In the plague there is everything which is dreadful, and nothing of this
kind is wanting as in other diseases. For there are delirium, vomitings
of bile, distension of the hypochondrium, pains, much sweatings, cold
of the extremities, bilious diarrhœas, which are thin and flatulent;
the urine watery, thin, bilious, black, having bad sediments, and the
substances floating on it most unfavorable; trickling of blood from
the nose, heat in the chest, tongue parched, thirst, restlessness,
insomnolency, strong convulsions, and many other things which are
unfavorable. Should a person foresee that the plague is coming, by
attending to the badness of the season, and the unhealthy occupations of
the inhabitants, and from observing other animals perishing; when one
observes these things, let him also observe this—what is the character
of the present season, and what that of the whole year, for you will be
able thereby to find out the best regimen; such, for example, as if the
temperature of the season ought to have been dry, but has become humid;
in that case, it will be necessary, by a drying diet, to consume the
superabundant moisture. Care also must be had of the belly, and when
there is phlegm in the stomach it must be evacuated by emetics. And when
a fulness of blood prevails, a vein should be opened. Purgings also by
urine, and otherwise by the whole body, are proper. But, if the patient
is affected with ardent fever, and has a fiery heat about the breast,
it will not be improper to apply cold things to the breast, and to give
cold drink, not in small quantities, for it only makes the flame burn
more; but in full draughts, so as to extinguish it. But if an ardent
fever prevails within, and the extremities are cold, and the skin cold,
the hypochondrium distended, and the stomach sends the matters which
have been melted, some upwards, and others downwards; if watchfulness,
delirium, and roughness of the tongue, are present; in these cases,
calefacient remedies are wanted to diffuse the heat all over the body,
and every other means ought to be tried, in order to determine the heat
from the internal to the external parts. The following propoma may be
used: of aloes, two parts; of ammoniac perfume, two parts; of myrrh, one
part; pound these in fragrant wine, and give every day to the quantity
of half a cyathus (ʒv.) I never knew a person, says Ruffus, who did not
recover from the plague after this draught. So says Ruffus: but Galen
says, concerning pestilential putrefactions, that to drink Armenian
bole, and, in like manner, the theriac from vipers, is of great service;
and that, in the plague which prevailed in Rome, all died who were not
benefited by either of these things.
* * * * *
COMMENTARY. By the plague, as Galen explains in his ‘Commentary on
Hippocrates,’ is to be understood an epidemical fever of a fatal nature.
Hippocrates has related several histories of diseases which came under
this description in his ‘Epidemics,’ but they present such variety of
symptoms, that we cannot undertake to give their general characters. It
is deserving of remark, however, that he several times makes mention of
fevers accompanied with buboes. (Aphor. iv. 54, Epidem. &c.) According to
M. Littré, buboes are noticed among the symptoms of plague by Ruffus, and
also by Dioscorides and Posidonius in an extract given in the following
publication: ‘Classicorum auctorum e Vaticanis codicibus editorum,’ tomus
iv, curante Angelo Maio, p. 11, Romæ, 1834. See Littré’s Hippocrates
(ii, p. 585.) Aretæus mentions incidentally that pestilential buboes
are connected with the liver. (Morb. acut. ii, 3.) Under Sect. XVI will
be found several passages from ancient authors, in which pestilential
buboes are incidentally mentioned. It must be admitted they are very
insufficient materials for illustrating the ancient history of the
glandular plague, and it may justly excite surprise that the historian
Procopius, in the sixth century, P. C., should be the first writer who
has given a complete description of this disease. At the same time we
cannot agree with M. Nauman, M. Pariset, and other late writers on
the plague, who maintain that the epidemic which devastated the world
in the reign of Justinian was a new disease. The frequent mention of
pestilential buboes by previous authors, although vague, is sufficient to
mark the existence of the disease. In this light, at all events, they are
viewed by the commentators on Hippocrates, who lived after the glandular
plague was properly described. (See Pallad. Comment. in Hippoc. Ep. t.
ii, p. 47, ed. Dietz.)
