CHAPTER III. THE CURE OF CARDIAC AFFECTIONS.
IN Syncope, it is necessary that the physician should exercise
fore-knowledge; for, if you foresee its approach, and if things
present co-operate strongly with you,
1 you may avert it before
its arrival. When it is come on, patients do not readily escape
from it, for I have said that syncope is the dissolution of
nature; and nature when dissolved cannot be restored. We
must try to prevent it then, when still impending, or if not,
at the commencement. We must form our prognosis from
the circumstances stated by us among the acute diseases, where
we have described the cause and also the symptoms. The
fever Causus, then, is the commencement of the attack, and
with Causus the worst of symptoms, dryness, insomnolency,
heat of the viscera, as if from fire, but the external parts cold;
the extremities, that is to say, the hands and feet, very cold;
breathing slowly drawn; for the patients desiderate cold air,
because they expire fire: pulse small, very dense, and trembling.
Judging from these and the other things stated by
me among the symptoms, you will immediately give assistance
at the commencement.
Unless, then, when everything is against it, the habit, the
age, the season, the timidity of the patient, we must open a
vein, and even if many symptoms contra-indicate it, but an
especial one require it, such as the tongue rough, dry, and
black (for it is indicative of all the internal parts). And in
all cases we must form an estimate of the strength, whether
or not it has failed owing to the pains of the disease and the
regimen; for the loss of strength takes place, not only from
deficiency, but also from smothering; and if the syncope arise
from redundancy, and if inflammation of the hypochondria,
or of the liver strongly indicate, there is no necessity for deferring
the bleeding. We are to open the hollow vein at the
elbow, and abstract the blood by a small orifice, that it may
not have a marked effect on the strength; for sudden depletion
tries the natural strength: and we must take away much less
than if from any other cause; for in syncope, even a slight mistake
readily sends a man to the regions below. We must,
therefore, immediately give food for the restoration of the
strength; for Nature delights in the removal of the old, and
in the supply of new things.
But if the strength reject venesection, and inflammations be
present, we must apply the cupping-instrument to the seat
thereof a considerable time previous to the crisis of the disease;
for the crisis takes place at the critical periods; since at
the same periods Nature brings on a favourable crisis, and
diseases prove fatal. And if the patient should come to such
a state as to require wine, it is not very safe to take wine
in inflammations; for, wine to persons labouring under inflammation
is an increase of the pains, but to those free from inflammation
it is an increase of the natural strength. A day or
two before the cupping there is need of cataplasms, both in
order to produce relaxation of the parts and to procure a flow
of blood; and in certain cases, after the cupping, we are to
apply a cataplasm on the next day. In this, too, let there be
moderation; for there is the same danger from the abstraction
of too much blood by cupping. Use clysters only for removing
scybala which have long lodged in the bowels; but
spare the strength.
Cold lotions to the head, such as have been directed by me
under Phrenitis, but somewhat more liberally. Pure air,
rather cooler than otherwise, for respiration. The delight of
the sight is to be studied as to plants, painting, waters, so that
everything may be regarded with pleasure. The conversation
of attendants cheerful; silence and cheerfulness on the
part of the patient. Smells fragrant, not calculated to prove
heavy to the senses in the head. And let the articles of food
also possess a fragrant smell, such as flour moistened with
water or vinegar; bread hot, and newly baked. The mouth
not to be very often rinsed with wine, nor is it to be altogether
rejected.
Drink to be given more frequently and more copiously than
in other complaints. Food every day, light, digestible, mostly
from grain, and that which is pleasant, even if somewhat less
suitable. For, in these cases, rather than in any other, the
palate is to be gratified, since not unusually the disease is
generated in the stomach, so as to occasion resolution thereof.
Abstinence or famine by no means; for the disease is sufficient
to devour up all. But if the period be already come to a
crisis, if there be a dew on the clavicle and forehead, the
extremities cold; the pulse very small and very frequent, as
if creeping, and feeble in tone, the patient must take a little
food, and partake of wine effectually. The head, too, is to
be strengthened by lotions, as also the bladder. These remedies
have been described by me under Phrenitis. We are
to give wine, not copiously nor to satiety, for certain patients
by unseasonable repletion have died of anorexia, and inability
to eat and drink; and to many patients having a good appetite,
when the natural powers were dissolved, the abundant
supply of food was of no avail; the food descending, indeed,
into the stomach, but not ascending from the belly to recruit
the strength. Let the food, therefore, be diversified,
for the most part from grain, so as that it may be supped
rather than masticated; or if solid, let it be made easy to
swallow. Eggs, not quite consistent nor roasted whole, but
deprived of their solid portion; two or three pieces of bread
soaked in wine, at first hot; but, after these, everything cold,
unless there be latent inflammations. The wine is to be fragrant,
and not very astringent; but by no means thick. Of
the Greek wines, the Chian or Lesbian, and such other of the
insular wines as are thin; of the Italian, the Surrentine, or
Fundan, or Falernian, or Signine, unless it be very astringent;
but of these we must reject such as are very old or very young.
