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Incoming links: Pleurisy
“For the remedies will be found in food.” More literally, the sentence says that the remedies “will lie in nourishment”. The connective “for” is retained, and the future tense expresses where the therapeutic resource is to be sought. The statement allows diet to act as treatment; it does not say that every illness can be cured by ordinary eating.
The attribution is to Aretaeus of Cappadocia. The sentence also occurs in the dietary discussion of pleurisy in On the Treatment of Acute Diseases by Aretaeus of Cappadocia, I.10. Thus the printed “Ib.” need not place this separate aphorism inside the preceding chapter on ancient mania. The wider dietary recommendations there belong to ancient medicine; the short maxim can be illustrated without endorsing all of them. [ref]
On the Treatment of Acute Diseases by Aretaeus of Cappadocia. I.10, dietary paragraph beginning with the discussion of nourishment; the Greek has the same future-tense verb
The classical sequence in lobar pneumonia is congestion, red hepatization, grey hepatization, and resolution. These are overlapping morphological phases, not a clock that every pneumonia follows. An affected lung may contain adjacent areas in different phases; bronchopneumonia has scattered airway-centred foci rather than uniform involvement of a whole lobe. Modern antibiotic treatment often interrupts the textbook sequence.[ref]
Pneumonia Pathology in StatPearls. Histopathology: lobar pneumonia and its four stages
During congestion, the lung is heavy, dark red and boggy but still contains some air. Its cut surface gives a blood-stained watery fluid. Microscopy shows distended alveolar capillaries, oedema within alveoli, and an early cellular exudate, before dense pulmonary consolidation has developed. Reduced alveolar ventilation begins as fluid replaces the normal air space.
In red hepatization, the affected lobe is enlarged, firm, red and substantially airless. Its granular cut surface resembles liver, which explains the name; it is not a transformation into liver tissue. The alveoli are occupied by a mesh of fibrin containing abundant red blood cells and neutrophils, while the alveolar capillaries remain congested. Filling of neighbouring air spaces produces continuous pulmonary consolidation. Associated pleurisy may put a fibrinous exudate on the overlying pleura.
In grey hepatization, pulmonary consolidation remains, but the colour becomes grey, grey-brown or yellowish as intact red blood cells disappear and the fibrin and inflammatory leukocytes dominate. Microscopy shows degenerating neutrophils, debris and persistent intra-alveolar fibrin; the conspicuous vascular engorgement of the preceding phase diminishes. Grey colour by itself does not establish a separate pathogen or mean that an abscess has formed.[ref]
Typical Bacterial Pneumonia in StatPearls. Histopathology: red and grey hepatization
In resolution, the intra-alveolar exudate is broken down, ingested by macrophages, removed through airways and cleared by absorption. The lobe softens and becomes aerated again. Where the alveolar septa have survived, the architecture can return nearly to normal; an air-space exudate need not become a permanent scar. Failure of clearance may instead lead to organisation and fibrosis; destructive infection can produce abscess or empyema. These are possible outcomes, not obligatory further stages.
A useful examination compares a cut section and a thin histological section from each region, following the alveolar septa to distinguish filling of existing air spaces from destruction of the framework. A dense airless piece may sink in water, but this physical test only shows reduced air content: atelectasis can also sink. The distribution and the microscopy establish why the tissue is airless.
The 1864 British Pharmacopoeia supplied mild rubefacients, blistering preparations and agents producing pustulation; these different degrees of injury were grouped under historical counterirritation. Redness of the skin demonstrates a local effect, not removal of inflammation from a distant organ. The following enumeration uses the preparations current for the 1865 examination.
- Mustard, as Sinapis and Cataplasma Sinapis, was a rapidly acting rubefacient, used historically for transient painful or spasmodic conditions and as a supposed revulsive application in internal disease. Its duration had to be limited because prolonged contact caused a burn. The later compound mustard liniment and mustard paper should not be silently inserted into this 1864 list.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Cruciferae, mustard and its official cataplasm
- Ammonia liniment, Linimentum Ammoniae, and the ammoniacal Linimentum Camphorae Compositum gave relatively prompt irritation. They were used for superficial muscular or rheumatic pains when a short rubefacient effect was desired. Simple camphor liniment and soap liniment were milder stimulating embrocations for stiff painful parts; the compound camphor liniment owed much of its greater irritation to Ammonia.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). strong solution of ammonia; Lauraceae, camphor preparations
- Turpentine, in Linimentum Terebinthinae or Linimentum Terebinthinae Aceticum, and in the official turpentine ointment, was used as a stimulating application. Historical indications included muscular pain, neuralgic pain and chest or abdominal applications intended to act on deeper disease. The acetic preparation was the more irritating form. This does not establish that either could cure pneumonia or intestinal disease.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coniferae, turpentine liniments and ointment
- Capsicum and its tincture supplied a pungent local stimulant, used in diluted embrocations for chronic painful conditions. Burgundy pitch, chiefly Emplastrum Picis, supplied milder sustained stimulation, historically chosen for chronic chest, back or rheumatic discomfort. An adhesive plaster could itself cause dermatitis.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Solanaceae, capsicum; Coniferae continued, pitch plaster
- Cantharides supplied Emplastrum Cantharidis, Linimentum Cantharidis, Emplastrum Calefaciens and Unguentum Cantharidis. The warming plaster aimed at a milder prolonged effect; the ordinary plaster and liniment were vesicants, while the ointment could maintain an already blistered surface. Period indications included pleurisy, pericarditis, chronic painful anatomical joints and neuralgia. These were intended remote effects, not demonstrated cures. The 1864 name is Linimentum Cantharidis; its later renaming as Liquor Epispasticus must not erase the edition difference. Cantharides vinegar and official blistering paper belong to the later additions, rather than this list.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coleoptera, British preparations and distinction from the old London vinegar[ref]British Pharmacopoeia by the General Medical Council (1867). prefatory lists of additions and altered names, pp. xvii–xx
- Iodine, as Linimentum Iodi, Tinctura Iodi and Unguentum Iodi Compositum, was painted or rubbed over chronic swellings, indurations and diseased anatomical joints. The strong liniment could blister; the intended historical effect was alteration of local action or promotion of absorption. Such an indication was not equivalent to proof that a swelling was benign or that it would resolve.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). iodine, official preparations and external therapeutic uses
- Croton oil, especially Linimentum Crotonis, and tartar emetic, in Unguentum Antimonii Tartarati, produced more persistent irritation and a pustular eruption. They were employed for prolonged counterirritation in chronic pulmonary or other deep-seated complaints when a temporary rubefacient was considered insufficient. Ulceration, scarring and systemic toxicity were substantial disadvantages, not evidence of effective elimination of disease.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Euphorbiaceae, croton liniment; tartarated antimony and its ointment
Other official substances could destroy tissue, but a caustic used to destroy a particular lesion is conceptually different from a counterirritant applied to influence another site. Likewise belladonna and aconite applications were principally intended to relieve pain, not simply to create a competing skin inflammation. Modern treatment should address the diagnosed condition; a historical claim of revulsion cannot justify blistering over a diseased heart or lung. The period literature itself recognised absorption, urinary irritation and sloughing from cantharides. No present-day use of a particular regulated skin preparation makes these broad historical indications valid.[ref]
The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coleoptera, precautions and toxic effects