THE
SYDENHAM SOCIETY
INSTITUTED
MDCCCXLIII
[Illustration: SYDENHAM]
LONDON
MDCCCXLVI.
THE
SEVEN BOOKS
OF
PAULUS ÆGINETA.
TRANSLATED FROM THE GREEK.
WITH
A COMMENTARY
EMBRACING A COMPLETE VIEW OF THE KNOWLEDGE
POSSESSED BY THE
GREEKS, ROMANS, AND ARABIANS
ON
ALL SUBJECTS CONNECTED WITH MEDICINE AND SURGERY.
BY FRANCIS ADAMS.
IN THREE VOLUMES.
VOL. II.
LONDON
PRINTED FOR THE SYDENHAM SOCIETY
MDCCCXLVI.
“MULTUM EGERUNT QUI ANTE NOS FUERUNT, SED NON PEREGERUNT.
SUSPICIENDI TAMEN SUNT, ET RITU DEORUM COLENDI.”
(SENECA, EPIST. LXIV.)
PRINTED BY C. AND J. ADLARD,
BARTHOLOMEW CLOSE.
CONTENTS OF THE SECOND VOLUME.
FOURTH BOOK.
SECT. PAGE
1. On Elephantiasis 1
2. On Leprosy and Psora 15
3. On Lichen 24
4. On Pruritus, or Prurigo 27
5. On Leuce 31
6. On white and black Alphi 33
7. On Stigmata, from the works of Archigenes 36
8. On Exanthemata 37
9. On Epinyctides 39
10. On Phlyctænæ, or Bullæ 41
11. On Burns 42
12. For those beaten with Scourges 45
13. To make Hairs grow on a part that has been burnt 46
14. For Excoriations 47
15. For Myrmecia and Acrochordon 48
16. On Ganglion 50
17. On Phlegmon 51
18. On external Abscesses 54
19. On Gangrene and Sphacelus 59
20. On Herpes 61
21. For Erysipelas 65
22. On Phyma, Bubo, and Phygethlon 71
23. On Furunculus 73
24. On Terminthus 75
25. On Carbuncle, or Anthrax ib.
26. On Cancers 79
27. On Œdema 83
28. On Emphysema 84
29. For Sprains and Contusions 86
30. On Contusions of the Flesh and Ecchymosis 87
31. On Rupture and tearing of the flesh 88
32. On Scirrhus ib.
33. On Strumæ, or Scrofula 91
34. On Steatoma, Atheroma, and Meliceris 94
35. Of Favi 97
36. On the simple Ulcer 99
37. On Agglutinants 101
38. On painful and inflammatory Sores 102
39. On unconcocted Ulcers, and such as have not suppurated 103
40. On hollow Ulcers 104
41. Medicines for cleansing foul Ulcers 106
42. For Worms in Ulcers 107
43. On fungous Ulcers 108
44. On spreading Ulcers, putrid Ulcers, and Phagedæna 109
45. On Ulcers requiring Cicatrization 112
46. On the malignant Ulcers called Chironian and Telephian 114
47. For black Cicatrices 118
48. On sinuous Ulcers 119
49. On Fistula 122
50. For Sores which break out again 125
51. On Ulcers in the Joints 126
52. Those things which extract Shafts, Javelins, Thorns, and
the like ib.
53. On Hemorrhage from Veins and Arteries 127
54. On Wounds of the Nerves 132
55. On Ancylosis 137
56. On Relaxation of the Joints 139
57. On Worms ib.
58. On Ascarides 144
59. On Dracunculus, or the Guinea-Worm 150
FIFTH BOOK.
1. On the Preservatives from venomous animals in general 155
2. The general treatment of all persons bitten or stung by
any venomous animal 157
3. On persons bitten by mad Dogs, and on Hydrophobia 162
4. For the Bites of Dogs that are not mad 168
5. On Wasps and Bees ib.
6. On the Phalangia, or venomous Spiders 169
7. On the Bite of the Spider 171
8. On the Sting of the Scorpion ib.
9. On the Land and Sea Scolopendra 174
10. On the Stellio, or spotted lizard 175
11. On the Mus araneus, or shrew-mouse ib.
12. On Vipers and Echidnæ 177
13. On the Amphisbæna and Scytala 180
14. On the Dryinus. The Introduction from Galen 181
15. On the Hæmorrhus, Prester, or Dipsas 182
16. On the Hydrus, or water serpent 185
17. On the Cenchrinus 186
18. On the Cerastes and Asp 187
19. On the Basilisk 189
20. On the Sea Pastinaca and Muræna 191
21. On the Sea-Dragon ib.
22. On the Sea-Scorpion 192
23. The preparation of the blood of the Sea-tortoise ib.
24. On persons bitten by Crocodiles 193
25. On persons bitten by a Man ib.
26. On Poisons 194
27. On the preservatives from Poisons 195
28. The general treatment of those who have taken any sort
of deleterious substance 196
29. A Catalogue of simple deleterious substances 200
30. On Cantharides 201
31. On the Buprestis 203
32. On the Salamander 204
33. On the Pityocampa, or pine-caterpillar 205
34. On the Sea-hare ib.
35. On the Red Toad or marsh frog 206
36. On Leeches 207
37. On the Chamæleon 208
38. On Henbane 209
39. On Coriander 210
40. On Psyllium, or Fleawort 211
41. On Conium, or Hemlock ib.
42. On the juice of the Poppy 213
43. On the juice of the Carpesia 218
44. On Mandragora, or Mandrake ib.
45. On Aconitum, or Wolfsbane 220
46. On Ixia 221
47. On Ephemeron, or Meadow Saffron 222
48. On the Smilax, or Yew 223
49. On the Strychnos Furiosa, called Dorycnium, by some 224
50. On the Sardonian Herb 225
51. On the horned Poppy 226
52. On Pharicum ib.
53. On Toxicum 227
54. On Mushrooms 228
55. On Bulls’ Blood 230
56. On coagulated Milk 231
57. On Heraclean Honey 232
58. On Gypsum 233
59. On Ceruse 234
60. On Lime, Sandarach, and Arsenic 235
61. On Litharge 236
62. On Lead 237
63. On Mercury 238
64. On white Hellebore, Thapsia, Elaterium, black Agaric, wild
Rue, Gith, and the Down of the Cactos 239
65. On domestic articles, such as Wine and cold Water 243
APPENDIX TO THE FIFTH BOOK.
On feigned Diseases, and the Detection of them 244
On professional Impostors 245
SIXTH BOOK.
1. Preface to the Surgical part 247
2. On burning of the Head for Ophthalmia, Dyspnœa, and
Elephantiasis 248
3. On Hydrocephalus 250
4. On Arteriotomy 253
5. On Angiology, or section of the temporal vessels, and
on burning the same 254
6. On Hypospathismus 256
7. On Periscyphismus 258
8. On suture of the upper Eyelid, and other modes of operating
for Trichiasis 259
9. On burning of the Eyelids by medicines 264
10. On Lagophthalmos, or Hare-eye 265
11. On the suture of the under Eyelid, and the burning of it
by medicines 266
12. On Ectropion, or eversion of the lower Eyelid 267
13. On Anabrochismus and burning with iron 269
14. On Hydatids 270
15. On adhesion of the Eyelids 272
16. On Chalazia, or tumours resembling hailstones 273
17. On Acrochordion and Encanthis 274
18. On Pterygia 275
19. On Staphyloma 277
20. On Hypopyon of the eye 278
21. On Cataracts 279
22. On Ægilops, or fistula lachrymalis 284
23. On imperforate Meatus Auditorius 286
24. On substances that have fallen into the meatus auditorius 287
25. On Polypus 289
26. On Maimed Parts 292
27. On Epulis and Parulis ib.
28. On the Extraction of Teeth 294
29. On constriction of the Tongue, or tongue-tied persons 295
30. On Antiades, or indurated tonsils 297
31. On the Uva 298
32. On thorny substances fixed in the pharynx 300
33. On Laryngotomy 301
34. On Abscess 303
35. On Strumæ, or scrofulous glands 307
36. On Steatoma, Atheroma, and Meliceris 309
37. On Aneurism 310
38. On Bronchocele 314
39. On Ganglion 315
40. On Venesection 316
41. On Cupping 324
42. On burning the Armpit 328
43. On preternatural fingers, and on persons having six fingers 329
44. On the operation of burning for Empyema 330
45. On Cancer 332
46. On male breasts resembling the female 334
47. On burning over the Liver 335
48. On burning over the Spleen 336
49. On burning over the Stomach ib.
50. On Dropsies 337
51. On Exomphalos, or Prolapsus of the Navel 340
52. On Wounds of the Peritoneum, and on falling down of the
Intestine or Omentum, where Gastroraphé also is described:
from the Works of Galen 342
53. On Deficiency of the Prepuce 346
54. On Hypospadiæum, or imperforate Glans Penis 347
55. On Phimus, or Phimosis ib.
56. On Adhesion of the Prepuce to the Glans 349
57. On Circumcision ib.
58. Of Thymi on the Penis 350
59. On Catheterism, and Injection of the Bladder 351
60. On Calculus 354
61. On the Parts about the Testicles 363
62. On Hydrocele 365
63. On Sarcocele and Tophi of the Testicles 369
64. On Cirsocele and Pneumatocele 370
65. On Enterocele, or Intestinal Hernia 372
66. On Bubonocele, or Inguinal Hernia 377
67. On Rhacosis, or Relaxation of the Scrotum 379
68. On Castration ib.
69. On Hermaphrodites 381
70. On Extirpation of the Nympha and Cauda Pudendi ib.
71. On Thymi, Condylomata, and Hemorrhoids about the Female
Parts of Generation 382
72. On Imperforate Pudendum and Phimus 383
73. On Abscess of the Womb 385
74. On Embryulcia and Embryotomy 387
75. On Retention of the Secundines 392
76. On burning the Hips 394
77. On Fistulæ and Favi 396
78. On Fistulæ in Ano 399
79. On Hemorrhoids, or Piles 403
80. On Condylomata, or Excrescences, and Fissures 405
81. On Imperforate Anus ib.
82. On the Excision of Varices 406
83. On the Dracunculi, or Guinea-Worms 409
84. On Amputation of the Extremities ib.
85. On Pterygia about the Nails 414
86. On a bruised Nail 415
87. On Clavi, Myrmecia, and Acrochordones 416
88. On the Extraction of Weapons 418
89. On Fractures and their Differences 427
90. On Fractures of the Bones of the Head 429
91. On Fracture and Contusion of the Nose 443
92. On Fracture of the Lower Jaw, and Contusion of the Ear 445
93. On Fracture of the Clavicle 447
94. On Fracture of the Scapula 450
95. On Fracture of the Breast-Bone 451
96. On Fracture of the Ribs 452
97. On Fracture of the Bones of the Loins and Pubes 454
98. On Fracture of the Vertebræ, Spine of the Back, and Os Sacrum 455
99. On Fracture of the Arm 464
100. On Fracture of the Ulna and Radius 464
101. On Fracture of the Hand and its Fingers 465
102. On Fracture of the Thigh 466
103. On Fracture of the Patella 468
104. On Fracture of the Leg 469
105. On Fracture of the Foot 470
106. On the Arrangement of the Limb ib.
107. On Fractures complicated with a Wound 472
108. On the redundant Callus of Fractures 476
109. On Distortion from the Union by Callus ib.
110. On Bones which have not united by Callus 477
111. On Luxations 478
112. On Dislocations of the Lower Jaw 479
113. On Dislocations of the Clavicle and Acromion 482
114. On Dislocation at the Shoulder 484
115. On Dislocation of the Elbow 489
116. On Dislocations at the Wrist and Fingers 492
117. On Dislocations of the Vertebræ of the Spine 493
118. On Dislocation at the Hip-Joint 498
119. On Dislocation at the Knee 505
120. On Dislocation at the Ankle, and also of the Toes 506
121. On Dislocations with a Wound 509
122. On Dislocation complicated with Fracture 510
PAULUS ÆGINETA.
BOOK FOURTH.
SECT. I.—ON ELEPHANTIASIS.
Well, in my opinion, did Aretæus the Cappadocian say, that the power of
remedies ought to be greater than those of diseases; and that for this
reason elephantiasis is incurable, because it is impossible to find a
medicine more powerful than it. For if cancer, which is, as it were,
an elephantiasis in a particular part, is ranked among the incurable
diseases by Hippocrates himself, how much more is not elephantiasis
incurable, which is, as it were, a cancer of the whole body? But the
black bile from which this affection is formed, having a double origin,
(for it arises either from the melancholic and feculent part, and, as it
were, dregs of the blood, or from yellow bile, both being overheated);
the first variety of the black bile produces the reddish elephantiasis,
which is the more mild, or to speak more truly, less malignant variety;
the others which are more malignant, being accompanied with ulceration of
the whole body and falling off of the extremities, are produced by the
latter variety, or that from yellow bile overheated. Wherefore, those
who are already overpowered by the disease, must be abandoned; but when
the affection is in its commencement, so as that none of the extremities
has fallen off, nor the surface of the body become ulcerated, nor the
hard swellings appeared, and the face merely appears foul, but not
altogether unseemly, we must attempt the cure. For not a few, by merely
burning the head, have prevented many who were beginning to be affected
from being overpowered by this disease. Wherefore, at the commencement
of the disorder, we must have recourse to venesection repeatedly, more
especially if in spring, when the complaint is most apt to occur, and
has its exacerbations. After an interval of a few days, say nine or
ten, we may purge them with the pottage of colocynth, not once only but
frequently, proportioning the dose of the medicine to its strength.
Purging with hiera also suits well with them. After the interval of about
ten days again, we must give them the vinegar of divided milk, not in
less quantity than three heminæ, nor in greater than five, and on the
following days they are to be supported with milk that is not divided
into parts, or new-drawn milk; by which means, if the affection yield,
the same food may be continued; but if it remains in the same state,
after eating acrid things, they must be made to vomit with radishes and
frumentaceous articles of food. After these things, purging with white
hellebore is proper, twice if possible when in spring, but once only
if in autumn. Those, however, who are thoroughly overpowered by the
complaint, must be neither bled nor put on a course of hellebore. For
neither can a translation of the disease from the superficies to the
inner parts, nor a diminution of the offending matter, be any longer
accomplished by these means; but the matter is to be determined to the
stomach and bowels, and alteratives (metasyncritica), used to dry and
constrict the skin. Dry-cupping is also to be applied over the mouth
of the stomach and to the hypochondria, and dropaces used to the same
places; but after a short interval, the same process is to be repeated,
beginning by purging with hiera, and omitting the venesection, which
would prove rather deleterious than beneficial. This process is to be
repeated three or four times in a year, more especially in the seasons
of spring and autumn. The draughts before meals, most suitable for them,
are a cyathus of vinegar, with a cyathus of cedria, and two cyathi of
the juice of unripe cabbage—they are given mixed together, morning and
evening; or, the dried leaves of the herb ironwort, to the amount of a
drachm in one cyathus of wine; or, a drachm of hartshorn and a cyathus of
the vinegar of squills, is given after the morning walk every day; and
other things are to be administered at the same season, such as drs. v
of washed squills in honied water, or in honey, as a linctus; or Cyrenaic
juice, to the amount of a bitter vetch, mixed with honey and butter; or,
dr. ss of the shavings of hartshorn, with two cyathi of wine; or, drs.
iij of Æthiopian cumin, with honey, as a linctus. But a more suitable
remedy is a drachm of the theriac trochisk, triturated in a cyathus of
fine wine, and drunk; and a drachm of the trochisk of squills may in like
manner be taken in a draught. And they praise the juice of calamint as
a most effectual remedy when drunk, and say that the dose to commence
with is three cyathi, which may be increased to six. But of all others
the theriac of vipers is the most effectual remedy, both in a draught
and when rubbed in externally. But where plenty of these animals can
be procured, nothing answers so well as eating the flesh of the vipers
boiled in white broth, with much water, salts, leeks, and dill, to the
separation of their back-bones, their head and tail being first cut off
to the extent of four fingers’ breadth, and their entrails and skin taken
away. And theriac salts are in the same celebrity when taken with other
food. By using them thus, it happens that the scales, or, as it were, the
bark, falls off from the skin.
