

take place anywhere; but if it be resolved without these, there will be

a relapse of the complaint, or pain in the hips and legs will ensue,

with thick sputa, provided the patient be convalescent. Another species

of ardent fever: belly loose, much thirst, tongue rough, dry, and

saltish, retention of urine, insomnolency, extremities cold. In such a

case, unless there be a flow of blood from the nose, or an abscess form

about the neck, or pain in the limbs, or the patient expectorate thick

sputa (these occur when the belly is constipated), or pain of the hips,

or lividity of the genital organs, there is no crisis; tension of the

testicle is also a critical symptom. Give attractive draughts.[568]

2. Bleed in the acute affections, if the disease appear strong, and

the patients be in the vigor of life, and if they have strength.[569]

If it be quinsy or any other of the pleuritic affections, purge with

electuaries; but if the patient be weaker, or if you abstract more

blood, you may administer a clyster every third day, until he be out of

danger, and enjoin total abstinence if necessary.

3. Hypochondria inflamed not from retention of flatus, tension of

the diaphragm, checked respiration, with dry orthopnœa, when no pus

is formed, but when these complaints are connected with obstructed

respiration; but more especially strong pains of the liver, heaviness

of the spleen, and other phlegmasiæ and intense pains above the

diaphragm, diseases connected with collections of humors,--all these

diseases do not admit of resolution, if treated at first by medicine,

but venesection holds the first place in conducting the treatment;

then we may have recourse to a clyster, unless the disease be great

and strong; but if so, purging also may be necessary; but bleeding

and purging together require caution and moderation. Those who

attempt to resolve inflammatory diseases at the commencement by the

administration of purgative medicines, remove none of the morbific

humors which produce the inflammation and tension: for the diseases

while unconcocted could not yield, but they melt down those parts which

are healthy and resist the disease; so when the body is debilitated the

malady obtains the mastery; and when the disease has the upper hand of

the body, it does not admit of a cure.[570]

4. When a person suddenly loses his speech, in connection with

obstruction of the veins,--if this happen without warning or any other

strong cause, one ought to open the internal vein of the right arm,

and abstract blood more or less according to the habit and age of the

patient. Such cases are mostly attended with the following symptoms:

redness of the face, eyes fixed, hands distended, grinding of the

teeth, palpitations, jaws fixed, coldness of the extremities, retention

of airs in the veins.[571]

5. When pains precede, and there are influxes of black bile and

of acrid humors, and when by their pungency the internal parts are

pained, and the veins being pinched and dried become distended, and

getting inflamed attract the humors running into the parts, whence

the blood being vitiated, and the airs collected there not being able

to find their natural passages, coldness comes on in consequence of

this stasis, with vertigo, loss of speech, heaviness of the head, and

convulsion, if the disease fix on the liver, the heart, or the great

vein (vena cava?); whence they are seized with epilepsy or apoplexy,

if the defluxions fall upon the containing parts,[572] and if they are

dried up by airs which cannot make their escape; such persons having

been first fomented are to be immediately bled at the commencement,

while all the peccant vapors and humors are buoyant, for then the cases

more easily admit of a cure; and then supporting the strength and

attending to the crisis, we may give emetics, unless the disease be

alleviated; or if the bowels be not moved, we may administer a clyster

and give the boiled milk of asses, to the amount of not less than

twelve heminæ, or if the strength permit, to more than sixteen.

6. Quinsy takes place when a copious and viscid defluxion from the

head, in the season of winter or spring, flows into the jugular veins,

and when from their large size they attract a greater defluxion; and

when owing to the defluxion being of a cold and viscid nature it

becomes enfarcted, obstructing the passages of the respiration and of

the blood, coagulates the surrounding blood, and renders it motionless

and stationary, it being naturally cold and disposed to obstructions.

Hence they are seized with convulsive suffocation, the tongue turning

livid, assuming a rounded shape, and being bent owing to the veins

which are seated below the tongue (for when an enlarged uvula, which

is called _uva_, is cut, a large vein may be observed on each

side). These veins, then, becoming filled, and their roots extending

into the tongue, which is of a loose and spongy texture, it, owing

to its dryness receiving forcibly the juice from the veins, changes

from broad and becomes round, its natural color turns to livid,

from a soft consistence it grows hard, instead of being flexible it

becomes inflexible, so that the patient would soon be suffocated

unless speedily relieved. Bleeding, then, in the arm, and opening the

sublingual veins, and purging with the electuaries, and giving warm

gargles, and shaving the head, we must apply to it and the neck a

cerate, and wrap them round with wool, and foment with soft sponges

squeezed out of hot water; give to drink water and hydromel, not cold;

and administer the juice of ptisan when, having passed the crisis, the

patient is out of danger. When, in the season of summer or autumn,

there is a hot and nitrous defluxion from the head (it is rendered

hot and acrid by the season), being of such a nature it corrodes and

ulcerates, and fills with air, and orthopnœa attended with great

dryness supervenes; the fauces, when examined, do not seem swollen;

the tendons on the back part of the neck are contracted, and have the

appearance as if it were tetanus; the voice is lost, the breathing

is small, and inspiration becomes frequent and laborious. In such

persons the trachea becomes ulcerated, and the lungs engorged, from the

patient’s not being able to draw in the external air. In such cases,

unless there be a spontaneous determination to the external parts of

the neck, the symptoms become still more dreadful, and the danger more

imminent, partly owing to the season, and the hot and acrid humors

which cause the disease.[573]

7. When fever seizes a person who has lately taken food, and whose

bowels are loaded with fæces which have been long retained, whether it

be attended with pain of the side or not, he ought to lie quiet until

the food descend to the lower region of the bowels, and use oxymel for

drink; but when the load descends to the loins, a clyster should be

administered, or he should be purged by medicine; and when purged, he

should take ptisan for food and hydromel for drink; then he may take

the cerealia, and boiled fishes, and a watery wine in small quantity,

at night, but during the day, a watery hydromel. When the flatus is

offensive, either a suppository or clyster is to be administered; but

otherwise the oxymel is to be discontinued, until the matters descend

to the lower part of the bowels, and then they are to be evacuated

by a clyster. But if the ardent fever (_causus_) supervene when

the bowels are empty, should you still judge it proper to administer

purgative medicine, it ought not be done during the first three

days, nor earlier than the fourth. When you give the medicine, use

the ptisan, observing the paroxysms of the fevers, so as not to give

it when the fever is setting in, but when it is ceasing, or on the

decline, and as far as possible from the commencement. When the feet

are cold, give neither drink nor ptisan, nor anything else of the kind,

but reckon it an important rule to refrain until they become warm,

and then you may administer them with advantage. For the most part,

coldness of the feet is a symptom of a paroxysm of the fever coming on;

