SECT. XXXIX.—ON CHOLERA.
Cholera is an immoderate disorder of the belly, with discharges upwards and downwards, arising from continued indigestion of the food. Persons are affected with indigestion sometimes from the badness of their food, and sometimes owing to a redundance of depraved humours. Wherefore, if the patient be seized with nausea and lancinating pains, while the food remains in the stomach undigested, we must order him to drink tepid water, and to produce vomiting by putting his fingers or feathers down the throat. We must also encourage the discharge by the bowels. After the evacuation of the superfluities, he must take rest, and apply warmth to the hypochondrium, by means of sweet oil, with some wine; or by the oil of mastich, or of spikenard, if it is winter: and he must be allowed to sleep. After digestion has been accomplished, let him have recourse to baths and wholesome food. When the discharge is immoderate, it will be sufficient at first to try those things which are mentioned in the [Second Book] for disorder of the belly. But when the discharge continues, and the belly loses its tone, and the pulse gets small and dense, we must apply a cataplasm of dates, with flowers of wild vine, acacia, the juice of hypocistis, and pomegranate rind. For drink, give a cupful of moderately cold water to swallow; or, what is still better, a decoction of roses, of the flowers of wild vine, of sumach, or of vine-shoots; or we may give the juice of an acid-sweet pomegranate, sprinkling upon it a little mint. When the excretions are more acrid, and heat and thirst come on, we must give the seed of cucumber, with three cupfuls of water; and succory and lettuces boiled in oxycrate are to be used for food. When the discharge cannot be stopped, we must administer some of the austere wines; if the patient be free of fever, the Palmatian, the Aminæan, or palm wine, or that from unripe grapes, with honey; but when he has fever, pomegranate wine, or myrtle wine, or Cibyratic hydromel for drink, and along with crumbs of bread, alica, or chondrus. If he loathes food from grain, he may chew some summer fruit, or medlars, pears, quinces, or pomegranates, but he must spit out the fleshy and hard parts. When he cannot retain the food, let a large dry-cupping instrument be fastened over the stomach, and while it is on let some of the afore-mentioned food be taken. For the spasmodic contractions apply to the muscles hot rags dipped in oil, and liquid cerates, containing some castor and Sicyonian oil; but before applying them let hot water be poured upon the legs. If he cannot get sleep, we must have recourse to the remedies recommended for watchfulness; and if his strength permit, he may take a potion from poppy-heads. When the disease is on the decline, he may be put into a bath, and recruited with chickens, pigeons, the feet of swine, or the like. Diarrhœa, being a corruption of the food, for the most part ceases spontaneously, if no more food be taken until after the complete digestion and evacuation of the corrupted matters; but if it continue, we must use the remedies applicable to cholera.
Commentary. Consult Hippocrates (Epidem. v, 4, et alibi); Galen (Comment., de Fac. Part., de Rat. Vict., de Med. sec. loc. viii); Aretæus (Morb. Acut. ii, 5; de Curat. M. A. ii, 4); Celsus (iv, 11); Alexander (vii, 16); Aëtius (ix, 12); Oribasius (Morb. Curat, iii, 11); Leo (v, 5); Actuarius (Meth. Med. iv, 5); Nonnus (164); Cassius Medicus (Problem.); Scribonius Largus; Cælius Aurelianus (Morb. Acut. iii, 19); Octavius Horatianus (ii, 16); Marcellus (30); Avicenna (iii, 16, 1); Serapion (iii, 14); Avenzoar (ii, 1); Alsaharavius (xvi, 20); Haly Abbas (Pract. vii, 14; Theor. ix, 25); Rhases (Divis. 60, Contin. xi; ad Mansor. ix.)
Hippocrates in his ‘Epidemics’ has given several well-detailed cases of cholera. In one, the patient drank hellebore in the juice of lentils, and vomited; he became cold, and was put into the hot hip-bath, where he regained his heat and recovered. In another place, he says that the disease is, for the most part, occasioned by unwholesome food, such as pork improperly boiled, pot-herbs, summer fruits, &c.
