There are four other causes from which men fall into syncope; namely,
violent pain, watchfulness, too great evacuation, and sometimes motion
when in a state of delirium. To these, if you please, you may add a
fifth, namely, an intemperament of the primary organs. Death takes place
most quickly when the heart is affected, next, when the brain, but not so
when the liver.
* * * * *
COMMENTARY. See, in like manner, Galen (Meth. Med. xii, 7); Oribasius
(Synops. vi, 28); Aëtius (v, 99.)
From the Commentaries on the last three Sections it will be seen that
Galen and his followers, whether Greek or Arabian, consider syncope in
the light of a symptom or complication of fever. But it is treated of
as a distinct disease by Celsus, Cælius Aurelianus, and Aretæus; by the
former two under the name of _morbus cardiacus_, and by the last under
that of _syncope_. We think ourselves called upon in this place to give a
brief exposition of their views.
Celsus treats of _morbus cardiacus_ after phrenitis, because, as he
says, persons affected with phrenitis are apt to fall into the other. He
calls it a great weakness of the body, which, owing to the languid state
of the stomach, is melted by immoderate sweating. It is recognized by
a small and weak pulse, immoderate sweats, breaking out from the chest
and neck, the feet and legs alone being dry and cold. He adds, it is a
sort of acute disease. His treatment consists in applying a repressing
cataplasm to the præcordia, and next, in stopping the sweats by friction
with sour oil, roses, &c., or with some cerate similarly prepared. If the
sweating gains ground, the body is to be anointed with parget, litharge,
Cimolian earth, or sprinkled with the powder of them. The patient is to
be lightly covered, laid in a place not too warm, with open windows, so
that a current of air may reach him. Light food is to be frequently
administered, and also, if necessary, wine neither too strong nor too
weak, which may be given with barley-meal, if the patient has not taken
other food. If he cannot take food, he is to be first treated with the
affusion of cold water; and if his stomach have lost its tone, he is to
be allowed to vomit before taking food. If the stomach still reject the
food, he is first to take a cupful of wine, which is to be repeated after
an hour, and then the whole body is to be anointed with pounded bulbi
(onions?), which will have the effect of making the stomach retain the
wine, and thereby heat will be restored to the whole body and strength
to the veins. As a last resource, he recommends an injection of ptisan
or gruel. Fragrant things may also be applied to the nose, such as roses
and wine; and if the extremities be cold, they are to be chafed with hot
hands smeared with oil. If the violence of the sweating be thus checked,
and life prolonged, the time thus gained will be of some assistance.
Means are afterwards to be taken to prevent a relapse. (iii, 19.)
Cælius, the Methodist, treats so fully of the _cardiac passion_,
that we feel at a loss how to give a competent outline of it within
our limits. The followers of Asclepiades, he says, held it to be a
swelling about the heart, connected with congestion; but, according to
Soranus, the great master of the Methodists, the heart is not primarily
affected; and he holds it to be an acute and sudden prostration, by
which the distribution of particles over the passages of the body is
stopped. The causes of it are many; such as protracted indigestion,
intoxication, baths after food, vomiting after supper, and depressing
passions, by which the body is dissolved into sweats. It takes place
most frequently, he says, in continual, ardent, and inflammatory fevers
on the sixth day. His description is too lengthy to find a place here.
