CHAPTER X. CURE OF PLEURISY.
IN cases of Pleurisy there is no time for procrastination, nor
for putting off the great remedy. For the fever, being very
acute, hastens to a fatal termination; the pain also of the
succingens hurries on to the worse; and moreover coughs which
agitate the chest and head exhaust the powers. Wherefore
then, on the selfsame day we must by all means open a vein.
But if it be in connection with repletion of food and drink,
having kept the patient fasting for one day, we are to abstract
blood from the vein in the hollow of the elbow, in a line
with the opposite side, (for it is better to take it from a very
great distance); but not to the extent of deliquium animi,
for there is danger of Peripneumonia supervening if the body,
being congealed, should leave the soul; for the fluids rush inward
when deprived of their external heat and tension. For the
Lungs are of loose texture, hot, and possessed of strong powers
of attraction; the lungs also are the neighbours of the ribs,
and their associates in suffering; and this succession of disease
is not readily recovered from; whereas in Pleuritis from
Peripneumonia, recovery readily takes place, this combination
being milder. It is necessary, therefore, after a moderate
flow of blood, to recruit the patient for a time, and afterwards
abstract again; if matters go on well, the same day, provided
the remission be long; but if not, on the day following. But if
there is no remission of the fever (for generally the fever
prevails and increases for one day), we are to abstract blood
the third day during the second remission, when also food is
to be given--after having anointed the patient freely, having
also applied to the side soft oil with the heating ointment of
rue, or the decoction of dill. A very soothing fomentation
is also to be applied to the side. In certain cases, the pain
and inflammation are determined outwardly, so as to make it
appear an affection of the parts there; but it is merely an exacerbation
of the internal symptoms.
Let us now treat of regimen, in order that, respecting all
the system of treatment, there may be no mistake. "For in
food will consist the medicines, but also the medicines in
food." In kind, then, it is to be hot and humid, smooth and
consistent, detergent, solvent, having the power of dissolving
and attenuating phlegm. Of all kinds of food, therefore,
ptisan is to be preferred; at the commencement, then, strained
to its juice, so that the solid part of it may be separated; and
made with honey only; and let the usual articles added to it
for seasoning and variety be absent (for now the juice alone
is sufficient). It will be calculated to moisten and warm, and
able to dissolve and clear away phlegm, to evacuate upwards
without pain such matters as should be brought up, and also
readily evacuate the bowels downwards. For its lubricity
is agreeable and adapted to deglutition. Moreover, its glutinous
quality soothes heat, purges the membranes, concocts
coughs, and softens all the parts. These are the virtues of
barley. The next place to it is held by chondrus,
1 being
possessed of some of the good qualities of ptisan. For in
regard to its glutinous quality, its lubricity, and its appropriateness
for deglutition, it is equal to the other, but in other
respects inferior. They are to be made plain, with honey
alone. The tragus also is excellent.
2 But rice is worse than
these, inasmuch as it has the property of drying, roughening,
and of stopping the purgation of the sides, rather than of
making it more fluid. A very excellent thing is dry bread,
broken into pieces, passed through a sieve, gently warmed,
well concocted, which with honeyed-water is sufficient nourishment.
But if the disease have already progressed, and the
patient have given up his food, the ptisan of barley is to be
administered in a soft state, and well boiled. Dill and salts
are to be the condiments of the ptisan, and oil which is thin,
without quality, without viscidity, without asperity; it is
better, however, not to boil much of the oil with the ptisan;
for thus the draught becomes fatty, and the oil loses its
badness, and with much boiling is no longer perceptible, being
drunk up by the juice. And let leek with its capillary leaves,
and bitter almonds, be boiled with the juice of ptisan; for the
draught thus promotes perspiration, and becomes medicinal,
and the leeks eaten out of the juice are beneficial and very
delicious. Now also is the season for using wholesome eggs;
but if the expectoration be fluid and copious, sprinkle on them
some native sulphur and natron. But the best thing of all
is to give new-laid eggs which have never been subjected to
the fire; for the heat of the hen is more humid than fire, and
more congenial to the patient, as proceeding from one animal
to another. But if the phlegm be glutinous and viscid,
pour oil into the eggs, and sprinkle some of the dried resin
of pine--so that the sulphur may be more powerful; melting
also with them some of the resin of turpentine; pepper also
and all cognate substances are beneficial in eggs, and in all
kinds of food; the extremities of animals melted down in
soups, pigeons, boiled hens; the brains of swine roasted with
the cawl, but without it they are not savoury. If the patient
has no
râle, we must give him fish from the depth of the sea,
or rock fish, the best which the country produces. And that
the patient may not transgress in regimen, owing to his
appetite, nor become wasted by a spare diet, he is to be gratified
with some fruit; such as apples boiled in water, or
honeyed-water, or stewed in suet (but we must take off the
skin and rough parts within along with the seeds,); and in
season we may give some figs. We must give likewise of any
other kind of autumn fruit which is not only not hurtful but
also beneficial. So much with regard to diet.
Wool fumigated with sulphur and moistened with oil
in which dill and rue have been boiled, is to be laid on the
side. Foment the side constantly with these, and, before the
administration of food, apply cataplasms, in addition to the
usual ingredients containing melilot boiled with honeyed-water,
and mixing therewith some of the fleshy part of the
poppy in a boiled state, and sprinkling on it the meal of the
manna thuris.
