Our author’s treatment, which consists of dry cupping, dry fomentations, and the internal use of calefacients and wine, is what Celsus also recommends. He likewise speaks favorably of exercising the upper parts of the body, of friction, and of using purgatives occasionally, and sometimes, though rarely, the bath. Serapion, Rhases, and Avicenna, recommend similar treatment, namely, purgatives and aromatics, such as aloes, anise, calamint, cumin, and the like. Haly Abbas forbids all flatulent food, such as pulse, milk, and grapes; recommends the bath after much exercise, and before dinner, and the stomach to be rubbed, and a cataplasm of salt and cumin applied to it. He also prescribes many calefacient and carminative articles, such as anise, rue, castor with old wine, also the peppers, theriac, mithridate, hiera picra, &c. Alsaharavius recommends aromatics and carminatives, and afterwards that the pit of the stomach should be rubbed with calefacient oils. Averrhoes directs us to give all solid food, as flesh, puddings, &c. quite cold; but spoon-meats may be eaten as warm as the blood or somewhat warmer. This method, he adds, will clear the head and stomach of wind, beget finer blood, brisker spirits, and cause a lively circulation of all the humours.
Rhases and Avicenna describe ulceration of the stomach very accurately, and also thickening of its coats.
Avicenna mentions rupture of the stomach, but does not say whether he alludes to spontaneous rupture or rupture from accident.
Actuarius has given a more distinct account of hæmatemesis than any other of the ancient authorities. He says the blood may be brought up either pure or of a dark colour, and it may be occasioned either by external injuries or proceed from constitutional causes. The constitutional causes are commonly either general plethora or atony of the liver. In certain cases, he says, it proceeds from rupture of the vessels, and in others from relaxation of them, in others again from corrosion. In melæna, he says, the skin is pale. (De Diagnos. i, 39.)
SECT. XXXIX.—ON CHOLERA.
Cholera is an immoderate disorder of the belly, with discharges upwards and downwards, arising from continued indigestion of the food. Persons are affected with indigestion sometimes from the badness of their food, and sometimes owing to a redundance of depraved humours. Wherefore, if the patient be seized with nausea and lancinating pains, while the food remains in the stomach undigested, we must order him to drink tepid water, and to produce vomiting by putting his fingers or feathers down the throat. We must also encourage the discharge by the bowels. After the evacuation of the superfluities, he must take rest, and apply warmth to the hypochondrium, by means of sweet oil, with some wine; or by the oil of mastich, or of spikenard, if it is winter: and he must be allowed to sleep. After digestion has been accomplished, let him have recourse to baths and wholesome food. When the discharge is immoderate, it will be sufficient at first to try those things which are mentioned in the [Second Book] for disorder of the belly. But when the discharge continues, and the belly loses its tone, and the pulse gets small and dense, we must apply a cataplasm of dates, with flowers of wild vine, acacia, the juice of hypocistis, and pomegranate rind. For drink, give a cupful of moderately cold water to swallow; or, what is still better, a decoction of roses, of the flowers of wild vine, of sumach, or of vine-shoots; or we may give the juice of an acid-sweet pomegranate, sprinkling upon it a little mint. When the excretions are more acrid, and heat and thirst come on, we must give the seed of cucumber, with three cupfuls of water; and succory and lettuces boiled in oxycrate are to be used for food. When the discharge cannot be stopped, we must administer some of the austere wines; if the patient be free of fever, the Palmatian, the Aminæan, or palm wine, or that from unripe grapes, with honey; but when he has fever, pomegranate wine, or myrtle wine, or Cibyratic hydromel for drink, and along with crumbs of bread, alica, or chondrus. If he loathes food from grain, he may chew some summer fruit, or medlars, pears, quinces, or pomegranates, but he must spit out the fleshy and hard parts. When he cannot retain the food, let a large dry-cupping instrument be fastened over the stomach, and while it is on let some of the afore-mentioned food be taken. For the spasmodic contractions apply to the muscles hot rags dipped in oil, and liquid cerates, containing some castor and Sicyonian oil; but before applying them let hot water be poured upon the legs. If he cannot get sleep, we must have recourse to the remedies recommended for watchfulness; and if his strength permit, he may take a potion from poppy-heads. When the disease is on the decline, he may be put into a bath, and recruited with chickens, pigeons, the feet of swine, or the like. Diarrhœa, being a corruption of the food, for the most part ceases spontaneously, if no more food be taken until after the complete digestion and evacuation of the corrupted matters; but if it continue, we must use the remedies applicable to cholera.
