When the heart itself is primarily affected, the case is far beyond all
medical aid, occasioning sudden death; and so also in the inflammations
and erysipelas of it, strong distemperatures in very acute fevers, and
hemorrhages when it is wounded, especially in the left ventricle. When
it is affected sympathetically with the brain, the liver, the orifice
of the stomach, and from sorrow, fear, and many other causes, it brings
on the affection called syncope, being a sudden collapse of the vital
powers, indicated by prostration of strength, deliquium animi, a small
pulse, coldness of the extremities, and copious perspiration. When
this affection is of a violent nature, it also is irremediable; but
if the strength stands out, it may sometimes be relieved. But strong
palpitations of the heart often arise from a fulness or effervescence
of its blood. When, therefore, the heart is over-heated, it renders the
respiration large and dense; but when it is too cold, the respiration is
small and rare. The complete cure of syncope of the heart, when it occurs
among the symptoms of fever, we have treated of in the Second Book.
This only may now be added, that when the collapse gains ground after
friction and ointments have been applied to the extremities, and after
purification of the floor, and other cooling means, we must sprinkle upon
the parts of the body which are sweating powdered myrtle, Cimolian earth,
or amber, or pomegranate-rind with manna, or Samian earth with gum; and
cataplasms of mustard or pellitory, or adarce, are to be applied to the
cold extremities, as far as to the groins and armpits. The food should
be bread out of water, or out of cold diluted wine, swines’ feet and the
joints and snout, and fowls; all the things being given in a cold state.
On the head and forehead is to be rubbed the juice of unripe olives, or
some astringent application, with gum, and the decoction of roses; and a
cataplasm is to be applied to the hypochondria and stomach, formed from
dates, roses, the flower of the wild vine, acacia, hypocistis, and alum.
_On palpitation of the heart._ “I knew a certain person,” says Galen,
“who suffered an attack of palpitation of the heart every year in the
season of spring. Wherefore, having for three years experienced benefit
from venesection, in the fourth he anticipated the attack by getting
bled, and escaped from it, and did so for many years afterwards, using at
the same time a suitable diet. And yet even he died before attaining old
age, as every other person in this complaint does, some being suddenly
cut off in acute fevers by syncope; but some of them without syncope,
being unexpectedly deprived of life, as if by apoplexy. The majority of
those who are thus affected do not reach the fiftieth year of age, but
pass the fortieth.”
* * * * *
COMMENTARY. See Galen (de Loc. Affect.); Aëtius (viii, 58); Oribasius
(Synops. ix, 6); Actuarius (Meth. Med. iv, 3); Leo (iv, 21); Nonnus
(134); Avicenna (iii, 11, 12); Serapion (ii, 27); Avenzoar, (1, 12);
Mesue (de Ægrit. Pect.); Haly Abbas (Theor. ix, 22, and Pract. vi, 16);
Alsaharavius (Pract. xiii); Rhases (Divis. i, 58, and Contin. xvi.)
Most of the knowledge which the ancients possessed of these obscure
complaints may be found in Galen (l. c.) In the body of a monkey he
had remarked hydrops pericardii, and in that of a cock he had detected
a scirrhous tumour, from which he inferred that these diseases occur
also in the human subject. One would almost suspect, however, that the
ancients were more familiar with _inspectiones cadaverum_ than they chose
to avow. As a proof of this, we may mention what is related by Hesychius
of Hermogenes the rhetorician: “Hermogenes the rhetorician having died
was dissected, and his heart was found covered with hair, and greatly
exceeding its natural size.” (See also Suidas.) Respecting persons
having hair on their hearts we quote the following note from Fabricius
(Bibliotheca Græca, iv, 429): “Plura exempla hominum quorum cor pilosum
est repertum collegit elegantissimus. Muretus (xii, 10, Var. Lect.);
Pontanus (Bellar. Attic. 301), et Alexander Tassonus in libro Italicè
edito cui titulus Pensieri Diversi, (vi, 30.) De Aristomene Messenio idem
tradit præter alios Dio. Chrysost. (xxxv, 430) de Leonida Plutarchus in
parallelis minoribus (306.)” It is proper to mention, however, that Senac
is incredulous as to the truth of these stories (Essai, &c. 62.) On the
subject we are treating of the learned Stephen Bernard has the following
remark: “Apparet, ni fallor, ex hoc loco Pauli (iii, 68), veteres
morborum sedes in cadaveribus rimari non neglexisse quod etiam patet ex
illis quæ de hepatis inflammatione habet (181), qui enim scire poterant
aliquando partem ejus cavam, nonnunquam vero gibbam inflammatione tentari
nisi ex cadaverum inspectione?” (Ad Nonni Epit. 208.) See also Pliny
(Hist. Nat. xi, 70), and the note of Harduin.
Since all the writers subsequent to Galen merely copy from him, we need
not say more of their opinions. We may state, however, what Actuarius
says regarding the characters of the urine in affections of the heart.
In hot intemperaments of the organ the urine at first is more acrid and
thinner, but as the disorder increases, it assumes an oily colour and
consistence. The sediments become grumous, furfuraceous, scaly, and
gritty. When it is affected with a cold intemperament, the colour of
the urine is whiter, and the sediment at first moderate and crude, but
afterwards it becomes black. (De Urin. vii, 4.)
The Arabians, especially Avicenna, treat of these complaints at great
length, but without supplying much additional information. Avenzoar
speaks obscurely of certain tumours resembling pellicles or cartilages
on the pericardium. He mentions also hydrops pericardii, and abscess
of the same. Pain of the heart, says Haly Abbas, may arise from an
intemperament, organic disease, or a solution of continuity. The last
two causes soon occasion death. He mentions that palpitation may be
occasioned by dropsy of the pericardium. He recommends bleeding in
cases of palpitation, upon the authority of Galen, and also things of
a cold nature, such as seeds of cucumbers, citrons, gourds, roses, and
camphor. Alsaharavius gives a similar account of these affections. Rhases
also approves of venesection and cold applications. He mentions that
palpitation is sometimes felt in the region of the stomach, for which he
recommends bitters, such as wormwood.
The disease which Galen and his followers describe under the name of
palpitation was no doubt that state of the heart now called hypertrophy
with dilatation. In confirmation of the truth of Galen’s prognosis,
we may quote the words of the celebrated translator of Laennec, as to
the issue of the disease of the heart we have mentioned: “Such persons
however are marked for destruction. After a certain time the disease
obtains the mastery, and brings the strong man down, the sooner, alas!
for the bold resistance made to his dominion.” (English Translation of
Laennec, p. 62.)