and if at such a season you apply those things, you will commit the

greatest possible mistake, for you will augment the disease in no small

degree. But when the fever ceases, the feet, on the contrary, become

hotter than the rest of the body; for when the heat leaves the feet, it

is kindled up in the breast, and sends its flame up to the head. And

when all the heat rushes upwards, and is exhaled at the head, it is not

to be wondered at that the feet become cold, being devoid of flesh, and

tendinous; and besides, they contract cold, owing to their distance

from the hotter parts of the body, an accumulation of heat having

taken place in the chest: and again, in like manner, when the fever is

resolved and dissipated, the heat descends to the feet, and, at the

same time, the head and chest become cold. Wherefore one should attend

to this; that when the feet are cold, the bowels are necessarily hot,

and filled with nauseous matters; the hypochondrium distended: there

is jactitation of the body, owing to the internal disturbance; and

aberration of the intellect, and pains; the patient is agitated, and

wishes to vomit, and if he vomits bad matters he is pained; but when

the heat descends to the feet, and the urine passes freely, he is every

way lightened, even although he does not sweat; at this season, then,

the ptisan ought to be given; it would be death to give it before.[574]

8. When the bowels are loose during the whole course of fevers, in

this case we are most especially to warm the feet, and see that they

are properly treated with cerates, and wrapped in shawls, so that they

may not become colder than the rest of the body; but when they are

hot, no fomentation must be made to them, but care is to be taken that

they do not become cold; and very little drink is to be used, either

cold water or hydromel. In those cases of fever where the bowels are

loose, and the mind is disordered, the greater number of patients pick

the wool from their blankets, scratch their noses, answer briefly when

questions are put to them, but, when left to themselves, utter nothing

that is rational. Such attacks appear to me to be connected with black

bile. When in these cases there is a colliquative diarrhœa, I am of

opinion that we ought to give the colder and thicker ptisans, and

that the drinks ought to be binding, of a vinous nature, and rather

astringent. In cases of fever attended from the first with vertigo,

throbbing of the head, and thin urine, you may expect the fever to be

exacerbated at the crisis; neither need it excite wonder, although

there be delirium. When, at the commencement, the urine is cloudy or

thick, it is proper to purge gently, provided this be otherwise proper;

but when the urine at first is thin, do not purge such patients, but,

if thought necessary, give a clyster: such patients should be thus

treated; they should be kept in a quiet state, have unguents applied

to them, and be covered up properly with clothes, and they should use

for drink a watery hydromel, and the juice of ptisan as a draught in

the evening; clear out the bowels at first with a clyster, but give

no purgative medicines to them, for, if you move the bowels strongly,

the urine is not concocted, but the fever remains long, without sweats

and without a crisis. Do not give draughts when the time of the crisis

is at hand, if there be agitation, but only when the fever abates

and is alleviated. It is proper to be guarded at the crises of other

fevers, and to withhold the draughts at that season. Fevers of this

description are apt to be protracted, and to have determinations, if

the inferior extremities be cold, about the ears and neck, or, if these

parts are not cold, to have other changes; they have epistaxis, and

disorder of the bowels. But in cases of fever attended with nausea, or

distention of the hypochondria, when the patients cannot lie reclined

in the same position, and the extremities are cold, the greatest care

and precaution are necessary; nothing should be given to them, except

oxymel diluted with water; no draught should be administered, until the

fever abate and the urine be concocted; the patient should be laid in

a dark apartment, and recline upon the softest couch, and he should be

kept as long as possible in the same position, so as not to toss about,

for this is particularly beneficial to him. Apply to the hypochondrium

linseed by inunctions, taking care that he do not catch cold when the

application is made; let it be in a tepid state, and boiled in water

and oil. One may judge from the urine what is to take place, for if

the urine be thicker, and more yellowish, so much the better; but if

it be thinner, and blacker, so much the worse;[575] but if it undergo

changes, it indicates a prolongation of the disease, and the patient,

in like manner, must experience a change to the worse and the better.

Irregular fevers should be let alone until they become settled, and,

when they do settle, they are to be treated by a suitable diet and

medicine, attending to the constitution of the patient.

9. The aspects of the sick are various; wherefore the physician should

pay attention, that he may not miss observing the exciting causes,

as far as they can be ascertained by reasoning, nor such symptoms as

should appear on an even or odd day, but he ought to be particularly

guarded in observing the odd days, as it is in them, more especially,

that changes take place in patients. He should mark, particularly,

the first day on which the patient became ill, considering when and

whence the disease commenced, for this is of primary importance to

know. When you examine the patient, inquire into all particulars;

first how the head is, and if there be no headache, nor heaviness in

it; then examine if the hypochondria and sides be free of pain; for

if the hypochondrium be painful, swelled, and unequal, with a sense

of satiety, or if there be pain in the side, and, along with the

pain, either cough, tormina, or belly-ache, if any of these symptoms

be present in the hypochondrium, the bowels should be opened with

clysters, and the patient should drink boiled hydromel in a hot state.

The physician should ascertain whether the patient be apt to faint when

he is raised up, and whether his breathing be free; and examine the

discharges from the bowels, whether they be very black, or of a proper

color, like those of persons in good health, and ascertain whether the

fever has a paroxysm every third day, and look well to such persons

on those days. And should the fourth day prove like the third, the

patient is in a dangerous state.[576] With regard to the symptoms,

black stools prognosticate death; but if they resemble the discharges

of a healthy person, and if such is their appearance every day, it is a

favorable symptom; but when the bowels do not yield to a suppository,

and when, though the respiration be natural, the patient when raised

to the night-table, or even in bed, be seized with deliquium, you may

expect that the patient, man or woman, who experiences these symptoms,

is about to fall into a state of delirium. Attention also should be

paid to the hands, for if they tremble, you may expect epistaxis; and

observe the nostrils, whether the breath be drawn in equally by both;

and if expiration by the nostrils be large, a convulsion is apt to take

place; and should a convulsion occur to such a person, death may be

anticipated, and it is well to announce it beforehand.

