Alexander’s directions are most minute and judicious, but we must be content with stating that he approves of opening the ranal and jugular veins, and that his treatment is otherwise similar to that of Galen. This is the first mention of opening the jugulars that occurs in a medical author.
Octavius Horatianus we shall merely mention, in order to state that he has described the two varieties of the disease like the others.
Cælius Aurelianus gives a singularly accurate and circumstantial account of this disease, but it is so long that we can merely afford room to point out a few of his leading opinions. He approves of a fomentation made with a bladder half filled with hot sweet oil. He directs the patient to inhale the steam of hot water, and to have sponges squeezed out of it applied to the neck and throat. He approves of cupping the neck or of leeching it, and also of scarifying the tongue and fauces if they are much swelled. With respect to the treatment of the other sects, he blames Hippocrates for making too rapid a detraction of blood, and also for opening the veins below the tongue, which, he says, will only aggravate the evil, and may be productive of inconvenience, owing to the difficulty of stopping the bleeding. But, in particular, he finds fault with Archigenes for mentioning laryngotomy, and treats the operation as entirely fabulous and the fiction of that physician. His aversion to it is so strong that he pronounces it a crime. Before having done with this author, we may remark that Prosper Alpinus, the modern advocate for ancient Methodism, does not agree with Cælius in condemning the Hippocratic practice of opening the veins below the tongue. In his own case he had experienced the good effects of this practice. (Meth. Med. vii, 10.)
The Arabians, like their Grecian masters, describe the two varieties of the disease, and treat them accordingly. For the variety called synanche by the Greeks, they approve of hot gargles consisting of mustard, pepper, and the like. This resembles the modern practice of using gargles of Cayenne pepper. In the following passage, Rhases evidently points at the contagious synanche: “It happens on certain years in spring that a bad and destructive species of synanche attacks a great many persons. Wherefore at such a time it will be proper to anticipate the disease by venesection, abstracting blood from the legs with cupping-instruments, opening the belly, and gargling with rose-water, or infusions of sumach, mulberries, and nuts.” Haly Abbas likewise states that the disease is sometimes epidemical. Rhases approves of general bleeding, of opening the sublingual veins, and of using astringent gargles at first, and afterwards maturative ones consisting of figs, sweet almonds, and the like. In his ‘Continens’ he seems to allude to bronchotomy. Alsaharavius describes the two varieties of the disease with great minuteness. He agrees with the others as to the danger of that variety in which there is no swelling nor inflammation outwardly. Avicenna and other of the Arabians follow Alexander in recommending bleeding by opening the jugulars. The two kinds of angina, mentioned by the ancients, are described in similar terms by Sydenham, Boerhaave, and Van Swieten. The first variety, or common quinsey, is well known. The second is of less frequent occurrence. The modern authorities have found it as fatal as the ancients gave them reason to expect. The reader will find a very interesting commentary on Aretæus’ description of malignant sore throat in a tract, ‘de Recondita Abscessum Natura.’ (Mangeti Bibl. Chirurg. i, 48.) It is the disease now called laryngitis acuta.
Haly approves of the treatment recommended by our author in cases of suspended animation. In treating those who have been in water, he directs, very improperly we are convinced, the patient to be hung by the heels, to favour the escape of the water by the mouth. It would appear, however, from the late experiments of Professor Meyer, that the ancients were correct in supposing that water is generally found in the lungs of drowned persons. When a person has hung by the neck for a time, and there is any prospect of recovery, Haly directs us, as soon as he can swallow, to make him gargle with oil of violets and tepid water, and to drink barley-gruel and the like.
SECT. XXVIII.—ON CORYZA, CATARRH, AFFECTIONS OF THE TRACHEA, AND COUGH.