We shall now begin our exposition of the ancient opinions regarding the
plague, with a brief notice of the celebrated description of it given by
Thucydides, the Greek historian. The more prominent symptoms mentioned by
him are the following: Strong heat of the head; redness and inflammation
of the eyes; the mouth and internal fauces turgid with blood; breath
fetid; sneezing, hoarseness, and afterwards violent cough; vomiting of
bile, retching, and convulsions; the heat of skin not much increased,
but the internal parts glowing with heat; the skin reddish, or livid,
and covered with minute phyletænæ and ulcers; despondency, restlessness,
and intense thirst; and, towards the conclusion, diarrhœa, ulceration
of the bowels, and various symptoms of putrefaction. Those who survived
the febrile attack were subject to blindness, fatuity, and mortification
of the testicles and extremities. The disease generally proved fatal on
the ninth or seventh day. The historian affirms that the plague never
attacked the same person more than once. This opinion, by the way, has
been advocated in modern times by Massarius, Diomedes Amicus, Heurnius,
and Sir William Pym, but general experience seems to be against it.
Evagrius relates of the plague which prevailed in the reign of Justinian,
that many persons who recovered from the first attack sunk under a
second. Ficinus, Montisianus, Joubertus, and many late authorities, hold
this opinion. He mentions that the disease was supposed to originate in
Ethiopia, and from thence to spread to Egypt, Lybia, and the Persian
empire; that in Athens it made its first appearance in the Piræus, where
it was at first suspected that the Peloponnesians had poisoned the
wells. He says the previous summer was remarkably healthy. Thucydides’
celebrated description of the plague is given in a poetical form by
Lucretius (de Rerum Natura, _apud finem_), and by Ovid (Metamorphoseon,
vii, 528.) Sophocles, the tragedian, appears also to have had the same
plague in view. (Œdip. Tyran. _ap. initium_.) The Latin poet Silius
Italicus evidently copies his images from it. (xiv.) See also Lucanus
(Pharsal. vi), and Manilius (Astronom. i.)
Our next great authority on this subject is Celsus. In his account of
the plague, we have to regret, however, that, although he dwells rather
minutely on the prophylaxis and treatment, he has omitted to give us a
description of the disease; and it is not easy to perceive the principles
upon which some of his directions as to the prophylaxis and treatment are
given. He recommends a journey to a distant place, or a sea voyage; when
this cannot be accomplished, gestation and gentle exercise in the open
air, but he forbids all excess. He also forbids early rising, exercise
with naked feet after a meal or the bath, also emetics, laxatives, and
sudorifics. He directs people to drink, by turns, first water and then
wine. (i, 10.) With regard to the treatment, he disapproves, in general,
of abstinence and purgative medicines, recommends bleeding, if the
strength permit, more especially if the fever be attended with pain; but,
if venesection cannot be practised, he directs emetics to be given. At
an earlier period than in ordinary fevers the patient is to be put into
the bath, and is afterwards to get hot undiluted wine, and everything of
a glutinous nature, and flesh of this description. In the case of young
persons, he directs these remedies to be administered with great caution.
(iii, 7.)
The historian Appian, Lucian, Pliny, and Plutarch, mention wine as an
antidote to the plague. Livy and other ancient writers say that the
plague is sometimes occasioned by excessive cold. (Histor. v.)
It is greatly to be regretted that Galen has given us no description
of the dreadful plague which prevailed in his time. It appears that
he fled from Rome for fear of infection. He alludes to it, indeed, in
several parts of his works, but in very brief terms, only mentioning
that it put on the appearance of dysentery; and in one place he strongly
commends the celebrated theriac as a most efficacious remedy for the
prevention and cure of pestilential disorders; and elsewhere he speaks
favorably of the Armenian bole. Of the writers on medicine posterior to
him, Oribasius and Aëtius, like our author, give no further information
on this important subject than what is contained in the brief extract
from the works of Ruffus; and the others, with the exception of Nonnus
and Psellus, do not treat of the disease at all, unless in an incidental
manner. Nonnus, after briefly stating the causes of the plague, proceeds
to lay down the principles for conducting the treatment. He recommends
clysters, and, if the stomach be loaded with phlegm, emetics: if there be
a fulness of blood, he approves of venesection; and also speaks well of
giving diuretics. When symptoms of ardent fever are present, he directs
cold drink to be given freely, in order to extinguish the febrile heat.