10. If, in a winter fever, the tongue be rough, and if there be

swoonings, it is likely to be the remission of the fever. Nevertheless

such a person is to be kept upon a restricted diet, with water for

drink, and hydromel, and the strained juices, not trusting to the

remission of the fevers, as persons having these symptoms are in danger

of dying; when, therefore, you perceive these symptoms, announce this

prognostic, if you shall judge proper, after making the suitable

observations. When, in fevers, any dangerous symptom appears on the

fifth day, when watery discharges suddenly take place from the bowels,

when deliquium animi occurs, or the patient is attacked with loss of

speech, convulsions, or hiccup, under such circumstances he is likely

to be affected with nausea, and sweats break out under the nose and

forehead, or on the back part of the neck and head, and patients with

such symptoms shortly die, from stoppage of the respiration.[577]

When, in fevers, abscesses form about the legs, and, getting into a

chronic state, are not concocted while the fever persists, and if one

is seized with a sense of suffocation in the throat, while the fauces

are not swelled, and if it do not come to maturation, but is repressed,

in such a case there is apt to be a flow of blood from the nose; if

this, then, be copious, it indicates a resolution of the disease, but

if not, a prolongation of the complaint; and the less the discharge,

so much worse the symptoms, and the more protracted the disease; but

if the other symptoms are very favorable, expect in such a case that

pains will fall upon the feet; if then they attack the feet, and if

those continue long in a very painful, and inflamed state, and if

there be no resolution, the pains will extend by degrees to the neck,

to the clavicle, shoulder, breast, or to some articulation, in which

an inflammatory tumour will necessarily form. When these are reduced,

if the hands are contracted, and become trembling, convulsion and

delirium seize such a person; but blisters break out on the eyebrow,

erythema takes place, the one eyelid being tumefied overtops the other,

a hard inflammation sets in, the eye become strongly swelled, and the

delirium increases much, but makes its attacks rather at night than by

day. These symptoms more frequently occur on odd than on even days,

but, whether on the one or the other, they are of a fatal character.

Should you determine to give purgative medicines in such cases, at

the commencement, you should do so before the fifth day, if there be

borborygmi in the bowels, or, if not, you should omit the medicines

altogether. If there be borborygmi, with bilious stools, purge

moderately with scammony; but with regard to the treatment otherwise,

administer as few drinks and draughts as possible, until there be some

amendment, and the disease is past the fourteenth day. When loss of

speech seizes a person, on the fourteenth day of a fever, there is

not usually a speedy resolution, nor any removal of the disease, for

this symptom indicates a protracted disease; and when it appears on

that day, it will be still more prolonged. When, on the fourth day of

a fever, the tongue articulates confusedly, and when there are watery

and bilious discharges from the bowels, such a patient is apt to fall

into a state of delirium; the physician ought, therefore, to watch

him, and attend to whatever symptoms may turn up. In the season of

summer and autumn an epistaxis, suddenly occurring in acute diseases,

indicates vehemence of the attack, and inflammation in the course of

the veins, and on the day following, the discharge of thin urine; and

if the patient be in the prime of life, and if his body be strong from

exercise, and brawny, or of a melancholic temperament, or if from

drinking he has trembling hands, it may be well to announce beforehand

either delirium or convulsion;[578] and if these symptoms occur on even

days, so much the better; but on critical days, they are of a deadly

character. If, then, a copious discharge of blood procure an issue

to the fullness thereof about the nose, or what is collected about

the anus, there will be an abscess, or pains in the hypochondrium, or

testicles, or in the limbs; and when these are resolved, there will

be a discharge of thick sputa, and of smooth, thin urine. In fever

attended with singultus, give asafœtida, oxymel, and carrot, triturated

together, in a draught; or galbanum in honey, and cumin in a linctus,

or the juice of ptisan. Such a person cannot escape, unless critical

sweats and gentle sleep supervene, and thick and acrid urine be passed,

or the disease terminate in an abscess: give pine-fruit[579] and myrrh

in a linctus, and further give a very little oxymel to drink; but if

they are very thirsty, some barley-water.

11. Peripneumonia, and pleuritic affections, are to be thus observed:

If the fever be acute, and if there be pains on either side, or in

both, and if expiration be attended with pain, if cough be present, and

the sputa expectorated be of a blond or livid color, or likewise thin,

frothy, and florid, or having any other character different from the

common, in such a case, the physician should proceed thus: if the pain

pass upward to the clavicle, or the breast, or the arm, the inner vein

in the arm should be opened on the side affected, and blood abstracted

according to the habit, age, and color of the patient, and the season

of the year, and that largely and boldly, if the pain be acute, so as

to bring on deliquium animi,[580] and afterwards a clyster is to be

given. But if the pain be below the chest, and if very intense, purge

the bowels gently in such an attack of pleurisy, and during the act of

purging give nothing; but after the purging give oxymel. The medicine

is to be administered on the fourth day; on the first three days after

the commencement, a clyster should be given, and if it does not relieve

the patient, he should then be gently purged, but he is to be watched

until the fever goes off, and till the seventh day; then if he appear

to be free from danger, give him some unstrained ptisan, in small

quantity, and thin at first, mixing it with honey. If the expectoration

be easy, and the breathing free, if his sides be free of pain, and

if the fever be gone, he may take the ptisan thicker, and in larger

quantity, twice a day. But if he do not progress favorably, he must

get less of the drink, and of the draught, which should be thin, and

only given once a day, at whatever is judged to be the most favorable

hour; this you will ascertain from the urine. The draught is not to be

given to persons after fever, until you see that the urine and sputa

are concocted, (if, indeed, after the administration of the medicine he

be purged frequently, it may be necessary to give it, but it should be

given in smaller quantities and thinner than usual, for from inanition

he will be unable to sleep, or digest properly, or wait the crisis;)

but when the melting down of crude matters has taken place, and his

system has cast off what is offensive, there will then be no objection.

The sputa are concocted when they resemble pus, and the urine when

it has reddish sediments like tares. But there is nothing to prevent

fomentation and cerates being applied for the other pains of the sides;

and the legs and loins may be rubbed with hot oil, or anointed with

fat; linseed, too, in the form of a cataplasm, may be applied to the

hypochondrium and as far up as the breasts. When pneumonia is at its

height, the case is beyond remedy if he is not purged, and it is bad if

he has dyspnœa, and urine that is thin and acrid, and if sweats come

out about the neck and head, for such sweats are bad, as proceeding

from the suffocation, _râles_, and the violence of the disease

which is obtaining the upper hand, unless there be a copious evacuation

of thick urine, and the sputa be concocted; when either of these come

on spontaneously, that will carry off the disease. A linctus for

pneumonia: Galbanum and pine-fruit in Attic honey; and southernwood in

oxymel; make a decoction of pepper and black hellebore, and give it in

cases of pleurisy attended with violent pain at the commencement. It is

also a good thing to boil opoponax in oxymel, and, having strained it,

to give it to drink; it answers well, also, in diseases of the liver,

and in severe pains proceeding from the diaphragm, and in all cases in

which it is beneficial to determine to the bowels or urinary organs,

when given in wine and honey; when given to act upon the bowels, it

should be drunk in larger quantity, along with a watery hydromel.

12. A dysentery, when stopped, will give rise to an aposteme, or

tumour, if it do not terminate in fevers with sweats, or with thick and

white urine, or in a tertian fever, or the pain fix upon a varix, or

the testicles, or on the hip-joints.[581]

13. In a bilious fever, jaundice coming on with rigor before the

seventh day carries off the fever, but if it occur without the fever,

and not at the proper time, it is a fatal symptom.

