On Regimen in Acute Diseases (app_3-app_7)

Hypochondria inflamed not from retention of flatus, tension of the diaphragm, checked respiration, with dry orthopnoea, when no pus is formed, but when these complaints are connected with obstructed respiration; but more especially strong pains of the liver, heaviness of the spleen, and other phlegmasiae and intense

pains above the diaphragm, diseases connected with collections of humors,—all these diseases do not admit of resolution, if treated at first by medicine, but venesection holds the first place in conducting the treatment; then we may have recourse to a clyster, unless the disease be great and strong; but if so, purging also may be necessary; but bleeding and purging together require caution and moderation. Those who attempt to resolve inflammatory diseases at the commencement by the administration of purgative medicines, remove none of the morbific humors which produce the inflammation and tension; for the diseases while unconcocted could not yield, but they melt down those parts which are healthy and resist the disease; so when the body is debilitated the malady obtains the mastery; and when the disease has the upper hand of the body, it does not admit of a cure.

When a person suddenly loses his speech, in connection with obstruction of the veins,—if this happen without warning or any other strong cause, one ought to open the internal vein of the right arm, and abstract blood more or less according to the habit and age of the patient. Such cases are mostly attended with the following symptoms: redness of the face, eyes fixed, hands distended, grinding of the teeth, palpitations, jaws fixed, coldness of the extremities, retention of airs in the veins.

When pains precede, and there are influxes of black bile and of acrid humors, and when by their pungency the internal parts are pained, and the veins being pinched and dried become distended, and getting inflamed attract the humors running into the parts, whence the blood being vitiated, and the airs collected there not being able to find their natural passages, coldness comes on in consequence of this stasis, with vertigo, loss of speech, heaviness of the head, and convulsion, if the disease fix on the liver, the heart, or the great vein (vena cava?); whence they are seized with epilepsy or apoplexy, if the defluxions fall upon the containing parts, and if they are dried up by airs which cannot make their escape; such persons having been first tormented are to be immediately bled at the commencement, while all the peccant vapors and humors are buoyant, for then the cases more easily admit of a cure; and then supporting the strength and

attending to the crisis, we may give emetics, unless the disease be alleviated; or if the bowels be not moved, we may administer a clyster and give the boiled milk of asses, to the amount of not less than twelve heminae, or if the strength permit, to more than sixteen.

Quinsy takes place when a copious and viscid defluxion from the head, in the season of winter or spring, flows into the jugular veins, and when from their large size they attract a greater defluxion; and when owing to the defluxion being of a cold and viscid nature it becomes enfarcted, obstructing the passages of the respiration and of the blood, coagulates the surrounding blood, and renders it motionless and stationary, it being naturally cold and disposed to obstructions. Hence they are seized with convulsive suffocation, the tongue turning livid, assuming a rounded shape, and being vent owing to the veins which are seated below the tongue (for when an enlarged uvula, which is called uva, is cut, a large vein may be observed on each side). These veins, then, becoming filled, and their roots extending into the tongue, which is of a loose and spongy texture, it, owing to its dryness receiving forcibly the juice from the veins, changes from broad and becomes round, its natural color turns to livid, from a soft consistence it grows hard, instead of being flexible it becomes inflexible, so that the patient would soon be suffocated unless speedily relieved. Bleeding, then, in the arm, and opening the sublingual veins, and purging with the electuaries, and giving warm gargles, and shaving the head, we must apply to it and the neck a cerate, and wrap them round with wool, and foment with soft sponges squeezed out of hot water; give to drink water and hydromel, not cold; and administer the juice of ptisan when, having passed the crisis, the patient is out of danger. When, in the season of summer or autumn, there is a hot and nitrous defluxion from the head (it is rendered hot and acrid by the season), being of such a nature it corrodes and ulcerates, and fills with air, and orthopnoea attended with great dryness supervenes; the fauces, when examined, do not seem swollen; the tendons on the back part of the neck are contracted, and have the appearance as if it were tetanus; the voice is lost, the breathing is small, and

inspiration becomes frequent and laborious. In such persons the trachea becomes ulcerated, and the lungs engorged, from the patient’s not being able to draw in the external air. In such cases, unless there be a spontaneous determination to the external parts of the neck, the symptoms become still more dreadful, and the danger more imminent, partly owing to the season, and the hot and acrid humors which cause the disease.

When fever seizes a person who has lately taken food, and whose bowels are loaded with faeces which have been long retained, whether it be attended with pain of the side or not, he ought to lie quiet until the food descend to the lower region of the bowels, and use oxymel for drink; but when the load descends to the loins, a clyster should be administered, or he should be purged by medicine; and when purged, he should take ptisan for food and hydromel for drink; then he may take the cerealia, and boiled fishes, and a watery wine in small quantity, at night, but during the day, a watery hydromel. When the flatus is offensive, either a suppository or clyster is to be administered; but otherwise the oxymel is to be discontinued, until the matters descend to the lower part of the bowels, and then they are to be evacuated by a clyster. But if the ardent fever (causus) supervene when the bowels are empty, should you still judge it proper to administer purgative medicine, it ought not be done during the first three days, nor earlier than the fourth. When you give the medicine, use the ptisan, observing the paroxysms of the fevers, so as not to give it when the fever is setting in, but when it is ceasing, or on the decline, and as far as possible from the commencement. When the feet are cold, give neither drink nor ptisan, nor anything else of the kind, but reckon it an important rule to refrain until they become warm, and then you may administer them with advantage. For the most part, coldness of the feet is a symptom of a paroxysm of the fever coming on; and if at such a season you apply those things, you will commit the greatest possible mistake, for you will augment the disease in no small degree. But when the fever ceases, the feet, on the contrary, become hotter than the rest of the body; for when the heat leaves the feet, it is kindled up in the breast, and sends its flame up to the head. And when

all the heat rushes upwards, and is exhaled at the head, it is not to be wondered at that the feet become cold, being devoid of flesh, and tendinous; and besides, they contract cold, owing to their distance from the hotter parts of the body, an accumulation of heat having taken place in the chest: and again, in like manner, when the fever is resolved and dissipated, the heat descends to the feet, and, at the same time, the head and chest become cold. Wherefore one should attend to this; that when the feet are cold, the bowels are necessarily hot, and filled with nauseous matters; the hypochondrium distended: there is jactitation of the body, owing to the internal disturbance; and aberration of the intellect, and pains; the patient is agitated, and wishes to vomit, and if he vomits bad matters he is pained; but when the heat descends to the feet, and the urine passes freely, he is every way lightened, even although he does not sweat; at this season, then, the ptisan ought to be given; it would be death to give it before.