Suffice it to say that when the affection is at its height, the pulse is
small, tremulous, and creeping; there is a profuse, viscid, and fœtid
sweat over the chest, face, and perhaps the whole body, with failing
respiration, pallid countenance, hollow eyes, and so forth. Some of the
preceding authorities, such as Asclepiades and Themison, held that it was
generally, but not always attended with fever; and with them he pretty
nearly agrees. As we have already hinted, he is not disposed to admit
that it is a primary affection of the heart, but rather holds it to be
a disorder of the general system. Having discussed, in two chapters,
the diagnosis, first, between it and affection of the stomach, and then
between it and critical sweats, he comes to the treatment. The patient
is to be laid in a cool and well-ventilated apartment, to be covered
over with light clothes, and to have his face, neck, and chest sponged
with cold water and vinegar; and if the sweating continue, astringents
and obstruents, such as alum and Samian earth, are to be added; or the
body may be anointed with astringent oils; but, in particular, various
applications of a fragrant and astringent nature are to be made to the
chest. He recommends great caution in the administration of food and
drink; directs that the mouth should be rinsed with something cooling;
and, in process of time, that various articles of a restorative nature
should be given for food, and at last, wine, about the choice of which
he is very scrupulous, approving, in general terms, of such as is white,
well clarified, and subaustere, and in particular of the Surrentine,
the Falernian, the Chian, and the Lesbian. He cautions, however, not to
give too much at a time. When there is great prostration of the vital
powers, he approves of ligatures to the extremities, and the application
of cupping instruments, with great heat to the præcordia. When all other
means fail, the patient is to be supported by administering nourishing
things in clysters. Such is his own mode of treatment. He afterwards
animadverts freely upon the practice of the other sects.
Although Aretæus treats of syncope as a separate disease, he holds that
it derives its origin from causus, or ardent fever. He pronounces it to
be a loosening of the vital cords, and that its seat is the heart; hence
his chapter on the treatment is entitled, on the cure of _cardiacs_.
The symptoms, he holds, mark an affection of the heart, namely, small
and weak pulse, great palpitation, throbbing of the heart, fainting,
unrestrainable sweats, &c.
His treatment is little different from that of Alexander in
syncoptic fever. Thus he begins with venesection, unless otherwise
contra-indicated, justifying this practice by the pithy remark that
the powers of the system may be reduced by suffocation as well as by
want. He recommends, however, that blood should be taken in moderation,
and that some wine should be given immediately afterwards, unless
inflammation be present. Wine, he remarks, in inflammations, adds to
the disease, but, in ordinary cases, to the strength. When general
bleeding cannot be borne, he advises cupping in a guarded manner. He
approves of bathing the head with cooling things, of cool air, and of
all things that are grateful to the senses. When the system is quite
sunk, and the extremities cold, he recommends wine guardedly with light
soups. The wine, he says, should be fragrant and not very astringent,
but should be given with moderation, unless the sweats are very profuse
and the skin cold, when he advises wine to be given to any extent, wine
in such cases being the last hope of life. He directs further that the
patient should be kept up with encouraging words, and the application of
fragrant and astringent things, such as alum, rose-water, and the like.
He is to be exposed to fragrant and cool air, and, if the sweats persist,
obstruent substances, such as Samian earth, &c., are to be added to the
applications, and a sponge soaked in cold water is to be applied to the
face. Stimulants and rubefacients are to be applied to the extremities.
He concludes with remarking that convalescence is often prevented by
latent inflammations, which end in marasmus, in which cases the physician
must endeavour by gestation, friction, baths, and the administration
either of a woman’s milk or that of an ass to support the strength. (De
Cur. Acut. ii, 3.)
Aëtius also has a separate chapter on _cardiacs_, although he holds
syncope to be symptomatic of acute fever. We need not enter upon an
exposition of his views further than to mention that he is of opinion
that the part originally affected is the cardiac orifice of the stomach.
(ix, 1.)
By _cardiac disease_ in fevers the ancients would seem to have meant
to describe a febrile affection, attended with congestion and great
nausea. Such a variety of remittent fever is described by the late Dr.
Robert Jackson as still occurring in warm climates. The symptoms are
great nausea, sluggishness, obscure, weak pulse, and deep respiration.
He recommends bleeding, and afterwards stimulant applications to the
extremities. (On Fever, p. 193.)
Since writing the above we have had an opportunity of consulting Hecker’s
‘Epidemics of the Middle Ages,’ and beg to refer our readers to it (p.
306) for an ingenious disquisition on the cardiac disease.