14. When the loins are in a tetanic state, and the spirits in the

veins are obstructed by melancholic humors, venesection will afford

relief.[582] But when, on the other hand, the anterior tendons are

strongly contracted, and if there be sweats about the neck and face,

extorted by the violent pain of the parched and dried tendons of the

sacral extremity (these are very thick, sustaining the spine, and

giving rise to very great ligaments, which terminate in the feet,) in

such a case, unless fever and sleep come on, followed by concocted

urine and critical sweats, give to drink a strong Cretan wine, and

boiled barley-meal for food; anoint and rub with ointments containing

wax; bathe the legs and feet in hot water, and then cover them up; and

so in like manner the arms, as far as the hands, and the spine, from

the neck to the sacrum, are to be wrapped in a skin smeared with wax;

this must extend to the parts beyond, and intervals are to be left for

applying fomentations, by means of leather bottles filled with hot

water, then, wrapping him up in a linen cloth, lay him down in bed. Do

not open the bowels, unless by means of a suppository, when they have

been long of being moved. If there be any remission of the disease, so

far well, but otherwise, pound of the root of bryonia[583] in fragrant

wine, and that of the carrot, and give to the patient fasting early

in the morning, before using the affusion, and immediately afterwards

let him eat boiled barley-meal in a tepid state, and as much as he can

take, and in addition let him drink, if he will, wine well diluted.

If the disease yield to these means, so much the better, but, if

otherwise, you must prognosticate accordingly.

15. All diseases are resolved either by the mouth, the bowels, the

bladder, or some other such organ. Sweat is a common form of resolution

in all these cases.[584]

16. You should put persons on a course of hellebore who are troubled

with a defluxion from the head. But do not administer hellebore to

such persons as are laboring under empyema connected with abscesses,

hæmoptysis, and intemperament, or any other strong cause, for it will

do no good; and if anything unpleasant occur the hellebore will get

the blame of it. But if the body have suddenly lost its powers, or if

there be pain in the head, or obstruction of the ears and nose, or

ptyalism, or heaviness of the limbs, or an extraordinary swelling of

the body, you may administer the hellebore, provided these symptoms

be not connected with drinking, nor with immoderate venery; nor with

sorrow, vexation, nor insomnolency, for, if any of these causes exist,

the treatment must have respect to it.

17. From walking arise pains of the sides, of the back, of the loins,

and of the hip-joint, and disorder of the respiration has often been

from the same cause, for, after excesses of wine and flatulent food,

pains shoot to the loins and hips, accompanied with dysuria.[585]

Walking is the cause of such complaints, and also of coryza and

hoarseness.

18. Disorders connected with regimen, for the most part, make their

attack accordingly as any one has changed his habitual mode of

diet.[586] For persons who dine contrary to custom experience much

swelling of the stomach, drowsiness, and fullness; and if they take

supper over and above, their belly is disordered; such persons will be

benefited by sleeping after taking the bath, and by walking slowly for

a considerable time after sleep; if, then, the bowels be moved, he may

dine and drink a small quantity of wine not much diluted; but if the

bowels are not opened, he should get his body rubbed with hot oil, and,

if thirsty, drink of some weak and white wine, or a sweet wine, and

take repose; if he does not sleep he should repose the longer. In other

respects he should observe the regimen laid down for those who have

taken a debauch. With regard to the bad effects of drinks, such as are

of a watery nature pass more slowly through the body, they regurgitate,

as it were, and float about the hypochondria, and do not flow readily

by urine; when filled up with such a drink, he should not attempt any

violent exertion, requiring either strength or swiftness, but should

rest as much as possible until the drink has been digested along with

the food; but such drinks as are stronger or more austere, occasion

palpitation in the body and throbbing in the head, and in this case

the person affected will do well to sleep, and take some hot draught

for which he feels disposed; for abstinence is bad in headache and the

effects of a surfeit. Those who, contrary to usage, restrict themselves

to one meal, feel empty and feeble, and pass hot urine in consequence

of the emptiness of their vessels; they have a salt and bitter taste in

the mouth; they tremble at any work they attempt; their temples throb;

and they cannot digest their supper so well as if they had previously

taken their dinner. Such persons should take less supper than they are

wont, and a pudding of barley-meal more moist than usual instead of

bread, and of potherbs the dock, or mallow, and ptisan, or beets, and

along with the food they should take wine in moderation, and diluted

with water; after supper they should take a short walk, until the urine

descend and be passed; and they may use boiled fish.

Articles of food have generally such effects as the following:[587]

Garlic occasions flatulence and heat about the chest, heaviness of the

head, and nausea, and any other habitual pain is apt to be exasperated

by it; it is diuretic, which, in so far, is a good property which it

possesses; but it is best to eat it when one means to drink to excess,

or when intoxicated. Cheese produces flatulence and constipation, and

heats the other articles of food; and it gives rise to crudities and

indigestion, but it is worst of all to eat it along with drink after

a full meal. Pulse of all kinds are flatulent, whether raw, boiled,

or fried; least so when macerated in water, or in a green state; they

should not be used except along with food prepared from the cerealia.

Each of these articles, however, has bad effects peculiar to itself.

The vetch, whether raw or boiled, creates flatulence and pain. The

lentil is astringent, and disorders the stomach if taken with its

hull. The lupine has the fewest bad effects of all these things. The

stalk and the juice of silphium (_asafœtida_), pass through some

people’s bowels very readily, but in others, not accustomed to them,

they engender what is called dry cholera;[588] this complaint is more

especially produced by it if mixed with much cheese, or eaten along

with beef. Melancholic diseases are most particularly exacerbated by

beef, for it is of an unmanageable nature, and requires no ordinary

powers of stomach to digest it; it will agree best with those who use

it well boiled and pretty long kept. Goat’s flesh has all the bad

properties of beef; it is as indigestible, more flatulent and engenders

acid eructations and cholera; such as has a fragrant smell, is firm,

and sweet to the taste, is the best, when well baked and cooled; but

those kinds which are disagreeable to the taste, have a bad smell, and

are hard, such are particularly bad, and especially if very fresh; it

is best in summer and worst in autumn. The flesh of young pigs is bad,

either when it is too raw or when it is over-roasted, for it engenders

bile and disorders the bowels. Of all kinds of flesh, pork is the best;

it is best when neither very fat, nor, on the other hand, very lean,

and the animal had not attained the age of what is reckoned an old

victim; it should be eaten without the skin, and in a coldish state.