He also recommends apomel, the water of ptisan with the seed of bastard
saffron, or Armenian bole, or lapis lazuli. Psellus merely mentions, in
very general terms, a few of the common symptoms of the plague. (Opus
Medicum.) Actuarius, treating of anthrax, mentions that it sometimes take
place in epidemical affections. (Meth. Med. ii, 36.)
Before proceeding to the Arabian authorities, we shall give a brief
abstract of Procopius’ description of the dreadful plague which desolated
the Roman empire in the reign of Justinian. Its usual precursors were
certain delirious fantasies and disturbed dreams, after which the fever
made its attack suddenly. The early symptoms, however, were not well
marked, for there was neither increased heat nor discoloration of the
skin, nor did the patient apprehend danger. Generally on the first or
second day, but in a few instances somewhat later, buboes appeared not
only in the groin, but also in the armpits and below the ears. Some were
affected with deep coma, and others with wild delirium. Some died from
sphacelus of the buboes, which, when inspected by the physicians after
death, presented the appearance of a _coal_ or _carbuncle_ (anthrax).
Some died at the commencement, and others after the lapse of several
days. In certain cases the skin was covered over with black phlyctænæ
of the size of a lentil, which were usually succeeded by sudden death.
Others were unexpectedly cut off by a discharge of blood. To women in the
puerperal state it proved particularly fatal. When the buboes came to a
proper suppuration, they generally proved a favorable crisis; but when
they did not suppurate, they were commonly followed by a wasting of the
thigh. One of the common consequences of the fever was an affection of
the organs of speech. All the usual prognostics proved fallacious, and
the effects of the common remedies were uncertain. In some cases the bath
proved beneficial, and in others it had a contrary effect. At one time
the amount of deaths in Constantinople ranged from five to ten thousand
each day. (De Bello Pers. 22, 23.) This pestilence is described likewise
by Agathias (v), and by Evagrius (Hist. Eccles. iv, 29.) It resembled the
plague of Avignon, described by Guy of Cauliac.
The symptoms of the plague, as enumerated by Avicenna, are as follows:
Heat, and strong inflammation within, but which are not perceived
outwardly; respiration large, fetid, and frequent; intense thirst,
dryness of the tongue, with nausea and loss of appetite, such as, if
not contended against, will prove fatal; enlarged spleen, great anxiety
and restlessness, dry cough, prostration of the powers approaching to
syncope; delirium, retraction of the hypochondria, insomnolency, with
tepid heat of the body. Sometimes there are yellow, whitish, or red
eruptions on the skin, which are of short continuance; or else aphthæ and
ulcers in the mouth. The pulse is generally frequent, small, and becomes
stronger towards night. Occasionally there are dropsical swellings.
The discharges from the bowels are bilious, mixed, fetid, unnatural,
and sometimes contain black bile; at other times they are frothy and
fetid, or unctuous, being produced by melting of the fat. The urine is
watery, bilious, and melancholic. There is sometimes vomiting of black,
but more frequently of yellow bile. There are often fetid sweats. The
disease usually terminates with syncope, coldness of the extremities,
lethargy, spasms, and convulsions. Some of the most fatal varieties of
the plague are not marked by any striking symptoms, neither the heat,
pulse, nor urine being much affected. Fetid breath, as indicating
putrefaction about the heart, is a most mortal symptom. The treatment
must commence with venesection, if there be a plethora of blood, or
with purging, if the body be loaded with other humours. The apartments
of the sick are to be cooled, and the air of them corrected: they are
to be cooled by cold odoriferous fruits, camphor, rose-water, or, if
possible, by introducing a stream of water into them. The fetid air may
be corrected by fumigations with camphor, myrtles, quinces, ebony, &c.;
by sprinkling the apartments with vinegar and assafœtida, and correcting
the putridity with lignum aloes, frankincense, musk, storax, _sandarach_,
mastich, juniper, bays, and the like. (It may be proper to mention that
arsenical fumigations are approved of by Muratori, Lind, and Russel, but
condemned by Mead.) As a preservative from the plague, he recommends,
in particular, exercise and restricted diet. Haly evidently copies his
description. (Theor. v, 11.)
