Alexander gives very minute directions how to distinguish pleurisy from hepatitis. He remarks that, in the latter disease, the patient is yellowish: in the former the pulse is hard and serrated. When the pain is not violent, he recommends us to trust to cupping, which he says was a popular remedy in Armenia. He disapproves in general of opiates. When the discharges from the bowels are bilious, he directs purging with scammony, black hellebore, and the like. According to Actuarius, the urine in pleurisy is first reddish, and afterwards becomes red and of a dark wine colour. (De Urinis, vii, 9.) The sputa, he says, in pleurisy and pneumonia, is of a whitish and bloody colour. (De Diagnos. i, 16.)
Psellus cautions us not to confound pleurisy with abscess of the side. In the latter case, he remarks, there is no cough, and pain is felt upon pressure. He appears to copy from Paulus.
There is nothing particularly original in the accounts given of it by Oribasius, Nonnus, Octavius, and Marcellus. We shall, therefore, proceed to explain the views of the Methodists. The remedies recommended by Cælius Aurelianus are, upon the whole, nearly the same as those directed by the other sects, but he attaches much importance to his own method of applying them. In illustration of his principles, we shall mention a few of his strictures upon the practice of the others. He condemns Hippocrates for carrying venesection the length of producing deliquium animi, which he pronounces to be a very pernicious practice. Indiscriminate purging, he thinks, increases irritation. He disapproves of abstinence for seven days, as enjoined by the father of medicine. Diocles he blames for enjoining the same rules with regard to bleeding and purging, and for allowing cold food in summer. Praxagoras he strongly and properly condemns for giving pepper or southernwood in mulse; and also for recommending the warm bath, and fomentations to the side, which he justly remarks will only occasion cold to the patient; and for prohibiting venesection, when the disease is occasioned by cold, and the patient is old and weak. He finds fault with Asclepiades for saying that venesection is not proper in certain countries, as at Rome and Athens, whereas Cælius properly maintains that venesection is everywhere proper. It is worthy of remark, by the way, that prejudices against bleeding prevailed in Rome when Galen wrote, and to a certain extent do so still. Cælius also justly condemns his too free allowance of mulse, or wine and honey. He blames Themison for using acrid applications to the chest. Of his strictures on the treatment of Heraclides, the most just are his condemnation of the practice of giving mulse with rue, and garlic with vinegar, to remove the nausea; and of his direction to bleed only on the second day after two or three clysters had been given.
Of the practice of the Arabians little need be said, as their views of treatment are entirely conformable to those of the Greeks. Avicenna’s directions are most minute, and would furnish an excellent guide to practice. He forbids cold things, and approves of cupping and sinapisms only when the disease does not yield to the ordinary treatment. When insomnolency continues long, he permits to give the syrup of poppies. Convalescents are directed to avoid saltish and sharp things, repletion, the sun, wind, smoke, loud talking, and the like. Serapion, on the fourth day, adds liquorice to the decoction of barley. Mesue and Avicenna agree in opinion, that fomentations to the side do no good unless in slight cases, and when applied early. Mesue forbids cupping until the seventh day; and, when the stomach and bowels are loaded, he opens the bowels before bleeding. Haly Abbas directs bleeding from the arm opposite the side affected, at first; but, if the disease is protracted, from the arm of the same side. He recommends gentle laxatives, and, after bleeding and purging, warm applications to the side, such as a bladder half filled with hot water. He also speaks of cupping, and of stimulant plasters, sinapisms, and such like. He says, when the body is cleansed, and the disease matured, the patient is to be put into a tepid bath. This practice may deserve consideration.
It is worthy of remark that the Arabians in general bleed from the arm of the opposite side. The Greek and Latin authorities are divided in opinion upon this rule of practice. Hippocrates, Galen, and Celsus recommend us to bleed from the arm of the affected side; but Aretæus, Aëtius, and Cælius Aurelianus, from the opposite. Galen, in one place, mentions that he had abstracted blood in a case of pleurisy by opening one of the arteries of the hand.
SECT. XXXIV.—ON AFFECTIONS OF THE HEART.
