CHAPTER I. THE CURE OF PHRENITICS.
THE patient ought to be laid in a house of moderate size, and
mild temperature--in a warm situation, if winter, and in one
that is cool and humid, if summer; in spring and autumn, to
be regulated according to the season. Then the patient himself,
and all those in the house, are to be ordered to preserve quiet;
for persons in phrensy are sharp of hearing, are sensitive to
noise, and easily become delirious. The walls should be smooth,
level, without projections, not adorned with frieze
1 or paintings;
for painting on a wall is an excitant. And, moreover, they
catch at certain false appearances before their eyes, and grope
about things which are not projecting, as if they were so; and
any unreal occasion may be a cause sufficient to make them
raise their hands. Length and breadth of the couch moderate,
so that the patient may neither toss about in a broad one, nor
fall out of a narrow bed. In plain bed clothes, so that there
may be no inducement to pick at their nap. But on a soft
bed, for a hard one is offensive to the nerves; as in phrenitics,
above all others, the nerves especially suffer, for they are subject
to convulsions. Access of their dearest friends is to be permitted;
stories and conversation not of an exciting character;
for they ought to be gratified in everything, especially in cases
where the delirium tends to anger. Whether they are to be
laid in darkness or in light must be determined by the nature
of the attack; for if they are exasperated by the light, and
see things which exist not, and represent to themselves things
not present, or confound one thing with another, or if strange
images obtrude themselves upon them; and, in a word, if they
are frightened at the light, and the things in the light, darkness
must be chosen; but if not, the opposite state. It is a good
symptom, too, when they become of a sound mind, and their
delirium abates, on exposure to the light. Abstinence from
food should not be prolonged; food should be rather liquid,
scanty, and frequently administered, for food soothes the soul:
the proper time for giving it is during the remissions, both of
the fever and of the delirium. But if they have become
delirious from want of food, and if the fever do not remit, we
are to give food that does not do much harm in fever. It is a
favourable circumstance, when the fever and the delirium agree
both as to the paroxysms and intermissions.
If, therefore, the time for the administering of food be come,
in the first place, it must be enquired whether it be necessary
to abstract blood. If, then, the delirium have come on with
fever at the commencement, in the first or second day, it will
be proper to open a vein at the elbow, especially the middle.
But if the delirium supervene on the third or fourth day, we
are to open a vein up to the first period of critical days. But
if it was past the proper time for bleeding, on the sixth or
seventh day, it will be proper to evacuate considerably before
the crises in acute diseases, either by giving purgative medicines,
or by using other stimulants. But when opening a
vein you must not abstract much, even if you open the vein
at the commencement; for phrenitis is an ailment easily convertible
into syncope. But if the patient be plethoric and
youthful, and if the ailment be connected with fulness in
eating and drinking, those indications have nothing to do with
the phrenitis; for even without the delirium, it would be proper
to abstract much blood in such circumstances; but much less
is to be abstracted, if such persons labour under phrenitis.
But we may open a vein the more boldly in these cases, if the
disease proceed from the præcordia, and not from the head; for
there (in the præcordia) is the origin of life. But the head is
the seat of sensation, and of the origin of the nerves; and it
attracts more blood from the heart than it imparts to the
others. If it therefore suffer, it is not proper to open the vein
at the elbow; for these affections are such that it is no small
injury to evacuate in them. And if the strength be sufficient
to withstand the evacuation, we must abstract only once, lest
during the interval between the acts of evacuation, the proper
season for food be lost. The fevers, in cases of phrenitis, are
of a continual type, neither have they long intermissions,
but experience short and ill-marked remissions. But if the
patient give way before a sufficient quantity has been abstracted,
it must be put off until another remission, unless it
occur at a distant period; but, if not, having resuscitated the
patient by odours, stroking the face, and pricking the feet, we
are immediately to abstract blood. The measure of sufficiency
is the strength.
Liquid food is proper in all febrile diseases, but especially in
phrenitic cases, for these are more arid than mere fevers. The
mulse is to be given, unless they are bilious, for it is indigestible
in patients who are subject to bitter bile. Alica
2 washed
with water, or mulse, is a good thing; also it is good to give
pottages of a plain kind, such as decoctions of savory, of parsley,
or of dill, for these are beneficial to the respiration, and
are diuretic, and a free discharge of urine is beneficial in
phrenetics. All kinds of pot-herbs, especially melons, for their
gluten is good for lubricating the tongue, the trachea, and for
the alvine evacuations; but the best of all are beet, blite, cress,
gourd in season, and whatever else is best in its own season.
The juice of ptisan in a very liquid state, and containing little
nourishment, is most proper at first, being made always thicker
as the disease progresses. But the quantity of nourishment is
to be diminished at the crises, and a little before them. And,
if the disease be protracted, the customary food must not be
abstracted, but we must give nourishing articles from the
cereals, in order to support the patient; and when there is need,
of the flesh of the extremities of beasts and fowls, mostly dissolved
in the soups: these ought to be completely dissolved
during the process of boiling. The rock fishes are preferable
to all others;
3 but on the whole we must choose the best in
the country, for countries are believed to differ as to the kinds
of fish which are best in them. Fruit containing wine must
be given restrictedly, for it is apt to affect the head and præcordia;
but if required by the state of the strength and of
the stomach, we must give such articles as apples boiled in
mulse or roasted in suet. Of other things, each is to be diluted
with hot water, if you give it solely for the refreshment of the
stomach; but if it is wanted also for strength, you must not
dilute the vinous part much. In a word, the food must be
such as I have described.