3 But if the expectoration be more fluid and
copious, we are to mix the flour of darnel, or of hedge
mustard, and sprinkle natron on it. But if the disease be
prolonged, the pain having become fixed, and the purging
liquid, it is to be apprehended that pus is about to form;
wherefore mix with the cataplasms mustard and
cachrys;4
and if the patients have a feeling as if the internal parts were
cold, some vinegar may be poured into it. The heat of the
cataplasms should be of a strong kind, that it may last the
longer; for this is better than having the heat kept up by
renewal of the cataplasms. Let the fomentations consist of
salts and millet in bags, or of warm oil in bladders. Every
apparatus used for fomentation should be light, so that the
weight may not add to the pain. These things moreover are
to be used also after the food, if the pain be urgent.
And, in addition to these means, now also should be the
time of cupping; but it is best after the seventh day: before
this you should not be urgent with it, for the diseases are not
of a favourable character which require cupping before the
seventh day. Let the instrument be large, broad every way,
and sufficient to comprehend the place which is pained; for
the pain does not penetrate inwardly, but spreads in width.
There should be plenty of heat below the cupping-instrument,
so as not only to attract, but also to warm before the extinction
of the fire. And after the extinction, having scarified, we are
to abstract as much blood as the strength will permit; much
more than if you had to take away blood from the hypochondria
for any other cause. For the benefit from cupping is
most marked in cases of Pleurisy. But salts or natron are to
be sprinkled on the scarifications, a pungent and painful practice
indeed, but yet a healthful one. But we must estimate the
powers and habits of the patient. For if strong in mind and
robust in body, we must sprinkle some of the salts, not indeed so
as to come into immediate contact with the wounds themselves,
but they are to be sprinkled on a piece of linen-cloth damped
with oil, and it is to be spread over the place; for the brine
which runs from the melting of the salts is less stimulant than
the salts themselves. We must also pour in much of the oil, that
by its soothing properties it may obtund the pain occasioned by
the acrimony of the other. On the second day it will be a very
good rule to apply the cupping-instrument again, so as that a
thin sanies may be abstracted from the wounds. This, indeed,
is much more effectual than the previous cupping, and much
less calculated to impair the strength; for it is not blood, the
nutriment of the body, but sanies that runs off. This then
you are to do after having made a previous estimate of the
strength. On the third day we are to apply cerate with the
ointments of privet and of rue. But if the sputa still require
purging, we are to melt into the cerates some resin, or mix
some native sulphur therewith, and again the part is to have
a fomentation. With regard to the form of the cupping-instrument,
it should either be an earthen vessel, light, and adapted
to the side, and capacious; or, of bronze, flat at the lips, so as
to comprehend the parts affected with pain; and we are to
place below it much fire along with oil, so that it may keep
alive for a considerable time. But we must not apply the lips
close to the skin, but allow access to the air, so that the heat
may not be extinguished. And we must allow it to burn a
long while, for the heat within it, indeed, is a very good fomentation,
and a good provocative of perspirations.
And we must not overlook purging downwards, in men
injecting oil of rue into the gut, and, in women, also into the
womb. And let something be constantly drunk and swallowed;
for this purpose, honeyed-water, with rue and juice of ptisan,
if there is a constant cough, as being a medicine in the food.
But if it is not the season of administering food, let it be one
of the compound preparations, such as butter boiled with
honey to a proper consistence. Of this, round balls the size
of a bean are to be given to hold under the tongue, moving
them about hither and thither, so that they may not be
swallowed entire, but melted there. The medicine also from
poppies with honey and melilot is agreeable, being possessed
of soothing and hypnotic properties. This is to be given
before the administration of food, after it, and after sleep. To
the patient when fasting, the following medicinal substances are
to be given: of nettle, of linseed, of starch, and of pine fruit in
powder, of each, a cupful (
cyathus), and of bitter almonds twenty-five
in number, and as many seeds of pepper. These things
being toasted and triturated with honey, are to be mixed up
into a linctus; of these the dose is one spoonful (
cochleare).
But if he expectorate thin and unconcocted matters, two
drams of myrrh, one of saffron, and fifteen grains of pepper to
be mixed with one pound of honey. This medicine should be
given also before the administration of food to the amount of
half a spoonful. It is good also in chronic cases, when
oxymel likewise is to be given if the dyspnœa be urgent.
Such physicians as have given cold water to pleuritics, I
cannot comprehend upon what principle they did so, nor can
I approve the practice from experience; for if certain patients
have escaped the danger from having taken cold water, these
would appear to me not to have been pleuritic cases at all.
But by the older physicians, a sort of congestion was called
pleuritis, being a secretion of bile with pain of the side,
attended with either slight fever or no fever at all. This
affection, indeed, got the name of pleurisy, but it is not so in
reality. But sometimes a spirit (or
wind, pneuma) collecting
in the side, creates thirst and a bad sort of pain, and gentle
heat; and this ignorant persons have called pleurisy. In
them, then, cold water might prove a remedy through the
good luck of the person using it; for the thirst may have
been extinguished, and the bile and wind expelled downwards,
while the pain and heat have been dissipated. But in inflammation
of the side and swelling of the
succingeus, not only
cold water but also cold respiration is bad.
If, then, owing to the treatment formerly described persons
affected with pleurisy survive the attack, but have still a
short cough, and now and then are seized with heat, we must
hasten to dissipate these symptoms; for the residue of the
disease either produces a relapse, or it is converted into a suppuration.