19. In dry cholera the belly is distended with wind, there is rumbling

in the bowels, pain in the sides and loins, no dejections, but, on the

contrary, the bowels are constipated. In such a case you should guard

against vomiting, but endeavor to get the bowels opened. As quickly

as possible give a clyster of hot water with plenty of oil in it, and

having rubbed the patient freely with unguents, put him into hot water,

laying him down in the basin, and pouring the hot water upon him by

degrees; and if, when heated in the bath, the bowels be moved, he will

be freed from the complaint. To a person in such a complaint it will

do good if he sleep, and drink a thin, old, and strong wine; and you

should give him oil, so that he may settle, and have his bowels moved,

when he will be relieved. He must abstain from all other kinds of food;

but when the pain remits, give him asses’ milk to drink until he is

purged. But if the bowels are loose, with bilious discharges, tormina,

vomitings, a feeling of suffocation, and gnawing pains, it is best to

enjoin repose, and to drink hydromel, and avoid vomiting.

20. There are two kinds of dropsy, the one anasarca, which, when

formed, is incurable; the other is accompanied with emphysema

(tympanites?) and requires much good fortune to enable one to triumph

over it.[589] Laborious exertion, fomentation, and abstinence (are to

be enjoined). The patient should eat dry and acrid things, for thus

will he pass the more water, and his strength be kept up. If he labors

under difficulty of breathing, if it is the summer season, and if he is

in the prime of life, and is strong, blood should be abstracted from

the arm, and then he should eat hot pieces of bread, dipped in dark

wine and oil, drink very little, and labor much, and live on well-fed

pork, boiled with vinegar, so that he may be able to endure hard

exercises.[590]

21. Those who have the inferior intestines hot, and who pass acrid and

irregular stools of a colliquative nature, if they can bear it, should

procure revulsion by vomiting with hellebore; but if not, should get

a thick decoction of summer wheat in a cold state, lentil soup, bread

cooked with cinders, and fish, which should be taken boiled if they

have fever, but roasted if not feverish; and also dark-colored wine if

free of fever; but otherwise they should take the water from medlars,

myrtles, apples, services, dates, or wild vine. If there be no fever,

and if there be tormina, the patient should drink hot asses’ milk in

small quantity at first, and gradually increase it, and linseed, and

wheaten flour, and having removed the bitter part of Egyptian beans,

and ground them, sprinkle on the milk and drink; and let him eat eggs

half-roasted, and fine flour, and millet, and perl-spelt (chondrus)

boiled in milk;--all these things should be eaten cold, and similar

articles of food and drink should be administered.

22. The most important point of regimen to observe and be guarded about

in protracted diseases, is to pay attention to the exacerbations and

remissions of fevers, so as to avoid the times when food should not be

given, and to know when it may be administered without danger; this

last season is at the greatest possible distance from the exacerbation.

23. One should be able to recognize those who have headache from

gymnastic exercises, or running, or walking or hunting, or any other

unseasonable labour, or from immoderate venery; also those who are of

a pale colour, or troubled with hoarseness; those who have enlarged

spleen, those who are in a state of anæmia, those who are suffering

from tympanites, those having dry cough and thirst, those who are

flatulent, and have the course of the blood in their veins intercepted;

those persons whose hypochondria, sides, and back are distended; those

having torpor; those laboring under amaurosis, or having noises in

their ears; those suffering from incontinence of urine or jaundice, or

whose food is passed undigested; those who have discharges of blood

from the nose or anus, or who have flatulence and intense pain, and who

cannot retain the wind. In these cases you may do mischief, but cannot

possibly do any good by purging, but may interrupt the spontaneous

remissions and crises of the complaints.[591]

24. If you think it expedient to let blood, see that the bowels be

previously settled, and then bleed; enjoin abstinence, and forbid the

use of wine; and complete the cure by means of a suitable regimen, and

wet fomentations.[592] But if the bowels appear to be constipated,

administer a soothing clyster.

25.[593] If you think it necessary to give medicines, you may safely

purge upwards by hellebore, but none of those should be purged

downwards. The most effectual mode of treatment is by the urine,

sweats, and exercise; and use gentle friction so as not to harden the

constitution; and if he be confined to bed let others rub him. When

the pain is seated above the diaphragm, place him erect for the most

part, and let him be as little reclined as possible; and when he is

raised up let him be rubbed for a considerable time with plenty of hot

oil. But if the pains be in the lower belly below the diaphragm, it

will be useful to lie reclined and make no motion, and to such a person

nothing should be administered except the friction. Those pains which

are dissolved by discharges from the bowels, by urine, or moderate

sweats, cease spontaneously, if they are slight, but if strong they

prove troublesome; for persons so affected either die, or at least do

not recover without further mischief, for they terminate in abscesses.

26. _A draught for a dropsical person._ Take three cantharides,[594]

and removing their head, feet, and wings, triturate their bodies in

three cupfuls (cyathi) of water, and when the person who has drunk the

draught complains of pain, let him have hot fomentations applied. The

patient should be first anointed with oil, should take the draught

fasting, and eat hot bread with oil.

27.[595] _A styptic._ Apply the juice of the fig inwardly to

the vein; or having moulded biestings into a tent, introduce up the

nostril, or push up some chalcitis with the finger, and press the

cartilages of the nostrils together; and open the bowels with the

boiled milk of asses: or having shaved the head apply cold things to it

if in the summer season.

28. The sesamoides[596] purges upwards when pounded in oxymel to the

amount of a drachm and a half, and drunk; it is combined with the

hellebores, to the amount of the third part, and thus it is less apt to

produce suffocation.

29. _Trichiasis._ Having introduced a thread into the eye of a

needle push it through the upper part of the distended eyelid, and do

the same at the base of it; having stretched the threads tie a knot on

them, and bind up until they drop out: and, if this be sufficient, so

far well; but if otherwise, you must do the same thing again.[597] And

hemorrhoids, in like manner, you may treat by transfixing them with a

needle and tying them with a very thick and large woolen thread; for

thus the cure will be more certain. When you have secured them, use a

septic application, and do not foment until they drop off, and always

leave one behind; and when the patient recovers, let him be put upon

a course of hellebore. Then let him be exercised and sweated; the

friction of the gymnasium and wrestling in the morning will be proper;

but he must abstain from running, drinking, and all acrid substances,

except marjoram; let him take an emetic every seven days, or three

times in a month; for thus will he enjoy the best bodily health. Let

him take straw-colored, austere, and watery wine, and use little drink.

30. _For persons affected with empyema._ Having cut some bulbs

or squill, boil in water, and when well boiled, throw this away, and

having poured in more water, boil until it appear to the touch soft and

well-boiled; then triturate finely and mix roasted cumin, and white

sesames, and young almonds pounded in honey, form into an electuary

and give; and afterwards sweet wine. In draughts, having pounded about

a small acetabulum of the white poppy, moisten it with water in which

summer wheat has been washed, add honey, and boil. Let him take this

frequently during the day. And then taking into account what are to

happen, give him supper.

31. _For dysentery._ A fourth part of a pound of cleaned beans,

and twelve shoots of madder having been triturated, are to be mixed

together and boiled, and given as a linctus with some fatty substance.

