We have already, in treating of phrenitis, mentioned the formation of
this disease, the symptoms whereof in general are the same as those
of phrenitis and lethargy, being modified according to the prevailing
matter. The peculiar symptoms are these: The patients remain fixedly
stretched in a supine posture, having sometimes their countenance
somewhat swelled and livid like those in lethargy, and sometimes with
a florid redness in it; the upper eyelid seems drawn upwards and
projecting, so that they cannot wink. They seem also not to breathe,
but to be as dead. The pulse is small, indistinct, and very dense. The
discharges from the bowels and bladder are suppressed, or in small
quantities. When the attack is moderate, they drink whatever fluid is
poured into the mouth; but those who are overpowered by it reject the
same by the nose. Those, therefore, in whom the phlegm prevails over the
bile, we distinguish from those affected with lethargy by this, that
there is no swelling present, nor is the colour livid like lethargics,
except to a very small degree; and that they perspire moderately. The
cases are dangerous in which there is much watchfulness, the urine is
suppressed, the difficulty of breathing is intense, when they have
sweats, and the drink regurgitates by the nose. If it be a woman that is
affected, the complaint may be distinguished from uterine suffocation
by the circumstance that she lies in a natural state, is sensible when
spoken to, can be roused, but sinks again into a state of sopor. Some
say that catochus is a different complaint from the coma vigil, for that
it has not a compound, but a simple cause; namely, a cold and dry matter
which obstructs the posterior ventricles of the brain, and occasions
the disease; in which case, the patient being suddenly seized with it,
remains in the same posture as when taken with it, that is to say,
standing or lying, with his eyes open or shut. The ancients, therefore,
called such patients _catochi_, which signifies _detained_, but the
moderns call the complaint catoche and catalepsy. The cure resembles
that which is already described, but is to be varied according to the
difference of the symptoms.
_The cure of catochus._ Wherefore we must have recourse to venesection,
more especially when the face is ruddy, or if the strength does not
contra-indicate, we must use clysters, sometimes stimulant, when phlegm
prevails; and sometimes emollient when bile prevails. In like manner
we are to apply other remedies, and give food sometimes every day, and
sometimes only every alternate one. The affection is very dangerous when
produced by an error of the food or drink, in which case the patient is
to be made to vomit without delay, and kept upon a restricted diet; and
the bowels are to be stimulated, and an embrocation with cumin or rue
applied to the belly. They who have been seized with the complaint from
intoxication, after their surfeit has passed off, must be cured by using
a more liquid diet, such as the juice of ptisan. And the head is to be
smeared with suitable ointments, which, if in summer, may be cold, but
tepid, if in winter. If the surfeit do not pass off, nor the patient
recover his senses, it will be time to give up the case as hopeless, and
pack off.
* * * * *
COMMENTARY. Most of the authors referred to in the preceding Section may
be consulted on catochus, or catalepsy. It is called by the Arabians
_subet alsari_. On the characters of the pulse in catochus, see Galen
(de Causis Puls. iv, 16.) Nonnus and other authorities remark that it is
accompanied with fever. Their general treatment consists of venesection;
clysters of the decoctions of rue and cumin, with nitre and honey;
epithemes applied to the belly; and fomentations of water and oil to
the head. Haly says that the disease arises from a collection of phlegm
on the brain; from pressure in cases of fracture of the skull; or from
the projection of the internal plate of the cranium. His treatment is
judiciously modified according to the nature of the exciting cause. He
approves of sinapisms to the head, friction of the feet, and so forth.
Alsaharavius recommends venesection when the exciting cause is a bilious
humour, but forbids it when the disease arises from a collection of
phlegm. His treatment is judicious, but not much different from our
author’s. (Pract. i, 2, 13.) Rhases’ general remedies are clysters,
purgatives, restricted diet, and, if indicated, bleeding at the arm or
ancles.
Cælius Aurelianus describes the disease with his usual accuracy. He says
it occurs in cases of continual, intermittent, and ephemeral fevers. The
symptoms, as detailed by him, are acute fever, loss of speech, dulness
of the senses, pulse large, strong, and full, and the eyes fixed. With
regard to his treatment, he says nothing of venesection, but approves
of fomentations to the head of sweet tepid oil; and mentions common
clysters, cataplasms to the loins, in order to relieve the retention
of urine; shaving the head, and applying cupping-instruments to it,
scarifications along the occiput, baths, fomentations of oil, &c. He
disapproves of the practice of Chrysippus and Themison, who recommended
stimulant ointments to the head, shaving the head, and applying sinapisms
to it with sternutatories and acrid clysters.