Aretæus defines cholera to be a retrograde movement of the matters in the body upon the stomach and intestines, consisting of a discharge upwards and downwards of bile, which, if the disease proves fatal, becomes black; and, at the same time, the extremities are cold, with profuse sweats, pulse small and dense, constant straining to vomit, and tenesmus. He also makes mention, among the symptoms, of spasms and contractions of the muscles in the legs and arms, borborygmi, tormina, and syncope. The complaint, he says, is occasioned by continued indigestion, and proves fatal by superinducing convulsions, suffocation, and retching. With regard to the treatment, he cautions us not to stop the discharge at first, but to encourage it by giving frequently some tepid water; and when attended with tormina and coldness of the feet, to apply to the belly hot oil of rue, and rub the legs to restore heat. When the fæces are all evacuated, he recommends some cold water to compose the stomach; and when the pulse sinks and becomes frequent, while at the same time there are profuse sweats and deliquium, he approves of adding a small quantity of wine to the water. It is to be of a fragrant and astringent kind, so as to strengthen the powers of the system. When all the symptoms get worse, when spasms of the legs occur, and the pulse becomes insensible, he advises us to give more wine and water. Should the vomiting continue, we must return to very hot drink and hot food, for, he remarks, the transition often proves beneficial. When all these fail, a cupping-instrument is to be put on between the shoulders or below the navel. He afterwards speaks of such applications as those recommended by our author, namely, calefacients applied to the belly, chest, and legs. He concludes with saying, that, if the symptoms, instead of improving, should get worse after this treatment, it will be proper for the physician to accelerate his retreat.
When cholera is not attended with fever, Galen approves of giving a piece of bread soaked in diluted wine, of cold drink, and of applying cupping-instruments to the belly. When the patient is strong, he even recommends the cold bath. He directs afterwards astringent food, and also speaks of clysters, old wine, and asses’ milk. He mentions with seeming approbation that Asclepiades gave tepid water at the commencement.
Celsus depends most upon tepid water, dry cupping, and sinapisms to the belly. In extreme cases, he prescribes a light fragrant wine diluted with water.
Alexander’s account is very minute, but little different from that of Aretæus. In certain cases, he permits poppies to remove insomnolency and wine to support the strength. Like Hippocrates, he describes correctly dry cholera. In this variety, which he attributes to a bilious humour, he recommends purging with scammony or the picra of aloes. But in particular he approves of friction and the application of strong ligatures to the extremities; to the arms and hands, when the evacuations are by the belly; and to the feet and legs, when by vomiting from the stomach.
Aëtius, Oribasius, Actuarius, and Nonnus treat of the disease in nearly the same terms as our author.
For cholera, Marcellus recommends various astringent remedies, both externally and internally. Myrtle-wine, he says, will stop the vomiting. He also commends opium.
Octavius Horatianus calls cholera “omnibus acutis ægritudinibus velocior.” Like the others, he recommends draughts of tepid water at the commencement, and wine and aromatics in extreme cases.
Cælius Aurelianus, with his accustomed accuracy, gives a complete history of the symptoms of this disease. The bile which is vomited, he says, is at first yellow, afterwards green, and at last black. His treatment is very similar to that of Aretæus, namely, tepid water at the commencement to facilitate vomiting, sponges out of cold water applied over the stomach, or else cupping-instruments with much heat; aromatics, bread soaked in wine, and the like. He condemns Hippocrates for sanctioning the giving of hellebore. He blames Diocles for recommending southernwood, which, he remarks, is a very harsh medicine; and also for allowing milk, which, he says, is apt to grow acid. He finds fault with Heraclides Tarentinus for trusting to opium and henbane.
Cassius Medicus accounts for the coldness of the extremities and contractions thereof upon the supposition that they are occasioned by the vital spirits having left them and been determined to the stomach.
There is nothing very original in the works of the Arabians. Haly remarks that cholera consists of a discharge of bile. He inculcates as a settled principle of treatment, that, when the strength continues good, and the discharge not immoderate, the vomiting is to be encouraged by giving tepid water with oil of sweet almonds to drink. When there is great prostration of strength and tendency to deliquium, he directs us to sprinkle water on the patient’s face, to apply ligatures to his limbs, and to rub his feet and legs with a calefacient oil. When the discharge cannot be got otherwise stopped, he advises us to apply a cupping-instrument over the stomach. Alsaharavius, like the others, directs us to promote the vomiting at first by giving tepid water. Among his other remedies, he recommends an infusion of aloes and wormwood, Rhases recommends draughts of tepid water, the application of snow over the stomach, ligatures to the extremities, wine, and astringents. He, Avicenna, and most of the authorities direct us to encourage sleep. Avicenna’s plan of treatment is exactly the same as that of Rhases.
With respect to diarrhœa, Celsus recommends us to give an emetic; to anoint next day with oil; to give moderate food and undiluted wine; and to apply over the belly a cerate with rue. Cælius Aurelianus enjoins at first rest and abstinence, then astringent applications to the belly, next day astringent food, and then wine and the hath. Haly Abbas remarks that a diarrhœa is not to be rashly stopped unless it become excessive, in which case astringents are to be given, such as galls, roses, pomegranate fruit, &c. Serapion and Rhases mention an emetic as a remedy for diarrhœa.
For the cure of diarrhœa, the veterinary surgeons recommend at first bleeding and hot water, and then astringents, such as sumach and pomegranate rind. (Geopon. xvi, 8.)