For the sake of refrigeration, the head is to be damped with
the oil of the unripe olive pounded; for in phrenitics the head
is not fond of being kept warm. But if restlessness and false
visions be present, we must mix equal parts of rose-oil at first;
and the rose-oil is to be increased for the astringing and cooling
of the head. But if they become disordered in understanding,
and their voice change, the hair (
capillary leaves?) of
the wild thyme must be boiled in oils, or the juice of ivy or
of knot-grass is also to be infused. But if the delirium get
more violent, hog's-fennel and cow-parsnip are to be boiled in
the oils, and some vinegar poured in; for these things dissipate
the vapours and heat, and are solvents of the thick humours
which contribute to the delirium. But care must be taken
that the moist application do not extend to the neck and the
tendons, for it is prejudicial to tendons and nerves. Every
season is suitable for the damp application, except the commencement
of a paroxysm; it should be used more rarely
during the increase, but most frequently at the acme; and
whenever they are delirious, then, in particular, it will be
proper to use a cold application, made still more cold in the
season of summer, but in winter tepid. To soothe the delirium
it is well to foment the forehead with oxycrate, or the decoction
of fleabane, by means of a sponge, and then to anoint
with the oil of wild vine or of saffron, and also to anoint the
nose and ears with them.
These things, moreover, also induce sleep. For if they lay
awake all night, nor sleep during the day, and the eyes stand
quite fixed like horns, and the patients toss about and start up,
we must contrive to procure sleep and rest for them; first, by
fomentations to the head, with unmixed rose-oil, or oil of
marjoram with the juice of ivy, or the decoction of wild thyme
or of melilot. But poppy boiled in oil is particularly soporific
when applied to the fontenelle of the head, or with a sponge
to the forehead. But the poppies, if recently plucked and
green, may be applied whole under the pillows; for they
thicken and humectate the spirit (
pneuma), which is dry and
attenuated, and diffuse over the senses fumes which prove the
commencement of sleep. But if greater applications are needed,
we may rub in the meconium (
expressed juice of poppy) itself
on the forehead with water, and also anoint the nostrils with
the same, and pour it into the ears. Gentle rubbing of the
feet with oil, patting of the head, and particularly stroking of
the temples and ears is an effectual means; for by the stroking
of their ears and temples wild beasts are overcome, so as to
cease from their anger and fury.
4 But whatever is
familiar to any one is to him a provocative of sleep. Thus, to the sailor,
repose in a boat, and being carried about on the sea, the
sound of the beach, the murmur of the waves, the boom of
the winds, and the scent of the sea and of the ship. But to
the musician the accustomed notes of his flute in stillness; or
playing on the harp or lyre, or the exercise of musical children
with song. To a teacher, intercourse with the tattle of
children. Different persons are soothed to sleep by different
means.
To the hypochondria and region of the stomach, if distended
by inflammation, hardness, and flatulence, embrocations and
cataplasms are to be applied, with the addition of the oil of the
over-ripe olive, for it is thick, viscid, and calefacient; it therefore
is required in inflammation: let dill or flea-bane be boiled
in it, and it is a good thing to mix all together; but if flatulence
be present also, the fruits of cumin and parsley, and
whatever other things are diuretic and carminative, along
with sifted natron, are to be sprinkled on the application.
But if the liver experience suffering and pain, apply unwashed
wool just taken from the ewe, oil from the unripe olive, or
rose-oil; but we must mix also Hellenic or Cretan rob, and
boil in it melilot, and mixing all these things into one juice,
foment the liver therewith. To the spleen the oil must be
mixed with vinegar; or if it should appear to be enlarged in
bulk, oxycrate, and instead of the wool a soft sponge; for the
spleen delights in and is relieved by such things. But if the
hypochondria be collapsed and retracted upwards, and the
skin be stretched, it will be best instead of the oil, or along
with it, to use thick butter in equal quantity, and let fleabane
and rosemary be boiled in the decoction, and dill is not
unsuitable.
But if it be the proper time for cataplasms, we may use the
same oils to the same places, the ingredients of the cataplasms
being linseed, fenugreek, or fine barley-meal; beans and vetches,
also, are proper if the abdomen be swelled. Roasted millet,
also, in bags, makes a light and soft fomentation; when ground
it makes, along with honey, oil, and linseed, an excellent cataplasm
for the hypochondria. Also let the same flowers, herbs,
and seeds which I have described among the embrocations be
used for the cataplasms. Honey, also, is useful along with
these things, to give consistency to the dry things, and for the
mixing of the toasted things, and for the preservation of the
heat; it is a good thing, likewise, by itself; also a cataplasm
half-boiled, and an embrocation dissolved in some of the
liquids, is effectual as an emollient, calefacient, carminative,
and diuretic, and to moderate the inflammations. These
effects are produced also by mulse when drunk, and even
more and greater effects when conveyed internally to the
trachea, the lungs, the thorax, and the stomach.