Rhases agrees with Hippocrates in stating, that pestilential fevers are
distinguished by great heat internally, while the surface of the body is
cool. The symptoms, as detailed by him, are vomiting and diarrhœa, pain
and distension of the belly, coldness of the extremities, urine showing
a tendency to putrefaction, discharge of blood from the nose, heat about
the breast, singultus tendinum, blackness of the tongue, bulimia, &c.
He particularly states that a black discharge from the bowels is a most
fatal symptom. Like Avicenna, he gives directions to perform fumigations
with camphor, musk, myrrh, bdellium, frankincense, and the like. He
mentions that, during the prevalence of a certain pestilence, it was
found that hunters escaped the contagion. Like Avicenna, he approves of
bloodletting. See Continens (xxx.) He also recommends cold drink and the
cold bath. Calefacients and wine, unless diluted with much cold water, he
disapproves of. He, like the other Arabian authorities, joins Galen in
speaking favorably of Armenian bole and the theriac. (Ad Mansor. iv, 25.)
The belief that the plague is preceded by extraordinary phenomena in the
earth and sky is very ancient. Thucydides concludes his brief account of
the last attack of the plague on Athens with the remark, that at that
time there were many earthquakes at Athens and other places. (iii, 87.)
Manilius says such plagues as that of Athens are commonly prognosticated
by comets and other celestial fires. Diodorus Siculus mentions that the
Athenian plague was preceded by earthquakes of extraordinary severity.
(xii, 59.)
While explaining the symptoms and treatment of the plague, as detailed in
the works of the ancient authors, we have purposely omitted to notice its
contagious nature, as we wished to give one connected view of the ancient
opinions regarding CONTAGION. Before entering upon this disquisition,
we think it proper to acknowledge the assistance which we have derived
from the writings of Fracastorius, Paulinus, Mead, Marx, Omodei, and
Winterbottom, leaving it to the reader to determine, after comparing our
humble attempt with their learned labours, whether or not our industry
and research have contributed in anywise to throw additional light upon
this important subject.
The earlier ancient authors appear to have entertained no suspicions
of contagion as a cause of febrile or of other complaints. Homer,
as formerly stated, evidently refers the origin of the plague which
prevailed in the Grecian army during the siege of Troy to the heat of the
sun. The works of the fathers of History and of Medicine have likewise
been ransacked in vain, for any traces of the doctrine of contagion.
Thucydides, therefore, appears to be the first author (if we except the
Mosaic description of leprosy) who makes any positive allusion to the
contagious nature of diseases. From his description of the plague of
Athens, there can be no doubt that he wishes it to be understood, that
the disease was transmitted from one person to another; for he mentions
that physicians were more attacked by it than any others, as having most
intercourse with the sick; and he afterwards describes the terror which
the citizens felt to approach those labouring under the disease, and
intimates that it was often contracted by such intercourse. The language
of Lucretius, who copies his description, and gives it a poetical form,
is still more precise:—
“——nullo cessabant tempore apisci
Ex aliis alios avidi contagia morbi.”
(L. 1235.)
And afterwards,
“Qui fuerant autem præsto contagibus ibant.”
(L. 1241.)
Ovid, in like manner, says of the dead bodies:
“Afflatuque nocent et agunt contagia latè.”
(Metam. v, 551.)
And so also, Silius Italicus:
“Et posuere avidæ mortis contagia pestes.”
(Lib. xiv.)
The historians we must dismiss in a few words, with stating that
allusions to the infectious nature of certain diseases are to be met
with in Livy, Dionysius the Halicarnassian, Diodorus Siculus, Appian,
Plutarch, Quintus Curtius, Dio Cassius, Eusebius, Gregory of Nyssa, and
Evagrius. Procopius was a non-contagionist.
