Galen, in the seventh book of his work, ‘de Med. sec. loc.’ has treated of these diseases so fully that he may be said to have exhausted the subject. We can only afford room for a few of his general remarks. He states that the arteriacs, or compositions for affections of the arteria trachea, consist of three different kinds of medicines. First, those called by him obstruents, and answering to those now called demulcents, such as Cretan sweet wine, tragacanth, liquorice, and the like, which act by smoothing the asperities of the parts. Second, the acrid, containing cinnamon, turpentine-rosin, and the like. Third, the intermediate, consisting of the juice of ptisan, almonds, and the like. He gives a great number of compositions from Andromachus, Criton, and others, which might deserve attention. Of their ingredients some are expectorants, such as squills, myrrh, &c.; some demulcents, such as liquorice, tragacanth, &c.; and some narcotic, such as opium, mandragora, hyoscyamus, and hemlock. With the medicinal properties of the last-mentioned article (we mean the conium maculatum), which Dr. Paris commends so highly in diseases of the chest, the ancients were sufficiently well acquainted. For humid coughs Galen recommends a composition of alum, opium, galbanum, and storax. He mentions lumbrici in the stomach as a cause of coughs. (Com. in Epid. iii.) Among the remedies mentioned by our author, by Galen, and by most of the ancient authorities, we may remark the inhaling the fumes of certain acrid medicines, such as yellow orpiment and sandarach, or realgar, i. e. red orpiment. Whether the practice be safe or not we shall not pretend to determine; but, unquestionably, it is recommended upon high authority; and therefore it is not true, as has been often stated, that this practice arose from the mistake of confounding the gum juniper, or vernix of the Arabians, also often called sandarach, with the sandarach of the ancients, or realgar. (See Bree on Asthma, p. 231.) We refer to Aëtius (viii, 61); Pseudo-Dioscorides (Euporist. ii, 33); Pliny (H. N. xxxiv, 55); Alexander (v, 4); Myrepsus (xli, 76); Serapion (ii, 19, and 24); and Rhases (Cont. viii.) The ancient veterinary surgeons used arsenic in fumigations for the coughs of cattle. See Vegetius (Mulom. iii, 67.) Platearius, a modern writer of the thirteenth century, recommends arsenic for chronic coughs, both in fumigations and taken into the stomach, and yet he distinguishes quite correctly the sandarach, or red arsenic, from the gum vernix. (De Simplici Medicina.) Some of the earlier writers on the venereal disease recommend fumigations with arsenic for syphilitic ulcers of the throat. (V. Aphrodisiacus, and [Sect. XXIX] of this Book.)
At the commencement of a common catarrh, Celsus advises to abstain “a sole, balneo, vino, venere;” but to use “unctione et assueto cibo.” When the lungs become affected he recommends much friction and exercise on foot. He gives the following account of the origin of these complaints: “Destillat autem humor de capite interdum in nares, quod leve est; interdum in fauces, quod pejus est; interdum etiam in pulmonem, quod pessimum est.” The idea of the disease originating in the head and spreading downwards prevails in all the ancient descriptions of the disease, and, we may mention, is now sanctioned by the authority of the illustrious Laennec. See, in particular, Aëtius, who copies, however, in part from Galen.
Alexander devotes a whole chapter to the consideration of these complaints. He forbids diuretics, because they carry off the thin part of the humours and leave the thick behind. Respecting the chalazia mentioned by Galen, and “the smooth, hard, and firm stone” said to have been expectorated by Alexander’s patient, we have a few remarks to make. The passage in Galen’s work where they are described is at ‘de Loc. Affect.’ iv, near the end. These sputa have been described by recent pathologists. Thus Andral calls them small clots, of a dull white, or inclining a little to yellow, from a small pin’s head to a pea in size. (Clinical Medicine, 464, Engl. ed.) The modern authorities agree that they are indicative of phthisis. Aretæus describes by the name of pneumodes, and as a species of asthma, a diseased state resembling that which we are treating of. The symptoms are dyspnœa, cough, and wasting; pulse small, frequent, and feeble; the sputa, if any, small, white, round, and like hail. The disease proves fatal in the course of a year, and often ends in dropsy and anasarca.
The treatment recommended by the great Methodist Cælius Aurelianus is not much different from the practice of the other sects, only he enjoins a more rigid abstinence from wine and food of a heating nature. He also condemns the practice of inhaling the vapours of red arsenic (sandaracha), and the like. In protracted cases he recommends a change of place.
