A torpid pain is occasioned by a cold affection; a throbbing is
characteristic of a strong inflammation. But, if a person feel as if
pierced by a sharp-pointed instrument, or bored by a wimble, this kind of
pain is peculiar to the thick intestine, i. e. the _colon_. The pungent
is seated in the membranes. The darting pain attends the most vehement
attacks, not only of hemicrania, but also of cephalæa. It is said to be
darting when it commences in the seat of the affection, as from a root,
and spreads quickly to the surrounding parts. Stretching pains take
place in the nerves, when they are affected and stretched towards both
extremities. But the nerves are not liable to be affected with lateral
distensions. The membrane under the skin when distended occasions tensive
and torpid pains; those between the flesh, as it were, divellent. For
they are many, have irregular insertions, and surround the flesh. But
the pains proceeding from the membranes which surround the bone, are
deep-seated, and seem to proceed from the bones themselves. Wherefore,
when no external cause of the pain is apparent, you must consider the
patient’s preceding regimen. If it has been more inactive than usual,
or if he has been taking more nutritive food than common, or if any
evacuation has been suppressed,—if any or all of these circumstances be
observed, plethora is the cause of the pain, and you must evacuate him
as quickly as possible; for, by this means you will be enabled with all
safety to use such remedies as are fitted to repel the defluxions from
the affected parts. If the part be distended with a fulness of blood,
open a large vein near it immediately; but when bad humours alone are the
cause, you must purge; and, when both meet together, you must use both
evacuations, beginning with the bleeding. If, after both these remedies
have been tried, the pain continue, it is clear that the offending matter
has become fixed in the part affected; and it is also clear, that the
cure will be accomplished by discutient remedies. In like manner, we may
cure pains from flatulence, by soothing them with attenuant food and
injections, and opening the pores of the containing part with cataplasms,
irrigations, and fomentations. If a swelling bearing down and pressing
upon the part be the cause of the pain, it must be removed; but, if it
proceed from a pungent humour, attenuant and calefacient things are most
improper. Dill boiled in oil is anodyne and soporific, and the green more
than the dry.
* * * * *
COMMENTARY. This Section is taken from Oribasius (Synops. vi, 29), or
Aëtius (v, 100.) All these authors, however, merely abridge the account
given by Galen. (Meth. Med. xii, 8, and de Locis Affect. ii.) In the
latter work he gives a most ingenious dissertation on the different kinds
of pain, and the states of the body in which they occur; but, as our
author has given a summary of his observations, we think it unnecessary
to go over the same ground. We shall, therefore, merely notice some
of his remarks on the treatment, as delivered in the other work. When
the pain is connected with flatulence, it is to be removed by food,
drink, cataplasms, and fomentations of an attenuant nature. When pungent
humours are the cause of the pain, they are to be treated by evacuants,
diluents, or narcotics. When occasioned by thick and viscid humours,
he forbids narcotics, the action of which, being frigorific, renders
them thicker, and the containing parts more compact. In all such cases,
therefore, he holds that opium and hyoscyamus, although they afford a
temporary relief from pain, act prejudicially. He also proscribes things
of a very hot nature, both internally and externally, and recommends
to give attenuants, or things of an incisive nature. He in particular
commends garlic, which he calls the theriac of rustics. As to external
applications, he directs, in febrile cases, first a dry fomentation of
millet-seeds, and, if it is not successful, friction with subtile or
attenuant oils, and the fat of fowls.
Aëtius defines pain to be a sensation produced by a sudden change
of temperament, or a solution of continuity. In illustration of the
former cause, he remarks that all sudden changes from heat to cold, or
_vice versa_, occasion severe pains. To the latter he refers rupture,
contusion, and erosion of the parts. Rupture is produced by tension,
contusion by weight, and erosion by some pungent quality. These causes
of pain ought to be particularly attended to, and the treatment modified
accordingly. His subsequent account is exactly the same as our author’s.
The different kinds of pain are fully treated of by Avicenna (i, 2,
3, 20), and by Haly Abbas (Theor. vi, 16.) Averrhoes has delivered
the treatment of this complication of fever in nearly the same terms
as Galen. When the pain is occasioned by warm air or flatulence, he
particularly commends cupping applied with great heat. He agrees with
Galen in condemning narcotics, when the exciting cause is of a cold
nature. He also joins him in condemning hot fomentations and clysters,
when the pain of the bowels is occasioned by a hot humour. (Collig. vii,
18.) See Rhases (Cont. xxxiii.)