32. _For diseases of the eyes._ Washed spodium (tutty?) mixed

with grease, and not of a thinner consistence than dough, is to be

carefully triturated, and moistened with the juice of unripe raisins;

and having dried in the sun, moisten until it is of the consistence of

an ointment. When it becomes again dry, let it be finely levigated,

anoint the eyes with it, and dust it upon the angles of the eyes.

33. _For watery eyes._ Take one drachm of ebony and nine oboli of

burnt copper, rub them upon a whetstone, add three oboli of saffron;

triturate all these things reduced to a fine powder, pour in an Attic

hemina of sweet wine, and then place in the sun and cover up; when

sufficiently digested, use it.[598]

34. _For violent pains of the eyes._ Take of chalcitis,[599] and

of raisin, of each 1 dr., when digested for two days, strain; and

pounding myrrh and saffron, and having mixed must, with these things,

digest in the sun; and with this anoint the eyes when in a state of

severe pain. Let it be kept in a copper vessel.

35. _Mode of distinguishing persons in an hysterical fit._ Pinch

them with your fingers, and if they feel, it is hysterical; but if not,

it is a convulsion.

36. _To persons in coma_, (dropsy?) give to drink meconium (_euphorbia

peplus?_) to the amount of a round Attic _leciskion_ (small

acetabulum[600]).

37. Of squama æris, as much as three specilla can contain, with the

gluten of summer wheat: levigate, pound, form into pills, and give; it

purges water downwards.

38. _A medicine for opening the bowels._ Pour upon figs the juice

of spurge, in the proportion of seven to one: then put into a new

vessel and lay past when properly mixed. Give before food.

39. Pounding meconium, pouring on it water, and straining, and

mixing flour, and baking into a cake, with the addition of boiled

honey, give in affections of the anus and in dropsy; and after eating

of it, let the patient drink of a sweet watery wine, and diluted

hydromel prepared from wax: or collecting meconium, lay it up for

medicinal purposes.[601]

FIRST AND THIRD BOOKS

OF

THE EPIDEMICS.

THE EPIDEMICS.

BOOK I.

THE ARGUMENT.

The ancient physicians commonly used the term Epidemic in the same

sense as it is understood now, that is to say, as applying to any

disease which attacks a multitude of persons in a locality at any

particular period. This, as will be seen in our annotations below, is

nearly the definition which Galen gives of it; and it is generally

used by Hippocrates, in the first and third books of the “Epidemics,”

in pretty much the same sense as it is used by our great modern

authority on epidemics, Sydenham. But, although this be the strict

sense in which the ancient authorities use the term, it must be borne

in mind that, as applied to the whole seven books of the “Epidemics,”

it must be taken in a much wider signification; for there are many

things treated of in them to which the term epidemic can by no means

be thus applied, such as surgical cases, fragments of anatomical

descriptions, philosophical speculations, empirical remedies, general

reflections on various topics, and so forth. In fact, the work entitled

“The Books of Epidemics” can be viewed in no other light than as an

_Adversaria_, or _Memorandum Book_, in which is collected

a variety of isolated facts and detached observations, to serve as

the materials for more elaborate and finished works on professional

subjects. Indeed, Galen does not hesitate to give it as his opinion,

that some of the most celebrated of our author’s productions, such

as the “Aphorisms” and “Prognostics,” are in a great measure made up

from the materials originally laid up in this capacious repertory of

observations;[602] and, with regard to the former of these works,

there is no person familiarly acquainted with it but must admit the

truth of Galen’s remark. But, respecting the other, although it

must be obvious, upon a comparison of them, that there is a close

connection between it and the “Epidemics,” there can be no doubt that,

in composing the “Prognostics,” Hippocrates availed himself of other

materials ready prepared for his use, in the “Prorrhetics” and “Coan

Prænotions” of his predecessors, the Asclepiadæ;[603] so that, of all

his admired productions, it, perhaps, is the one which has the least

pretension to any originality of matter. If it be thought strange that

the term epidemics should have been applied to a work composed of

such heterogeneous materials, I would remark, in explanation, that,

although the subject-matters of which it consists are not all of this

nature, the most valuable portion of them refers to epidemics, and it

is not to be wondered at that the whole collection should have got its

appellation from the most prominent subject to which it relates.

* * * * *

I shall now proceed to give a succinct analysis of the various subjects

which are contained in the First and Third Books of the “Epidemics.”

The first book opens with a description of the leading phenomena of

a certain season, which is called the First Constitution; it was

southerly, coldish, rainy, clouded and misty, with some intervals of

drought. The most noted diseases of spring in this constitution were

causus and an epidemical parotitis. But the most important subject

which is handled under this head, is an epidemic phthisis, of which a

very interesting description is given.

The Second Constitution is described as being northerly and humid;

humid ophthalmies, dysenteries, and diarrhœas are described among the

prevailing diseases of the season; but the most marked affection which

is said to have occurred in this constitution, is a continual fever

of a serious character, which did not come to a crisis until after it

had run a long course. It is described as passing off by deposits, and

principally by dropsies, and an affection of the urinary organs. One

cannot help being struck with the remark which Hippocrates makes, that

he never knew a case prove fatal in which the strangury supervened.

The directions as to the treatment he condenses into one general rule,

which well deserves to be engraved in letters of gold, that “_the aim

of the physician should be to do good to his patient, or, at least, to

do no harm_.” The description of this constitution concludes with

some general reflections on the prognostics in causus and phrenitis.

The Third Constitution is described as being of a very variable

character; winter stormy, spring rainy, summer hot, autumn cold and

dry. The ardent fevers (_or_ causi) began early in the season, but

did not assume a fatal character until autumn. This disease came to a

crisis in four modes--by an epistaxis, by a copious flow of urine, by a

deposit, or by an alvine discharge. In women, there was also sometimes

a crisis by menstruation.

The Fourth Constitution is one which, by Galen and the other

authorities, has been entitled the pestilential, and has attracted

great attention, as being supposed to have derived its peculiar

characters from the great Plague which prevailed during the

Peloponnesian war, and which is described in so interesting a manner

by Thucydides. Galen, not only in his Commentary, but in various

other parts of his works, advocates this opinion, and it will be seen

from what is stated in our annotations, that there is in reality a

striking resemblance between the features of the plague, as delineated

by Thucydides, and the epidemical diseases which are noticed by

Hippocrates as having prevailed during this constitution. Of all the

diseases here described the most remarkable is the erysipelas, which,

although not of a very fatal character, was still of a formidable

nature, as it frequently terminated in gangrene. Causus, phrenitis, and

anthrax are also described as being common under this constitution. The

last of these being a well-known symptom of the Oriental plague, it has

naturally excited a good deal of speculation to determine whether or

not our author here refers to the glandular plague. See our remarks on

Epidem. III.