All these complaints have this in common, that they are occasioned by the defluxion of a redundant humour from the head to the parts below. When, therefore, it seats in the nostrils, the disease is called coryza; when in the pharynx and roof of the mouth, simply catarrh; but when it attacks the larynx and arteria trachea, so as to occasion a roughness of the membrane which lines them, the voice becomes hoarse, and the disease is called branchus, or morbus arteriacus: these terms being applicable not only to the inflammatory roughness occasioned by a defluxion from the head, but also to that arising from vociferation and inhaling cold air. When the complaint is protracted, and the defluxion is carried down to the chest and lungs, it gives rise to bad coughs. And a cough often arises from an intemperament; sometimes a hot one, as in fevers, and sometimes a cold, as in northerly states of the weather, which is rather a dry one. Cough is also sometimes symptomatic of some other disease, such as pleurisy, hepatitis, phthisis, or peripneumonia. Wherefore Galen relates that, in certain chronic cases of cough, chalazia (hail-stones) have been brought up from the chest. But Alexander relates that a certain heavy stone, like that which forms in the urinary organs, was brought up in a chronic cough, upon which the cough ceased. We ourselves have seen a discharge of stones with vomiting of blood, as we will describe more accurately when we come to that part. Those who have coryza and catarrh from exposure to heat have a sensation of heat about the parts, and a running of acrid and thin humours from the nostrils and mouth, and there is redness about the face and nose. When they are occasioned by cold, there is distension about the head and forehead, and obstruction of the ethmoid pores, so that the voice does not resound through the nose; and when they are protracted, cough supervenes, and expectoration of phlegm, which is sometimes unconcocted and fluid, and sometimes green. In some cases fever comes on, which does not alleviate the complaint when it proceeds from heat, but when from cold it promotes concoction.
The cure of catarrh and of coryza. When a hot intemperament prevails, those remedies will apply which suit with headachs from the same cause. They must have recourse to baths, and have a large quantity of hot water poured upon the head. The food most befitting are spoon-meats and eggs in a state to be supped, starch, sweet cake, sesame, rice, almonds, the fruit of the cones of pine, and all confections from milk. The wines which are drunk should be sweet and not old. The lohoch from poppy-heads, called diacodium, and other compound medicines for these complaints, are to be taken. When a cold intemperament prevails, and the disease is difficult to remove, a restricted diet is to be observed, and the head anointed with some heating and attenuating ointment, such as that of nard or rue. But the ointment of iris is not only to be rubbed in, but is also to be injected into the nostrils; and, internally, they are to be rubbed with frankincense and myrrh, with oil; and this more especially when the coryza arises from cold. But these are remedied by odoriferous substances with burnt linen, or by gith and cumin burnt and bound up in a linen rag. Let them also smell to the cyphi seleniacum, and let it be rubbed into the forehead; and to it let there be added one of the antiphlogistic plasters, such as the Icesian, the Oxera, the Barbarum, and the Athena. For catarrh from cold it will be expedient to drink of cyphi, and to rub into the chest the juice of balsam by means of unwashed wool; or to apply calefacients to it, along with storax, the ointment of iris, or that of dill. Let them also use hot and concocting food. But when the matter is already concocted, a masticatory will answer well with them, and detergent ointments (smegmata) to the head, such as the soap of Constantine, and the like.
The cure of affections of the trachea, or hoarseness. For the complaint called arteriacus and branchus, those things already mentioned will apply; but, in particular, when an inflammatory affection of the trachea and larynx prevails, we must, at the commencement, use the emplastic remedies, until the inflammation become more moderate; such as those from Cretan sweet wine, tragacanth, gum, and starch, and a decoction of the fatty dates and that of liquorice, with rob, until it become of the consistency of honey. And we must use that class of electuaries called hypoglottides. But, above all things, the patient at this period must abstain from drinking wine; but when the inflammation becomes moderate, he may take some sweet wine. And let him use those spoon-meats which are made from honey and milk, with starch, and bread of fine flour, and almond emulsions; and let him take butter. When a humour remains fixed in the parts, he must have recourse to detergent remedies, such as the porridge of beans, and those things which are prepared from honey, cabbage, and well-boiled leeks. He may also take the hotter medicines, and those used for the cough, in the rob of dried figs, of frankincense, iris, turpentine, storax, galbanum, pepper, cinnamon, cassia, and the like.
On cough. Coughs are to be cured by the same method, attending only to this, whether they be occasioned by sympathy with other parts, such as a defluxion from the uvula or head, and whether they be symptomatic of other diseases; in which case, they are to be disposed of in the manner already mentioned, or as will be described afterwards. An exposition of the compound remedies follows.