Fevers accompanied with an erysipelatous affection about the viscera,
may be known by the vehement effervescence and violent pain in the part,
also, by the thirst and inordinate burning; in a word, by the symptoms
of very acrid bile putrefied along with a deficient blood. They are to
be treated in this manner: the patient must abstain altogether from the
bath, and at the acme of the complaint, use very cold water in the most
decided manner. Yet it must not be used at the commencement, but cold
things are to be applied externally; and if this is not sufficient, they
must be taken internally. Lettuces and such like things are particularly
befitting. The juice of the lettuce is likewise a seasonable application
externally, also, that of the house-leek (_semper-vivum_), and such
like cooling things. We may use the following application, which is an
excellent one: Squeezing out the juice of some cooling thing, we put
it into a mortar with purslain, then pound and strain it; at the time
of using, we mix a little polenta with it, and place it in cold water
to cool it. A piece of cloth folded double is to be put into it, and
afterwards applied to the hypochondrium, and not suffered to remain, but
another cold one must be substituted. We sometimes mix the oil of unripe
olives.
* * * * *
COMMENTARY. This section is mostly taken from Oribasius, (Synops. vi,
20.) On erysipelas of the lungs consult Hippocrates, (De Morbis, i, 13,
and ii, 53.) Hippocrates says in one of his aphorisms (vi, 25), that
it is dangerous when an external erysipelas is determined internally,
but favorable when an internal erysipelas is determined externally. He
describes an epidemical erysipelas which was attended with extensive
gangrene of the limbs, but did not often prove fatal. (Epid. i.)
The following are the symptoms of fever connected with erysipelatous
inflammation, as detailed by Alexander: The patient experiences thirst
more strikingly than in any other case, throws the clothes off his body,
has exacerbations every third day, with bilious and ichorous discharges
from the bowels; those in whom the erysipelatous inflammation is seated
in the lungs have not so intense thirst, but breathe thick and large,
their cheeks are red, tongue rough, they are delirious, and long rather
for cool air, and are more benefited by it than by cool drink, which
ought rather to be given to those who have erysipelatous inflammation in
any other part, whereas those in whom the lungs are affected ought to
be supplied with cool air. In ordinary cases he approves of giving cold
water to extinguish the fever, but says that he has seen patients brought
to imminent danger by the unseasonable application of cold cataplasms and
clysters.
Aëtius states that fevers are kindled by the parts about the bowels,
liver, and lungs, being attacked with erysipelas. Like our author, he
approves of cold drink, cool air, and cold applications to the part
affected. (v, 88.)
The acute affection of the vena cava, which is minutely described by
Aretæus, ought probably to be ranked with the diseases which we are now
treating of. He himself is in doubt whether to consider it as a species
of causus. Like the latter, he says, it has a tendency to pass into
syncope. (De Sign. Morb. Acut. iii, 8.) He recommends for it venesection
and the refrigerant plan of treatment. (Cur. Morb. Acut. ii, 7.) We have
stated in the xxixth section that Palladius refers one variety of ardent
fever to erysipelas of the lungs.
A similar account of these affections is given by Avicenna, (iv, i, 4, c.
13, 14, and 15); and by Rhases (ad Mansor. x, 15, _alibique_.)
We can draw no information from modern works to illustrate the opinions
of the ancients respecting the febrile affections treated of in this
section. It does not seem to be suspected now that erysipelas ever
attacks the lungs or bowels; and yet, as this disease when it occurs
externally is known to be seated principally in the epidermis, and as
the epithelium, or membrane which lines the internal cavities, is
admitted to be a prolongation of it, (see Kaau Boerhaave, Perspiratio
Dicta Hippocrati,) it would seem probable _a priori_, that the diseases
of both portions of it should be alike. That fevers are often complicated
with ardent affections of the lungs and bowels, and bilious symptoms,
we all admit; and it was, no doubt, to such febrile affections that the
ancients gave the name of fevers from erysipelas—erysipelas, as we shall
see afterwards, being referred by them to the state of the bile. One
cannot but admire the sagacity of Hippocrates in tracing the connexion
and resemblance between the diseases of the epidermis and those of the
epithelium. (See Littré’s Hippocrat. t. iv, 419.)