The regimen is to be as follows: After sleep, having been first rubbed,
and the bowels evacuated, let the patient have recourse to gestation
and vociferation, then to friction and gymnastic exercises of all
kinds, partly by leaping, but more especially by using the halcteres
and leather bag. Having wiped off the sweat, let him be rubbed with the
grease of a boar, of a wolf, of a goat, or of some winged animal, or
with fresh butter; and after a short interval let him bathe, having his
body anointed with the juice of fenugreek, of ptisan, or with a little
ammoniac dissolved in vinegar. After the bath, having got his body wiped,
let him anoint with the oil of lentisk, of wild vine, or of myrtles;
and with a little wine, containing alum and ammoniac, so as to be of
the thickness of the sordes of baths. Having had his body rubbed again
with soft rags, let him rest for half an hour, after which, having drunk
water, let him make himself vomit by putting his fingers or a feather
down his throat. Having vomited, let him drink the wine of wormwood or
of marjoram. The food should be barley bread, or a cake of dried barley
flour, and of potherbs, the beet, the lettuce, the radish, leeks, and
cabbage sweetened in two waters, and capers. Of sea animals, he may
take oysters, pelorides, urchin, all shell fishes, limpets boiled with
beets, and old pickle in place of medicine. But let him abstain from wine
during the whole continuance of the complaint, and from venery; only he
may take a little thin watery wine at the time of his recovery from the
purging, at which season all acrid substances must be abstained from,
except condiments. Give him ptisan, eggs and chondrus, milk and honey,
with bread, mallows, dock, skirret, and fishes with tender flesh; and
of fowls, those which contain wholesome juices; and of fruits, the fig,
grape, and raisins: but of sweetmeats, those which are prepared from pine
kernels, toasted almonds, or bastard saffron. He may take food twice a
day, as it is injurious to subsist upon one meal. After taking care of
the internal parts, let him use detergent ointments (smegmata) in the
bath, from the decoction of beet, or of fenugreek with aphronitrum, soap,
or myrobolan, and sometimes apply depilatories. Purslain triturated with
vinegar is detergent and also the slender houseleek, and the roots of
dock boiled in vinegar, and alum with salts, and red arsenic in equal
proportions with wine and oil of lentisk. Also the composition for
alphos, consisting of alcyonium, nitre, myrtle, sulphur, and the dried
leaves of the wild fig, being rubbed in dry with vinegar; and that
from the burnt shell of the cuttle-fish, and pumice, nitre, and burnt
Cimolian earth, gum, unripe galls in equal quantity, sprinkled dry, or
rubbed in with vinegar. And this one is admirable: Of the roots of dock
a bunch to the amount of a handful, of natron, dr. xl; of frankincense,
dr. xxv; of sulphur, dr. xxv; it is rubbed in with Egyptian vinegar. And
this one is efficacious: Of arsenic, dr. x; of sulphur vivum, dr. viii;
of costus, dr. xii; of quicklime, dr. iv; of wax, dr. iv; of dried bay
berries, dr. xii; these things are mixed with the juice of white poplar
leaves, or with a thick decoction, and they are rubbed in, having the
consistence of honey.—_Another_: Two fasciculi of the roots of dock are
to be boiled in vinegar, pounded in a mortar and triturated, then of
alcyonium, lb. j; of aphronitrum, oz. viij; of sulphur vivum, lb. j; of
the burnt shells of cockles, oz. iv; of chamæleon with its roots, oz.
iv; these things are pounded together until they are of the consistence
of the sordes of the baths, and are then rubbed in often in the sun,
if summer, but if winter, in the bath, until it occasions sweating. And
the dry smegma of Æsculapius would agree excellently with these cases,
and all the smegmata about to be described, even unto those for alphos,
and also those now mentioned, are applicable for those complaints. And
the tumid excrescences, whether inflammatory or ulcerous, are to be
rubbed with Indian buckthorn: or horned poppy, or aloe, or the Andronian
trochisk, or that of Polyides; and let cataplasms be applied of chondrus
with the juice of knot-grass or plantain; or of pellitory of the wall,
triturated; and the leaves of the green Melisian herb, when pounded with
axunge and applied, are wonderfully efficacious, for they redden the
parts, but the redness is easily repressed by the application of bread;
or of the cerate made from almond oil. By this means their natural colour
is restored. When the parts are ulcerated, plasters are suitable: that
from diphryges, and the apple one with wine, that called coracium, that
made from oxymel, the Andronian trochisk, pompholyx and calamine. It
is a symptom that the whole disease is becoming more moderate when the
first ulcers are cicatrized. For the dyspnœa of persons labouring under
elephantiasis give a draught of five or six slaters in three cyathi of
honied water. And some of the general remedies described for dyspnœa will
be applicable for them. Of the natural baths we must select, as being
most particularly useful, the aluminous and chalybeate, and if possible,
such as are cold. It is also particularly serviceable to drink them. And
the use of the sand of the sea-shore has the same effect, and so have all
the sudorifics. But since this affection is one of those which are easily
communicable, no less so than the plague, they are to be removed as far
as possible from cities, and lodged in inland and cold situations, where
there are few inhabitants, if this can be accomplished; for so they may
descend from thence to surrounding places. This is proper partly on their
own account and also on account of those whom they might come in contact
with. For they themselves will thus enjoy the use of a more commodious
air, and they will not communicate the evil to others.
* * * * *
COMMENTARY. Consult Lucretius (vi, 1112); Celsus (iii, 25); Pliny (Hist.
Nat. xxvi, 5); Scribonius Largus (102); Cælius Aurelianus (Pass. Tard.
iv, 1); Marcellus (De Med. xix); Serenus Samonicus (11); Octavius
Horatianus (i, 32); Isidorus (Orig. iv, 8); Vegetius (Mulom. i, 9);
Aretæus (Curat. Morb. Chron. ii, 13); Plutarch (Symp. viii, Quest. 9);
Galen (ad Glauc. ii, 10; de Causis Morb. 7); Oribasius (Morb. Curat. iii,
62; Synops. vii, 5); Pseudo Dioscorides (Euporist. i, 105); Aëtius (xiii,
120); Actuarius (Meth. Med. ii, 11, and iv, 15); Nonnus (Epit. 233);
Psellus (op. medicum); Leo (vii); Myrepsus (De Med. comp.); Avicenna (iv,
3, 3, 1); Serapion (v, 14); Avenzoar (ii, 7, 12, 26); Albucasis (Chirurg.
i, 49); Haly Abbas (Theor. viii, 15, Pract. iv, 3, ix, 69); Alsaharavius
(Pract. xxxi, 2); Rhases (ad Mansor, v, 35, ix, 93, Contin. xxxv, 26.)
We owe the earliest notice which we have of this disease to the poet
Lucretius, who briefly mentions it in the following lines:
“Est elephas morbus qui propter flumina Nili
Gignitur Ægypto in mediâ neque præterea usquam.”
Celsus says that elephantiasis is a chronic disease, almost unknown in
Italy, but very common in certain countries. He calls it an affection of
the whole body, even of the bones. The upper part of the body is covered
with frequent spots and tumours, the redness gradually changes to black,
the skin is thickened, and covered with hard asperities like scales; the
body wastes, but the face, legs, and feet swell; and when the disease
is protracted, the fingers and toes become buried in the swelling, and
a slight fever comes on, which finishes the patient’s sufferings. Such
is his description of the disease. His treatment consists in bleeding
at the commencement, abstinence, then supporting the strength, purging,
exercise, sudorifics, and friction. Baths are to be rarely used; fatty,
glutinous, and flatulent articles of food are to be avoided, but wine is
to be allowed, except at the beginning. The body is to be rubbed with
pounded plantain.
According to Pliny, elephantiasis was never known in Italy until the days
of Pompey the Great, when it was imported from Egypt, and raged for a
time, but soon became extinct. He describes it as affecting the face in
particular with hard, rough, black maculæ, which sometimes spread to the
bones, the toes and fingers being swelled.
Serenus Samonicus, who is said to have flourished about the beginning of
the third century, thus describes the disease:
“Est elephas morbus tristi quoque nomine dirus,
Non solum turpans infandis ora papillis,
Sed cito præcipitans funesto fata venino.”
His remedies are the juice of the bark of the juniper, the ashes and
blood of the weasel, mint, and various external applications, consisting
of ceruse, Egyptian paper, roses, &c.
Scribonius Largus recommends sulphur with common oil for lepra, “et quam
elephantiam dicunt,” but he gives no description of the latter.
It is greatly to be lamented that Cælius Aurelianus’ account of
elephantiasis has come down to us in an imperfect state. His description
is entirely lost, and his detail of the treatment is in a mutilated
state. It appears, however, that his views were similar to those of
Celsus, and that he considered it to be a malignant disease, affecting
principally the skin. He approves of rubbing stimulant ointments into
the skin, and of using medicinal baths, especially the aluminous and
chalybeate. When the applications produce ulceration of the skin, he
directs us to treat it upon general principles. He makes mention of
vomiting by radishes, and latterly by means of the white hellebore. He
approves of a sea voyage and change of scene. He says the first author
who described elephantiasis was Themison, the same person that is damned
to everlasting fame in one of the lines of Juvenal: “Quot Themison agros
autumno occiderit uno.” (Sat. x, 221.) If this statement be correct,
it is clear that Celsus cannot be of so early a date as is generally
believed, that is to say, the Augustan age, for Themison flourished
towards the end of the first century, P. C. He was the founder of the
Methodical sect. Cælius also blames Themison for recommending bleeding
and vomiting unseasonably, and disapproves of his directions respecting
the applications to the skin. It appears that he also disapproved of the
theriac of vipers, and of giving to drink water in which red-hot iron had
been extinguished. There can be no doubt, from the circumstances which he
mentions, that the disease was thought contagious in his time.
Octavius Horatianus, who lived under the emperor Valentinian, gives a
pretty full detail of the treatment, but his description of the symptoms
is defective. He makes mention, however, of _maculæ_, which affect
principally the face; he contends that the whole system is attacked with
the disease, and that the flesh is corrupted. His remedies are much the
same as those recommended by the other authorities, namely, bleeding,
purging, vomiting, the theriac of vipers, and rubbing with the usual
applications for scabies. He also speaks favorably of the natural and the
sea-water baths.
Marcellus the Emperic, who is supposed to have flourished in the reign of
Theodosius, recommends, like Serenus, mint, juniper, and mezereon, for
elephantiasis. He describes it as being attended with hard excrescences
of the extremities, eruptions on the face, and disease of the bones. He
speaks of its being endemic in Ægypt.
The disease, elephantiasis, according to Isidorus, is so called from
its resemblance to the elephant. The skin in it is hard and rough, from
which it gets its appellation, because the surface of the patient’s body
resembles that of an elephant; or because it is a mighty affection, as
the elephant is one of the largest of animals.
Vegetius, the great ancient authority on veterinary surgery, describes
elephantiasis as it affects cattle. The symptoms are hardness and
roughness of the skin, squamæ, eruptions on the feet and head, and a
fetid discharge from the nose. He approves of bleeding, and the other
means recommended by the regular surgeons.
We shall next give the descriptions of the Greek authorities.
Aretæus gives a most elaborate but surely somewhat overstrained
description of elephas, which he paints in colours the most hideous and
disgusting. We shall endeavour to convey to the reader an idea of his
sketch, stripping his picture of its flowery ornaments, and contracting
its bulk. The disease is called _elephas_, he says, from its magnitude,
_leontium_ or _morbus leoninus_, from the supposed resemblance of the
eyebrows to those of the lion; and _satyriasis_, from the venereal
desires with which it is attended. The disease is described as escaping
notice at first, being deep-seated and preying upon the vitals, but
afterwards it is determined to the superficies, commencing sometimes with
the face, and at other times with the extremities. The belly is dry,
because, as he ingeniously remarks, the distribution of the food is
performed regularly, and the vitiated parts strongly attract the chyle
to them as a pabulum to the disease. There are large callous eminences
on the skin, and the veins appear enlarged, owing to a thickening of the
vessels and not to a plethora of blood. The hairs of the head, pubes, and
other parts of the body, drop off. The face in particular is affected
with callous tubercles or warts, and it is not uncommon for the tongue,
and most parts of the body, to be also covered with them. The eyebrows
are thickened, stripped of their hair, and hang down like those of the
lion. The general appearance of the skin, covered as it is with hard
tubercles, and intersected with deep fissures, is said to bear some
resemblance to that of the elephant. Sometimes particular members, such
as the nose, feet, fingers, the whole hand, or the pudenda, will die and
drop off; and it is not uncommon for incurable ulcers to break forth on
different parts of the body. Dyspnœa, and a sense of suffocation, are
occasionally present. He says, it is dangerous to have any intercourse
with persons labouring under the disease, no less so than in the case of
the plague, as both are readily communicated by respiration. He directs
us, at the commencement, to abstract blood freely, because blood is the
_pabulum morbi_. He recommends us to purge with hiera, and to procure
vomiting by radishes, but more particularly by the white hellebore,
upon which he bestows a glowing and eloquent eulogy. Like our author,
he approves of the theriac of vipers. He makes mention of many external
applications of a detergent nature, and in particular praises a soap
used by the Celts for cleaning their clothes. He also commends natron,
alcyonium, sulphur, alum, ammoniac with vinegar, and the like, for the
same purpose. When the flesh is livid, he directs us previously to make
deep incisions in it. The diet is to be plain and digestible; sulphureous
baths are to be used: the patient is to swim frequently in sea-water, to
take a sea voyage, and otherwise not neglect suitable exercise.
Plutarch informs us that it was disputed in his time whether or not
elephantiasis was a new complaint.
Galen, as far as we can recollect, has nowhere treated very particularly
of elephantiasis, but in his work ‘De Causis Morborum’ he has briefly
mentioned that in this disease the nose becomes flattened, the lips
thick, and the ears extenuated, the whole appearance resembling that of
a satyr: and in his work entitled ‘De Curatione ad Glauconem’ he ranks
elephantiasis with cancerous swellings, and says that the disease is
common about Alexandria, owing to the heat of the place and the food of
the inhabitants, which consists principally of lentils, snails, pickles,
the flesh of asses, and the like, all which things have a tendency to
engender the melancholic humour. The temperature of the place likewise,
he shrewdly remarks, determines the superfluities of the system to the
skin. He recommends the treatment which we have already had occasion to
mention, namely, bleeding, purging, and the theriac of vipers. In the
‘Isagoge,’ the black and white hellebores are particularly commended.
Galen elsewhere calls it contagious. (Lib. ii, Simpl. de carne viperæ.)
Oribasius gives no description of the disease, but briefly recommends the
theriac of vipers, and in certain cases purging and bleeding for the cure
of it.
The account given by Aëtius is principally taken from Archigenes, and
is very circumstantial. The disease, he remarks, has been called by the
several names of elephantiasis, leontiasis, and satyriasis. Suspicions,
he says, have been entertained of its being contagious, and he is of
opinion that it is unsafe to hold intercourse with those who are ill of
the disease, as the air becomes contaminated by the effluvia from their
sores, and by their respiration. The disease, he says, is insidious,
for it begins in a concealed manner internally, and does not make its
appearance on the skin until it is confirmed. Men are more subject to
it than women, and intemperate climates predispose to it. The first
symptoms of the disease are torpor, slow respiration, constipated bowels,
urine like that of cattle, continued eructations, and strong venereal
appetites; and when it is determined to the skin, the cheeks and chin
become thickened and of a livid colour, the veins below the tongue are
varicose, and eminences are formed all over the body, but especially on
the forehead and chin. The body becomes increased in bulk, and is borne
down by an intolerable sense of heaviness. Those affected with it become
pusillanimous, and shun the haunts of men. Though the disease, when
confirmed, is of the most hopeless description, he forbids us to abandon
the sick at the commencement. His treatment is almost the same as our
author’s: venesection at the beginning, purging with colocynth or hiera,
and vomiting with radishes or white hellebore. Some, he says, having
remarked that eunuchs escaped taking this complaint, have castrated
themselves as a preventive. He makes mention of all the medicinal
substances recommended by our author, namely, iron-wort, Cyrenaic juice,
the theriac of vipers, &c. For the cutaneous affections he recommends a
great many external applications, containing white hellebore, sulphur,
rue, natron, aloes, and even arsenic. He also speaks of cataplasms,
depilatories, and detergent ointments. He is very particular in directing
that the diet be light and wholesome.
Actuarius calls elephantiasis a cancer of the whole body, which preys
upon all the flesh, and derives its origin from black bile corroding
everything like fire. The first symptoms of it are a falling off of
the hairs of the eyebrows and chin, tumours on the face, an alteration
of the appearance of the eyes, a change of the voice, turgidity of the
sublingual veins, and afterwards cutaneous eruptions of an intractable
nature. He then states that elephantiasis, lepra, psora, and impetigo
are diseases of different gradations of malignity. In another place he
has given the treatment, which is exactly the same as that recommended
by Aretæus, namely, bleeding, purging with hellebore, detergent and
desiccative applications to the skin, &c.
Some applications, seemingly of little efficacy, are recommended for
elephantiasis in the ‘Euporista’ of the Pseudo-Dioscorides.
Nonnus, as usual, abridges our author’s detail of the treatment, and
omits the description. He says it arises from a melancholic humour, which
corrodes the extremities. According to Psellus, the disease is produced
by _melancholy adust_ and the lees of putrid blood.
The account of elephantiasis given by Leo is brief and imperfect. The
disease, he says, is produced by a melancholic humour, which has become
putrid, and corrodes the extremities. It is, he adds, almost incurable,
but may be benefited by purging with the dodder of thyme, by the theriac,
and burning the head at the bregma. The affection, he says, is also
called satyriasmus.
Myrepsus merely mentions some of the common remedies for elephantiasis,
such as arsenic, turpentine, litharge, &c. He gives no description of the
disease.
We now proceed to the Arabians.
Avicenna gives a very circumstantial account of elephantiasis, under the
name of _juzam_ or _judam_, which his translator renders by _lepra_.
He calls it a cancer of the whole body, which arises from black bile,
and is sometimes attended with ulceration, and is sometimes without
it. The disease, he says, is contagious: it is produced by living upon
the flesh of asses, lentils, &c., and is endemic in Alexandria. It is
sometimes called _leonina_, because the face assumes the stern appearance
of the lion’s. He states that, although it begins internally, its first
symptoms are manifested on the extremities. He then describes minutely
the symptoms, namely, redness of the face, inclining to lividity; falling
off of the hairs, enlargement of the veins, affection of the breathing,
thickening, and discoloration of the lips; and afterwards ulceration of
different parts of the body, corrosion of the cartilages of the nose,
then falling off of the nose and extremities, loss of voice, &c. The
treatment he gives with great minuteness, but as it is little different
from that of the Greeks, we need scarcely enter upon it. Suffice it to
say that he mentions early bleeding, purging with hellebore, colocynth,
scammony, &c.; the theriac of vipers, the application of the cautery
to the head, and so forth. Enough has been said to show that this
description applies to the elephantiasis of the Greeks. Considerable
confusion, however, has arisen in consequence of his translator applying
the term _elephantia_ to a very different disease, namely, to an
enlargement of the leg with varicose veins, now generally known by the
name of the _Barbadoes leg_. This complaint he directs to be treated at
first with local bleeding and astringents; but when ulceration takes
place, it is to be remedied only by amputation.