* * * * *

In these books it is remarkable that phthisis is treated of as a

febrile disease, and in particular as supervening upon attacks of the

semitertian. There seems reason to suppose that our author means to

describe a hectic fever succeeding to intermittents, which had caused

organic derangement of the internal viscera, more especially of the

liver and spleen. See PAULUS ÆGINETA, Book II., 32.

In the first book, fourteen cases of disease are related, and in the

beginning of the third twelve, and sixteen in the end; thus making

forty-two in all. It is worthy of remark, that in twenty-five of these

the result was fatal. There is every reason, then, to suppose that

they were selected for a purpose, but what that purpose was cannot now

be easily determined. The most natural would, no doubt, have been to

illustrate, by examples, the forms of the different diseases which are

described as occurring during the Constitutions previously described.

But there seems to be little or no reason to suppose that this is the

object for which they are related. In proof of this, I may mention

that there is not in the collection a single case of the epidemical

erysipelas which is described as having been the prevailing disease

during the fourth Constitution. Indeed it must strike everybody, who

reads them carefully, as a singular feature in these cases, that the

lineaments of a particular disease are seldom to be recognized, and

this perhaps may be regarded as a proof of the faithfulness with which

they have been copied from nature. In short, we here recognize the

features of disease in the concrete, and not in the abstract. And is

not this what we should expect in all true copies from Nature? How

often does the candid physician find himself forced honestly to admit

that he is at a loss what name to give to the combination of morbid

actions which he is called upon to treat! The common herd of mankind

would seem to fancy, as in Nature there are certain types of all

animal and vegetable substances, and the botanist has no difficulty in

classing such a plant, for example, as the _conium maculatum_;

and the natural historian can readily pronounce that such a bird is

the _alcedo Ispida_; that the physician, in like manner, upon

examining the characteristic features of any case, should have no

difficulty in pronouncing that it is _pleuritis_, for example,

or _pneumonia_, or the like. But how often does it happen, that

the complaint in question is an aggregate of symptoms, produced by

peculiarities of constitution, and incidental circumstances, which,

taken together, constitute an _ensemble_ which does not well admit

of being referred to any one of the general forms of disease described

in our nosological systems? Now, I say the most wonderful feature in

the cases related by Hippocrates, is that they are descriptive of the

symptoms observed in certain diseased individuals, instead of being,

what most modern cases are, symptoms drawn to correspond with certain

ideal forms of disease. What, in my opinion, likewise adds very much

to the value of these cases is, that (as Galen somewhere remarks in

his Commentary) the author never aimed to make his Books of Epidemics

a work on Therapeutics, and hence, in noting morbid phenomena, his

mind in not warped by any particular hypothesis, nor by any selfish

interest, in order to place some favorite mode of practice, advocated

by himself, in a favorable light. May I be permitted here to remark,

that the reader will be much struck with our author’s admirable

talent for describing the phenomena of disease as they are actually

presented to us, if he will compare the case related by him in these

two books with those of almost any modern authority whatever;--for

example, with those related by the late Dr. James Hamilton, in his

celebrated work on Purgative Medicines. In the latter, you look

in vain for the strongly-marked features which present themselves

in all the cases related by our author,--for a description of the

condition of the hypochondriac region,--of the state of the animal

heat in the extremities,--of the minute characters of the alvine and

urinary discharges,--of the respiration,--of the patients’ position

in bed,--and many other symptoms, which are invariably noticed by

Hippocrates. And what reasonable person will venture to deny, that

the symptoms I have just now mentioned are most important features in

every febrile disease, and that no one can be said to have a sufficient

view of such a case, who does not take these into account? To confine

our attention at present to only one of these symptoms,--can it ever

be a matter of indifference what are the physical characters of so

important an excretion as the urine? that is to say, whether the

grosser particles of it, which usually fall to the bottom, be present

in the urine or not? Yet in all the seventeen cases related in the

modern work just now referred to, the characters of the urine are not

given in a single instance. And although the object of the writer is

to enforce his own peculiar views, as to the utility of purgative

medicines in this disease, he scarcely ever gives the minute characters

of the alvine discharges, as is uniformly the case with Hippocrates;

or if they are noticed at all, it is in so confused a manner that

the reader is at a loss to determine whether they are produced by

the disease, or by the medicines which have been administered. For

the issue of the case no obvious cause is stated, but the reader is

expected to draw the conclusion that, as purgatives were freely given,

and a considerable proportion of the cases did well,--(agreeably to the

hackneyed rule, _post quod, ergo propter quod_,)--the purgatives

brought about the fortunate result. Had the cases been fully and

circumstantially detailed, it might have been found that, as in those

related by Hippocrates, recovery was preceded by a critical discharge

of urine, accompanied with a copious sediment; and then the more

probable inference would have been, that the amendment was referable to

_it_, and not to the purgative medicines which were administered.

It is, I regret to say, a notable example of the want of logical

training in the education of professional men, in the present age, that

inferences regarding a peculiar method of practice were allowed to be

founded upon narratives of observations so defective and one-sided as

those I refer to.

* * * * *

I cannot quit the present subject of discussion, without saying a

few words in reference to what must strike the reader as a singular

feature in the cases related in the books of the Epidemics; I mean the

general omission of any mention of treatment. The reader will find in

our annotations various remarks of Galen on this head, from which he

will learn that the Great Commentator inclines to the opinion, that in

all these cases the usual routine of practice was followed, but that

no mention is made of medicines, unless when there was some deviation

from the established rules. For example, in a certain febrile case,

it is stated that the patient was bled on the eighth day, and Galen

contends that venesection is noticed in this instance, merely because

it was contrary to the established rule of not bleeding after the

fourth day; for that if the practice had been in accordance with the

general rule, it would not have been noticed at all. Now it must be

admitted, that this supposition is by no means improbable, and that

examples of this usage are not wanting, even in the modern literature

of medicine. To give an example, which just occurs to me; in not a

few of the cases of cerebral disease related by Dr. Abercrombie, in

his work “On the Brain,” there is no allusion whatever to remedies,

although no one, who recollects the vigorous system of treatment then

pursued by the profession in “Modern Athens,” will doubt for a moment

that they must have been applied. As this eminent authority, then,

when he believed that the treatment had no perceptible effect on the

course which the disease ran, thought himself warranted in omitting all

mention of it, it might be supposed, in like manner, that Hippocrates

may have passed over the remedies applied, from some such motive or

consideration. But another reason for the absence of remedies in these

Reports may be readily supposed. May not Hippocrates have been at first

quite undecided what was the proper plan of treatment to be adopted

in those cases, and thought it the wisest course to attempt nothing

rashly, but to be for a season the quiet spectator of the course

which the diseases in question were naturally disposed to run, before

attempting to interfere in the struggle between morbific agents with

which he was imperfectly acquainted, and their great physician, as

he held Nature to be?[604] And however much the advocates for a bold

system of treating diseases may be disposed to deride this expectant

method, which Asclepiades contemptuously denominated “the contemplation

of death,”[605] it does not want the sanction of a name which is

second only to Hippocrates in the literature of epidemical fevers.