The bowels, also, are to be frequently stimulated by suppositories
or liniments (for they are generally constipated), in
order to act as derivatives from the head, and also for the
evaporation of the vapours in the chest, and for the evacuation
of the matters in the belly; but, if the belly be confined for
several days, it must be opened by a clyster of mulse, oil, and
natron.
But if the distension of the inflammation do not properly
subside, we must apply a cupping-instrument with scarificators
where the inflammation points and is greatest, on the
first or second day, according as the inflamed parts may indicate,
and the strength direct; and from those the amount of
the evacuation of the blood must be determined, for excess
occasions syncope. During the first and second day the
fomentation should be the same; but, on the third, cerate with
some of the oils used in the embrocations is to be applied:
then, if they be still in a state of inflammation, epithemes,
consisting of hyssop, fenugreek boiled in mulse, the resin of
the turpentine plant, and wax; the oils the same for these
places. If by these means the delirium do not at all abate, it
will be necessary to have recourse to cropping of the head,
provided the hairs be very long, to the extent of one half;
but, if shorter, down to the skin: then, in the meantime
having recruited the strength, to apply a cupping-instrument
to the vertex, and abstract blood. But dry-cupping is first to
be applied to the back.
But since in all the acute diseases the chest must be remedied,
this part generally suffering with the heart and lungs,
more especially from the difficulty of the respiration, which is
sometimes hot, at other times cold; and, moreover, from ardent
fever, cough, badness of the humours, and sympathy of the
nerves, and complaint of the stomach, and illness of the pleura
and of the diaphragm (for the heart, if it suffer from any dreadful
illness, never recovers),--in cases of phrenitis these parts in
particular must be soothed. For, indeed, the delirium in certain
cases arises from some of the parts in the chest; respiration hot
and dry; thirst acrid; febrile heat not easily endured, as being
determined from all parts to the chest; and illness from the perversion
of its native heat, but greater and more intolerable the
communication of the same from the other parts to the chest:
for the extremities are cold--the head, the feet, and the
hands; but, above these last, the chest. It is to be remedied,
then, by humectation and refrigeration. For bathing, oil
boiled with camomile or nard; in summer, also, Hellenic rob.
But if it be necessary also to apply epithemes, dates moistened
with austere wine, then levigated and pounded into a mass with
nard, barley meal, and flower of the wild vine, form a soothing
cataplasm for the chest: a cooling one is formed of apples
bruised with mastich and melilot; all these things, however, are
to be mixed up with wax and nard. But if the stomach be
affected with torpor and loathing of food, the juice or hair of
worm-wood are mixed up with them; and the hypochondriac
region is to be fomented with this boiled up in oil. The
infusion or the juice of it may be drunk before food to the
amount of two cupfuls of the infusion, or one cupful of the
bitter juice with two cupfuls of water. But if the stomach
be affected with heartburn, not from the constitution of the
disease, but of itself from acrid and saltish humours, or from
being pinched with bile, or from being parched with thirst, we
must give in the food milk mixed with water to the amount
of half a hemina of milk in one cupful of water; the patient
should swallow the most of it, but he may take a small portion
of it with bread.
But if the patient be also affected with Causus, and there be
thirst, restlessness, mania, and a desire of cold water, we must
give less of it than in a case of Causus without phrenitis, for
we must take care lest we injure the nerves; we are to give
them as much as will prove a remedy for the stomach, and a
little is sufficient, for phrenitics are spare drinkers.
But if converted into syncope, and this also happens (the
powers of life being loosened, the patient being melted in
sweat, and all the humours being determined outwardly, the
strength and spirit (
pneuma) being also dissolved), we must disregard
the delirium, and be upon our guard lest the patient be
resolved into vapours and humidity. Then the only support
is wine, to nourish quickly by its substance, and to penetrate
everywhere, even to the extremities; to add tone to tone, to
rouse the torpid spirit (
pneuma), warm that which is cold,
brace what is relaxed, restrain those portions which are flowing
and running outwards, wine being sweet to the senses of smell
so as to impart pleasure; powerful to confirm the strength for
life; and most excellent to soothe the mind in delirium. Wine,
when drunk, accomplishes all these good purposes; for they
become composed by the soothing of their minds, are spontaneously
nourished to strength, and are inspired with
pleasure.
But when the fever has become protracted and feeble, and
the delirium is converted into fatuity, but the hypochondrium
is not much injured by swelling, flatulence, or hardness,
and the head is the part principally affected, we must
boldly wash the head, and practise copious affusions on it; for
thus will the habit of body be moistened, the respiration of the
head and exhalation over the whole body will be restored;
and thus will that which is dry become diluted, and the sense
purified of its mist, while the understanding remains sound
and firm. These, indeed, are the indications of the removal
of the disease.