Serapion, in like manner, describes the elephantiasis of the Greeks by
the name of _lepra_. The face, he says, is swelled, livid, and covered
with hard pustules, the hairs of the eyebrows fall off, the whole aspect
becomes hideous, the voice is changed, the perspiration becomes vitiated,
and ulceration seizes different parts of the body. The disease, he says,
takes its origin from the liver, in which the office of sanguification is
improperly performed. His remedies are bleeding, hellebore, the theriac,
&c.
Avenzoar describes the _lepra_ as a cancer arising from contact with
other lepers, or from unwholesome food. He recommends to purge away the
melancholic humour with scammony, colocynth, black hellebore, &c. The
_elephantia_ he describes as a disease in which the leg is swelled like
the leg of an elephant. He considers it almost incurable.
Albucasis gives an account of the operation of burning the head for
_lepra_, i.e. the elephantiasis of the Greeks.
The translator of Haly Abbas, namely, Stephanus Antiochensis, who says
he wrote about the year 1127, describes the disease which we have been
treating of by the name of elephantia. Like the others, Haly represents
it to be a general cancer arising from black bile. He says it proves
contagious by respiration. Among the symptoms, he mentions falling off of
the ciliary and superciliary hairs, dryness of the nose, which sometimes
falls in; in short, he enumerates the same symptoms as the preceding
authorities. For the cure he directs us to bleed from the arteries behind
the ears, those of the temples, or from a vein in the arm; to give
emetics, such as hellebore; to avoid cold; to apply cupping-instruments
to the scrobiculus cordis; to administer the theriac, &c. He recommends
externally decoctions of beans and vetches at first; and afterwards
stimulant lotions, containing arsenic, sulphur, quicklime, and so forth.
He also applies the term elephantia, and sometimes elephas, to the
swelled leg, which he considers to be a species of varix.
Alsaharavius describes four varieties of _lepra_, namely, the leonina,
elephantia, serpentina, and vulpina. The disease, he says, may be
contracted, 1st, by an hereditary taint; 2d, by the use of corrupted
food, such as the flesh of buck-goats, cows, &c.; 3d, by contagion,
through the medium of the respiration. He describes all the gradations
of the disease with greater minuteness than any other ancient author.
In its last stage, he says, the nose falls in, the hairs drop off, the
voice is lost, ulcers break out on the skin, the extremities mortify and
fall away, and the breath is fetid. His treatment varies according to
the circumstances of the case, but, upon the whole, it is scarcely at
all different from that of the others. By the name of elephantia he also
describes the _swelled leg_, which he pronounces to be a very intractable
disease. He directs us, however, to have recourse to bleeding,
melanogogues, abstinence from gross food, emetics, and various external
applications of a stimulant nature, among which he mentions burying the
leg in hot sand.
The translator of Rhases also applies the term _lepra_ to the
elephantiasis of the Greeks. The colour of the eye, he says, is changed,
the voice becomes rough, the face is swelled, like a bladder, and red
with nodes, the hairs fall off, and the extremities at last become
swelled and ulcerated. There is nothing peculiar in his treatment.
He describes, likewise, the _swelled leg_ by the name of elephantia
or elephas. He says that, when tubercles arise on it, it is utterly
incurable; but that when simply enlarged, it may be remedied by
bleeding in the arm, cupping, emetics, attenuant food, and the like.
In his ‘Continens,’ he calls the lepra (elephantiasis) hereditary and
contagious. He says, it is a general cancer, arising from black bile. For
the _swelled leg_ he recommends, as in his other work, bloodletting and
emetics, with stimulant applications, containing pearlashes, sulphur,
&c., and also tight bandages.
Such is the history of elephantiasis given by ancient authors.
The earlier of our modern writers on medicine, describe elephantiasis
as a species of lepra, of which they enumerate four varieties, namely,
elephantia, leonina, alopecia, and tyria. This arrangement is evidently
taken from Alsaharavius. Such is the account which Platiarius gives of
these diseases. In like manner, the Pseudo-Macer ranks elephantiasis with
lepra:
“Est lepræ species elephantiasisque vocatur,” &c. Upon this passage
Cornarius makes the following annotation: “Vulgus medicorum Arabas in hoc
secuti lepram cum elephantiasi confundunt. Immo lepram pro elephantiasi
accipiunt.”
Guido de Cauliaco’s account of the disease is also nearly the same as
that of Alsaharavius. He states decidedly that the disease is contagious,
and recommends bleeding, purging, the actual cautery, the theriac of
vipers. (vi, 1.) Rogerius remarks that the disease is contracted _per
coitum_. (i, 15.) And here, by the way, we may be permitted to state
that we have long been convinced that the syphilis of modern times is a
modified form of the ancient elephantiasis. This opinion is maintained
by several of the writers of the Aphrodisiacus, and also by the learned
Sprengel, who gives a very interesting disquisition on Syphilis in his
‘History of Medicine.’
It appears that the disease in its ancient form is still prevalent in
certain parts of the world; as, for example, in the Sardinian States,
where it is still looked upon as being both contagious and hereditary.
It is also endemic in Norway: nay, it is reported to have broken forth
with all its ancient character in the province of New Brunswick. In the
East, elephantiasis and leontiasis are still considered as aggravated
forms of leprosy. (See Heber’s Travels, ii, 50; and Niebuhr’s Travels,
xxvii, 11.) We may be allowed to add, in conclusion, that a great mass of
misapprehension has prevailed in modern times regarding the elephantiasis
of the Greeks and Arabians. We trust the above sketch will remove the
difficulties which formerly beset this subject.
SECT. II.—ON LEPROSY AND PSORA.
Both these affections consist of an asperity of the skin, with pruritus
or wasting of the body, having their origin from a melancholic humour.
But leprosy spreads over the skin more deeply in a circular form,
throwing out scales which resemble those of fishes. But psora is more
superficial and variously figured, and throws out furfuraceous bodies. In
these cases we must premise venesection when the body appears more than
usually plethoric; but, if not, we must by all means purge with those
things which evacuate black bile. Externally we may use in common either
of the hellebores; and have washed lime dried, and, when going to use it,
we may dilute it in water until it attain the thickness of the wrestler’s
sordes, and anoint.—_Another_: Of sage, of the tears of Æthiopian olive,
of each, dr. viij; of the bark of capper’s root, of gum, of each, dr.
xiij; anoint with vinegar, in the sun. Anemone, when applied, and the
root of the white vine particularly, remove psora. But the following
are compound remedies: Of the flour of darnel, one chœnix; of the white
cardamom, dr. iv; of the scum of natron, dr. j; of copperas, dr. viij; of
the middle roots of asphodel, dr. iv; having triturated them in vinegar,
and made of the thickness of a cerate, anoint, having first applied
nitre to the part; and having removed it, (which do about the third
day,) and washed with cold water, again anoint.—_Another_: Of the juice
of kings’ spears’ roots, oz. vj; of sulphur vivum, of manna, of each,
dr. x; of natron, dr. viij; anoint, mixing with vinegar. The following
simple remedies are particularly applicable for psora: Stavesacre, bitter
lupins, cardamom with vinegar, the root of lily with honey, turpentine
rosin, sulphur, chick peas, goat’s dung; and these compound ones—mix
equal parts of chalcitis and misy with wine, and anoint the more humid
kinds of psora.—_Another_: Boil the tender leaves of rose-bay in a
sextarius of oil until they are dried, and, throwing away the leaves,
add to the oil oz. iij of white wax, and, after it is dissolved, cool
and sprinkle upon it oz. j of sulphur vivum, and anoint in the sun or
in the bath. Some boil also squills with the rose-bay.—_Another_: Of
diachylon, oz. ij; of wax, oz. ij; of oil of roses, oz. j; of litharge,
oz. iij; of ceruse, oz. iij; of liquid pitch, oz. vj; of the dross of
silver, oz. ij; of siricum, oz. ij; of vinegar, what will be sufficient
for the trituration of the dry things.—_Another_: Of ceruse, oz. ss; of
starch, oz. ss; of lead, oz. j; of red lotuses, or of alkanet, oz. ij;
of wax, oz. vj; of oil of roses, oz. ix; boil the alkanet properly with
the oil of roses, and then add the other things.—_Another_: Take ten
eggs, or as many as are required, and having macerated in the most acrid
vinegar until their shell become tender; boil in the vinegar the yelks
of them; having triturated with rose-oil and what remains of the vinegar
a moderate quantity of litharge, anoint, when of the consistence of the
sordes of oil in baths.—_Another_: Three yelks of eggs out of vinegar;
of rose-oil, oz. vj; of sulphur vivum, oz. iij; having triturated the
yelks of the eggs and the sulphur with the vinegar, add the cerate.
And litharge triturated with vinegar and rose oil, until it be of the
consistence of a plaster, cleanses the most acrid kinds of psora; and the
detergent ointments from dock, and the most of those for elephantiasis,
answer well in general with leprosy and psora.
* * * * *
COMMENTARY. See Hippocrates (de Usu Humidorum, Epidem. ii); Galen.
(Meth. Med. xiv; de Causis Sympt. iii, 6; et alibi); Oribasius (Morb.
Curat, iii, 58); Aëtius (xiii, 134); Actuarius (Meth. Med. ii, 11);
Nonnus (Epit. 234); Pseudo-Dioscor. (Euporist. i, 128); Leo (vii, 15,
18); Pollux (Onomasticon, iv, 9); Æschylus (Choeph. 274); Alexander
Aphrodisiensis (Prob. i, 146, and ii, 42); Celsus (v, 28); Scribonius
Largus; Octavius Horatianus (i, 31); Serenus Samonicus; Marcellus (de
Med. xix); Isidorus (Orig. iv, 8); Psellus (op. Medicum); Vegetius
(Mulom. iii, 71); Geopon. (xviii, 15); Serapion (v, 2); Avicenna (iv, 7,
2, 9); Avenzoar (ii, 7, 4); Haly Abbas (Theor. viii, 16; Pract. iv, 4);
Alsaharavius (xxxi, 1, 2, 3, 4); Rhases (ad Mansor. v, 31 et seq.; Divis.
117, et seq.); Contin. (xxxvi.)
As in the preceding chapter, we shall here give a separate account of the
views of the Greeks, Latins, and Arabians, beginning, in this instance,
with the Greeks.
Hippocrates makes only casual mention of these diseases, and has nowhere
marked their distinguishing characters. In one place he calls leprosy
a blemish rather than a disease; and in another he remarks that some
varieties of it itch before rain. He speaks of vinegar, and of lime and
water as remedies for it. It is proper to apprize the reader that the two
works quoted above from the Hippocratic Collection are, most probably,
not genuine.
Galen also is very deficient on the subject of lepra, having nowhere
given a complete description of it, although he notices it incidentally
in many parts of his works. In one place he calls elephas, leuce, and
alphos cognate affections. Alphos, he says, is much more superficial than
leuce. In another, he attributes these complaints to the melancholic
humour which becomes fixed in the skin. In the ‘Isagogue,’ which,
however, seems not to be a genuine work of his, it is said that lepra is
an affection of the skin, which becomes whiter and rougher than natural,
the roughness resembling that from prominent psydracia. Psora is said to
partake more of the nature of ulceration. Both are represented as arising
from a saltish phlegm, and as being cured by phlegmagogues, and ointments
rubbed into the skin. It is also stated that leuce is distinguished from
lepra by there being no roughness of the skin in the former disease. In
another place he mentions psora as a disease most inveterate to cure.
(Facult. Natur. i, 13.)
Oribasius thus distinguishes leuce, alphos, melas, lepra, and psora
from one another. Leuce is occasioned by a pituitous and viscid blood,
which, in process of time, renders the colour white. Alphos arises in
like manner, but the superficial skin only is affected, and not the whole
flesh. When a pituitous humour is the cause of the complaint, it puts
on the appearance of alphos, and when the melancholic, of melas. Lepra
affects mostly the deep-seated parts, and psora the superficial. For all
these complaints he recommends a mixture of lime and water and some other
such things.
In the ‘Euporista,’ generally ascribed to Dioscorides, there is given a
long list of medicinal articles for lepra, such as the flour of darnel
with sulphur, hellebore with vinegar, verdigris, cantharides, &c.
Aëtius, copying from Archigenes, thus marks the difference between
lepra and its cognate diseases. Lepra differs from leuce and alphos,
inasmuch as lepra is distinguished by roughness and a sense of itching,
and yet the skin only is affected, and when it is removed, the flesh
below is discovered to be sound; but in leuce, the flesh below assumes
an unnatural degree of whiteness, while the surface of the part is very
smooth, and when rubbed it soon becomes red, especially in those who
are readily cured; and alphos is altogether superficial, having the
appearance of a scale fastened to the skin. Lepra differs from psora,
inasmuch as in psora the substances which appear on the skin are of a
furfuraceous nature, while in lepra they resemble the scales of a large
fish. He omits the constitutional treatment so judiciously stated by our
author, but his local applications are little different. They contain
hellebore, sulphur, misy, verdigris, liquid pitch, cantharides, natron,
copperas, myrrh, galls, vinegar, &c., mixed in various proportions.
Actuarius states that lepra is next to elephantia in malignity, and that
it is distinguished from psora by spreading deeper and having scales of a
circular shape like those of fishes; whereas, psora is more superficial,
and its scales are furfuraceous and of no determinate shape. Both are
attended with asperity of the skin, and itching. Leuce holds the same
place to alphos that lepra does to psora, that is to say, leuce is
more deep-seated, and affects the colour of the hair, while alphos is
more superficial, and the hair is in general unchanged. For all these
affections he recommends an application containing copperas, black
hellebore, arsenic, and cantharides, mixed with oil, cedar resin, or rose
oil.
Psellus states correctly that the scales in leprosy assume a circular
shape.
Nonnus marks the distinction between these diseases very accurately.
Lepra arises from a corroding humour, and hence scales fall from the
surface of the skin, and it is attended with pruritus. But lepra is more
deep-seated, and affects the skin circularly; whereas psora is more
superficial and variously figured. Leuce and alphos albus and niger, he
says, are allied; but leuce is deeper seated, so as to change the colour
of the hairs, whereas the alphi are more superficial affections.
Pollux, like most of the others, states that in leuce, when the skin is
pricked, it does not bleed, and that the disease is difficult to cure.
Alphos and melas, he says, are easily cured.
Although Myrepsus has not described these diseases, he gives
prescriptions for various compositions to remove them. The most active
ingredients in them are hellebore, natron, sulphur, quicksilver, sal
ammoniac, quicklime, bay-berries, &c.
Alexander Aphrodisiensis mentions psora among the contagious diseases,
but says that lepra and leuce are not contagious.
Chrysostom alludes to the common opinion that psora is a contagious
disease. The poet Æschylus gives a short description of leprosy in his
‘Chöepheræ’ by the name of lichenes. (l. 277.)
Celsus nowhere uses the terms lepra and psora, and therefore there is
considerable difficulty in comparing his account of these cutaneous
affections with the descriptions of the Greeks. Alphos, melas, and leuce,
he describes very intelligibly, connecting them together by the generic
term of vitiligo. We shall give his own characteristic description of
these diseases:—“Ἄλφος vocatur ubi color albus est, fere subasper, et non
continuus, et quædam quasi guttæ dispersæ esse videantur: interdum etiam
latius, et cum quibusdum intermissionibus serpit. Μέλας colore ab hoc
differt quia niger est et umbræ similis: cætera eadem sunt. Leuce habet
quiddam simile alpho, sed magis albida est et altius descendit; in eâque
albi pili sunt, et lanugini similes. Priora curationem non deficillimam
recipiunt: ultimum vix unquam sanescit.” Another class of cutaneous
affections he connects by the generic term of impetigo, and it is to be
remarked that they are all squamous diseases, and not pustular, like
the complaints to which Drs. Willan and Bateman have applied the term.
His second species of impetigo (as Bateman remarks) appears to be the
psora of the Greeks:—“Alterum genus pejus est, simile papulæ feræ, sed
asperius rubicandiusque, figuras varias habens: squamulæ ex summâ cute
discedunt, rosio major est, celerius et latius procedit, certioribusque
etiam quam prior temporibus et fit et desinit. Rubra cognominatur.” His
third species bears some resemblance to the lepra nigricans of Willan and
Bateman:—“Tertia etiamnum deterior est: nam et crassior est et durior, et
magis tumet, in summâ cute finditur, et vehementius rodit, _ipsa quoque
squamosa sed nigra_, &c. Nigræ cognomen est.” His account of the fourth
species seems to refer to the lepra vulgaris:—“Quartum genus est quod
curationem omnino non recipit distans colore: nam sub-albidum est et
recenti cicatrici simile: squamulas habet pallidas, quasdam subalbidas,
quasdam lenticulæ similes: quibus demptis nonunquam profluit sanguis.”
For all these diseases he recommends a composition containing sulphur,
natron, and rosin.
Scribonius Largus describes several compositions, “ad lepram, quæ quasi
impetigo est cum prurigine cutis,” and for scabies. They contain sulphur,
Æthiopian cumin, vinegar, frankincense.
Serenus Samonicus makes mention of a few popular remedies for scabies,
prurigo, and papulæ, but he gives no description of these complaints.
Octavius Horatianus recommends for scabies (meaning, we suppose, the
psora of the Greeks,) bleeding, purging, frequent baths, and external
applications containing natron, frankincense, and sulphur. He does not
mention lepra by name, nor does he seem to allude to it at all.
Marcellus recommends for lepra a composition containing equal parts of
natron, frankincense, litharge, and sulphur pounded with vinegar.
Vegetius says that the scabies of cattle “contagiosa est et transit in
plures.” Probably Virgil alludes to the scab of sheep in this line: “Nec
mala vicini pecoris contagia lædant.” (Ecl. i.) He mentions, as remedies
for it, sulphur, litharge, pitch, hellebore, &c. (Georg. iii, 449.) See
also Geopon. (xvi, 18, xviii, 15); Columella (viii, 5); and Gratius
(Cyneget. 412).
