Phrenitis is an inflammation of the membranes, the brain also being
sometimes inflamed along with them, and sometimes a preternatural heat
fixes originally in the brain itself. The cause of this disorder is
either a fulness of blood, or of a yellow bilious humour; and sometimes
the yellow bile, being excessively heated and converted into the black,
becomes the cause of the worst species of phrenitis. And sometimes
the affection arises from the brain’s sympathizing with the diaphragm
by means of the nerves distributed upon it. But the aberration of
intellect which occurs at the acme of very hot fevers, and that which
is occasioned by sympathy with the stomach, is not called frenzy but
delirium. Cases of true phrenitis are, for the most part, attended with
watchfulness, but sometimes with disturbed sleep, so that the patients
start, leap up, and cry out furiously; when the complaint is occasioned
by a sanguineous humour, with laughter; but when by yellow bile, with
ferocity; and when by a black, with unrestrainable madness. They forget
what is said and done by them, their eyes are bloodshot, and they rub
them; they are sometimes squalid, sometimes filled with tears, or loaded
with rheums. The tongue is rough, there is a trickling of blood from
the nose, they pick at flocks of wool and gather bits of straw, and
have acute fever during the whole continuance of the disorder. When a
fever of a bad character is seated deeply, they have the pulse small and
indistinct, with a certain degree of hardness. The respiration is large
and rare when the brain is primarily affected. And, if the phrenitis be
occasioned by sympathy with the diaphragm, the respiration is irregular,
the hypochondria are retracted and have considerable heat; but, when
it arises from sympathy with the brain itself, the parts about the
face are hot and suffused with blood, and the veins are full. When a
pituitous humour is mixed with the bilious, as the cause of the disease
is compound, so also is its appellation; for it is called coma vigil.
When a bilious humour prevails, persons so affected are troubled with
watchfulness; and, when a pituitous is the cause, they lie in a state of
coma. The elder writers before Galen called this disease catochus, but
since then it has been called catoche and catalepsy.
_The cure of phrenitis._ If the strength admit of bloodletting, we
are to abstract blood from the arm immediately and freely; but, if
the patient be delirious and will not present his arm, or if there be
apprehension of hemorrhage after the bleeding from the patient tearing
his arm during the agitation of his delirium, we must open the straight
vein in the forehead, and take away at once a sufficient quantity of
blood. We are to use clysters and injections of oil, or rose-oil with
the juice of ptisan. When watchfulness prevails, we anoint the head
with rose-oil, or with vinegar and rose-oil; in some cases fomenting it
with hot water; and we must give the medicine from the heads of poppy,
unless prevented by the weakness of the patient’s powers; and must have
recourse to the other remedies for insomnolency formerly mentioned. Let
the patient be laid in a place which is in a moderate state as to light
and temperature, and let there be no paintings in it, for these are apt
to excite emotions in such cases. Let some of his most beloved friends
come in and converse with him in a suitable manner, sometimes gently
soothing him, and at other times chiding him more harshly. His food at
first should consist of honied water, and afterwards of the juice of
ptisan, or spoon-meats formed from chondrus, with some sweet potion, such
as apomel, or hydrorosatum, or rhodomel, or the sweet hydromel. But the
vinous hydromel which is brought from Cebyra in small vessels must be
rejected, as it produces more mischief than wine itself, especially in
affections of the head and before concoction. We are also to administer
bread that has been soaked in water, and succory, and boiled lettuces.
Or, if there be much effervescence, they may be given raw, and also the
medullary part of the cucumber, of the pompion, of apricots, and the
like. They must be kept from cold water, more especially if the affection
be found to proceed from sympathy with the diaphragm. If their urine
(as is likely) be retained, owing to their delirium, we must foment the
lower part of the belly and bladder with warm oil and water, and then, by
applying the fingers of the hand to the part, we must try to incite them
to make water. We must also anoint the rest of the body with warm oil;
and the patients are to be kept in a recumbent posture, for a state of
quietude is to be maintained as much as possible; and, if they be rich,
they are to be restrained by their servants; but, if not, they are to be
bound with ligatures. For irregular motion is apt to produce prostration
of the strength. And for another reason, too, the feet ought to be bound
with ligatures after having been bathed, and friction applied to them,
namely, for the sake of revulsion. But, if the attack be more protracted
and difficult to remove, we must abstain from all narcotics; and to
the fomentations of the head are to be added things of a discutient
nature, such as the juice of mint, or of wild thyme, or of calamint,
or of rue; and then we must use errhines. After the seventh day, if the
viscera be inflamed, we are to soothe them by cataplasms of linseed and
raw barley-flour in oil and water. We are then to apply dry cupping or
cupping with scarifications to the parts, and to the back part of the
head and the spine. But, if the body be observed to be very squalid
and hot, even if the fever remain, we must use baths of fresh water,
and plentiful anointing, and give some thin and weak wine, in order to
rouse the strength; we need not apprehend any mental alienation that
will thereby be produced; for, either it will not take place at all, as
the disease is on the decline, or, if it do, it may be easily removed.
