Those things which remedy a dry state of the bowels are treated of in the
First Book sufficiently. But since a humid or loose state of the bowels
may prevail in fevers, this also must be treated of; for many are cut off
not by the fever itself, but by this symptom alone. In the commencement,
we must not interfere with the discharge when it proceeds from corruption
of the food and indigestion; but when the evacuation becomes immoderate,
it must be restrained. If the discharges are of an acrid nature, that
which is given should consist of good juices, and be otherwise thick,
such as spoon-meats from pearl-spelt (chondrus) and ptisan. Baths are
also befitting after the complaint has become concocted. But when the
discharges consist of phlegm and are watery, on the other hand, the
food ought to be of a more dry and heating nature, as far as the fever
will permit. Of this kind, are those things which are prepared from
heating condiments. But they must abstain from baths, unless otherwise
required. When the digestive faculty is in an atonic state, we must give
food and applications of an astringent nature; the food consisting of
things in particular, to which pomegranates, apples, pears, or medlars
have been added, or these fruits themselves, and thin fragrant wine of
an astringent quality; and the applications are to be cataplasms made
of polenta, and dates, and wormwood, roses, myrtles, and such like
things. It must be considered also, to what part these cataplasms are
to be applied, I mean the region of the stomach, the lower belly, or
perhaps the loins. Bloody discharges are restrained and dried up by
remedies containing fine flour of polenta, with frankincense, or manna
mixed with wine, or oxycrate. When the watery discharge is acrid, it
must be sweetened by a _lavement_ either with water alone, or the juice
of ptisan, or of chondrus, or rice, or tragum, not once, but often; and
afterwards there are to be added dried roses, or myrtles, and sometimes
galls; and an egg with rose oil, and a thin astringent wine, or the
decoction of roses, may be injected or applied to the anus, which will
blunt the desire of going to stool. But when the calls are frequent, a
clew formed of warm threads may be applied to the anus.
* * * * *
COMMENTARY. Galen forbids venesection when the fever is complicated with
diarrhœa. (Therap. ad Glauc. i.)
When the body is constipated, Celsus recommends laxatives, diuretics,
and sudorifics. He adds, it may also be proper to let blood, practise
gestation, enjoin abstinence from food and drink, and keep the patient
from sleeping. He likewise recommends the bath, both of tepid water
and of oil. When the bowels are loose he enjoins rest and sleep, gives
medicines to restrain sweating, and forbids all exercise except gentle
gestation. He also directs us to excite vomiting by copious draughts of
tepid water, unless the complaint be of long standing, or there be pain
of the throat, præcordia, or side. (iii, 6.)
Alexander forbids narcotics, unless in cases of extreme urgency. Avicenna
joins him in laying down this injunction, and otherwise directs us to
treat the diarrhœa febrilis upon general principles. (iii, 16, 1, 4.)
Haly Abbas treats fever, when complicated with constipation, by giving
gentle laxatives, such as prunes and tamarinds, or, if these prove
injurious to the stomach, by administering clysters. When the diarrhœa is
complicated with a discharge of blood, he approves of adding to the other
medicines Armenian earth, purslain, sumach, or such like astringents.
(Pract. iii, 24.) See Serapion (iii, 17); Rhases (Divis. 67.)
According to Prosper Alpinus, the ancient Methodists approved of
astringent applications and astringent clysters for febrile diarrhœa.
(Med. Meth. vi, 10.) Sydenham and Van Swieten agree with Alexander and
Avicenna in forbidding to stop diarrhœa in fevers by means of opiates,
unless in extreme cases.