SECT. XXII.—ON SPONTANEOUS LASSITUDE.
Since the Ulcerose lassitude is occasioned by the ill digestion of acrid superfluities, if the cacochymy be small, the restorative exercise will be sufficient; but if it be greater and deeper-seated, we must not permit such a one either to exercise or to take any motion whatever, but he must for one day remain without food, in a state of quietude and sleep; and then in the evening, when he has been rubbed with emollient unguents, and bathed in tepid water, we must give him wholesome food and some soup. And we must also not restrict him from wine, for nothing contributes so much to the digestion of half-digested humours as wine. Should the symptoms be removed by means of the aforesaid treatment, we may allow the man to return to his usual employments; but if on the following day they should still remain, we must bethink ourselves of a more potent remedy. If his strength be good, we must have recourse either to phlebotomy or purging, having first determined which of these remedies we shall try. If he be weak, we must not bleed, but may purge him moderately. If there be many crude humours in the system, we must neither bleed, nor purge, nor exercise, nor move at all, nor try the bath; but we must keep him in a state of perfect quietude, and give him food, drink, and medicines of attenuating and incisive qualities, without being of a manifestly heating nature. We may give vinegar and honey, and occasionally some ptisan or honied water. And since, in such persons, the lower belly is apt to become swelled and distended with wind, and whatever food is taken to be converted into flatulence, it will be better to give some pepper along with the food. It will be better, too, to use the composition called Diospoliticus, and that simple medicine which consists of three kinds of peppers. Oxymel is also most proper. Let them likewise use a drink made from honey, particularly when it begins to become acid; and such wines as are gently acid, and such articles of food as are attenuant without being heating, as capers, if taken with vinegar and honey, or vinegar and oil. When the Tensive species of lassitude takes place without exercise, it indicates that a plethora distends the solid parts of the body. If the fulness be occasioned by blood, it will be best to open a vein, or scarify the ankles. If the Inflammative lassitude be spontaneous, it will not endure a delay of a few hours, much less of two or three days, for it straightway induces a strong fever, unless one anticipate by letting blood. It will be best, if possible, to abstract blood twice in one day; for if care be taken that the first bleeding do not occasion swooning, it will be of less consequence whether or not it occur after the next. Those who are not bled will be fortunate indeed if they escape with the life.
Commentary. These judicious observations are taken from Oribasius (Synops. v, 21.) See also Galen (de Sanit. tuendâ, iv); Aëtius (iv, 41); Avicenna (i, 3, 3, 16); Alsaharavius (Pract. xxxi, 2, 11); Rhases (Contin. xxxi); Averrhoes (Collig. vi, 14.)
All the authorities recommend nearly the same methods of treatment. Galen’s account of the subject is full, complete, and satisfactory, but so lengthy, that we cannot venture even upon an abstract of it. He gives proper directions for the physician to endeavour to find out the cause of the lassitude, and to remedy it accordingly. It is often connected, he says, with retention of the menstrual or hemorrhoidal evacuation, or the stoppage of some customary discharge. When attended with inflammatory symptoms, he is very urgent in recommending immediate venesection, without which, as he remarks, the patient cannot escape with his life, unless he is saved by a critical evacuation, such as bleeding from the nose, or profuse sweating.
When, in the inflammative lassitude, the head is affected, Aëtius directs us to open the cephalic vein; when the chest or back, the basilic; and when the whole body equally, the median. He recommends also cooling herbs, such as beet, mallows, lettuce, and the like, with ptisan and tepid water. He forbids the use of cold water. After the third day, if the patient is convalescent, he allows a thin weak wine, much diluted.
Averrhoes approves very much of Galen’s directions respecting the treatment, except that the peppers recommended by him had not been found to answer in his climate (Cordova). Instead of them, he directs cinnamon, amber, cassia lignea, and similar aromatics to be given.
Avicenna joins Galen in cautioning the physician to be guarded in allowing his patient to take much food, as the veins being emptied by the remedies applied for removing the lassitude, greedily absorb the chyle before it is properly concocted.