CHAPTER II. THE CURE OF LETHARGICS.
LETHARGICS are to be laid in the light, and exposed to the
rays of the sun (for the disease is gloom); and in a rather
warm place, for the cause is a congelation of the innate heat.
A soft couch, paintings on the wall, bed-clothes of various
colours, and all things which will provoke the sense of sight;
conversation, friction along with squeezing of the feet, pulling,
tickling. If deep sleep prevail, shouting aloud, angry reproach,
threats regarding those matters which he is accustomed
to dread, announcement of those things which he
desires and expects. Everything to prevent sleep--the reverse
of that which is proper for phrenitics.
With regard to the depletion of lethargics this should be
known:--If the obliviousness be the sequela of another disease,
such as phrenitis, we must not open a vein, nor make a great
evacuation of blood in any way, but inject the belly, not
solely for the evacuation of its contents, but in order to produce
revulsion from above, and to determine from the head:
there should be a good deal of salts and natron in it, and it
answers very well if you add a sprinkling of castor to the
clyster; for in lethargics the lower intestine is cold, and dead,
as it were, to evacuation. But, if the lethargy is not the consequence
of another disease, but is the original affection, and
if the patient appear to be plethoric, provided it be with blood,
we must open a vein at the elbow; but, if with a watery
phlegm, or other humours, we must purge by means of cneoros
1
with the ptisan, or by black hellebore with honeyed-water, in
the beginning, if you wish to do so moderately; but if to a
greater extent, you must give to the patient when fasting of the
medicine called Hiera, to the extent of two drams with three
cupfuls of honeyed-water; and, having waited until it purges,
then give food, if it be the proper season; but otherwise
nourishment is to be given the next day. It will be seasonable
then to give in the evening a dram of the hiera, dissolved
either in two cupfuls of water or of honeyed-water.
Total abstinence from food is bad, as is also much food. It
is proper, then, to administer a little food every day, but not
to withdraw food altogether; for the stomach to be reminded
of its duties and fomented, as it were, during the whole day.
Also the food must be attenuant and laxative, rather in the
form of soups than roasted, such as hens or shell-fish; and the
herb mercury is to be boiled with it, and some vinegar added.
And we may add to the juices, if it be proper to use the juice
of ptisan, something to promote exhalation and the discharge
of urine, such as fennel, parsley--the pot-herbs themselves, or
their fruits. Horehound, also, by its acrid qualities, does good;
and likewise colewort with oil, and the brine of fish (
garum).
The sweet cumin is a most excellent medicine for the flatulence
and urine; for the stomach and bladder are to be stimulated
during the whole time of the disease.
The moist applications to the head the same as in the case
of phrenitics; for in both the senses are filled with vapours,
which must either be expelled by refrigerants and astringents,
such as the oil of roses or the juice of ivy, or dissipated into
exhalation by attenuants, such as wild thyme in vinegar, with
the rose-oil. But if there be pain of the nerves, and coldness of
the whole body, but more especially of the extremities, we
must besmear and bathe the head and neck with castor and
oil of dill, and anoint the spine with the same along with
Sicyonian oil, the oil of must, or old oil; at the same time, we
must rub both the arms from the shoulders and both the legs
from the groins. With these, moreover, the bladder is to be
soothed, which suffers, as being of a nervous nature, and is
stressed as being the passage for the urine; and also is irritated
by the acrimony of the humours, for the urine is bilious. But
if the trembling increase, and there be danger of a convulsion,
we must necessarily use Sicyonian oil to the head, but use it
in small quantity. But if there be inflammation of the hypochondria,
and fulness thereof, flatulence, and tension of the
skin, or if there be a hollow there from retraction inwards of
the hypochondria, we must apply the embrocations and cataplasms,
described by us under Phrenitics.
The cupping-instrument is by no means to be used if the
disease be the consequence of phrenitis, but this may be done
more boldly if it be the original disease. If the tongue be
black, and a swelling point in the hypochondria, the cupping-instrument
must necessarily be used. When in the course of
time the senses have been evacuated, and the patient is otherwise
more tolerant of the disease, we may apply the cupping-instrument
to the top of the head, since we can evacuate from
it without injury to the strength.