Commentary. Consult Hippocrates (Epidem. v, 4, et alibi); Galen (Comment., de Fac. Part., de Rat. Vict., de Med. sec. loc. viii); Aretæus (Morb. Acut. ii, 5; de Curat. M. A. ii, 4); Celsus (iv, 11); Alexander (vii, 16); Aëtius (ix, 12); Oribasius (Morb. Curat, iii, 11); Leo (v, 5); Actuarius (Meth. Med. iv, 5); Nonnus (164); Cassius Medicus (Problem.); Scribonius Largus; Cælius Aurelianus (Morb. Acut. iii, 19); Octavius Horatianus (ii, 16); Marcellus (30); Avicenna (iii, 16, 1); Serapion (iii, 14); Avenzoar (ii, 1); Alsaharavius (xvi, 20); Haly Abbas (Pract. vii, 14; Theor. ix, 25); Rhases (Divis. 60, Contin. xi; ad Mansor. ix.)
Hippocrates in his ‘Epidemics’ has given several well-detailed cases of cholera. In one, the patient drank hellebore in the juice of lentils, and vomited; he became cold, and was put into the hot hip-bath, where he regained his heat and recovered. In another place, he says that the disease is, for the most part, occasioned by unwholesome food, such as pork improperly boiled, pot-herbs, summer fruits, &c.
Aretæus defines cholera to be a retrograde movement of the matters in the body upon the stomach and intestines, consisting of a discharge upwards and downwards of bile, which, if the disease proves fatal, becomes black; and, at the same time, the extremities are cold, with profuse sweats, pulse small and dense, constant straining to vomit, and tenesmus. He also makes mention, among the symptoms, of spasms and contractions of the muscles in the legs and arms, borborygmi, tormina, and syncope. The complaint, he says, is occasioned by continued indigestion, and proves fatal by superinducing convulsions, suffocation, and retching. With regard to the treatment, he cautions us not to stop the discharge at first, but to encourage it by giving frequently some tepid water; and when attended with tormina and coldness of the feet, to apply to the belly hot oil of rue, and rub the legs to restore heat. When the fæces are all evacuated, he recommends some cold water to compose the stomach; and when the pulse sinks and becomes frequent, while at the same time there are profuse sweats and deliquium, he approves of adding a small quantity of wine to the water. It is to be of a fragrant and astringent kind, so as to strengthen the powers of the system. When all the symptoms get worse, when spasms of the legs occur, and the pulse becomes insensible, he advises us to give more wine and water. Should the vomiting continue, we must return to very hot drink and hot food, for, he remarks, the transition often proves beneficial. When all these fail, a cupping-instrument is to be put on between the shoulders or below the navel. He afterwards speaks of such applications as those recommended by our author, namely, calefacients applied to the belly, chest, and legs. He concludes with saying, that, if the symptoms, instead of improving, should get worse after this treatment, it will be proper for the physician to accelerate his retreat.
When cholera is not attended with fever, Galen approves of giving a piece of bread soaked in diluted wine, of cold drink, and of applying cupping-instruments to the belly. When the patient is strong, he even recommends the cold bath. He directs afterwards astringent food, and also speaks of clysters, old wine, and asses’ milk. He mentions with seeming approbation that Asclepiades gave tepid water at the commencement.