Isidorus gives the following definitions of the complaints we have been
treating of: “_Lepra_ vero cutis asperitas squammosa lepidi similis unde
nomen accepit: cujus color nunc in nigridinem vertitur, nunc in alborem,
nunc in ruborem. _Scabies_ tenuis asperitas et squammata est. Impetigo
est sicca scabies; prominens a corpore cum asperitate et rotunditate
formæ. Hanc vulgus _sarnam_ appellat.”
Justin applies the terms _vitiligo_ and _scabies_ to the diseases treated
of in this chapter. See Hist. (xxxvi, 2.) We now turn to the Arabians.
In the Latin translation of Serapion, lepra and psora are described
under the generic term of “impetigines in quibus excoriatur et
scinditur cutis;” but they are further distinguished from one another
by the specific titles of _albaras_ nigra and pruritus. The former is
characterized as arising from the melancholic humour, and as casting off
round scales. The latter is said to consist of pustules, which appear
on different parts of the body, are variously figured, and cast off
furfuraceous scales. The leuce is described by the name of _baras_, as
arising from viscid, pituitous blood, and being produced by a defect
of the assimilative faculty. In it the flesh itself is said to be
changed to a white colour. If, when pricked with the head of a needle it
bleeds, there is a probability of cure; but if it does not bleed, it is
incurable. The two alphi are described by the names of _morphea alba_
and _nigra_. The morphea alba resembles the white albaras (leuce) only
that in the latter the affection of the skin is more deep-seated, and the
hairs in it are turned to a white colour; but in morphea the only change
is in the external appearance of the skin. The morphea nigra (melas?) is
said to resemble the albaras nigra (lepra nigricans?) only that it is
more superficial.
In the Latin translation of Avicenna by Bullonensis, alphos albus and
niger are distinguished by the names of _morphea alba_ (or _alguada_),
and _morphea nigra_; leuce by that of _albaras_; and lepra by those of
_albaras_ nigra and _impetigo excorticativa_. The specific differences
between them are stated with great precision. The morpheæ are superficial
affections of the skin, but the albaras affects also the flesh,
penetrating sometimes down to the bone. All these diseases are said to
arise from a weakness of the assimilative faculty. In the _albaras_
nigra, or leprosy, the skin is said to be covered with scales, like those
of a fish. Like the authorities formerly quoted, Avicenna states that in
_alguada_ (alphos albus) the hairs do not change their colour, but that
they do so in _albaras_. The puncture of a needle likewise extracts blood
from the _guada_, but not from the _baras_.
Avenzoar makes mention of the _morphea_ alba and nigra, but has not
described them particularly. These authors seem to have treated lepra
and psora like the Greeks, by bleeding, melanogogues, and abstergent
applications to the skin, such as the two hellebores, lime, lupines, &c.
In the translation of Haly Abbas, leuce is correctly described by the
name of _lepra_. It is represented as a whiteness sometimes affecting
the whole body, and it is said to be occasioned by debility of the
assimilative faculty. When the hairs are white, and the skin does not
bleed when pricked with a lancet or needle, the disease is incurable.
Alphos albus is described by the name of _morphea_ alba, and is
distinguished from the former by the whiteness being more superficial,
and the colour of the hairs remaining unchanged. In the morphea nigra,
that is to say the alphos niger, the colour is said to be black, owing
to the prevalence of black bile, and if rubbed a furfuraceous scale
falls off, and it becomes red. The lepra nigricans is described by the
names of _impetigo_ and _sarpedo_, as an asperity of the skin, inclining
to blackness or redness, and terminating in round scales, like those
of fishes. For the cure of lepra, he directs us to abstain from all
articles of food which engender phlegm, to take hiera of colocynth, with
pepper, &c., and also the theriac of vipers, and various other internal
medicines. He recommends various external applications, containing
sulphur, arsenic, hellebore, spurge, &c.
Alsaharavius describes three varieties of _morphea_. 1st. The morphea
terrestris, which is attended with furfuraceous scales on the skin, and
tingling. This is evidently the psora of the Greeks. 2d. The morphea
alba, which consists of a more superficial whiteness of the skin than the
_albaras_ (leuce): this is the alphos albus. 3d. The morphea nigra, is
like the former, only that the colour is black. This must be the alphos
niger. All these affections he treats upon much the same principles as
the Greeks, namely, by evacuants, and stimulant applications to the skin,
such as sulphur, hellebore, &c. _Albaras_ he describes as a deep-seated
whiteness of the skin, and directs us to prick the skin with a needle,
and if it does not bleed the disease is to be set down as incurable.
This, of course, is the leuce of the Greeks. He treats it upon much the
same principles as the morpheæ. He appears not to make any distinction
between the leuce and the lepra.
Rhases describes the lepra of the Greeks by the term _impetigo_; alphos
albus by that of _morphea_ alba; alphos niger by that of _morphea_ nigra;
and leuce by that of _albaras_. There is nothing very particular in his
treatment of leprosy. It may be worth while to mention, however, that he
strongly recommends leeches to the affected part, at the commencement.
Scabies, he says, is formed by a salt diet, old wine, and neglect of the
bath. For the cure of it, he recommends bleeding, purging, and various
external applications, some of which contain quicksilver, nitre, vinegar,
and the like. In his ‘Continens’ he gives a full account of these
diseases, upon the authority of preceding writers. He gives the names of
_baras_ to lepra, and _morphea_ alba to alphos. He recommends stimulant
applications containing cantharides, nitre, with vinegar, &c. He says
that he had found a mixture of sal ammoniac and oil of eggs an excellent
application.
It will be remarked that the leuce of the Greeks, the leuce and fourth
species of impetigo of Celsus, and the albaras of most of the Arabians,
are the same as the _lepra vulgaris_ of Drs. Willan and Bateman; that the
alphos of most of the Greek authorities and of Celsus, and the morphea
alba of most of the Arabians, correspond to the _lepra alphoides_ of
our English nosologists; that the melas, alphos niger, and common lepra
of the Greeks, Celsus’ third species of impetigo and his melas, and the
morphea nigra and impetigo of most of the Arabian translators, apply
to the _lepra nigricans_ of our modern arrangement; and that the psora
of the Greeks, Celsus’ second species of impetigo, and the scabies of
Octavius Horatianus, and of most of the Arabian translators, comprehend
both the _psoriasis_ and _scabies_ of Willan and Bateman.
Since many of the ancient authorities speak of _scabies_ as being
infectious, they must have applied the term to the true itch, with which
it is not likely, as Rayer maintains, that they were wholly unacquainted.
The earlier modern writers, such as those of the Schola Salernitana,
Platearius, Guy of Cauliac, and Lanfrancus, jumble together the Latin
and Arabian names, so as to produce no ordinary degree of confusion.
Guy of Cauliac, indeed, maintains that there is little necessity for
distinguishing lepra, alphos, melas, impetigo, gutta rosacea, and such
like cutaneous complaints from one another, as they are all varieties of
the same disease. Lanfrancus, however, is of a different opinion. (i, 3,
6.)
SECT. III.—ON LICHEN.
Lichen is formed by the mixture of a thin and acrid ichor with other
gross humours, and passes readily into leprosy and psora; wherefore
it requires to be treated by the most desiccative applications. After
general depletion, if necessary, the following simple medicines will
be proper: chick-peas, hellebore, the urchin which dwells among rocks,
pitch mixed with cerate and rosin, the dung of the land crocodile,
that of starlings fed solely upon rice. And many have cured the
complaint when occurring on the chin, or other parts of the body, by
this application alone: take several grains of wheat and place upon a
stithy red-hot, and taking the fluid which flows from them while yet
warm, anoint the part affected with lichen. The lichen of children is
to be rubbed frequently with human saliva. The gum of the plum tree,
when rubbed in, is beneficial in these cases. When the complaint is
protracted, the leaves of the chaste tree, triturated with vinegar, are
to be applied, or the leaves of capers in like manner. The following are
compound applications: Dissolve sulphur with rosemary in vinegar, or
with ammoniac, and anoint. A trochisk for lichen: Of artificers’ glue,
dr. iv; of frankincense, dr. iij; of vinegar half a cyathus; dissolve
in vinegar, and anoint.—_Another_: Of chalcitis, of gum, of each, dr.
viij; of sulphur vivum, of misy, of each, dr. vj; of the flakes of
copper, of acacia, of each, dr. ij; anoint with vinegar.—_Another_:
Of sulphur vivum, of spuma nitri, of each, dr. iv; of the seeds of
rosemary, lx; triturate with vinegar, and anoint only the part which is
affected, not touching the sound skin. When dry, wash it away with cold
water.—_Another_: Of white hellebore, dr. viij; of the flour of lupines,
of burnt shell-fishes called buccina, of natron, of each, one chœnix; rub
with it dry. They call that variety of lichen _agrius_ which is nowise
remedied by moderately desiccative applications, and is exacerbated by
more acrid ones. These cases are therefore to be treated by applications
which are sufficiently strong, without being pungent, such as this: of
horned poppy, of frankincense, of alcyonium, of bitumen, of sulphur,
of gum, of each, oz. j; anoint with vinegar. Boil African pitch with
vinegar, and, when dissolved, anoint.—_Another_, for lichen and prurigo:
Of copperas, of sulphur vivum, of natron, of frankincense, equal parts;
use for lichen with vinegar, and for prurigo with wine.—_Another_, for
lichen: Of ammoniac perfume, of the flour of bitter vetch, of the flour
of lupines, equal parts; add to vinegar.
* * * * *
COMMENTARY. See Hippocrates (de Humor., de Affect.); Galen. (Isagoge, de
Med. sec. loc. v); Oribasius (Morb. Curat. iii, 59); Aëtius (viii, 16);
Actuarius (Meth. Med. ii, 11); Marcellus (19); Nonnus (236); Celsus (v,
28); Pliny (H. N. xxvi, 2); Serapion (v, 2); Avicenna (iv, 7, 3, 3);
Alsaharavius (Pract. xxxi, 7); Rhases (Divis. 117); Haly Abbas (Pract.
iv, 10.)
Dr. Bateman states, that the exact acceptation of the term lichen cannot
well be ascertained from the writings of Hippocrates; but Dr. Willan
affirms that he restricted it to a papular eruption on the skin.
In the ‘Isagoge,’ usually ascribed to Galen, two varieties are described,
the lichen mitis, and the lichen agrius, in both of which scales are
formed upon the skin, which appear almost ulcerated when they are
removed. They are to be cured by cholagogues internally, and liniments
externally.
Galen remarks the tendency of the disease to pass into lepra and scabies.
To prevent this, he directs desiccative and detergent applications, for
the preparation of which he gives various prescriptions. One of these,
which bears the name of Pamphilus, is a powerful escharotic, composed of
orpiment, realgar, burnt copper, and cantharides. (Med. sec. loc. v.) He
says it affects principally the chin, but is apt to spread over the face.
Oribasius, Aëtius, Actuarius, and Nonnus, treat of the complaint in
nearly the same terms as our author. Their translators improperly render
it by impetigo. Leo ascribes the origin of the disease to hot and
corrupted blood.
Celsus describes the lichen of the Greeks by the name of _papula_, of
which he mentions two varieties. In the first, he says, the skin is
merely roughened by small pustules, is reddened and slightly corroded;
the middle is somewhat smoother, and it spreads slowly, generally in
a round shape. This description would seem to apply to the _lichen
circumscriptus_ of Drs. Bateman and Willan, although the latter author
thinks that it possessed a wider signification. The second variety, he
says, is called ἀγρία by the Greeks, and in it the skin is more rough,
red, and corroded. The more it departs from the circular form the less
tractable is it, and, unless removed, it is said to pass into impetigo.
From this account it is clear that the lichen of the Greeks, in its
original form, was different from impetigo. Celsus recommends friction
with the saliva of a fasting person, and also mentions a composition
containing natron, frankincense, sulphur, &c.
The translator of Serapion improperly renders the name of this affection
by the term impetigo. His remedies are nearly the same as our author’s,
namely, the saliva of a person fasting, compositions containing
hellebore, natron, the ashes of starlings, &c.
In the translation of Avicenna it is likewise described by the name of
impetigo. It is called a species of dry achor, by which is no doubt
meant papula. It is stated that it has a tendency to pass into lepra or
psora. The remedies which are recommended are human saliva, the chaste
tree, capers, leeches (which are not mentioned by the Greeks), likewise
gum arabic dissolved in vinegar, mustard and vinegar, salt water, the
roots of king’s spear, &c. Haly Abbas recommends stimulant liniments of a
similar kind.
Rhases briefly recommends lotions of vinegar and ammoniac, and, when it
becomes inveterate, leeches, strong friction, &c. His translator also
misapplies the term impetigo to it.
The lichen appears to be the cutaneous complaint which Alsaharavius
describes by the name of _alcoab_. He represents it as a superficial
ulceration, and mentions four species of it.
Dr. Willan confirms the statement of the ancient authorities, that the
disease has a tendency to pass into lepra and psora. The species called
_lichen tropicus_ by Dr. Willan, seems to be the _hidroa_ of Hippocrates
(Aph. iii, 21); the _sudamen_ of Pliny (xxiii, 45); one of the _essere_
of Haly Abbas (Theor. viii, 17); one of the _alsara_ of Alsaharavius
(Pract. xxx, 8); and the _hasef_ of Avicenna (iv, 7, 3, 8). See also
Galen’s ‘Commentary’ (v, 261); ed. Basil. Galen says it is attended with
pruritus, asperity, and ulceration. Avicenna and Rhases particularly
commend bleeding, cleansing the skin, and the cold bath. Most of Rhases’
authorities in his ‘Continens,’ recommend for the _asaf_, or sudamen,
cooling and astringent applications, containing roses, myrtles, galls,
sandals, camphor, and the like. They attribute the complaint to profuse
perspiration. In certain cases, Rhases directs us to allay the pruritus
or tingling, with hot water and the flesh of melons. He also approves of
purging with tamarinds and myrobalans. (Cont. xxxvi.) See also ad Mansor.
(v, 30). Mercurialis is of opinion that Virgil alludes to the sudamina in
the following lines:
“Verum etiam invisos si quis tentarat amictus,
Ardentes papulæ atque immundus olentia sudor
Membra sequebatur.”
(Georg. iii, 565.)
We shall briefly notice in this place the singular disease of the face
which prevailed in the Roman empire during the reign of Tiberius, called
_mentagra_ by Pliny, in his curious description of it, but which he says
was named _lichenes_ by some. He represents it as a contagious disease,
which was readily propagated by kissing. It attacked principally the
higher class, the lower and middle ranks and women having generally
escaped it. The seat of it was commonly the chin, but it sometimes spread
over the whole face, and affected even the neck, breast, and hands.
The only means of cure was burning with caustics down to the bone. (H.
N. xxxvii; see also Marcellus, 19.) We are inclined to think that it
must have been some variety of elephantiasis. Modern authorities have
ranked it under _sycosis_, but it would appear to have been a much more
intractable disease. The sycosis is distinctly described by Celsus, among
the diseases of the hairy parts. He recommends for it elaterium, linseed,
or figs boiled in water, &c. (vi, 3.)
SECT. IV.—ON PRURITUS, OR PRURIGO.
The prurigo occurring in old age is not to be thoroughly cured, but may
be alleviated by the remedies mentioned below: but that which arises from
a cacochymy in other ages, is to be cured by evacuation, being formed by
a bilious or pituitous humour that has become putrid, or by a saltish
one. It is known by attending to the age, temperament, diet, season of
the year, situation, and the like. If, therefore, it appear to prevail in
the blood contained in the veins, we must begin with venesection; but
if it offend rather by its quality, we must evacuate it by corresponding
medicines, and turn our attention to external applications. Wherefore we
must use the bath at all times before a meal; and sometimes, after eating
a little, it may be used a second time, for the affection is of difficult
humectation. They are to be rubbed with the decoction of fenugreek, or of
beet, or of barley-meal, or of wild or of garden mallows, or of ptisan;
and along with these may be joined the flour of beans, or of lupines, or
of myrobalan (ben), or of the detergent ointment called _peponaton_. If
it is protracted, we may use the bath in like manner, and foment with
the decoction of sage, of tamarisk, of the herb mercury, of marjoram,
of pennyroyal, of bay berries, of the root of the wild cucumber, of
capers, of strained ley, of vinegar and brine; and then the parts are
to be sprinkled with dried natron, or with the lees of vinegar, or with
the composition containing of spuma nitri one sextarius, of rosemary,
of sulphur vivum, of each, lb. j, of cimolian earth, lb. ss; or this:
of aphronitrum, of sulphur vivum, of burnt alcyonium, equal parts; to
be used dry, or with some of the decoctions already mentioned; and, if
you please, sprinkle some dried hellebore, without grease. But rub in
with vinegar and oil, stavesacre pulverized, or sulphur, or red arsenic,
or all together; or mustard, with the refuse of expressed myrobalan,
and vinegar and oil; or with snails burnt and triturated with honey
or the roots of dock, or the detergent ointments prepared from them,
as described under the head of Elephantiasis; or with some of the
applications for scabies. If the parts become ulcerated, use the plaster
called parygron, or that prepared from pompholyx; or melt oz. j of wax
in a cyathus of oil of privet, and sprinkle upon it of sulphur vivum oz.
j. _Another_ application for prurigo: Of large nuts in a rancid state,
oz. j; of sulphur, oz. j; triturate with the juice of parsley, and use
in the bath with much friction. This alone has proved sufficient for the
cure of many cases of scabies and prurigo; and green parsley by itself,
when pounded and rubbed in while the patient is in the bath, has been
of great service: and in like manner, pellitory of the wall and maple
rosin dissolved with rose oil, and rubbed in.—_Another_: Bruise three
ounces of pure and very white rice, and, having strained, triturate with
strong vinegar until it become of the thickness of the sordes of the
oil in baths; and adding separately of sulphur vivum pulverized, oz. j;
and mixing properly, use in the bath with much friction. When there is a
greater redundance of humours, it will be better to mix the ingredients
in equal proportions.
