Cæelius Aurelianus enumerates nearly the same causes as Aretæus, and describes all the symptoms of the disease with the greatest precision. His treatment also is nearly the same as that of Aretæus, namely, emollient applications to the neck, venesection, and oily clysters. He even enjoins the bath of oil, which has fallen into disuse in modern practice, most probably solely on account of the expense with which it would be attended. He also permits sometimes the use of the common bath, but not of cold water. He allows wine in certain cases. He condemns Hippocrates for giving both wine and emetics, and having recourse to venesection, without due discrimination. He blames him also for recommending the affusion of cold water, inasmuch as he himself had pronounced cold to be injurious to the nerves, bones, &c. Galen, however, remarks, in his Commentary upon this Aphorism of Hippocrates (sect, v, 21), that cold, in this case, is not the direct cause of the benefit derived from this remedy, but (if we understand him right) that the shock which it imparts to the system proves beneficial, by rousing the vital heat and energies of the patient. Hippocrates, however, as stated above, forbade the cold affusion in traumatic tetanus. Our author’s opinion of this practice is just such as the profession in general now entertain, after it has received another trial upon the recommendation of the late Dr. Currie. (See ‘Medical Reports,’ and Larrey’s ‘Mémoires de Chirurgie’, t. 1.)
Octavius Horatianus recommends bleeding, emollient applications, purgative clysters, the tepid bath, antispasmodics, and soporifics. The use of the last-mentioned class of remedies does not appear to have been sufficiently understood by the ancients; at all events they were less partial to them in this case than the moderns.
The Arabians enjoin nearly the same treatment as the Greeks. Avicenna and Mesue join the preceding authorities in recommending strongly the use of castor and assafœtida as antispasmodics. Avicenna, like all the others, praises the bath of oil. Serapion speaks of a bath prepared with emollient herbs. Haly Abbas describes minutely the two varieties as occasioned by repletion and inanition. For the former, he approves of purging with hot drastic purgatives, of rubbing the part affected with hot oils, and of using the warm bath with friction after it. He also approves of castor. For the other variety, he praises the affusion of plain water in which lettuces, barley, &c. have been boiled. He recommends the internal use of milk and other demulcents, and the bath of oil, and rubbing the body with oil of violets. The treatment recommended by Alsaliaravius is very similar. Rhases mentions Hippocrates’ proposal of the cold affusion; but, like our author, he rather disapproves of it. He himself recommends bleeding, when there are symptoms of repletion, emollient applications to the neck, the bath of oil, the application of leeches to the part affected, purging with aloes, &c. and the administration of antispasmodics, such as castor, assafœtida, and the like.
SECT. XXI.—ON TREMBLINGS.
Trembling is generally occasioned by a weakness of the nerves (old age is a proof of this); but there are many particular causes which occasion it; for it arises from a cold intemperament, from draughts of cold water, more especially if taken unseasonably during a fever, also from a redundance of cold and viscid humours, and from the too liberal use of wine. Those, therefore, who have tremblings from any obvious error in regimen, must abstain from the things which prove injurious to them. And, again, when the tremor remains during fevers, we must first rub the body with Sabine oil; but in the remissions of the attacks with old or Sicyonian oil. Let the extremities after being anointed, be wrapped in soft wool, and then let cupping instruments be applied along the spine, from the first vertebra to the loins; these parts, together with the hypochondria, being previously covered over with raw barley-meal. Let them also be wrapped with wool out of old or Sicyonian oil. But if the fever continue, every alternate day let them be put into a hip-bath of oil, or oil and water, and use soft frictions. But if the affection be prolonged, and cold is suspected, they should take a propoma, or sweet potion, of honied water and castor, and be carried about in warm places; and we ought to give them food of easy distribution, at first spoon-meats, and afterwards such fowls and fishes as have tender flesh. When the fever is gone, they must be washed, avoiding the cold bath and wine. But, if there be a fulness of thick and viscid humours, we must use remedies of an incisive and attenuant nature. They are these: Of the shoots of rue, of cow-parsnip, as much as can be contained in three fingers; of castor, of nitre, of each two oboli. Give every day one spoonful with oxymel, for three days while fasting; or of panacea and pepper, five grains; take in a draught of a cyathus of honied water. The following simple things in proportion relieve tremors: Castor, the brain of a hare eaten, the decoction of the root of marshmallows, of the leaves of water plantain, dr. iv, in honied water, hemp agrimony with water. When the cold prevails, we may use the liniment of Zosimus, and the restoratives, liniments, and rubefacients described above for paralysis, also exercises and frictions. Those who have tremblings from drinking wine must abstain from wine altogether, until a complete cure take place.
Commentary. See Galen (de Tremore, et alibi); Nonnus (40); Cælius Aurelianus (de Morb. Acut. iii, 7); Mesue (de Ægr. Cap. 5); Serapion (i, 3); Haly Abbas (Theor. ix, 11, Pract. v, 32); Alsaharavius (Pract. i, 2, 24); Rhases (ad Mansor. ix, 8.)
Galen, in the work referred to above, explains the rationale of this affection with his usual penetration, but at too great length to allow of our entering upon an exposition of it. The others treat of it similarly to our author. Thus Haly Abbas mentions various causes of tremors, such as old age, drinking cold water unseasonably, excessive indulgence in wine or venery, inanition, and the like. He recommends aloes and castor, the hot bath, friction with calefacient oils, and other such remedies. Serapion gives a sensible account of the nature of the affection, and recommends fetid or antispasmodic remedies internally, and friction with calefacient oils externally. When it is occasioned by exposure to cold, Rhases recommends the hot bath and insolation. We may mention here that Hippocrates has given a very accurate history of a case of delirium tremens. (Epid. iii, 5.)
SECT. XXII.—ON DISEASES OF THE EYE; AND FIRST OF PAIN, FROM GALEN.
When violent pains in the eyes take place, consider from what diathesis the eye happens to be pained in the inflammations; for they are either occasioned by the pungency of an acrid defluxion, or from the coats being over filled and stretched, or from the distension of thick humours or of flatulent spirits. When the pains proceed from pungency, they are to be cured by evacuating with purgatives, and by injecting into the eye the white of an egg. When the inflammation is concocted, if the body be free of impurities, the most befitting remedies are baths. Inflammations from plethora are to be cured by the detraction of blood, purging the belly, and applying friction to the inferior extremities. Those from distension are to be cured by first evacuating the whole body, then by occasioning a revulsion downwards of the humours, and afterwards by using topical applications of a discutient nature. The eyes must be fomented, and the decoction of fenugreek poured into them. When the vessels of the eye are distended with thick blood, while there is no plethoric diathesis in the general system, the patient must drink wine which has the power of heating, evacuating, and removing obstructions.