The philosopher Aristotle, in one of his problems, makes it a question
why the plague is the only disease which infects those who approach the
sick. (Probl. i.) There is a curious passage in the works of the orator
Isocrates, which shows that consumption was reckoned contagious in his
days. (Æginet.) The elder Pliny mentions the contagion of the pestilence.
(Hist. Nat. xxxiii, 80.)
Virgil mentions the infectious nature of certain diseases of cattle.
(Ecl. i, Georg. iii, 464.) The ancient writers on veterinary surgery and
agriculture in like manner state that the plague and scabies of cattle
are infectious. See Columella (vi, 5); Vegetius (Mulomed. iii, 23.)
The philosopher Marcus Antoninus alludes to the plague as being
contagious. (ix, 2.) Chrysostom does the same. (In Joan. Orat. lvii.) The
language of Seneca is very precise: “Itaque ut in pestilentiâ cavendum
est ne corruptis jam corporibus et morbo flagrantibus assideamus, quia
pericula trahemus, afflatuque ipso laborabimus.” (De Tranquil. vii.) To
these we may join Isidorus Hispalensis, a much later writer: “Pestilentia
est contagium quod quum unum apprehenderit celeriter ad plures transit.”
And, in another place: “Pestilentia est morbus latè vagans et contagio
suo quæ contigerit interimens.” Alexander Aphrodisiensis intimates that
pestilential fevers are contagious, but common fevers not so. (Probl. ii,
42.)
Aretæus appears to be the first medical author who alludes to contagion
in unequivocal terms. He says of elephantiasis, that it is as infectious
as the plague, being communicated by respiration. Cælius Aurelianus,
who was probably nearly contemporary with him, mentions as contagious
diseases the plague, incubus, hydrophobia, and elephantiasis. Galen
expresses his sentiments on the contagious nature of certain diseases
in the following terms: “That a pestilential state of the atmosphere
produces fever, is unknown to no one possessed of good understanding;
and, also, that it is dangerous to associate with persons having the
plague, for there is a risk of catching it, like the itch and ophthalmy.
It is dangerous also to live with those labouring under consumption, and,
in a word, with all those having a putrid respiration of such a nature
as to render the houses in which they lie fetid.” (De Diff. Febr. i, 3.)
Aëtius (xiii, 120) and our author (iv, i) state their decided opinion
of the infectious nature of the plague and elephantiasis. Oribasius,
Alexander, Synesius, Palladius, Actuarius, and all the Latin medical
authors, with the exception of Cælius Aurelianus, have omitted to make
any allusion to the contagious nature of diseases.
Of the Arabians, Rhases mentions, as diseases “which are transmitted from
one person to another,” lepra (elephantiasis?), itch, consumption, and
pestilential fever. These, he says, prove infectious, when one is shut up
in a narrow house along with those labouring under them, or when one sits
in the wind blowing from them. He states afterwards that ophthalmy and
malignant pustules are sometimes contagious. (Ad Mansor. iv, 24; see also
Contin. xxxiii, 5.) By malignant pustules he means the smallpox. Avicenna
and Haly Abbas give the same list of contagious diseases. Avicenna says
that smallpox and measles are of all diseases the most contagious. Of the
other Arabians, Avenzoar alone, while treating of elephantiasis, alludes
to the doctrine of contagion.
Having now done with the ancient authorities, we shall only give further
the declaration of the celebrated Boccacio regarding the plague of
Florence: “E fu questa pestilenza di maggior forza, percio che essa dagl’
infermi di quella per lo communicare insieme s’avventava a’ sani non
altramenti che faccia il fuoco alle cose secche o unte, quando molto gli
sono avvicinate.” (Decameron, Introduzione.)
The result of our investigations into the opinions of the ancients on
this subject leads us to the conclusion, that all, or at least the
most intelligent of the medical authorities, held that the plague is
communicated, not by any specific virus, but in consequence of the
atmosphere around the sick being contaminated with putrid effluvia.