When the heart itself is primarily affected, the case is far beyond all medical aid, occasioning sudden death; and so also in the inflammations and erysipelas of it, strong distemperatures in very acute fevers, and hemorrhages when it is wounded, especially in the left ventricle. When it is affected sympathetically with the brain, the liver, the orifice of the stomach, and from sorrow, fear, and many other causes, it brings on the affection called syncope, being a sudden collapse of the vital powers, indicated by prostration of strength, deliquium animi, a small pulse, coldness of the extremities, and copious perspiration. When this affection is of a violent nature, it also is irremediable; but if the strength stands out, it may sometimes be relieved. But strong palpitations of the heart often arise from a fulness or effervescence of its blood. When, therefore, the heart is over-heated, it renders the respiration large and dense; but when it is too cold, the respiration is small and rare. The complete cure of syncope of the heart, when it occurs among the symptoms of fever, we have treated of in the [Second Book]. This only may now be added, that when the collapse gains ground after friction and ointments have been applied to the extremities, and after purification of the floor, and other cooling means, we must sprinkle upon the parts of the body which are sweating powdered myrtle, Cimolian earth, or amber, or pomegranate-rind with manna, or Samian earth with gum; and cataplasms of mustard or pellitory, or adarce, are to be applied to the cold extremities, as far as to the groins and armpits. The food should be bread out of water, or out of cold diluted wine, swines’ feet and the joints and snout, and fowls; all the things being given in a cold state. On the head and forehead is to be rubbed the juice of unripe olives, or some astringent application, with gum, and the decoction of roses; and a cataplasm is to be applied to the hypochondria and stomach, formed from dates, roses, the flower of the wild vine, acacia, hypocistis, and alum.
On palpitation of the heart. “I knew a certain person,” says Galen, “who suffered an attack of palpitation of the heart every year in the season of spring. Wherefore, having for three years experienced benefit from venesection, in the fourth he anticipated the attack by getting bled, and escaped from it, and did so for many years afterwards, using at the same time a suitable diet. And yet even he died before attaining old age, as every other person in this complaint does, some being suddenly cut off in acute fevers by syncope; but some of them without syncope, being unexpectedly deprived of life, as if by apoplexy. The majority of those who are thus affected do not reach the fiftieth year of age, but pass the fortieth.”
Commentary. See Galen (de Loc. Affect.); Aëtius (viii, 58); Oribasius (Synops. ix, 6); Actuarius (Meth. Med. iv, 3); Leo (iv, 21); Nonnus (134); Avicenna (iii, 11, 12); Serapion (ii, 27); Avenzoar, (1, 12); Mesue (de Ægrit. Pect.); Haly Abbas (Theor. ix, 22, and Pract. vi, 16); Alsaharavius (Pract. xiii); Rhases (Divis. i, 58, and Contin. xvi.)
Most of the knowledge which the ancients possessed of these obscure complaints may be found in Galen (l. c.) In the body of a monkey he had remarked hydrops pericardii, and in that of a cock he had detected a scirrhous tumour, from which he inferred that these diseases occur also in the human subject. One would almost suspect, however, that the ancients were more familiar with inspectiones cadaverum than they chose to avow. As a proof of this, we may mention what is related by Hesychius of Hermogenes the rhetorician: “Hermogenes the rhetorician having died was dissected, and his heart was found covered with hair, and greatly exceeding its natural size.” (See also Suidas.) Respecting persons having hair on their hearts we quote the following note from Fabricius (Bibliotheca Græca, iv, 429): “Plura exempla hominum quorum cor pilosum est repertum collegit elegantissimus. Muretus (xii, 10, Var. Lect.); Pontanus (Bellar. Attic. 301), et Alexander Tassonus in libro Italicè edito cui titulus Pensieri Diversi, (vi, 30.) De Aristomene Messenio idem tradit præter alios Dio. Chrysost. (xxxv, 430) de Leonida Plutarchus in parallelis minoribus (306.)” It is proper to mention, however, that Senac is incredulous as to the truth of these stories (Essai, &c. 62.) On the subject we are treating of the learned Stephen Bernard has the following remark: “Apparet, ni fallor, ex hoc loco Pauli (iii, 68), veteres morborum sedes in cadaveribus rimari non neglexisse quod etiam patet ex illis quæ de hepatis inflammatione habet (181), qui enim scire poterant aliquando partem ejus cavam, nonnunquam vero gibbam inflammatione tentari nisi ex cadaverum inspectione?” (Ad Nonni Epit. 208.) See also Pliny (Hist. Nat. xi, 70), and the note of Harduin.