SECT. XL.—ON PAIN.
A torpid pain is occasioned by a cold affection; a throbbing is characteristic of a strong inflammation. But, if a person feel as if pierced by a sharp-pointed instrument, or bored by a wimble, this kind of pain is peculiar to the thick intestine, i. e. the colon. The pungent is seated in the membranes. The darting pain attends the most vehement attacks, not only of hemicrania, but also of cephalæa. It is said to be darting when it commences in the seat of the affection, as from a root, and spreads quickly to the surrounding parts. Stretching pains take place in the nerves, when they are affected and stretched towards both extremities. But the nerves are not liable to be affected with lateral distensions. The membrane under the skin when distended occasions tensive and torpid pains; those between the flesh, as it were, divellent. For they are many, have irregular insertions, and surround the flesh. But the pains proceeding from the membranes which surround the bone, are deep-seated, and seem to proceed from the bones themselves. Wherefore, when no external cause of the pain is apparent, you must consider the patient’s preceding regimen. If it has been more inactive than usual, or if he has been taking more nutritive food than common, or if any evacuation has been suppressed,—if any or all of these circumstances be observed, plethora is the cause of the pain, and you must evacuate him as quickly as possible; for, by this means you will be enabled with all safety to use such remedies as are fitted to repel the defluxions from the affected parts. If the part be distended with a fulness of blood, open a large vein near it immediately; but when bad humours alone are the cause, you must purge; and, when both meet together, you must use both evacuations, beginning with the bleeding. If, after both these remedies have been tried, the pain continue, it is clear that the offending matter has become fixed in the part affected; and it is also clear, that the cure will be accomplished by discutient remedies. In like manner, we may cure pains from flatulence, by soothing them with attenuant food and injections, and opening the pores of the containing part with cataplasms, irrigations, and fomentations. If a swelling bearing down and pressing upon the part be the cause of the pain, it must be removed; but, if it proceed from a pungent humour, attenuant and calefacient things are most improper. Dill boiled in oil is anodyne and soporific, and the green more than the dry.
Commentary. This Section is taken from Oribasius (Synops. vi, 29), or Aëtius (v, 100.) All these authors, however, merely abridge the account given by Galen. (Meth. Med. xii, 8, and de Locis Affect. ii.) In the latter work he gives a most ingenious dissertation on the different kinds of pain, and the states of the body in which they occur; but, as our author has given a summary of his observations, we think it unnecessary to go over the same ground. We shall, therefore, merely notice some of his remarks on the treatment, as delivered in the other work. When the pain is connected with flatulence, it is to be removed by food, drink, cataplasms, and fomentations of an attenuant nature. When pungent humours are the cause of the pain, they are to be treated by evacuants, diluents, or narcotics. When occasioned by thick and viscid humours, he forbids narcotics, the action of which, being frigorific, renders them thicker, and the containing parts more compact. In all such cases, therefore, he holds that opium and hyoscyamus, although they afford a temporary relief from pain, act prejudicially. He also proscribes things of a very hot nature, both internally and externally, and recommends to give attenuants, or things of an incisive nature. He in particular commends garlic, which he calls the theriac of rustics. As to external applications, he directs, in febrile cases, first a dry fomentation of millet-seeds, and, if it is not successful, friction with subtile or attenuant oils, and the fat of fowls.
Aëtius defines pain to be a sensation produced by a sudden change of temperament, or a solution of continuity. In illustration of the former cause, he remarks that all sudden changes from heat to cold, or vice versa, occasion severe pains. To the latter he refers rupture, contusion, and erosion of the parts. Rupture is produced by tension, contusion by weight, and erosion by some pungent quality. These causes of pain ought to be particularly attended to, and the treatment modified accordingly. His subsequent account is exactly the same as our author’s.
The different kinds of pain are fully treated of by Avicenna (i, 2, 3, 20), and by Haly Abbas (Theor. vi, 16.) Averrhoes has delivered the treatment of this complication of fever in nearly the same terms as Galen. When the pain is occasioned by warm air or flatulence, he particularly commends cupping applied with great heat. He agrees with Galen in condemning narcotics, when the exciting cause is of a cold nature. He also joins him in condemning hot fomentations and clysters, when the pain of the bowels is occasioned by a hot humour. (Collig. vii, 18.) See Rhases (Cont. xxxiii.)
SECT. XLI.—ON COLLIQUATIVE DIARRHŒA OR MELTING.
When anything is discharged from the bowels which was not part of the food or drink that was taken, but of the fluids of the body which had flowed to them, (resembling the yellow bile which is continually discharged by vomiting and purging, but differing from it in fetor; and in this, that the alvine discharge is of a darker yellow, of the consistence of the sordes balneorum, oily, and adipose,) the disease is called colliquation or melting. At first the fat and newly-made flesh are dissolved and melted by the heat of the fever; but as the evil is protracted, some of the solid parts themselves are melted down. In this most unfavorable state of fever, a draught of cold water from the coolest fountain is the most proper remedy; likewise cold cataplasms and epithems ought to be applied to the chest and hypochondriac regions, and cooling food to be given.
Commentary. Galen mentions that a colliquative discharge from the bowels was a common symptom of the fatal plague which prevailed in his time. He adds that the fæces were generally of a deep yellow colour, and always fetid. (Comment. in Hippocrat. Epidem. iii.) In another place, he states that it is a fatal practice to bleed or purge in cases of fever complicated with diarrhœa. (Therap. ad Glauc. i.)