Flatulence is to be expelled both upwards and downwards;
for lethargy produces collections of flatus both in the cavities
and in the whole frame, from inactivity, torpor, and want of
spirit, which motion and watchfulness dissipate; wherefore,
having rubbed up green rue with honey and natron, we anoint
therewith; it will expel the wind more effectually if one part
of the resin of turpentine be added to these things. A fomentation
also will expel flatus, either with hot unwashed wool,
or with rough old rags, or a sponge with water in which hyssop,
marjoram, penny-royal, or rue, have been boiled. The
potions
2
also which are taken before food expel flatus, and these also
bring away phlegm and bile in the stomach and bowels; such
are hyssop, boiled mulse, Cretan dictamny, or marjoram:
maiden-hair and agrostis
3
are
acrid, but possessed of expulsive
qualities, for indeed they evacuate flatus and urine.
If there be trembling of the hands and head, he may take
a draught, consisting of castor with three cupfuls of honeyed-water,
for some days; or if he will not drink this, we may
melt down the castor in a sufficient quantity of oil, wherein
rue has been boiled, to the amount of three cupfuls; and a
double amount of this is to be injected into the lower bowel,
and is to be repeated for several days; and after the benefit
derived from it (for it brings off flatus upwards and downwards,
and, in certain cases, urine and fæces), if it should
be diffused over the whole system in any way, the nerves
recover from their tremblings and become strong, and it
changes the habit of body to the hot and dry, and alters the
constitutions of diseases. It is also a very excellent thing to
blow it into the nostrils, for in this way it expels flatulence by
sneezing; for as the bladder secretes urine, so does the nose
mucus. It effects these things by its gentle heat, in which respect
it is superior to the other sternutatories, pepper, hellebore,
soap-wort, and euphorbium; for these things, both at their first
and last impression are harsh, and disorder the head and the sense,
whereas castor gradually creates a gentle heat. To the head
it is also otherwise suitable, because the nerves everywhere
derive their origin from it; and castor is a remedy for the
diseases of the nerves; but to mix it with some one or more
of the medicines described will not be disagreeable, for if it
be mixed, it will not immediately disorder the head, even in
a moderate degree, but after a time it will stir up the heat.
The nose is to be moistened by tickling; by odours acrid
indeed to the sense, but possessed of heating powers, such as
the castor itself, or savory, or penny-royal, or thyme, either
in a green state, or in a dried, moistened well with vinegar.
Anointing with acrid medicines is proper to the feet and
knees. The
materiel thereof should be heating and pungent
by degrees; for there is need of both in cases of lethargy to
induce warmth and watchfulness. In the first place, it is
proper to whip the limbs with the nettles, for the down
thereof sticking to the skin does not endure long, but imparts
no disagreeable tingling and pain; it also moderately stimulates,
induces swelling, and provokes heat. But if you desire
to have these effects produced more powerfully, rub in equal
parts of lemnestis
4 and euphorbium, with oil of must. It is
also a very good thing to rub with raw squill pulverised; but
it is necessary to rub off the oily matter of the limb (for
everything acrid loses its stimulant properties with oil) --
unless it be medicinal -- either the oil of privet, or that
of must, or the Sicyonian. But if after these things a deep
coma prevail, it will be proper, having pounded the wild
cucumber with vinegar, and mixed it with an equal quantity
of a cake of mustard, to apply this as an acrid cataplasm,
and one which will speedily occasion redness, and will also
quickly produce swelling. But if there be danger of blistering
and of wounds, it will be proper to raise the cataplasm
frequently, and see that none of these effects be produced.
These things, therefore, are to be done to relieve the torpor
and insensibility of the parts at all seasons, except at the
commencement of the paroxysms.
But if the patient have already recovered his sensibility,
but there is still some heaviness of the head, noise, or ringing
thereof, it will be proper to evacuate phlegm by the mouth,
first by giving mastich to chew, so that he may constantly
spit, then again stavesacre, the granum cnidium,
5 but more
especially mustard, because it is a common article, and also
because it is more of a phlegmagogue than the others. And
if the patient drink it willingly, it will be sufficient to dissolve
the matters in the stomach, it will also be able to moisten the
stomach and expel flatulence; for this once fortunately happened
to myself in the case of a man who drank it by my
directions; for experience is a good teacher, one ought, then,
to try experiments, for too much caution is ignorance.
The head, then, after the hair has been clipped to the skin,
if much good is not thereby accomplished, is to be shaven to
procure insensible perspiration, and also to allow the anointing
with acrid medicines, such as that from lemnestis (or
adarce),
or thapsia,
6 or mustard moistened with water; these things,
with double the quantity of bread, are to be rubbed on an old
piece of skin, and applied to the head, taking good care at the
expiry of an hour to foment the parts with hot sponges.
It will also not be devoid of utility, when all, or most at
least, of the fatal symptoms of the disease are gone, but the
languor remains, to bathe; and then also gestation, friction,
and all gentle motion will be beneficial.
