APPENDIX
PART 1
Ardent fever (causus) takes place when the veins, being dried up
in the summer season, attract acrid and bilious humors to themselves;
and strong fever seizes the whole body, which experiences aches of
the bones, and is in a state of lassitude and
[p. 81] pain. It takes place
most commonly from a long walk and protracted thirst, when the veins
being dried up attract acrid and hot defluxions to themselves. The
tongue becomes rough, dry, and very black; there are gnawing pains
about the bowels; the alvine discharges are watery and yellow; there
is intense thirst, insomnolency, and sometimes wandering of the mind.
To a person in such a state give to drink water and as much boiled
hydromel of a watery consistence as he will take; and if the mouth
be bitter, it may be advantageous to administer an emetic and clyster;
and if these things do not loosen the bowels, purge with the boiled
milk of asses. Give nothing saltish nor acrid, for they will not be
borne; and give no draughts of ptisan until the crisis be past. And
the affection is resolved if there be an epistaxis, or if true critical
sweats supervene with urine having white, thick, and smooth sediments,
or if a deposit take place anywhere; but if it be resolved without
these, there will be a relapse of the complaint, or pain in the hips
and legs will ensue, with thick sputa, provided the patient be convalescent.
Another species of ardent fever: belly loose, much thirst, tongue
rough, dry, and saltish, retention of urine, insomnolency, extremities
cold. In such a case, unless there be a flow of blood from the nose,
or an abscess form about the neck, or pain in the limbs, or the patient
expectorate thick sputa (these occur when the belly is constipated),
or pain of the hips, or lividity of the genital organs, there is no
crisis; tension of the testicle is also a critical symptom. Give attractive
draughts.
PART 2
Bleed in the acute affections, if the disease appear strong, and the
patients be in the vigor of life, and if they have strength. If it
be quinsy or any other of the pleuritic affections, purge with electuaries;
but if the patient be weaker, or if you abstract more blood, you may
administer a clyster every third day, until he be out of danger, and
enjoin total abstinence if necessary.
PART 3
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 in-
[p. 82]tense 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.
PART 4
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.
PART 5
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
[p. 83] 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.
PART 6
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
[p. 84] 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.
PART 7
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
[p. 85] 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.
PART 8
When the bowels are loose during the whole course of fevers, in this
case we are most especially to warm the feet, and see that they are
properly treated with cerates, and wrapped in shawls, so that they
may not become colder than the rest of the body; but when they are
hot, no fomentation must be made to them, but care is to be taken
that they do not become cold; and very little drink is to be used,
either cold water or hydromel. In those cases of fever where the bowels
are loose, and the mind is disordered, the greater number of patients
pick the wool from their blankets, scratch their noses, answer briefly
when questions are put to them, but, when left to themselves, utter
nothing that is rational. Such attacks appear to me to be connected
with black bile. When in these cases there is a colliquative diarrhoea,
I am of opinion that we ought to give the colder and thicker ptisans,
and that the drinks ought to be binding, of a vinous nature, and rather
astringent. In cases of fever attended from the first with vertigo,
throbbing of the head, and thin urine, you may expect the fever to
be exacerbated at the crisis; neither need it excite wonder, although
there be delirium. When, at the commencement, the urine is cloudy
or thick, it is proper to purge gently, provided this be otherwise
proper; but when the urine at first is
[p. 86] thin, do not purge such patients,
but, if thought necessary, give a clyster; such patients should be
thus treated; they should be kept in a quiet state, have unguents
applied to them, and be covered up properly with clothes, and they
should use for drink a watery hydromel, and the juice of ptisan as
a draught in the evening; clear out the bowels at first with a clyster,
but give no purgative medicines to them, for, if you move the bowels
strongly, the urine is not concocted, but the fever remains long,
without sweats and without a crisis. Do not give draughts when the
time of the crisis is at hand, if there be agitation, but only when
the fever abates and is alleviated. It is proper to be guarded at
the crises of other fevers, and to withhold the draughts at that season.
Fevers of this description are apt to be protracted, and to have determinations,
if the inferior extremities be cold, about the ears and neck, or,
if these parts are not cold, to have other changes; they have epistaxis,
and disorder of the bowels. But in cases of fever attended with nausea,
or distention of the hypochondria, when the patients cannot lie reclined
in the same position, and the extremities are cold, the greatest care
and precaution are necessary; nothing should be given to them, except
oxymel diluted with water; no draught should be administered, until
the fever abate and the urine be concocted; the patient should be
laid in a dark apartment, and recline upon the softest couch, and
he should be kept as long as possible in the same position, so as
not to toss about, for this is particularly beneficial to him. Apply
to the hypochondrium linseed by inunctions, taking care that he do
not catch cold when the application is made; let it be in a tepid
state, and boiled in water and oil. One may judge from the urine what
is to take place, for if the urine be thicker, and more yellowish,
so much the better; but if it be thinner, and blacker, so much the
worse; but if it undergo changes, it indicates a prolongation of the
disease, and the patient, in like manner, must experience a change
to the worse and the better. Irregular fevers should be let alone
until they become settled, and, when they do settle, they are to be
treated by a suitable diet and medicine, attending to the constitution
of the patient.