It is to be given at first hot, to the amount of not less than
four cyathi, before the crisis, nor more than a hemina even if
the patient be accustomed to drink. But after these things,
having given food, if the symptoms of inflammation be past,
we are again to give it cold as if for a remedy of the thirst;
but this from necessity, and not by itself, but along with the
food. We must also take care that the wine do not affect the
brain; and after this, abstain. And if after an interval, he
wish to sleep, quiet is to be enforced. But if much sweat
flow, the pulse come to a stop, the voice become sharp, and
the breast lose its heat, we are to give as much wine as the
patient can drink. For those who are cold, wine is the only
hope of life. Wine, therefore, if the patient be accustomed
to it, is sometimes to be taken in drink, and sometimes food
is to be eaten with the wine, after an interval, as a respite
from the fatigue induced by the disease and the food, for
when the strength is small, they are much fatigued, even
by the act of taking food. Wherefore the patient must be
stout-hearted and courageous, and the physician must encourage
him with words to be of good cheer, and assist with
diversified food and drink.
The other treatment is also to be applied energetically for
restraining the sweats, and for resuscitating the spark of life.
Let, therefore, an epitheme be applied to the chest on the
left mamma,--dates triturated in wine along with aloes and
mastich,--and let these things be mixed up with a cerate
composed of nard.
2 And if this become disagreeable, we
may apply another epitheme, made by taking the seed, and
whatever is hard out of the apples, and having bruised them
down, mix up with some fragrant meal; then we are to mix
together some of the hair of wormwood, and of myrtle, and of
acacia, and of the manna of frankincense, all sifted; which being
all rubbed up together, are to be added to the cerate of wild vine.
But if the sweat be not thereby restrained, the juice of the
wild grape is to be added to the mixture, and acacia, and
gum, and the edible part of sumach, and alum, and dates,
and the scented juice of roses. All these things along with
nard and oil of wild vine are to be applied to the chest; for
this at the same time cools and is astringent. Let him lie in
cool air, and in a house having a northern exposure; and if the
cool breeze of Boreas breathe upon him, "it will refresh his
soul sadly gasping for breath." The prospect should be to-wards
meadows, fountains, and babbling streams, for the
sweet exhalations from them, and the delightful view, warm
the soul and refresh nature. And, moreover, it is also an
incentive to eat and to drink. But if from want one is not
fortunate enough to possess these things, we must make an
imitation of the cool breeze, by fanning with the branches of
fragrant boughs, and, if the season of spring, by strewing
the ground with such leaves and flowers as are at hand. The
coverlet should be light and old, so as to admit the air, and
permit the exhalation of the heat of the chest; the best kind
is an old linen sheet. We are to sprinkle the neck, the region
of the clavicle and chest with flour, so that it may nourish by
its fragrance, and restrain by its dryness; and the spongy parts
of the body are to be dusted with meal, but the face with
the Samian earth, which is to be passed through a sieve; and
having been bound into a spongy cloth, it is to be dusted on
the part, so that the finer particles may pass through the
pores to the forehead and cheeks. And slaked lime and
roasted gypsum, sifted in a small sieve, are to be applied to
the moist parts. A sponge out of cold water applied to the
face has sometimes stopped the sweats, by occasioning congelation
of the running fluids, and by condensation of the
pores. The anus is to be anointed, so that the flatus arising
from the cold and food may be discharged. And we are to
recall the heat of the extremities by gleucinum,
3 or Sicyonian
oil, along with pepper, castor, natron, and cachry,
4
melting into them a little wax, so that the liniment may
stick. And we are to resuscitate the heat by means of the
ointment of lemnestis, and of euphorbium, and of the fruit of
the bay. The small red onions raw, along with pepper, and
the powdered lees of vinegar, make an excellent cataplasm
to the feet; but it is to be constantly raised from the place
every hour, for there is danger of ulceration and blisters.
From these things there is hope that the patient may thus
escape.
And if the physician should do everything properly, and if
everything turn out well, along with the syncope the inflammations
that supervene are resolved; and sweat, indeed,
is nowhere, but a restoration of the heat everywhere, even at
the extremities of the feet and the nose; but the face is
of a good colour; pulse enlarged in magnitude, not tremulous,
strong; voice the same as customary, loud, and in every
respect lively. Lassitude not out of place, but the patient
is also seen sleeping: and, if sleep seize him, he digests his
food, recovers his senses, and sprouts out into a new nature;
and if roused from sleep, the breathing is free, he is light
and vigorous; and here calls to his memory the circumstances
of the disease like a dream.
But in other cases obscure fevers are left behind, and sometimes
slight inflammations, and a dry tongue: they are parched,
have rigors, are enfeebled, and relaxed, in which cases there
is a conversion to marasmus; when we must not waste time
with rest and a slender diet, but have recourse to motions,
by gestation, and to friction and baths, so that the embers of
life may be roused and mended. We are to give milk, especially
that of a woman who has just borne a child, and that a
male child; for such persons require nursing like new-born
children. Or if it cannot be obtained, we must give the
milk of an ass which has had a foal not long before, for such
milk is particularly thin;
5 and by these means the patient is to
be brought back to convalescence and his accustomed habits.