There is nothing original in the practice of the Arabians. Avicenna prudently forbids preparations of poppies after expectoration has commenced. For coryza Haly Abbas recommends, if the patient’s age and temperament permit, bleeding, a spare diet, abstinence from wine, fumigations with the vapours of camphor, lignum aloes, vinegar, &c.; avoiding to lie on the back, and so forth. He treats at great length of coughs, distinguishing them according as they are seated in the throat, gullet, or lungs, and whether they be sympathetic or not. For hoarseness, he directs gargles from the seed of anise or fennel, or a decoction containing radishes, parsley, fennel, mastich, spikenard, iris, figs, &c. Alsaharavius treats fully of these complaints in much the same terms.
SECT. XXIX.—ORTHOPNŒA, ASTHMA, AND DYSPNŒA.
Those who breathe thick without fever, like those who have run fast, are said to be asthmatic, that is to say, to pant for breath; and from their being obliged to keep the chest erect for fear of being suffocated, they are called orthopnoic. The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs. Dyspnœa is a common symptom which accompanies these and many other complaints. The indication of cure in asthmatic complaints is to consume the viscid and thick humour by attenuant and detergent medicines. Wherefore the vinegar of squills will answer well with them, and the oxymel prepared from it; the baked squill itself when triturated with honey; the antidote called hiera, continued purging with drastic medicines, and vomiting from radishes. And, in like manner, the round birthwort may be drunk, the root of the great centaury, the fruit and root of cow-parsnip, the fruit of calamint, hyssop, iris, and gith. Put a sextarius of slaters, into an earthen vessel, roast upon the coals; when whitened, pulverize, and, mixing with boiled honey, give a mystrum thereof before and after food. If there be any urgent necessity, before doing all these things, open a vein and evacuate proportionably to the patient’s strength; and stimulate the belly by clysters. Externally to the chest we may apply cataplasms from figs, the flour of iris, and of barley, containing rosin, wax, and honey; and iris and manna may be sprinkled upon them. Some benefit may also be derived from raw barley-flour, with rosin, wax, iris, and manna. We may use the more heating ointments, such as those of iris, dill, and rue. But the following application is particularly proper: Of pumice-stone, p. j; of burnt lees of wine, p. iv; of arsenic, p. j; of the schenanth, p. ij; of alcyonium, p. j; of aphronitrum, p. ij; pound, sift, mix with the ointment, and with it rub the parts about the chest, and use emollient ointments for attracting the humours.
A draught for asthmatics. Of poley, of southernwood, of castor, of ground pine, of ammoniac perfume, equal parts; mix with honey, and give.—Otherwise: Some give a spoonful of aphronitrum in three cyathi (cupfuls) of honied water.—Another: Of aphronitrum, dr. ix; of pepper, dr. j; of laserwort, dr. ss; give a spoonful in water.—Another: Of castor, of ammoniac perfume, of each, dr. vj; of pepper, xl grains; mix with must, and give to the size of a bean in honied water.—Another: Of mustard, dr. j; of the spuma nitri, three oboli; of elaterium, a diachylon (i. e. half an obolus): form the whole into eight trochisks, and give two every two days; for they will evacuate upwards gently. To those who are choked for want of breath, give, of aphronitrum, dr. iij, with three cyathi of hydromel, and sometimes with cardamom, and it will relieve them immediately. It is also useful in ischiatic disease.
Commentary. The following ancient works may be consulted: Hippocrates (Aphoris.); Galen (de Comp. Med. sec. loc. vii); Celsus (iv, 4); Aretæus (Morb. i, 11); Cælius Aurelianus (Morb. Tard. iii, 1); Aëtius (viii, 63); Oribasius (Loc. Affect. iv, 79); Actuarius (Meth. Med. iv, 4); Marcellus (de Med. 17); Nonnus (127); Octavius Horatianus (ii, 2, 12); Serapion (ii, 24); Avicenna (iii, 10, 1, 38); Mesue (de Ægrit. Pect.); Haly Abbas (Pract. vi, 8; Theor. ix, 20); Alsaharavius (Pract. viii, 5); Rhases (ad Mansor. ix, 56; Contin. viii.)
Our author’s theory of the disease is borrowed from Galen, and seems very plausible. It being admitted by our best modern pathologists, that there is no organic alteration of structure in ordinary cases of convulsive asthma, it seems likely that the paroxysm is occasioned by thick and viscid humours infarcted in the lungs; or, most probably, in many cases from the system being loaded with such humours which nature casts off by the lungs. We need scarcely add, that it is now well ascertained that asthma is frequently produced by engorgement of the lining membrane of the bronchi, thus forming what is called the dry catarrh. Galen, like our author, maintains that the use of attenuant and detergent medicines is indicated. His internal remedies are squills, pepper, wormwood, opopanax, storax, sulphur, oxymel, millepedes, &c. He forbids all things which are either of a very hot or cold nature, as in either case they tend to thicken the humours.