Hence, they maintained that mild fevers (συνηθεῖς) which show no
tendency to putrescency are not communicable from one person to another.
See Alexander Aphrodisiensis, (_l. c._) Fracastorius, in like manner,
considered putrefaction as the source of all contagion. (De Contag.
i); and nearly the same opinion was maintained by the learned Fernel,
Franciscus de Pedemont, Ingrassius, Ficinus, and others. (See Prælect.
Mar. 77.) Although Galen several times speaks of a poison being formed
in the human body, he means that the animal fluids are so altered as to
become deleterious, and does not hold that there is any specific virus
transmitted from one person to another. (De Loc. Affect. v, 7, vi, 5;
Epidem. iii.)
We may take this opportunity of stating that, after a pretty extensive
investigation into the histories of pestilential epidemics, we have come
to the conclusion that the plague has almost invariably assumed one or
other of the following phases: 1st. That of cholera and dysentery. The
plague described by Thucydides, and that of Ingrassias, and many other
pestilential epidemics described in ancient and modern times, including
the Asiatic cholera of the present age, belong to this class. 2d. That of
profuse; and, as they have been termed, syncoptic sweats. The celebrated
epidemic of the fifteenth century, now so admirably illustrated by M.
Hecker, is the best marked instance which we possess of this form of
the disease. M. Hecker, indeed, supposes that the Cardiac disease of
the ancients was of a similar nature to the sweating sickness. But it
strikes us (although we must admit that we have not had time to consider
this point maturely), that the syncoptic fever or cardiac disease of the
ancients, was not of a pestilential nature. 3d. The other form is the
Glandular plague, which many late authorities would consider as the only
form of the disease; but as we think erroneously, since the other types
are often mixed up with this in the same epidemic. Thus in the plague
of Aleppo, during the years 1760, 1761, and 1762, although the ordinary
form of the disease was the glandular, a considerable proportion of the
cases assumed the first form which we have noticed. And in the plague of
Athens, although it commonly put on the appearance of the first form, it
would appear probable, from the obscure allusion to cutaneous eruptions
in the description of Thucydides, that a certain proportion of the cases
were of the second type. The three forms then would appear to us to be
as closely allied to one another as diphtherite, ulcerous sore-throat,
and scarlatina are; that is to say, that they are all varieties of one
species of disease.
SECT. XXXVII.—ON THE TREATMENT OF THOSE WHO ARE SEIZED WITH SYNCOPE FROM
CRUDE HUMOURS.
Some are seized with fever while having a great collection of crude
humours, and while the mouth of the stomach is at the same time
disordered. In them the hypochondrium is distended with flatulence,
the orifice of the stomach is more swelled than natural; in some the
complexion is turned to a more white and watery, and in others to a
blacker. None of these can bear the abstraction of blood without the
most imminent danger; but they require evacuation, although they cannot
endure phlebotomy nor purging, for even without them they are disposed
to fall suddenly into a state of syncope. They are to be cured, then, by
friction. It will be proper, at the commencement of the disease, to begin
with rubbing the limbs from above, downwards, with moderately rough linen
cloths, and afterwards, the whole arms from above, downwards. But when
the limbs have been sufficiently warmed, and there is danger of a sense
of lassitude, we must use a relaxing oil, and avoid all astringents. When
it is winter, we must also use a sudorific one, such as the Sicyonian
oil, or that of chamomile. After rubbing the limbs freely, we must next
rub off the oil, and proceed to the spine, which we must rub in like
manner, and then immediately return to the legs, and from them to the
arms again, and afterwards to the spine again, continuing this practice
for a whole day. Honied water, in which hyssop has been boiled, is most
beneficial in these cases. And they must neither get farinaceous food,
nor soup, nor water, nor be permitted at all to drink freely; but they
ought to be contented with honied water alone for the first three days,
and be rubbed in succession. If the strength be moderately good, and the
contents of the stomach do not pass properly downwards, you may venture
with a clyster. But if there is a greater overflow of the superfluities
than proper upon the stomach, you must first boil the honied water well,
for thus it will be less laxative; but when the belly is looser than
proper, you must not thus stop it, but, instead of the honied water,
give the juice of ptisan. But if the discharge still continue, we must
support with a gruel made from chondrus. But if we ascertain from the
weakness of the pulse that the powers of the system are prostrated, it
will be proper to give bread out of diluted wine, provided there be no
inflammation of the stomach or liver. But should they be inflamed at the
same time that the body is loaded with crude humours, the state of the
patient is hopeless. If you perceive that the humours are thick, give
oxymel always instead of honied water; if it is summer, the patient hot,
and fond of cold drink, give him cold oxymel; but when in winter, it must
be hot. Baths are most prejudicial to such persons. If, when you are
called, syncope has already come on, and the parts which I have mentioned
are free from inflammation, give a small bit of bread out of wine, and
proceed straightway to the friction in the manner I have described. In
those cases in which the syncope is occasioned by yellow bile infesting
the mouth of the stomach, we must give cold drink, and administer wine
that is thin, of a bright yellow colour, and old.