* * * * *
COMMENTARY. See Hippocrates (Aphor. iii, 31); Galen (Comment. et alibi);
Oribasius (Morb. Curat. iii, 22); Aëtius (xiv, 20); Actuarius (Meth. Med.
ii, 11); Nonnus (237); Alexander Aphrodisiensis (Probl. i, 24); Myrepsus
(pluries); Pliny (xxviii, 5); Octavius Horatianus (i, 31); Marcellus (de
Med. 4); Isidorus (Orig. iv, 8); Serapion (v, 6); Avicenna (iv, 7, 3,
6); Haly Abbas (Theor. viii, 17, and Pract. iv, 6); Alsaharavius (Pract.
xxxi, 5); Rhases (Divis. 121); Avenzoar (ii, 7, 2.)
The prurigo of Dr. Willan is here distinctly described, and a suitable
method of treatment recommended.
Hippocrates remarks that prurigo is common in old age. The reason which
Galen assigns for this is, that the superfluities of the system are
then not properly discharged by the skin. He says in another place,
that pruritus may either be produced by external substances, such as
nettles, squills, &c., or it may arise from indigestion and the neglect
of cleanliness.
Oribasius gives an account of the disease not very different from our
author’s. Among other applications, he recommends one consisting of opium
mixed with liquid cerate.
Aëtius speaks highly of the sulphureous bath for the cure of this disease.
Actuarius characterizes the disease very well, when he says that it is
allied to lichen, and that when rubbed either nothing runs from the
place, or some slight humidity of various colour and consistence. He
assigns, as a reason for its frequency in old age, that the pores of the
skin then get constricted.
Alexander Aphrodisiensis assigns, as the reason why the warm bath proves
useful in cases of pruritus, that it dispels the phlegm, which is the
cause of the complaint.
Celsus gives a particular account of scabies, but says nothing of prurigo.
Octavius Horatianus recommends us, when the patient is young, to bleed,
purge, and use baths medicated with frankincense, natron and sulphur.
He also says that the cold bath, and friction with the oil of roses,
myrtles, &c., will do much good.
Isidorus uses the term prurigo: “Prurigo vocatur perurendo et ardendo.”
Marcellus also uses this term, and recommends much the same substances as
the others.
This affection is clearly described by the Arabians, and is rendered
pruritus by most of their translators. Serapion recommends us, if there
is a sanguineous plethora, to bleed, and then to purge with myrobalans,
colocynth, and black hellebore, and along with these the warm bath is to
be used, and the liniments for removing the pruritus, containing vinegar,
roses, nitre, &c. The prurigo senilis he pronounces to be incurable.
Rhases and Avicenna recommend similar remedies. They treat of prurigo and
scabies together, and there is no doubt of their alliance. Hence Bateman
says that prurigo, when neglected, terminates in scabies. Haly Abbas
says that scabies and prurigo arise from a saltish phlegm. Scabies, he
says, consists of reddish pustules, which appear most frequently between
the fingers and upon the arms. Prurigo, he adds, is apt to run into
scabies. He recommends, as a lotion, vinegar with rose-oil, the use of
the warm-bath, and other remedies like those of our author. Alsaharavius
says that the disease arises from debility of the expulsive faculty of
the body or constriction of the pores. He praises highly the hot bath.
Avenzoar states that pruritus arises from bile or a sharpness of the
blood.
Our author has omitted to treat of _phthiriasis_, for an account of
which see in particular Cælius Aurelianus (de Tard. Pass. iv, 2); also,
Aristot. (Hist. An. v, 32); Galen (de Comp. Med. sec. loc. i, 8);
Pliny (Hist. Nat. xxvi, 86); Haly Abbas (Pract. iv, 7); Plutarchus (in
Vitâ Syllæ.) The authorities quoted by Rhases recommend compositions
consisting of stavesacre, white hellebore, arsenic, nitre, sulphur,
sublimed mercury, and the like. (Contin. xxxvi.) Antiochus, Herod of
Judæa, Philip II of Spain, and many other celebrated personages, are
said to have died of phthiriasis. Virey accounts for the disease in the
following manner: “Il est, en effet, tel tempérament muqueux, telle
dégénération des humeurs lymphatiques, dans le phthiriasis ou la maladie
pédiculaire, que ces insectes y trouvent une pâture inépuisable, qu’ils
se propagent avec une extrême exubérance sous le peau, pénétrent dans le
tissu cellulaire, et établissent d’énormes colonies parmi les ulcères
qu’ils y forment.” (Hist. des Mœurs des Anim. ii, 207.) Aldrovandi gives
a very full history of phthiriasis. (De Insectis, v.)
SECT. V.—ON LEUCE.
Leuce is a change of the skin to a white colour, occasioned by a viscid
and glutinous phlegm. Since all the kinds of leuce are not curable,
you may form a diagnosis of it in this manner. Pierce the leuce
superficially, not deeper than the skin, with a needle, and if blood
flow, the complaint may be cured; but if a milky moisture be discharged,
it is incurable. Or, rub it with a rough woollen rag, and if the part
become red, the complaint may be cured; but if it remain of the same
colour, it cannot be cured. And those kinds which attack a great part of
the body are to be supposed more difficult to cure than those which are
confined to a small space, and old cases than recent. Some, therefore,
in leuce, have approved of burning by iron, consisting simply of the
application of heat. Others, dreading the pain of burning, and the scar
arising from it, as being no less unseemly than leuce itself, have had
recourse to escharotic medicines, such as they say will produce a scar
of the natural colour. Others rejecting all these things on account
of the difficulty of their application, have used dyes (paying more
consideration to the deception than the utility which they produce,)
which are, of all others, the most to be rejected, owing to the speedy
renewal of the affection. We must use, then, the under-mentioned remedial
powers: Of adarce, of rosemary seed, of sulphur vivum, of each, equal
parts; bruise and strain singly, and then, having triturated together
for a sufficient number of days, anoint in the sun, but not in great
quantity, lest the skin be ulcerated; and, after some time, a little
hellebore and galls may be added in like manner.—_Another_: Macerate the
tops of the black fig in vinegar, and having triturated, mix equal parts
of aphronitrum, sulphur vivum, and the fruit of tamarisk, and having
rubbed natron into the part, anoint and expose to the sun, taking care
lest an ulcer be produced. But Archigenes having mixed a sufficiency of
quicklime with fig-leaves, used them in like manner: or, he says, having
rubbed the leuce with white hellebore until the part perspire and become
of the same colour as the rest of the body, anoint with sinopis or melian
earth; or, having perforated them with needles until they bleed, anoint
with sinopis in vinegar; or, having first rubbed them as formerly said,
anoint with the fresh juice of figs, or rub in so much with the leaves of
it.
* * * * *
COMMENTARY. In the second Section we have stated so fully the nature of
the leuce, and the difference between it and its cognate affections,
that it will be unnecessary for us now to resume the subject. It is
there mentioned that leuce is Celsus’ third species of vitiligo, and the
_baras_ of all the Arabian translators, with the exception of Stephanus
Antiochensis, the translator of Haly Abbas, who applies the term _lepra_
to it. It was therefore the white species of leprosy. All the medical
authorities represent it as an intractable disease, not only the cuticle
being altered in structure, but also the flesh below, and even the hairs,
having undergone a change of colour. All direct us to prick the skin with
a needle, and, if it bleed, the cure is to be attempted; but if a slight
colourless fluid issue from it, the case is to be abandoned as hopeless.
They consider it as arising from debility of the assimilative faculty
of the part which can no longer convert the nutritive juices into their
proper consistence. All recommend nearly the same treatment. The diet
is to be regulated with a strict abstinence from gross food; if there
be plethora, venesection is to be premised; then drastic purgatives and
emetics are to be given, and the parts affected are to be rubbed with
stimulant and caustic applications, containing hellebore, nitre, sulphur,
misy, red arsenic, &c., or even the actual cautery may be applied. In
short, all treat the disease in nearly the same manner as our author.
(See in particular Serapion and Avicenna.)
Aristotle, we believe, is the first Greek writer who makes mention of
leuce. He calls it a disease in which all the hairs of the body turn
white. (Hist. Nat. iii, 11.)
“The snow-white leprosy” of the ancient Jews was the leuce of the Greeks.
Moses describes very correctly the method of distinguishing it from the
alphos and melas; (Leviticus, c. xiii.) The symptoms of leuce are given
in the 3d verse; of the alphos in the 4th; of the melas in the 6th. He
calls it contagious, which might lead us to suspect that elephantiasis
was mixed up with the leprosy of the Jews. This opinion is further
confirmed from what is mentioned by Josephus of its being said that his
countrymen were driven out of Egypt because they were affected with
leprosy. (See also Justin. xxxvi, 20, and Tacit. Hist. v, 3.) Now we
know that elephantiasis was endemial in that country. (See chap. i.) The
English translation of this chapter is very inaccurate, the translators
having evidently failed to recognize the nice distinction between cognate
diseases, laid down by the Jewish legislator.
Leuce is still common in tropical climates. Negroes affected with it
are called Albinos. It is merely an aggravated variety of the _Lepra
vulgaris_.
SECT. VI.—ON WHITE AND BLACK ALPHI.
The formation of alphos is similar to that of leuce, but the latter
produces a deep change of the skin, so that the hairs grow of a similar
colour, whilst the alphi affect the skin superficially, except that
when continued, they extend more deeply, so that the hairs grow white,
owing to the humour which causes it. From the pituitous humour then
they are produced white, but black from the melancholic. Wherefore, a
common application for both is washed lime dissolved in water, or, the
root of dracunculus applied with vinegar; in like manner, either species
of hellebore, the decoction of bitter lupines poured on the part, and
their flour when applied as a cataplasm with vinegar or oxymel, the
bark of the root of capers with vinegar, the root of lily with honey,
onions with vinegar rubbed into the part in the sun, the dung of the
land crocodile, and in like manner, that of starlings, when they are fed
solely upon rice, and the burnt shells of the cuttle-fish. The following
is a compound application: of alcyonium, of natron, of each, oz. ij; of
white hellebore, of sulphur vivum, of each, oz. j; and some also add the
burnt lees of wine.—_Another_: Of sulphur vivum, of the spuma nitri, of
each, dr. iv; rosemary seeds, vij; triturate with vinegar. But rub only
the part affected with alphos, not touching the unaffected parts, and
when dry, wash with cold water.—_Another_: Of the flour of lupines, of
buccina, and natron, of each, a chænix; of white hellebore, dr. viij; rub
with it in a dry state.—_Another_: Of the flour of bitter vetches, lb.
ij; of the seeds of rocket, of bitter almonds, of the root of the wild
cucumber, of each, lb. j; triturate with wine and honey and anoint, and
after an interval of an hour wipe it away with a sponge. It applies also
for freckles, warts, and other spots on the skin.
A tried remedy for white alphos: of sulphur vivum, ii sextarii, of
quicklime whitened, oz. iv; five whites of eggs, of nard-oil and vinegar,
a small quantity. The sulphur is first pounded, then we add to it the
oil of nard, and again triturate; then the vinegar is poured in, and
the mixture is again triturated. But the quicklime is to be washed
separately, once, twice, and thrice, and then we add it to the sulphur
with the white of the eggs and triturate; and we pour out the collected
fluid; but leaving a small quantity so that the ointment may admit of
anointing, we use it thus.—_Another_ tried remedy: Take sulphur vivum,
dried fig leaves, aphronitrum, alcyonium, Cimolian earth, and myrtle,
use with vinegar.—_Another_ of Archigenes: Rub in equal parts of fig
leaves dried in the shade, of sulphur, and of alum with vinegar, or of
fig leaves, dr. iv; of nitre, dr. ij; of burnt alcyonium, dr. ij; anoint
with vinegar in the bath. But red arsenic with one half of sulphur is
excellent for removing the black alphos; thus having cleansed the part
with natron, anoint with it in the sun. For white alphos: of copperas,
of verdigris equal parts, of natron the double, rub without fat: or, of
rosemary seeds, of sulphur vivum, of adarce, equal parts; triturate with
vinegar, rub, and anoint; but when it is dry, bathe by rubbing. This
applies also to the white species.
* * * * *
COMMENTARY. We have again to refer the reader to the second chapter for
an account of these complaints, and an exposition of the differences
between them and the affections to which they are allied. It will be
seen that they are varieties of the genus vitiligo of Celsus, and that
they bear a near resemblance to leuce, from which they are chiefly
distinguished as being mere superficial affections of the skin. The
Arabians treat of them under the names of morphea alba and nigra. Dr.
Willan makes them to be varieties of lepra, in which opinion we fully
coincide with him.
The description of the two diseases by Actuarius is so precise that
we shall give it in lieu of all the others. The alphi, he says, are
superficial, but sometimes extend in depth, so that the hairs appear
of the same colour. The white species is tried as to the depth it has
spread, by being pricked moderately with a needle; when blood flows
though the needle has only penetrated the skin, the disease is curable,
but if the discharge be milky it is incurable, inasmuch as the flesh is
converted into the disease. Others, he adds, rub the part with rough
towels, and if it become red they have good hopes, but if it remain of
the same colour they abandon all hopes of recovery. They are of a more
aggravated nature when they affect different parts of the body and are
inveterate. The alphi, he says, are generally milder than leuce, and can
be cured by gentler means, but when they become inveterate they require
similar treatment. The difference between the white and the black alphos
is produced by the colour of the prevailing humour.
There is scarcely any difference of opinion among the authorities
respecting the general plan of treatment. Haly Abbas has correctly
remarked, that the alphi are to be cured by the same sort of remedies
as lepra (leuce?) only that they do not require so strong applications.
The Arabians greatly commend their myrobalans with ginger, mastich,
parsley, &c. Their internal applications are powerful detergents and
escharotics, such as hellebore, natron, sulphur, vinegar, arsenic,
copperas, &c. Celsus says nothing of internal remedies, but recommends
external applications of a stimulant nature, containing sulphur, alum,
nitre, frankincense, alcyonium, &c. In the ‘Isagoge’ it is said that all
these complaints are to be cured by phlegmagogues, and by abstergent
applications externally.
Guy of Cauliac, and the other medical authorities of that age, describe
these diseases by the names of _Morphea_ alba and _M._ nigra. They
recommend applications containing sulphur, alum, natron, arsenic, and the
like. As usual they are the mere copyists of the Arabians.
SECT. VII.—ON STIGMATA, FROM THE WORKS OF ARCHIGENES.
You may remove stigmata by rubbing in that which sticks to a chamber-pot,
along with the most acrid vinegar, or rub of quicklime, p. j; of red
natron toasted, p. ss; with water, in the sun: but when it ulcerates let
it be healed like an ulcer. But Crito says, for stigmata, having first
scrubbed the part with nitre (soda), cover it with an application of
turpentine; then having bound it, let it remain for six days, and on the
seventh perforate the stigma with a needle, and having wiped away the
blood with a sponge, after a little time rub with some powdered salt.
Then, having applied the medicine, allow it to remain for five days. It
is this: of frankincense, of natron, of the lye of quicklime, of wax, of
each, dr. iv; of honey, dr. viij; having loosed it, you will find the
blackness upon the application.—_Another_ ointment: Of pepper, dr. ij;
of rue, dr. iv; of realgar, dr. iv; of orpiment, dr. j; of honey, q.
s. Anoint with it, have previously scrubbed the part with natron, and
done otherwise in like manner as for the former. Taking it away after
three days, and cleaning away the blackness, anoint with it again; for,
he says, it removes the complaint in twenty days, without ulceration or
cicatrix.—_Another_ called Criticum: Of frankincense, dr. iv; of nitre,
dr. ij; of copperas, dr. iv; of wax, dr. vj; of pepper, dr. iij; of lime,
dr. iij; of thapsia, dr. iij; of orpiment, dr. iss; of realgar, dr.
iij; of honey, q. s; use as the former. Oribasius says, that crowfoot
(ranunculus) if applied, or the leaves of capers, take away the marks.
But if they be deep seated upon only a small extent of skin, form an
eschar by a cold cautery, and thus remove them.
* * * * *
COMMENTARY. Consult Aëtius (viii, 12); Actuarius (Meth. Med. vi, 8);
Scribonius Largus (§ 231); Avicenna (iv, 7, 2, 7); Pseudo-Dioscor.
(Eupor. i, 116.)
Aëtius explains that by stigmata are meant the marks of injuries on
the face or any part of the body. To eradicate them he recommends
compositions containing quicklime, natron, arsenic, &c.
The Pseudo-Dioscorides recommends the ranunculus, the juice of the leaves
of capers, or that of mandragora, &c.
Actuarius copies from our author.
Scribonius Largus mentions a composition containing garlic, cantharides,
sulphur, chalcitis, &c.
Avicenna recommends friction with natron and the other substances
mentioned by our author.
Dr. Willan defines the stigma, “a small speck on the skin, occasioning no
elevation of the cuticle.” The ancient authorities, it will be perceived,
apply the term in a wider sense.
SECT. VIII.—ON EXANTHEMATA.
Exanthemata are formed by thick humours impacted in the skin, and more
especially if the cuticle be thick. In these cases, then, even if the
humours are deep-seated, they must be first purged away; for unless you
do this in the first place, before attempting to dispel them, you will
only impact them the more firmly, instead of evacuating them by the skin.
But if the deep-seated parts be free from crudities, you may evacuate the
humours by the skin, and not produce revulsion of them to a distance,
which is the case, if you attempt to evacuate them by the belly or
emetics. But the cure of humours fixed in the skin, is to be accomplished
by fomentations and calefacients, more especially when the exanthemata
happen to be broad, for these are formed by a cold and thick humour.
