Those affected with hectic fevers should be well supplied with food from
the commencement, on account of the pungency of the humours. The best
cure is a moistening diet. You ought therefore to give for nourishment
the juice of ptisan, and broths of chondrus, with a little bread in
addition; and to treat the patient with a draught, of moderately cold
water, when neither inflammation nor putrefaction of the humours is
present. But if you conclude that the lesion is great, you must proscribe
the cold water, and have recourse to the cooling applications externally.
To those affected in this manner, baths are at all times proper.
* * * * *
COMMENTARY. This section is taken from Oribasius (Synops. vi, 22.) It
will be remarked that our author’s treatment consists of diluents and
refrigerants internally, with cold applications and baths. It is entirely
derived from Galen. Galen defends, in very strong terms, the use of the
cold bath, which had been condemned by a celebrated physician of the name
of Philip. (Meth. Med. x.) He admits, indeed, that an inflammatory or
erysipelatous affection of a vital organ, and a redundance of crude and
putrid humours in the body, may compel us to abstain from the bath; but,
in all other circumstances of hectic fever, he insists that it is the
_remedium unicum_. He also recommends cold drink and cold applications
to the part primarily affected. He speaks favorably also of the internal
administration of refrigerants, such as lettuces, which may also be
applied externally. (De Marasmo.) For diet, he recommends articles of a
diluent and cooling nature, such as ptisan, bread steeped in cold water,
and the milk of asses. (Meth. Med. l. c.)
Aëtius, in like manner, recommends the bath, unless the use of it be
contraindicated by the inflammation of some vital organ, or a fever
enkindled by the putrescency of the humours. He gives minute directions
for the application of the bath, the amount of which is this, that,
under certain circumstances, it will be most prudent to use the tepid
bath before the cold. In all cases he directs the body to be rubbed with
oil before going into the bath, and to be gently rubbed with towels
after coming out of it. He greatly praises the milk of asses, which he
recommends to be drunk warm.
Alexander also forbids the use of the bath, when inflammation of any
vital part is present. He approves greatly of the milk of asses for food.
He allows wine only when the patient is of a cold and dry intemperament.
He inculcates the necessity of ascertaining whether the hectic fever and
marasmus be connected with chronic inflammation of any internal organ,
such as the stomach, mesentery, colon, liver, kidneys, womb, lungs, or
diaphragm, in order that the remedies may be applied to the seat of
the disease. We need not go over the practice of the subsequent Greek
authors, as they follow servilely the doctrines of Galen.
According to Avicenna, the great indications of cure are dilution
and refrigeration. To the class of refrigerant remedies he refers
barley-water, the milk of asses, and trochisks of camphor, with cooling
epithemes and ointments. To the class of diluents he refers the bath,
about the administration of which he is very particular. He directs us
to use the tepid bath at first, and gradually bring the patient to bear
the cold. When it can be borne, he says, the cold bath should be taken
immediately after the hot. He also speaks favorably of the affusion of
tepid water.
Haly Abbas directs us, when the symptoms of consumption are fairly set
in, to administer before sunrise trochisks containing camphor, poppies,
&c. to mitigate the cough. Like most of the other authorities, he speaks
favorably of the milk of asses and of women for food. But, upon the
whole, his greatest dependence seems to have been upon camphor. (Pr. iii,
26.)
Alsaharavius directs us first to make the patient go into the warm bath,
and immediately afterwards to plunge him into the cold. (Pract. xxxii.)
What Avenzoar most particularly recommends is the tepid bath of fresh
water, which he directs to be taken several times in the day. He speaks
favorably of goat’s milk. (iii, 1, 13.)
Averrhoes recommends nearly the same practice; but he says that the bath
ought to be gradually applied. He approves of the milk of women, asses,
and goats, and also of refrigerant herbs. (Colliget. vii, 15.)
Serapion is very minute in his directions about the asses’ milk. He
says the animals should be fed upon juicy and cooling herbs, such as
grow by the side of rivers. He also directs us to medicate the bath, by
previously boiling in it refrigerant herbs, such as gourds, barley, and
violets. (vi, 11.)
Rhases’ directions, although they possess, perhaps, little originality,
are in the highest degree interesting. He recommends for food fishes,
cooling herbs, such as mallows, lettuces, citrons, cucumbers, &c. and
the milk of asses or of goats. He especially commends the tepid bath,
and rubbing with oil afterwards. He also speaks of applying to the chest
cloths soaked in rose-water, which has been cooled in snow. When these
cold applications bring on shivering, he directs them to be somewhat
warmed. He forbids copious draughts of cold water. He recommends cool and
humid air, and cautions to avoid smoke. When the belly is constipated,
he gives opening medicines, such as prunes and manna. When, on the other
hand, the belly is loose, he recommends astringents. He particularly
commends trochisks of camphor, which, he says, will cool the heat of the
heart, liver, or chest. (Ad Mansor. x, 3; see also Contin. xxxi.) In
the latter work he informs us that physicians were divided in opinion
regarding the use of the bath in hectic fever. He forbids the cold
bath and cold drink when the patient is much wasted, because the cold
penetrates to the vital organs and impairs them.