* * * * *
COMMENTARY. This Section is taken either from Oribasius (Synops. vi, 27),
or Aëtius (v, 97.) These authors, however, merely abridge the account of
this subject which is given by Galen. (Meth. Med. xii, 5, and Therap. ad
Glauc. i.) Syncope, according to the explanation of Galen, is a sudden
prostration of the vital powers, without suspension of the respiration,
as in _deliquium animi_. Our author has given a very correct account of
Galen’s treatment. He states that, the system labouring under a load,
the great indication is evacuation, but that venesection cannot be borne
in such cases. In short, he insists that our great dependence must be
placed on friction, for the application of which he gives very minute
directions. When the pulse suddenly sinks and becomes irregular, he
administers wine, unless there be inflammation of the stomach or liver.
In cases complicated with crude humours, he pronounces the bath to be
most prejudicial, and also disapproves of very cold or very warm air. He
is most particular in his directions for the selection of the most proper
wine to be used, and gives some interesting observations on the principal
Greek and Roman wines used in his time. He concludes his remarks with
stating that thick wines ought to be avoided as injurious, and such as
are watery and thin as ineffectual, whereas those of a middling kind are
to be selected. He particularly praises the Ariusian and the Lesbian. The
Falernian he condemns, as being too fragrant and austere, which qualities
render it injurious to the head.
Alexander disagrees with Galen as to several of the points of treatment
laid down by him. He insists that Galen’s rigid rules for applying strong
friction, at the same time that abstinence is enjoined, are such as no
ordinary powers of constitution could bear up under; and, therefore, he
recommends to rub first, and then to give some light nourishment, such
as thin ptisan, oxymel, and bread soaked in wine, when the strength is
greatly overpowered. Nay, when the powers of the constitution are in
danger of sinking under the weight of the load, he suggests the propriety
of having recourse to venesection; and accounts for the benefit derived
from this evacuation upon the same principle that a fire which is like to
be extinguished by an excessive load of green fuel burns brighter when
part is taken off. This is an ingenious explanation of the manner in
which bleeding proves useful in cases of congestive fevers. Respecting
the use of wine and the bath, his views are similar to those of Galen. He
approves very much of administering a light-coloured diffusible wine when
the powers of the system are much sunk.
Avicenna adheres closely to the principles of treatment laid down by
Galen; and, therefore, says nothing of venesection. (iv, 1, 2, 58.)
Rhases treats this complication of fever in like manner. He calls it
“Febris syncoptica, ex humorum copiâ et cruditate nata.” (Ad Mansor. x,
14.) He mentions emetics, but approves most particularly of friction.
(Contin. xxx.)
Averrhoes contends that, in such a case, it is lawful for a Mussulman
to drink wine, although forbidden by the Prophet. He approves also of
friction. (Collig. vii, 16.)
Prosper Alpinus informs us that the Methodists, in such cases, gave wine
and aromatics, and used every means to rouse the system. (Med. Method,
vi, 9.)