Wherefore, take of the tender leaves of bay, of manna, and of rue equal
parts, triturate together, and dissolving frankincense in honey, anoint
with it; or, having boiled and pounded tender beet, apply as a cataplasm;
or, take of wax, dr. viij; of sulphur the same quantity; of salt, dr.
vj; triturate them dry, and having poured on them half a cyathus of oil,
boil all together, and use the plaster that is formed. But one must
attentively sit by while the boiling is going on. It is a very excellent
medicine.
* * * * *
COMMENTARY. See Hippocrates (Epidem. et alibi); Galen (Meth. Med. v);
Alexander (i, 5); Oribasius (Synops. vii, 7); Morb. Curat. (iii, 21);
Aëtius (v, 129); Actuarius (Meth. Med. ii, 11; i, 23); Celsus (v, 28);
Pseudo-Dioscor. (Euporist. i, 106); Haly Abbas (Theor. viii, 17; Pract.
iv, 8).
As stated in another place, the Greeks used the term exanthema in a
much laxer signification than it is applied in Dr. Willan’s ‘System
of Cutaneous Diseases.’ Hippocrates in particular may be mentioned as
applying it to various classes of these affections. Alexander describes
the exanthemata of the head as superficial ulcerations, which are red and
rough. Does he allude to porrigo? He recommends for the cure of them a
composition of litharge, ceruse, alum, the green leaves of rue, vinegar,
and myrtle oil.
Galen says that exanthemata is a term applied by some to all ulcerative
and rough affections of the skin, which, according to Archigenes, stand
in need of desiccative applications. In another place he mentions
the exanthemata as a common symptom of the plague. Aëtius in like
manner gives from Herodotus an interesting account of fevers which are
accompanied with exanthemata. Both have been supposed to allude to the
smallpox, but we agree with Dr. Willan, that this interpretation of their
descriptions is altogether fanciful.
Our author follows Oribasius closely.
According to Actuarius exanthemata, properly speaking, are produced by
thick humours either formed in the skin or in the whole body, and being
detained by the density of the epidermis.
Celsus describes the exanthemata under the generic term pustulæ. His
words are: “Earum plura genera sunt. Nam modo circa totum corpus partemve
asperitudo quædam fit, similis iis pustulis, quæ ex urticâ, vel ex sudore
nascuntur: ἐξανθήματα Græci vocant. Eæque modo rubent, modo colorem
cutis non excedunt.” For pustules of all kinds he recommends exercise,
restricted diet, and abstinence from all things of an acrid and attenuant
nature, which regimen is likewise to be enforced upon the nurse, if
the child be at the breast. If the patient be strong, he is also to be
put into the hot bath, and rubbed with natron and a mixture of wine
and oil. If this treatment does not succeed lentils are to be applied,
especially if the pustules be large; and after the outer skin has been
removed they are to be treated with gentle applications. Such is the
plan of cure recommended by the great Roman authority. His directions
respecting the diet are particularly important, and appear to be quite
in accordance with the practice of the modern physicians, who recommend
the _half-starving system_ in all such complaints.
For red exanthemata the Pseudo-Dioscorides recommends ceruse with oil of
bays and sulphur, pure bark with wax, &c.
The exanthemata are described by the name of pustulæ parvæ in most of the
translations of the Arabians. The exanthemata is, we think, the first
species of _Serie_ described by Haly Abbas.
For the opinions of Alsaharavius and Haly Abbas about the exanthemata of
infancy, see Book i, 6.
Dr. Willan thinks that the nettle-rash was comprehended under the term
exanthemata. He is also of opinion that the _benat noctis_ of Avicenna is
the nettle-rash. It would appear, however, that the _benat noctis_ was
the same as the _sera_ or _epinyctis_. See Rhases (Cont. xxxvi, 2). The
symptoms of it are said to be itching, roughness of the skin, and small
eruptions attacking the patient during the night.
Thucydides, Hippocrates, and Galen mention exanthemata as a common
symptom of the plague.
We may take the present occasion to mention that none of the Greek or
Latin authorities has given any distinct account of _purpura_. Avicenna
has briefly described it in its chronic form. (iv, 3, 1, 8).
SECT. IX.—ON EPINYCTIDES.
Epinyctides are small ulcers breaking out spontaneously on the skin, in
the form of bullæ, reddish, and when broken, discharging a bloody ichor.
These are not very troublesome during the day, but at night, they are
more painful than the smallness of the ulcer would bespeak. Wherefore,
having dissolved the juice of laserwort in water, apply it; for it is
desiccative without being pungent; or, having levigated hemlock, apply
it; or crude cabbage with water, or triturate parsley with polenta, and
apply; or, triturate the leaves of henbane with honey, and apply; or,
strychnos by itself, and with the green coriander; or, use the leaves of
olives boiled with water; or, having triturated raisins deprived of their
stones, and spread them upon a splenium or oblong pledget, apply; or
triturate maiden-hair with honey. They must avoid all acrid, acid, and
saltish things, also fomentations, baths, and insolation.
* * * * *
COMMENTARY. Celsus (v, 28); Aëtius (xiv, 61); Oribasius (Morb. Curat.
iii, 54); Actuarius (Meth. Med. ii, 11; vi, 8); Pollux (Onomasticon iv,
24); Avicenna (iv, 3, 1, 13); Serapion (v, 8); Haly Abbas (Theor. viii,
17); Pract. (iv, 8); Rhases (Divis. i, 122.)
Celsus describes the epinyctis as a bad species of pustule, somewhat
livid or red, about the size of a bean, very painful and inflamed, and
coming on principally at night, whence it derives its name. Persons of
all ages, even infants at the breast, are subject to it, and in treating
them he directs the regimen of the nurse to be properly attended to. In
laying down the rules of treatment he puts particular stress upon the hot
bath.
Aëtius, Oribasius, and Actuarius treat of it as our author. Pollux
defines it to be a vesicle of a palish colour, somewhat humid and bloody,
and forming about the legs and feet in the night.
The Arabians give a similar account of epinyctis, under the names of
Sare, Serie, and Essere. Thus Serapion recommends bleeding if required by
the general symptoms, purging with myrobalans and prunes; and external
applications, containing sumach, savin, &c. Haly Abbas, who describes
it as one of his serie, approves of much the same treatment. Avicenna
and Rhases in like manner recommend bleeding, gentle purgatives, cooling
lotions, and the tepid bath. Rhases, in his ‘Continens,’ applies the
directions given in this chapter by Paulus to the treatment of the
cutaneous disease, which he calls sera. This establishes their identity
(xxxvi, 6.) As stated in the preceding chapter, the epinyctis is also the
“benat noctis,” i. e. “filia noctis” of the Arabians. Marcus Aurelius
Severinus, therefore, is mistaken in distinguishing between the epinyctis
and the benat noctis. Ingrassius admits their identity.
Fracastorius gives the following account of this affection: “Si
inflammata et accensa sit cholera, pustulam illam facit, quæ ἐπινυκτις
vocatur, quod sæpissime noctu nascatur, Arabes Essere appellant.” (De
Morb. Cont. ii, 15.) Both Lorry and Rayer confess themselves unable to
determine what the epinyctis of the ancients was. It would appear to
have been some peculiar species of eczema, now extinct. It must have been
a more formidable disease than the nettle-rash, which certain modern
authorities have taken for the _epinyctis_ of the ancients.
SECT. X.—ON PHLYCTÆNÆ OR BULLÆ.
As Bullæ when they burst spontaneously are attended with acute pain, it
is proper to perforate at their under part with a sharp needle, and then
to squeeze out the humour gently, suffering the skin which covers it to
remain. And if the wound should close up and the bullæ fill up, it is to
be evacuated again in like manner, and pressed out; and the incumbent
skin is to be kept pressed down until the ulcer below be healed. Before
the bullæ break, apply boiled lentils triturated with water; or, the
shoots of pomegranate, having been warmed upon hot coals, are to be
applied, so as to burn the parts. But if they burst and form an ulcer,
having melted axunge, and mixed levigated litharge, put into a linen
cloth, and apply; or, having boiled the root of lily in water, triturate
it with cerate, and apply.
_For epinyctis and phlyctæna._ Having triturated equal portions of
litharge and sulphur vivum with vinegar and myrtle-oil, until it become
of the thickness of the sordes of baths, rub with oil and wine. For hot
eruptions, warm papulæ, achores, incipient furunculus, and burns, the
composition of plumbago, and that from eggs is applicable.
* * * * *
COMMENTARY. See Aëtius (xiv, 63); Oribasius (Morb. Curat. iii, 23);
Actuarius (Meth. Med. vi, 8); Avicenna (iii, 3, 1, 11.)
This appears to be the pompholyx of Drs. Willan and Bateman. Aëtius
remarks, that the disease principally attacks women whose menses
are obstructed. (Bateman says, “it seems to affect only women.”) He
recommends emmenagogues, laxatives, and diuretics, and forbids all acrid
things.
Our author copies the whole from Oribasius. Actuarius recommends nearly
the same applications.
Celsus describes the phlyctænæ as a variety of the pustulæ. There is
nothing particular in the treatment recommended by Avicenna.
Thucydides mentions small phlyctænæ and ulcers among the symptoms of the
plague of Athens. (De Bello Pelopon. ii.) Hippocrates gives the name of
_pemphyx_ to the cutaneous eruption, by which the plague of Athens was
distinguished. (Epidem. vi.) See Galen’s Comment. (v, 453, ed. Basil.)
Procopius also takes notice of black phlyctænæ among the symptoms of
the great plague which raged in the reign of Justinian (Pers. ii.) See
also Diodorus Siculus (Biblioth. xiv.) Some suppose, however, that by
phlyctænæ were meant petechie. See Prælect. Marc. p. 301.
SECT. XI.—ON BURNS.
Burnt parts require applications which are moderately detergent, without
being decidedly heating or cooling. Wherefore, Chian, Cimolian, Cretan,
and every light earth, when rubbed in with vinegar not very acrid, or
mixed with water, are excellent applications, and prevent blisters
from forming; also a whole raw egg immediately applied upon soft wool,
for it cools moderately, and dries without being stimulant. And anoint
the part with black ink, or with frankincense dissolved in water, or
use a cataplasm of boiled lentils, or of tares. For burning with hot
water, before blisters arise, pour frequently on the part the brine of
pickled olives, or apply olives themselves triturated with polenta;
or, triturate stone-alum with vinegar, and rub it in; or, anoint with
bull’s gall dissolved with much water; or, pour on the part strained
ley with sauce of pickles, or brine; or, triturate the bulbous roots of
lilies, hyacinths, or narcissi with rose-oil, and having made it of the
consistence of the sordes of oil in baths, anoint with it. But Marcellus
gives the following composition: having smeared a rag with honey, and
wrapped it around barley, burn it, and mix of the ashes, dr. viij; of
ceruse, dr. iv; of butter, dr. viij; of wax, dr. xvj; of goat’s fat, dr.
xvj; of rose-oil, dr. xvj. For burnt parts already blistered, having
triturated sumach and polenta with vinegar, apply it; or, mix quicklime
with cerate, put it on a rag, and apply. And the medicine called
Sphæria is applicable in such cases. The parts which are ulcerated, may
be covered with pounded leeks; or, triturate purslain with polenta, and
apply; or, put pigeon’s dung into a rag of linen, burn it, and mix the
ashes with oil, and use; (this is an excellent application:) also the
bark of pine and of spruce fir, or dried maiden-hair levigated, or the
burnt leaves of myrtle, are to be triturated and sprinkled upon the part.
Each of these things answers well, when applied with cerate. But a good
application is formed by triturating together of the dried roots of the
red alkanet, oz. iv; of white wax, oz. ix; of rose-oil, oz. xviij; and
also that made of ceruse, with a small quantity of stag’s marrow.
* * * * *
COMMENTARY. See Hippocrates (de Ulceribus.) Celsus (v, 27); Galen (de
Simpl. Med. et alibi.) Aëtius (xiv, 64); Pseudo-Dioscor. (Euporist. i,
178); Actuarius (Meth. Med. vi, 6, 8); Nonnus (240); Serapion (v, 11);
Avicenna (iv, 4, 2, 12); Haly Abbas (Pract. 4, 25); Alsaharavius (xxix,
2, 8); Rhases (Antid. i, 27); (ad Mansor. vii, 18); (Div. i, 136.) The
author of the Hippocratic treatise referred to above, recommends various
applications to burns, such as old axunge rubbed into the part, and the
root of squills applied above; or a mixture of old axunge, rosin, and
bitumen, spread upon a rag and heated at the fire; or the roots of the
ilex boiled in white wine at a gentle fire until it be of the consistence
of a liniment.
Dioscorides, Avicenna, and Galen, agree in praising Cimolian earth as
an application to recent burns. Galen says that copperas, especially
when dissolved in vinegar, forms an excellent application for the ulcers
occasioned by burning.
Aëtius treats burns upon nearly the same principles as our author.
When blisters rise he forbids an early opening to be made in them. As
an application to them he recommends alum with water and the white of
an egg. Some of his applications can only be supposed proper for the
foul ulcers left by burning. Such is that consisting of verdigris and
litharge, pounded with wine and oil. For healing ulcers he recommends a
composition containing ceruse, litharge, toasted barley pounded, wax, and
rose or myrtle oil.
In the ‘Euporista’ Cimolian earth, litharge and oil, and many other
applications are recommended.
Actuarius recommends a composition of litharge, ceruse, wax, turpentine,
and some other articles of less importance. We need scarcely mention
how much the oil of turpentine has been used of late in such cases. He
praises such things as are moderately astringent, such as alum dissolved
in vinegar, &c.
Celsus recommends at first such things as are, “mediocriter exedentia
reprimentiaque,” and afterwards articles of a soothing nature. To the
former class belong the farina of lentils and honey; myrrh with urine,
or the Cimolian chalk, with the bark of frankincense; and to the latter
belong all fatty applications, and such things as contain the dross of
lead and the yelks of eggs. He also mentions turpentine rosin, as an
application to foul ulcers from burning.
Serapion, like our author, recommends applications which are moderately
detergent, and neither very calefacient nor refrigerant. He gives the
following directions for making a preparation from lime. Take of lime,
seven times washed in sweet water and dried, oz. viij; of wax, oz. ij;
of oil of roses, oz. vj: let the wax be melted along with the oil,
and well mixed with lime. This is to be rubbed into the part. He also
gives a prescription for preparing a mixture of lime-water and oil,
exactly similar to that which is now used in cases of burns. (vii, 28.)
Avicenna, with his usual accuracy, lays down very particular rules for
the treatment of burns. To prevent blisters from rising he recommends
cooling things; when the burning is occasioned by hot water, he directs
us to apply sandals, rose-water, and camphor: or a cloth dipped in
congealed water is to be kept constantly applied, and it will prevent
blisters from rising. Most of the applications recommended by our author
are also mentioned by him. Haly Abbas directs us to apply a cloth cooled
in rose-water. He also speaks of the ointment of lime and rose-oil,
mentioned above. When the burning is not severe, Alsaharavius directs us
in the first place to wash the part with vinegar and salt, and then to
sprinkle upon it the flour of barley or of oats. Then if blisters do not
rise, but there is a sensation of burning in the part, he recommends us
to apply cloths dipped in cold water, rose-water, or snow-water, which
are to be changed frequently. Afterwards some emollient applications,
such as the white of an egg, with gum arabic is to be used. When the
burning is more severe, he recommends us to bleed and use a cooling
application, such as the brain of a sheep, the white of an egg mixed
with rose-oil, or an ointment made of white wax and rose-oil. He also
makes mention of the application from lime. Rhases recommends an ointment
containing ceruse, camphor, opium, &c. Like Avicenna, he directs us to
apply at first a cloth wetted in cold water, or in rose-water, which
has been cooled with snow. If the burning be extensive he recommends
venesection, with a cooling and attenuant diet. When the pain is great
he directs us to apply the yelks of eggs mixed with rose-oil. When a
large ulcer is formed, he directs us to dress it with the ointment of
lime, described above. He also approves of a white ointment, consisting
of ceruse, oil of roses, and wax. In his ‘Continens,’ he relates a case
of severe burning, which he treated with liniments composed of sandals,
camphor, and roses; a cloth wetted in snow-water being applied externally
to it. He approves of opening the blisters. To prevent them from forming,
he recommends strongly an astringent collyrium of galls. Like many of
the other authorities, he recommends Cimolian earth very much. The
applications recommended by Haly Abbas are of a refrigerant and cooling
nature, such as Armenian earth in vinegar, the white of an egg, ceruse,
&c.
The earlier modern authors treat burns upon the plan laid down by the
ancients, more especially the Arabians. Thus Guy, of Cauliac, recommends
us in cases of extensive burning to have recourse to venesection,
along with a cooling and attenuant regimen. As a local application, he
recommends a cloth wetted in rose-oil congealed in snow, and afterwards
cooling ointments containing ceruse, litharge, and the like. He approves
of opening the blisters, of afterwards dressing the part with desiccative
remedies, such as the ointment of lime, seven times slaked. (Tr. vi,
Doct. C. 6.)
SECT. XII.—FOR THOSE BEATEN WITH SCOURGES.
Take of ceruse and litharge equal parts, of wax four parts, use as a
plaster with the oleum susinum, or rose-oil; but on the first day use
the susinum separately; or, of saffron, dr. j; of tragacanth, dr. j;
unite with them a whole egg, without the shell, and use. For those who
have been scourged, the skin of a sheep newly taken off, when applied
while yet warm, of all remedies cures the soonest, effecting this purpose
in a day and a night.
* * * * *
COMMENTARY. See Aëtius (xiv, 62); Avicenna (iv, 4, 2, 7); Haly Abbas
(Pract. iv, 26); Alsaharavius (Pract. xxxi, 2, 1); Rhases (Contin.
xxviii.)