PART 9
The aspects of the sick are various; wherefore the physician
[p. 87]should
pay attention, that he may not miss observing the exciting causes,
as far as they can be ascertained by reasoning, nor such symptoms
as should appear on an even or odd day, but he ought to be particularly
guarded in observing the odd days, as it is in them, more especially,
that changes take place in patients. He should mark, particularly,
the first day on which the patient became ill, considering when and
whence the disease commenced, for this is of primary importance to
know. When you examine the patient, inquire into all particulars;
first how the head is, and if there be no headache, nor heaviness
in it; then examine if the hypochondria and sides be free of pain; for if the hypochondrium
be painful, swelled, and unequal, with a sense of satiety, or if there
be pain in the side, and, along with the pain, either cough, tormina,
or belly-ache, if any of these symptoms be present in the hypochondrium,
the bowels should be opened with clysters, and the patient should
drink boiled hydromel in a hot state. The physician should ascertain
whether the patient be apt to faint when he is raised up, and whether
his breathing be free; and examine the discharges from the bowels,
whether they be very black, or of a proper color, like those of persons
in good health, and ascertain whether the fever has a paroxysm every
third day, and look well to such persons on those days. And should
the fourth day prove like the third, the patient is in a dangerous
state. With regard to the symptoms, black stools prognosticate death;
but if they resemble the discharges of a healthy person, and if such
is their appearance every day, it is a favorable symptom; but when
the bowels do not yield to a suppository, and when, though the respiration
be natural, the patient when raised to the night table, or even in
bed, be seized with deliquium, you may expect that the patient, man
or woman, who experiences these symptoms, is about to fall
into a state of delirium. Attention also should be paid to the hands,
for if they tremble, you may expect epistaxis; and observe the nostrils,
whether the breath be drawn in equally by both; and if expiration
by the nostrils be large, a convulsion is apt to take place; and should
a convulsion occur to such a person, death may be anticipated, and
it is well to announce it beforehand.
[p. 88]
PART 10
If, in a winter fever, the tongue be rough, and if there be swoonings,
it is likely to be the remission of the fever. Nevertheless such a
person is to be kept upon a restricted diet, with water for drink,
and hydromel, and the strained juices, not trusting to the remission
of the fevers, as persons having these symptoms are in danger of dying;
when, therefore, you perceive these symptoms, announce this prognostic,
if you shall judge proper, after making the suitable observations.
When, in fevers, any dangerous symptom appears on the fifth day, when
watery discharges suddenly take place from the bowels, when deliquium
animi occurs, or the patient is attacked with loss of speech, convulsions,
or hiccup, under such circumstances he is likely to be affected with
nausea, and sweats break out under the nose and forehead, or on the
back part of the neck and head, and patients with such symptoms shortly
die, from stoppage of the respiration. When, in fevers, abscesses
form about the legs, and, getting into a chronic state, are not concocted
while the fever persists, and if one is seized with a sense of suffocation
in the throat, while the fauces are not swelled, and if it do not
come to maturation, but is repressed, in such a case there is apt
to be a flow of blood from the nose; if this, then, be copious, it
indicates a resolution of the disease, but if not, a prolongation
of the complaint; and the less the discharge, so much worse the symptoms,
and the more protracted the disease; but if the other symptoms are
very favorable, expect in such a case that pains will fall upon the
feet; if then they attack the feet, and if these continue long in
a very painful, and inflamed state, and if there be no resolution,
the pains will extend by degrees to the neck, to the clavicle, shoulder,
breast, or to some articulation, in which an inflammatory tumor will
necessarily form. When these are reduced, if the hands are contracted,
and become trembling, convulsion and delirium seize such a person;
but blisters break out on the eyebrow, erythema takes place, the one
eyelid being tumefied overtops the other, a hard inflammation sets
in, the eye become strongly swelled, and the delirium increases much,
but makes its attacks rather at night than by day. These symptoms
more frequently occur on odd than on even
[p. 89] days, but, whether on the
one or the other, they are of a fatal character. Should you determine
to give purgative medicines in such cases, at the commencement, you
should do so before the fifth day, if there be borborygmi in the bowels,
or, if not, you should omit the medicines altogether. If there be
borborygmi, with bilious stools, purge moderately with scammony; but
with regard to the treatment otherwise, administer as few drinks and
draughts as until there be some amendment, and the disease is past
the fourteenth day. When loss of speech seizes a person, on the fourteenth
day of a fever, there is not usually a speedy resolution, nor any
removal of the disease, for this symptom indicates a protracted disease;
and when it appears on that day, it will be still more prolonged.