Sydenham admits, that with all the diligence which he had applied to

the study of these diseases, he was always greatly puzzled what plan

of treatment to adopt at the first breaking out of a new epidemic, and

that it was only “ingenti adhibita cautela intentisque animi nervis,”

that he could make up his mind what course of treatment to adopt in

such an emergency. Need it be wondered at, then, that two thousand

years earlier the modest mind of our great author should have hesitated

for a time, before deciding how to act under similar circumstances? I

must own, therefore, that I have long inclined to the opinion, that,

distracted with the conflicting plans of treatment adopted by his

contemporaries, Hippocrates at first did little or nothing in the

treatment of epidemical fevers, and that it was only after a patient

study of their symptoms, and many cautious trials, that he ventured to

lay down those excellent rules of treatment which he has described so

admirably in his work “On Regimen in Acute Diseases.” This, however, is

merely my individual opinion, and the reader must receive it as such.

M. Littré, in the Argument prefixed to his translation of the

Epidemics, enters very fully into the discussion of the question

regarding the nature of the diseases which are treated of in the course

of this work. This is a task, however, which I deem it superfluous to

undertake at any length, as I have stated my opinions on this subject

in the Commentaries on the Second Book of PAULUS ÆGINETA,

and after maturely weighing what has been elicited by subsequent

inquirers, I find no cause to retract any of the opinions which are

there advanced. That the causus of Hippocrates, and the other ancient

authorities, was not the typhus of the more temperate parts of Europe,

but a bilious fever, of the remittent type, must be quite apparent

to every person at all acquainted with the medical literature of

febrile diseases. M. Littré’s researches lead him to exactly the same

conclusion, and much deference is due to his judgment in this case,

as it must be admitted that a French physician is now very favorably

situated for contrasting the diseases of temperate and hot climates,

owing to the familiar intercourse which at present subsists between

Paris and Algiers. Of all the materials which he has collected from

the observations of French physicians in Algeria, the most interesting

are those which he draws from a work on Fevers, by M. Maillot. The

description which is there given of “la fièvre algide,” is so striking,

and is so much calculated to illustrate the nature of the fevers which

are treated of in this work of Hippocrates, that I shall not scruple to

quote it entire.

“La fièvre algide (dit M. Maillot) n’est pas généralement, comme

on le dit, la prolongation indéfinie du stade de froid; je l’ai vue

rarement débuter de la sorte. Il y a même entre ces deux états une

contraste frappante. Dans le premier stade des fièvres intermittentes,

la sensation du froid est hors de toute proportion avec l’abaissement

réel de la température de la peau, tandis que, dans la fièvre algide,

le froid n’est pas perçu par le malade, alors que la peau est

glacée. C’est ordinairement pendant la réaction que commencent les

symptômes qui la caractérisent; souvent ils surviennent tout à coup

au milieu d’une réaction qui paraissait franche. Au trouble de la

circulation succède en peu d’instants et presque sans transition le

ralentissement du pouls, qui devient bientôt très rare, fuit sous le

doigt et disparaît; l’abaissement de la température du corps va vite

et suit la progression promptement décroissante de la circulation;

les extrémitiés, la face, le torse, se refroidissent successivement;

l’abdomen seul conserve encore quelque temps un peu de chaleur;

le contact de la peau donne la sensation de froid que procure le

marbre. Les lèvres sont décolorées, l’haleine froide, la voix cassée,

les battemens du cœur rares, incomplets, appréciables seulement

par l’auscultation; les facultés intellectuelles sont intactes, et

le malade se complaît dans cet état de repos, surtout lorsqu’il

succède à une fièvre violente, la physionomie est sans mobilité,

l’impassibilité la plus grande est peinte sur son visage; ses traits

sont morts. La marche de cette fièvre est très insidieuse; il n’est

peut-être personne, dont elle n’ait surpris la vigilance, avant

d’être familiarisé avec l’observation des accidens de cette nature,

on prend souvent pour une très grande amélioration due aux déplétions

sanguines, le calme qui succède aux accidents inflammatoires; et plus

d’une fois, dans de semblables circonstances, on n’a été détrompé que

par la mort soudaine du malade. Toutes les fois qu’à une réaction

plus on moins forte, on verra succéder tout à coup un ralentissement

du pouls, avec pâleur de la langue et décoloration des lèvres, on ne

devra hésiter à diagnostiquer une fièvre algide. La temporisation ici

donne la mort, en quelques heures. Dans quelques cas très rares, j’ai

cependant vu cet état algide se prolonger trois ou quatre jours. Le

malade expire en conservant toutes ses facultés intellectuelles,[606]

il s’éteint comme par un arrêt de l’innervation. Lorsque la mort n’est

pas le terme de cet état morbide si grave, le pouls se relève; la peau

reprend sa chaleur naturelle; quelquefois alors la réaction détermine

une irritation de l’encéphale ou des voies digestives; mais rarement

elle est assez intense pour qu’on soit obligé de la combattre par des

déplétions sanguines.”[607] I shall add a remark, which M. Littré

gives on the same authority: “J’ai tenu à mentionner ici l’impression

qu’éprouva M. Maillot au début de sa pratique en Algérie, et qui est si

instructive; car, aller subitement de France exercer la médecine dans

un pays chaud, ou lire les observations d’Hippocrate, c’est tout un:

l’impression est la même, le changement de scène est aussi grand.”[608]

I cannot help remarking in this place, however, that it appears to

me singular, that M. Littré should represent the febris algida as

being confined to southern climates, and should speak of it as being

unknown in Paris; for, at all events, there seems to be no doubt

that it prevails in a more northerly region, namely, in Holland. It

is thus described by the celebrated Franciscus de le Boe (_or_

Sylvius), who was professor of practical medicine at Leyden about the

middle of the 17th century: “Febres algidæ observantur nonnunquam,

non tantum frigore præsertim, sed frigore tantum molestæ: adeo ut

aliquando et frequentius levis, aliquando et rarius nullus sequatur

calor. Tales, etiam semper algidas in Nosocomio academico habuimus

ita manifestas, ut non tantum incipiente, atque augescente, sed etiam

vigente et déclinante, imò cessante paroxysmo, id est, semper tum suo,

tum adstantium, tum medicorum sensu moleste ubique frigerent, nunquam

teperent, minus calerent ullibi ægri. Suntque hæ algidæ graviores

semper forsan quotidianæ.”[609] The febris algida is also named “rigor

without heat,” by the Greek authorities, and “frigus quod non calefit”

by the Arabians, who, like Sylvius, as quoted above, regard it as a

variety of the quotidian intermittent. See PAULUS ÆGINETA,

Book II., 26.