Aëtius gives similar directions. The following is said to be an excellent
application for the stripes of a whip: mix washed lime with raw eggs,
and add some rose cerate. Aëtius, Galen, Nonnus, Avicenna, Rhases, Haly
Abbas, and Alsaharavius join our author in recommending the fresh skin
of a newly-killed sheep as an application in such cases. Alsaharavius
recommends an ointment containing white wax, rose-oil, and ceruse,
when the wounds are deep; when there is any apprehension of heat and
inflammation, and more especially if the patient be plethoric, he
approves of venesection. When on the other hand the patient is weak, and
is in danger of falling into a state of syncope, he recommends musk and
wine to be administered. When there is much appearance of ecchymosis he
speaks of scarifying the part after the heat is gone. Rhases recommends
a composition of ceruse, litharge, wax, and rose-oil, as a general
application.
Most of the applications recommended by Bertapalia contain litharge,
ceruse, tutty, wax, and oil. (De Ulceribus, 16.) The other earlier
medical authors of modern times likewise follow the ancients in this case.
SECT. XIII.—TO MAKE HAIRS GROW ON A PART THAT HAS BEEN BURNT.
Hairs grow on a burnt part if you apply fig leaves boiled in a pot
with cerate, in the form of a plaster; or, of dried fig, dr. viij; of
marjoram, dr. j; triturate with oil to the thickness of a cerate, and
use; or, of gypsum, dr. _c_; of squama æris, dr. j; form trochisks with
water, and keep. When going to use, mix one part with eight parts of
cerate.
* * * * *
COMMENTARY. The Arabians mention various things which were supposed to
be possessed of the property of making hairs grow; such as turpentine,
spikenard, thapsia, &c.
SECT. XIV.—FOR EXCORIATIONS.
For excoriated surfaces and superficial ulcers, at first use astringents,
such as wine, or vinegar and brine, and afterwards such plasters as
contain fat and promote cicatrization, and the most delicate of the white
plasters. This is particularly applicable: of ceruse, p. j; of ammoniac,
p. ss; of myrtle-oil, q. s; having triturated the ammoniac in water, mix
the ceruse, adding the myrtle-oil, and use in an oily state: or, mix the
squama æris with gypsum, and having triturated with myrtle-oil, use: or,
having triturated Cimolian earth and litharge with wine, and the oleum
ricini, or myrtle-oil, use.
_For excoriations, intertrigo, chronic ulcers, and old and tender skin._
Of golden-coloured litharge, dr. lx; of wax, dr. xx; of dried pitch
rosin, dr. xij; of oil, iss cyathus: having boiled the litharge and the
oil, add the other things, and having agitated it with a spatula, or
softened it in a mortar, use. Skin which has been torn away, ought not
to be cut from the sores, but it ought to be laid on, and the medicine
applied; for thus they coalesce, even if it is black. When stripped of
the skin, the cicatrization is difficult, the ulcer being irritated and
rendered foul. Excoriated parts are preserved from inflammation by the
application of red sumach, triturated with honey, or with the hair of
sweet flag burnt and applied with honey.
_An anodyne for excoriations, sores from stripes, and contusions of the
joints._ Of litharge, of ceruse, of each, oz. j; of wax, oz. vj; of pure
oil or rose-oil, lb. iss; of starch, oz. ij. The composition called
pelarium, from the dross of silver, produces the same effects, and that
from eggs in like manner.
* * * * *
COMMENTARY. See Oribasius (Morb. Curat. iii, 18); Aëtius (xiv, 66, 67);
Scribonius Largus (88); Marcellus (De Med.); Avicenna (iv, 4, 2, 9);
Haly Abbas (Pract. iv, 10); Rhases (ad Mansor. vi, 18.)
Our author copies closely from Oribasius.
Aëtius recommends as a good application for intertrigo occasioned by the
friction of shoes, the warm liver of a pig or lamb, or unwashed wool.
Here he follows Dioscorides (ii, 37.) He also makes mention of several
cooling applications, containing ceruse, litharge, the dross of lead, &c.
Scribonius Largus recommends an ointment containing litharge, ceruse, the
flour of frankincense, alum, axunge, old austere wine, roses, and sour
oil.
Marcellus also recommends litharge for intertrigo.
The Arabians treat these cases similarly. Thus Avicenna agrees with
Aëtius in recommending the liver, and the ointment containing ceruse, &c.
For bruised parts he recommends astringents; such as galls, acacia, &c.
To relieve the heat and irritation occasioned by riding, or any such
cause, Rhases directs us to apply a cloth dipped in rose-water properly
cooled, he means, perhaps, with ice. After the heat and pain have been
removed, an ointment of ceruse, or litharge is to be applied. Blisters
produced by walking are to be opened and then washed with rose-water;
and afterwards they are to be dressed with an astringent application,
containing Armenian bole, galls, pomegranate flowers, or the like.
SECT. XV.—FOR MYRMECIA AND ACROCHORDON.
Each of these is a small rising of the skin, of a callous nature, and
for the most part circular; but the myrmecia have a broad base, and when
rubbed, convey a sensation like the bites of ants. But the acrochordon
has a narrow base so as to seem to hang, resembling the extremity of
a cord. Wherefore, elaterium with salts, when applied, removes these
swellings; and frankincense with vinegar, green figs with vinegar, flour
and natron, the juice of the fig rubbed in, and in like manner, that
of the spurge, the pickled head of picarel burnt, verdigris burnt with
sulphur vivum, the leaves of basil with copperas; that which flows from
green vine shoots when burning, sheep’s dung with vinegar, a buck-goat’s
gall when rubbed in, the fruit of the large sun-flower, when applied
with wine, rue with natron and pepper, natron with the urine of a youth
not come to puberty, the dung of an ox of the herd in vinegar.
* * * * *
COMMENTARY. See Celsus (v, 28); Galen (Meth. Med. xiv); Aëtius (xiv, 4);
Oribasius (Morb. Curat. iii, 55); Actuarius (Meth. Med. vi, 8); Pollux
(Onomast. iv); Avicenna (iv, 3, 1, 6); Rhases (Divis i, 131, _et seq._;
ad Mansor. vii, 15, 16.)
Celsus defines these tumours in the following terms: “Ἀκροχορδόνα Græci
vocant, ubi sub cute coit aliquid durius, et interdum paulo asperius,
coloris ejusdem: infra tenue, ad cutem latius: idque modicum est quia
raro fabæ magnitudinem excedunt. Vix unum tantum eodem tempore nascitur;
sed fere plura, maximeque in pueris; eaque nonnunquam subito desinunt;
nonnunquam mediocrem inflammationem excitant; sub quâ etiam in pus
convertuntur.” He then describes the θύμιον to be about the size of an
Ægyptian bean, and of the colour of thyme. He adds: “Μυρμήκια autem
vocantur humiliora thymio durioraque: quæ radices altius exigunt,
majoremque dolorem movent: infra lata, supra autem tenuia; minus
sanguinis mittunt; magnitudine vix unquam lupini modum excedunt.
Nascuntur ea quoque aut in palmis aut in inferioribus partibus pedum.”
The acrochordon, he says, if cut out, leaves no roots, and does not grow
again. This is not the case with the myrmecia. For it he recommends an
application consisting of alum and red arsenic.
Galen describes minutely the method of extracting these tumours; but that
belongs more properly to the surgical part of this work.
Applications containing arsenic, chalcitis, quicklime, elaterium,
sulphur, and alum are mentioned by Oribasius and Aëtius. See in like
manner the ‘Euporista’ of the Pseudo-Dioscorides.
The myrmecia is generally rendered _formicaria_ by the Latin translators
of the Greek medical authors, and _formica miliaris_ by those of the
Arabians. Avicenna seems to confound the myrmecia with the herpes.
Pollux defines the thymus, or thymium, to be an excrescence about the
pudenda, anus, fingers, or face, of a red colour, rough, bloody, and not
difficult to remove. The acrochordon, he says, is white at the root, and
it gets enlarged at the extremity. The myrmecia he defines to be a hard,
rough excrescence of a callous nature, but bloody at its extremity.
The acrochordon is thus described by an intelligent modern author:
“Est verruca subcutanea durior et asperior, callosa, atque plerumque
teres, cute concolor, in basi tenuis, summitatis vero latioris, fabæ
magnitudinem raro excedens, juniores maxime infestans.” (Mangeti Bibl.
Chirurg. i, 72.) The terms thymus, myrmecia, and acrochordon, have now
fallen into disuse.
SECT. XVI.—ON GANGLION.
Ganglion is a round tumour of a nerve (tendon?) arising from a blow or
pressure, in many parts of the body, but particularly in those parts
which are moved, such as the extremities of the hands and feet. In this
case, says Archigenes, apply quick lime with the grease of geese and
turpentine. But Poles uses the medicine from agate stone, and Oribasius
the following: of ceruse, of pine rosin, of old oil, of each, oz. j; of
ammoniac perfume, of galbanum, of each, oz. j; of wax, oz. iv; or, he
says, apply a thick plate of lead, like the vertebræ, and larger than the
ganglion, and bind it on; for by its weight this dissolves it in process
of time. This we have used.
* * * * *
COMMENTARY. See Hippocrates (De Artic. xxvi); Galen (Comment., de Med.
Simpl. ix); Celsus (vii, 6); Oribasius (De Virt. simpl. ii, in voce
Plumbum); Aëtius (xv, 9); Actuarius (Meth. Med. ii, 11); Avicenna (iv, 3,
2, 6); Albucasis (Chirurg. ii, 50); Rhases (ad Mansor. vii, 15: Contin.
xxviii.)
Hippocrates points out the danger of opening these tumours
indiscriminately. They consist, as Galen remarks, of a viscid and mucous
fluid. Galen and Oribasius agree with our author in directing a piece of
lead to be bound upon the ganglion. Nearly the same plan of treatment is
recommended by Aëtius, who directs us to bind a piece of lead upon the
tumour, and after some days to remove it, when the ganglion will be found
much softened; it is then to be squeezed firmly between the thumb and the
fingers, by which means it will be speedily dissolved. Albucasis approves
of extirpating the tumour, unless it be seated near a joint. Rhases as
usual collects the opinions of all preceding authorities. Antyllus, he
says, directed the surgeon to break the sack, or to bind a heavy plate
over it, or to extract it by the knife. When an operation is attempted,
he recommends that the surgeon be sure that he has removed the whole sac.
He relates a case in which the swelling was dissolved by an application
containing mustard.
SECT. XVII.—ON PHLEGMON.
In general, we call all those swellings phlegmons which are red and
painful, and accompanied with heat; some diversity of their nature
arising from the cause which occasions them. For when good blood and
of moderate consistence rushes abundantly to a part and from its
quantity becomes seated in it, the disease is that which is properly
called phlegmon; but when yellow bile is seated in a part, it is called
herpes; and when blood and yellow bile together are collected in a part,
erysipelas is formed; but when in this case the blood is hot and thick,
it usually gives rise to carbuncle. Wherefore, we shall begin with
what is properly called phlegmon, which occurs in many cases, being a
swelling which is red, painful, elastic, and hot, deriving its origin,
as I said, from good blood which is sometimes collected from the whole
body, and sometimes is formed abundantly in the part itself, so that it
cannot be contained in the vessels, but escapes from them in the form of
vapour into the surrounding cavities. And this affection supervenes upon
wounds, fractures, ulcers, and many other causes. When therefore a part
becomes inflamed without any obvious cause preceding it, the whole body
sending a defluxion to the part, we must evacuate the general system by
venesection, and apply to the part embrocations and cataplasms, not such
as are of a heating and moistening nature, but such as are calculated to
repel the fluid, which is flowing to the part, and evacuate that which
is already contained in it. Apply, therefore, a cataplasm of house-leek,
and of the bark of the pomegranate tree boiled in wine, with sumach and
polenta: when the pain is not violent, this or such like applications are
to be used; but when there is a defluxion to the part with greater pain,
then cataplasms of hot water and oil, or of polenta, must not be applied
(for all these are inimical to such defluxions); but the vehemence of the
pain is to be allayed by that which is composed from musk, rose-oil, and
a little wax, with unwashed wool containing much grease: these things are
to be prepared and applied cold in summer, but tepid if in winter, so
that the parts above the affected places be covered with a sponge soaked
in austere wine or cold oxycrate. But we must add to the cataplasms such
herbs as are proper for the purpose required. Pellitory of the wall,
therefore, is applicable to every phlegmon at the commencement, and
while on the increase; and in like manner, horned poppy, orach, mallows,
lettuce, and gourd, when applied on hot parts. Both kinds of caltrops
(tribuli) are applicable to inflammatory defluxions, and the cabbage to
such as are hard. When a change is thereby effected, and no pus falls
into the part, you may accomplish the cure by means of the plaster from
chalcitis, or some of those plasters of a similar nature, which apply to
defluxions; but clean wool soaked in austere wine is to be put externally
to the medicine. In this manner you may cure phlegmons from defluxion.
But such as are occasioned by any external cause will not be injured by
moistening and heating applications, and if necessity require, you may
scarify them with advantage. But in phlegmons arising from defluxion,
scarification, more especially at the commencement, may become the cause
of much mischief to the patient.
* * * * *
COMMENTARY. See Galen (ad Glauc. ii); de Different. Morb. (12); Meth.
Med. (xiii, 2); Celsus (iii, 10); Oribasius (Morb. Curat. iii. 41);
Aëtius (xiv. 31); Leo (vii, 4); Actuarius (Meth. Med. ii, 12); Avicenna
(iv, 3, 1, 2); Serapion (v, 22); Haly Abbas (Theor. viii, 9; Pract. iii,
27); Alsaharavius (Pract. xxix, 2); Rhases (Divis. 126, and Contin.
xxvii.)
Galen explains that the term _phlegmone_ is used either to signify
inflammations in general, or a red, resisting, and painful tumour in
particular. It is here used in the latter acceptation. He says, when a
defluxion of blood of good quality and of moderate consistence takes
place to a part, and from its quantity becomes fixed in it, the person
is seized with a violent pain, unless the part be very insensible; it is
also accompanied with a deep-seated throbbing; it seems stretched and
broken; there is a sensation of increased heat, so that the part feels
as if it were burnt and desires cooling; there is a florid redness as in
those who have been in the bath, or have been warmed at the fire, and
by other means. This affection, he says, gets the generic appellation
of phlegmone, or inflammation. He enumerates many causes of it, such as
bruises, fractures, and dislocations; but even without these, he adds,
it may arise from the veins being immoderately distended with humours,
and the superfluity being cast off upon a part fitted to receive them at
the time. Such a part, from some cause or other, happens to be weaker,
or more lax, or more calculated to attract, or is more inactive than
the other parts of the body. He lays it down as a general principle,
that the cure of such affections is to be accomplished by evacuation.
Reason and experience, he adds, teach us that the general system is to be
evacuated by the suitable means, and the inflamed part by embrocations
and cataplasms of a repellent nature, and such as are calculated to give
tone and strength to it. Such are his general principles of treatment.
His particular remedies we need not mention, as in fact our author’s are
entirely borrowed from him. Oribasius, Aëtius, Actuarius, and Nonnus,
in like manner, borrow from him everything which they advance upon this
subject.
Celsus does not treat of phlegmon in particular, but he has given
an excellent account of inflammation in general. His definition of
inflammation is singularly appropriate: “Notæ inflammationis sunt
quatuor, rubor, et tumor, cum calore et dolore.” Isidorus attempts the
same not so successfully: “Phlegmone est fervor cum extensione et dolore;
sive est inquietudo cum rubore, et dolore, et extensione, et duritie, et
vastitate: quæ quum cæperit fieri, inquietudo et febris insequitur.”
Avicenna gives a clear and comprehensive exposition of the doctrines of
the Greeks, but supplies no new information. He is at pains to explain
that the term phlegmon applies generally to every inflamed part; and also
to a hot aposteme in particular. He joins Galen in recommending a free
incision when it is apprehended that the member in which it is seated
will become corrupted. Serapion’s treatment is nowise dissimilar. A
phlegmon, says Haly Abbas, is a sanguineous collection, arising either
from an external cause, such as a bruise, a blow, a wound, or the
like, or from an internal cause, namely, a defluxion upon the part. He
attributes the collection which takes place in a part to its debility,
which makes it unable to cast off the load which is thrown upon it.
When seated in a vascular part, phlegmon, he says, is attended with a
throbbing pain. He approves of free and bold incisions. Alsaharavius
treats of phlegmon at great length, but there is nothing original in his
views. Rhases recommends at first bleeding, purging, and applications
of a cooling and astringent nature. But when suppuration has commenced
he properly forbids depletion, lest it only protract this process. He
remarks that phlegmons are often occasioned by disorder of the stomach,
and the use of too much food and drink. He recommends in general
maturative applications, to which, if necessary, narcotics may be added.
SECT. XVIII.—ON EXTERNAL ABSCESSES.
If it appear to you impossible to prevent suppuration, boil bread in
water and oil, and apply it as a cataplasm; or apply barley flour
prepared in like manner; and bathe the part with an infusion of
marshmallows. But when the swelling is difficult, either to convert into
pus or to dissipate, you may use a cataplasm of dried figs. But sweet
and fat figs are to be dissolved by boiling in water, and made like thin
honey, and barley flour added to it. And if the swelling is resolved
but imperfectly, you may boil with the figs hyssop or marjoram; or, if
you wish to increase its strength, add salts to the decoction. But you
must attend that the part be not dried too much, for thus will it be
rendered hard. If you perceive any such thing, you must boil with the
water the root of wild cucumber, or of marshmallows, or of bryony. But
the root of the dracunculus is stronger than these and more discutient;
and the medicine formed from the dracunculus itself is very discutient.