When, on the fourth day of a fever, the tongue articulates confusedly,
and when there are watery and bilious discharges from the bowels,
such a patient is apt to fall into a state of delirium; the physician
ought, therefore, to watch him, and attend to whatever symptoms may
turn up. In the season of summer and autumn an epistaxis, suddenly
occurring in acute diseases, indicates vehemence of the attack, and
inflammation in the course of the veins, and on the day following,
the discharge of thin urine; and if the patient be in the prime of
life, and if his body be strong from exercise, and brawny, or of a
melancholic temperament, or if from drinking has trembling hands,
it may be well to announce beforehand either delirium or convulsion;
and if these symptoms occur on even days, so much the better; but
on critical days, they are of a deadly character. If, then, a copious
discharge of blood procure an issue to the fullness thereof about
the nose, or what is collected about the anus, there will be an abscess,
or pains in the hypochondrium, or testicles, or in the limbs; and
when these are resolved, there will be a discharge of thick sputa,
and of smooth, thin urine. In fever attended with singultus, give
asafoetida, oxymel, and carrot, triturated together, in a draught;
or galbanum in honey, and cumin in a linctus, or the juice of ptisan.
Such a person cannot escape, unless critical sweats and gentle sleep
supervene, and thick and acrid urine be passed, or the disease terminate
in
[p. 90]an abscess: give pine-fruit and myrrh in a linctus, and further
give a very little oxymel to drink; but if they are very thirsty,
some barley-water.
PART 11
Peripneumonia, and pleuritic affections, are to be thus observed:
If the fever be acute, and if there be pains on either side, or in
both, and if expiration be if cough be present, and the sputa expectorated
be of a blond or livid color, or likewise thin, frothy, and florid,
or having any other character different from the common, in such a
case, the physician should proceed thus: if the pain pass upward to
the clavicle, or the breast, or the arm, the inner vein in the arm
should be opened on the side affected, and blood abstracted according
to the habit, age, and color of the patient, and the season of the
year, and that largely and boldly, if the pain be acute, so as to
bring on deliquium animi, and afterwards a clyster is to be given.
But if the pain be below the chest, and if very intense, purge the
bowels gently in such an attack of pleurisy, and during the act of
purging give nothing; but after the purging give oxymel. The medicine
is to be administered on the fourth day; on the first three days after
the commencement, a clyster should be given, and if it does not relieve
the patient, he should then be gently purged, but he is to be watched
until the fever goes off, and till the seventh day; then if he appear
to be free from danger, give him some unstrained ptisan, in small
quantity, and thin at first, mixing it with honey. If the expectoration
be easy, and the breathing free, if his sides be free of pain, and
if the fever be gone, he may take the ptisan thicker, and in larger
quantity, twice a day. But if he do not progress favorably, he must
get less of the drink, and of the draught, which should be thin, and
only given once a day, at whatever is judged to be the most favorable
hour; this you will ascertain from the urine. The draught is not to
be given to persons after fever, until you see that the urine and
sputa are concocted (if, indeed, after the administration of the medicine
he be purged frequently, it may be necessary to give it, but it should
be given in smaller quantities and thinner than usual, for from inanition
he will be unable to sleep, or digest properly, or wait the crisis);
but when the melting down of crude matters has
[p. 91]taken place, and his
system has cast off what is offensive, there will then be no objection.
The sputa are concocted when they resemble pus, and the urine when
it has reddish sediments like tares. But there is nothing to prevent
fomentations and cerates being applied for the other pains of the
sides; and the legs and loins may be rubbed with hot oil, or anointed
with fat; linseed, too, in the form of a cataplasm, may be applied
to the hypochondrium and as far up as the breasts. When pneumonia
is at its height, the case is beyond remedy if he is not purged, and
it is bad if he has dyspnoea, and urine that is thin and acrid, and
if sweats come out about the neck and head, for such sweats are bad,
as proceeding from the suffocation, rales, and the violence of the
disease which is obtaining the upper hand, unless there be a copious
evacuation of thick urine, and the sputa be concocted; when either
of these come on spontaneously, that will carry off the disease. A
linctus for pneumonia: Galbanum and pine-fruit in Attic honey; and
southernwood in oxymel; make a decoction of pepper and black hellebore,
and give it in cases of pleurisy attended with violent pain at the
commencement. It is also a good thing to boil opoponax in oxymel,
and, having strained it, to give it to drink; it answers well, also,
in diseases of the liver, and in severe pains proceeding from the
diaphragm, and in all cases in which it is beneficial to determine
to the bowels or urinary organs, when given in wine and honey; when
given to act upon the bowels, it should be drunk in larger quantity,
along with a watery hydromel.
PART 12
A dysentery, when stopped, will give rise to an aposteme, or tumor,
if it do not terminate in fevers with sweats, or with thick and white
urine, or in a tertian fever, or the pain fix upon a varix, or the
testicles, or on the hip-joints.