When the disease further abates, we must have recourse to gestation and
suitable restoratives. Recovery may be promoted by avoiding intoxication,
anger, indigestion of the food, and more especially exposure to the heat
of the sun.
* * * * *
COMMENTARY. Hippocrates treats cursorily of phrenitis in several of his
works, particularly ‘de Morb.’ (iii, 9,) and ‘Epid.’ See Galen (Meth.
Med. xiii, de Loc. Affec. v, 4); Aretæus (de Morb. Acut. i, 1); Alexander
(i, 13); Aëtius (vi, 2); Actuarius (Meth. Med. iv, 2); Nonnus (c. 25);
Pseudo-Dioscorides (Euporist. i, 13); Cælius Aurelianus (Morb. Acut. i,
1, &c.); Celsus (iii, 18); Serenus Samonicus; Octavius Horatianus (ii,
2); Serapion (i, 20); Mesue (de Ægr. Capit. c. 19); Avenzoar (i, 4, c.
6); Haly Abbas (Theor. ix, 4, and Pract. v, 13); Alsaharavius (Pract. i,
2, c. 8); Rhases (ad Mansor. ix, 3, and Contin. i, 28.)
Hippocrates, in his ‘Epidemics,’ details several cases of phrenitis,
which would appear to be remittent fevers, complicated with determination
to the brain, rather than inflammation of the brain.
Galen gives a very circumstantial detail of the symptoms, which is
well worth consulting. (Loc. Affec. l. c.) Our author’s description is
very complete, considering its brevity. He closely follows Alexander,
who agrees with him in recommending the most questionable part of our
author’s treatment; we mean the administration of wine. Of course,
however, it must have been a weak light wine. He insists that when the
strength is much reduced, it does more good than harm, by improving the
powers of the constitution. Cælius, however, says that wine is nothing
less than a poison. Alexander, Aretæus, and Aëtius agree that cold drink
should be given with caution. Most of the authorities have correctly
described the pulse as being small and dense. Our author’s practice, in
regard to bleeding from the temporal vein, is derived from Alexander,
who gives a very interesting case, in which he applied it with great
success. He recommends great caution in the administration of narcotics.
Upon the whole he is favorable to the tepid bath, as serving to procure
sleep, but he condemns the hot. Among the minutiæ of practice, we may
mention that Aretæus and Celsus, like our author, recommend all pictures
and such like gaudy objects to be removed from the apartment of the sick.
Celsus directs us, in pointed terms, after bleeding and purging, to get
the head shaved, and fomented with a decoction of emollient herbs. To
procure sleep, he recommends us to give draughts containing poppies and
hyoscyamus; or to apply the apples of the mandragora below the pillow of
the patient; or, to rub his forehead with amomum, or with the tears of
mulberry. He informs us, however, that Asclepiades condemns soporifics,
as inducing lethargy. For the sake of procuring sleep he recommends
gestation performed at night, and of swinging the patient in a suspended
couch. For the same purpose, the Pseudo-Dioscorides recommends us to
introduce the juice of poppies or mandragora upon wool into the rectum.
Cælius Aurelianus gives an admirable account of the symptoms and
treatment of this disease; and his views are, in this case, not very
different from those of Hippocrates and Galen. He informs us that
Asclepiades condemned venesection, which, he said was nothing less than
murder; that he disapproved of keeping the patients in a dark place;
and that he allowed them plenty of strong wine. Both Cælius and Celsus
properly animadvert upon his treatment. Cælius also blames Diocles for
admitting of venesection after the seventh day, and for approving of too
acrid clysters. He finds fault with Themison for allowing too much food
and wine at the commencement, and for using the bath indiscriminately.
He condemns the practice of Heraclides, because he applied the treatment
of the Empirics injudiciously, and admitted of bleeding from the frontal
vein, which, Cælius says, is most prejudicial.
The treatment recommended by Octavius Horatianus is little different from
that of the others.
The Arabians call the disease _karabitus_. The symptoms, according to
Haly, are heat not much increased, but the head warmer than the rest of
the body; alienation of the mind; watchfulness, but sometimes somnolency,
from which state the patient wakes with starting; blackness of the
tongue; picking at the bed-clothes; pulse in all cases weak, small, and
hard. He is very minute on the treatment, recommending bleeding from the
cephalic vein _ad deliquium_; cupping; gentle laxatives, such as prunes
and tamarinds; vessels filled with cold water or snow applied to the
head; in certain cases sinapisms to the feet; and, when watchfulness is
protracted, applications to the head, containing poppies, mandragora,
lettuce, &c. Alsaharavius particularly mentions general bleeding,
bleeding from the temporal vein or the angular vein of the nose, pouring
decoctions of refrigerant herbs over the head, and, when the insomnolency
is obstinate, washing the temples with infusions of hyoscyamus, poppies,
lettuce, &c. Avenzoar speaks of opening the artery in the head, an
operation mentioned by Galen. Rhases directs us to pour vinegar and
rose-oil from a height upon the head. His general remedies are similar
to those of the others, namely, general and local bleeding, with gentle
laxatives, such as myrobalans, prunes, and tamarinds. Serapion and
Avicenna direct much the same treatment as our author.