Sometimes, therefore, you may apply decoctions of these things alone; but
at other times you may add dried figs, and mix polenta with fat. And the
oil of dill is discutient, and adapted for concocting crude humours, and
unconcocted swellings. And pitch, more especially the liquid, concocts
all hard and unconcocted swellings, when added to the cataplasms. A
compound medicine for procuring the discharge of the concocted matter
of abscesses, so that often the pus is found on the pledget; and for
thoroughly discussing what is not concocted: of pyrites, of levigated
ammoniac, of each, dr. xij; of the flour of beans, dr. vj; add to liquid
pitch, and spread upon skin, and apply. But do not take away the pledget
until it fall off spontaneously. The medicine must not be prepared long
beforehand, as it soon becomes dry. When the tumour is no wise dissipated
by these means, and matter falls into it, it is to be opened, and the
matter evacuated, taking care not to apply to it water or oil; or, if
it be necessary to clean the sore, it must be done with honied water,
oxycrate, wine, and wine and honey; and if it become inflamed, the
cataplasm of lentils is to be applied; but if it is not inflamed, we may
use some of the plasters to such openings, more especially that from
chalcitis; but apply to them sponge or wool soaked in austere wine. But
to the wound itself, do not apply any of the oily ointments, such as the
tetrapharmacon, for it stands much in need of being dried.
_Those things which open abscesses._ Since some persons will not endure
to have abscesses opened with iron, we must endeavour to have recourse to
epispastic medicines. Having triturated the root of narcissus in honied
water, boil it with oil of iris, and apply; or, having triturated the
tender root of calamus, and if it be hard, boil it in honied water, and
apply; or, use a cataplasm of birthwort and honey. But equal parts of dry
pitch and Cretan bee-glue, produce the rupture of abscesses and promote
cicatrization.
_The Dionysian plaster, a wonderful epispastic application for abscesses,
to the breasts and to buboes, dissipating by the insensible pores._
Of old oil, of water, of each, lb. j; having boiled the oil and water
for a little time, add of aphronitrum, oz. vj; of misy, oz. j or ij;
and boil until it does not stain the finger; then add of the manna of
frankincense, of wax, of turpentine, of each, oz. vj.
_For abscesses of the nervous parts._ Of wax, of colophonian rosin, of
butter, of each, lb. j; of dry pitch, of honey, of each, lb. ij, oz. vj;
of verdigris, oz. iij; of bird lime, q. s.—_Another_, an epispastic:
Of ammoniac perfume, oz. vj; of wax, of turpentine, of each, oz. iv; of
sulphur vivum, oz. iij; of natron, oz. iij; and the application called
smilium, and that from garlic are strongly calculated to promote the
breaking of abscesses already formed. But that which consists of the
juice of linseed dissipates, changes, and bursts abscesses most aptly.
For the milder sorts of abscesses, those also which were mentioned for
parotis will apply. These observations apply to an abscess following
phlegmon. But, Galen says, that an abscess will sometimes take place
without being preceded by inflammation, in which case, it has its
origin from good blood. For at the commencement, he says, owing to some
humour, excoriation takes place, and in process of time, the containing
parts are separated from those below. And, therefore, when opened, they
appear to contain within them all kinds of fluid and solid bodies.
For, bodies resembling dung, urine, thrombus, a honey or mucus-like
humour, bones, nails, and hairs, have been found in abscesses. And even
animals have been found very like to those which derive their origin
from putrefaction. Nay, they affirm that, more particularly in chronic
abscesses from metastasis, bodies have been formed resembling stones,
sand, shells, wood, coals, clay, the sordes of the oil of baths, the
lees of oil, and the lees of wine. Wherefore, we shall now give a
succinct account of abscesses, more especially such as are seated in the
external parts of the body, and those which do not admit of resolution
by medicines. An abscess, then, is a corruption and change of the flesh
or fleshy parts, such as muscles, veins, and arteries. Of them, some are
contained in a cyst, as atheroma, steatoma, and meliceris, and others are
formed without a cyst, and are properly called by the generic name, and
of them we have now to treat. The formation of an abscess then is most
commonly preceded by inflammation, as we have stated, but sometimes it
arises at once originally, as we have just now mentioned. An abscess,
then, is attended with strong heat of the place, the swelling becomes
greater and more red than formerly, and is hard, with a pungent pain,
throbbing, and weight, so that it seems as if something were suspended
from the part. And if the part be a vital one, fever supervenes with
irregular rigors, and the pain and fever are greatest at night. Sometimes
too a bubo is formed in the neighbouring glands. When the abscess is
fairly formed, the most of these symptoms are diminished, the pungent
pain becomes itchy and somewhat dull, the swelling is more sharpened into
an acute point, is soft and yielding to the touch, and the skin at the
top is separated; I speak with regard to those that burst externally. If
therefore, it has burst spontaneously, or from medicines, it is to be
cured by means of pledgets spread with ointment, the pus being evacuated
by degrees; but if not, it is to be opened in the manner to be described
in the surgical part of the work.
* * * * *
COMMENTARY. All the writers referred to in the last Chapter may be
consulted on the treatment of abscesses. See especially Aëtius. He
recommends when suppuration is not taking place properly to apply barley
meal, or bread boiled in the decoction of figs, to which if necessary
may be added nitre, turpentine, or the like. When suppuration takes
place, the abscess is to be opened where the skin is thinnest. (See
Book 6.) The incision is to be made long and narrow, and if any putrid
substance appear it is to be cut out. The opening is to be sprinkled
with frankincense and suitable pledgets applied. When the neighbouring
parts are inflamed a cataplasm will be the most proper application. When
the ulcer is foul, turpentine and honey will serve for cleaning it; or
applications containing verdigris may be used for the same purpose. After
the ulcer is cleaned, first incarnants and afterwards incrassants are to
be applied. For producing rupture of the abscess, he recommends various
applications, such as ammoniac, and nitre triturated with vinegar, and
the like. This account, however, is mostly taken from Galen.
The treatment recommended by Celsus is nearly the same in principle.
At first if the part be soft he recommends applications of a repellent
and cooling nature: but if it is hard he directs us to use applications
which digest and produce resolution, such as dried figs pounded. To
such applications may be added equal proportions of ammoniac, galbanum,
bees-glue, and birdlime, with somewhat less than one half of myrrh. The
plasters and malagmata for this purpose are likewise to be applied. When
these applications do not produce resolution, we must conclude, he says,
that the abscess will ripen. The symptoms of an unripe abscess are
strong motion of the arteries, weight, distension, pain, redness, and
hardness; to which are to be added horror and fever if the abscess be
large. When there is a remission of these symptoms, and the part becomes
itchy, and somewhat livid or white, the suppuration is ripe, and the
matter is to be let out by medicines or iron. Unless the opening be large
he properly forbids tents or pledgets to be put into it. When these are
used, however, lentils and honey, or pomegranate rind boiled in wine are
to be applied over them. Whatever is applied must not be tightly bound.
The Arabians mention a variety of applications for producing the rupture
of abscesses. (See in particular Avicenna and Rhases.) Thus, they
recommend a plaster consisting of cantharides and old oil. Some of their
applications contain nitre, quicklime, and arsenic. Such a composition,
by producing a slough, would no doubt effect the purpose for which it
was intended. Haly Abbas recommends a poultice made of leaven, boiled
figs, and the seeds of rosemary. He speaks of onions as an application to
indolent abscesses. Alsaharavius treats of abscesses at great length.
By abscesses of the nervous parts it will be readily understood that
our author does not mean that they are seated in what are now properly
called nerves, but in tendinous and membranous parts, for all these were
comprehended under the name of nerves by the older writers, namely,
Hippocrates, Plato, and Aristotle. Galen pointed out clearly the
distinction between these parts, but the term is often used in its old
and popular acceptation by the writers subsequent to him.
The account which our author gives of deep-seated abscesses is highly
interesting, but is mostly borrowed from Galen (ad Glauc. ii.) Rhases,
in his ‘Continens’ (xxvii), gives an interesting outline of the opinions
of all preceding authorities, with some ingenious observations of his
own. When there is any hope of producing resolution he approves of
scarifications. When the pain is violent he recommends hot and humid
applications with the addition of narcotics. After the abscess has
been opened with the knife, he says that desiccative applications are
indicated, and not ointments containing wax or oil. He describes the
leaven cataplasm, and others of a similar nature. He gives Antyllus’
directions for opening abscesses. Abscesses in the limbs are to be
opened by a straight incision, but those about the ancles by a circular,
as they are apt to terminate in fistulæ. He recommends it to be made
at the lower part of the abscess, but mentions that Galen prefers the
thinnest part.
SECT. XIX.—ON GANGRENE AND SPHACELUS.
When the inflammation is neither resolved nor converted into pus, it
often passes into gangrene and sphacelus, of which we shall now treat.
Wherefore, we give the name of gangrene to mortifications arising from
the violence of the inflammation, when they are not yet formed but
forming; and if such a state is not speedily cured, the affected part
readily dies, and the disease seizing upon the surrounding parts, kills
the person. But when the parts thus affected become totally insensible,
the affection is no longer called gangrene, but sphacelus. This affection
happens also to the bones when the flesh that surrounds them engendering
noxious humours impregnates the bones therewith, and causes them to
putrefy. When, therefore, the part is completely mortified, it must be
speedily cut away, where it joins the sound part. Gangrene is to be cured
by evacuating as much as possible of the blood in the affected part; and
we may either procure the discharge of the corrupted blood by opening a
vein, when the vein of the part is large, or we may divide the whole skin
by many and deep incisions, so that the blood may be permitted to escape;
and we may apply some of the medicines suitable to mortifications. These
are, the flour of tares, or of darnels, or of beans with oxymel. When
wishing to apply stronger ones we may add salts, or use the trochisk of
Andron, or the like. Old walnuts are good applications for gangrene.
The nettle also cleans them, and the juice of spurge, when applied in
season and in proper quantity. The decoction of bitter lupines, poured on
the part, is also beneficial. Some after the incision, for the sake of
security, apply the cautery, in which cases we must use salt with leeks:
afterwards, in order to remove the eschar, we may apply a cataplasm of
bread, or of barley, or of wheaten flour boiled in water and oil; or the
dry cephalic powder with honey, and the tetrapharmacon; and that called
the Macedonian may be used. The eschars may be properly removed by bread
triturated with parsley, or basil, or by iris, panacea, or birthwort, or
by the sweet-flag with honey, or by frankincense. And the medicine of
Machærion takes away the eschars in a proper manner, and the iris spread
upon pledgets with honey; but in soft bodies the flour of tares, with
honey, is sufficient.
_From the works of Oribasius, for gangrene._ Of scraped verdigris, of
vermilion, of stone alum, equal parts; triturate in water and anoint. The
flour of darnel, with radish and salts, and sometimes with vinegar, will,
when applied as a cataplasm, be proper for the scarified parts; also
dried grapes deprived of their stones with the bark, and with salts and
oxymel; the inner parts of walnuts, and myrtle leaves boiled in wine and
triturated with honey. Radish, with vinegar, breaks the eschars even to
the bone.
* * * * *
COMMENTARY. See the authors referred to in the 17th Section.
Paulus copies freely from Oribasius (Synops. vii, 27.) Upon comparing
Oribasius with our author we have ventured to give an interpretation of
the last sentence not justified by the text as it now stands, and at
variance with the translation of Cornarius. Oribasius does not say that
the flour of darnel will scarify the parts (how could he?) but that it
will be a proper application after the parts are scarified.
Galen (ad Glauc. and Comment. in Hippocr. App. vii. 50,) is the great
ancient authority on mortification, and from him Oribasius, Aëtius,
Paulus, and all the subsequent writers on this subject have copied. He
lays it down as the great rule of treatment, to evacuate the blood which
is impacted in the part and prevents the diastole of the arteries. To
accomplish this end he directs free incisions to be made, after which the
actual cautery is to be applied, at the line of separation between the
sound and diseased parts.
Celsus is a strong advocate for this practice, which has been revived
lately and is much used in France. (See Encyclopédie Méthiodique, art.
Gangrène, and Cross’s Sketches of the Medical Schools in Paris.) He
states, however, that when the disease goes on spreading, amputation
of the mortified limb is the “auxilium unicum.” At the commencement he
approves of venesection, if the strength permit, and of a restricted
diet; and, afterwards, astringent food and drink are to be given. He also
recommends, for gangrene, applications containing arsenic, quicklime,
chalcitis, and the like (v, 22.)
The practice of the Arabians is little or nothing different from that
of the Greeks. Avicenna at the commencement approves of Armenian bole
and terra sigillata with vinegar; but if these have not the effect he
directs us to empty the part by scarifications, leeches, or opening the
veins which lead to it. He then recommends us to apply the flour of
beans and the other remedies mentioned by the Greeks. When the disease
proceeds, free incisions and the actual cautery must be had recourse to.
Alsaharavius recommends us to bleed at first, if the strength permit;
then to use powerful caustics and escharotics such as arsenic, quicklime,
and sublimed quicksilver; or if these do not succeed, the actual cautery.
He approves of early incisions, and of amputation, if the mortification
spread. He describes a species of gangrene which seizes the hand and
spreads upwards; and relates a case of it in which he refused to amputate
for fear of hemorrhage. The same case is related by Albucasis, which
certainly amounts to a strong presumptive proof that Alsaharavius was the
same person as Albucasis. Rhases inculcates in the strongest terms that
when an inflammation threatens to terminate in mortification, it is to be
treated by scarifications, stimulant applications, and the cautery.
The earlier modern surgeons followed the ancient practice of applying the
cautery in cases of gangrene.
SECT. XX.—ON HERPES.
When yellow bile, unmixed with any other humour is fixed in a part, the
affection is called herpes: but if it is thicker and rather acrid it
ulcerates the whole skin as far as the subjacent flesh, and is called
herpes exedens; but if it is thin, less acrid and hot, it raises small
blisters on the surface of the skin like millet-seeds, and hence has been
called herpes miliaris. According to Oribasius, a mixture of phlegm, with
yellow bile, produces the herpes miliaris. Wherefore we may evacuate the
whole body with cholagogue medicines, and apply cooling and desiccant
things to the affected part. At the commencement, therefore, we may apply
cataplasms from vine shoots, bramble, and plantain; but afterwards we may
add lentil to them, sometimes with honey and polenta. And the cataplasm
recommended for phlegmons from defluxion may be applied without the
house-leek. But ulcerated parts are to be rubbed with trochisks dissolved
in must, or in a thin and austere wine, not very old, or in a watery
oxycrate. Administer also horned poppy, and similar things in water;
and when these do not prove effectual, vinegar may be added. But wine
diluted with the juice of plantain or strychnos is of great service, or
linseed bruised and boiled in wine and oil may be applied; or Cimolian
earth, mixed with the juice of strychnos may be applied by anointing: and
take of litharge, oz. iv; of the juice of leeks, vij cyathi, and of the
juice of beet an equal quantity, triturate and anoint. But when these
ulcers have become chronic, the trochisk of Musa and that of Andron will
be convenient applications.—_Another_: For herpes phlyctænodes: having
triturated the dross of lead in austere wine and anointed with it, apply
above it beet leaves boiled in wine, or of wax, oz. iv; of myrtle oil,
oz. xvj; of the dross of lead, oz. iv; anoint with one half of wine. When
it has stopped from spreading, use the cerate from the dross; or apply
boiled lentil with honey. For herpes, under the skin, mix the dross of
lead with the juice of levigated rue, or myrtle cerate, instead of the
rue.—_Another_: Of old unwashed wool wrapped round a dead pine and burnt,
dr. xij ss; of wax, dr. xxv; of the dross of lead half an acetabulum; of
goat’s tallow cured and washed in water, dr. xxxj; of myrtle oil, oz.
v.—_Another_: To those which spread rapidly: of the rind of the sweet
pomegranate, dr. vj; of litharge, dr. vj; of unwashed wool about a dead
pine and burnt, dr. iij; of wax, dr. xij; of ceruse, dr. viij; of fissile
alum, dr. j; add to wine and myrtle oil.
* * * * *
COMMENTARY. The writers on phlegmon treat immediately afterwards of
herpes and erysipelas. Fabricius ab Aquapendente, Dr. Bateman, and most
of our modern authorities on this subject, are of opinion that the _ignis
sacer_ of Celsus and the other Latin authors was herpes. Scribonius
Largus, however, distinguishes the ignis sacer from zona, which, he says,
was called herpes by the Greeks. The ignis sacer of Octavius Horatianus
likewise appears to be erysipelas. And Isidorus states decidedly that the
ignis sacer was erysipelas:—“Erysipelas est quam Latini _sacrum ignem_
appellant, id est, _execrandum_, per antiphrasin. Siquidem in superficie
rubore flammeo cutes rubescunt. Tunc mutuo rubore quasi ab igne vicina
invaduntur loca ita est etiam febris excitatur.” (See a learned
dissertation on the ignus sacer in Burman’s edition of Serenus Samonicus,
‘Poet. Latini Minores.’ ii, 335.) Having thus stated the doubts which
prevail respecting the ignis sacer of the ancients, we shall return to
Celsus’s account of it, which certainly, as already mentioned, seems to
apply to herpes. He describes two varieties of it. The first is reddish,
or a mixture of redness and paleness, and in it the skin is covered with
a great number of small pustules. The disease spreads, the part first
affected either healing, or becoming ulcerated from the rupture of the
pustules and discharging a humour intermediate between sanies and pus.
The breast and sides are mentioned as being frequently the seat of this
complaint, and hence Bateman concludes that it is the herpes zoster. The
second variety is described as consisting of a superficial ulceration of
the skin, broad, somewhat livid, but unequal; the middle part healing as
the extremities spread, and the part about to become affected becoming
swelled, hard, and of a colour compounded of black and red. It affects
principally old and cachectic persons, especially their legs. We cannot
understand what could have led Dr. Bateman to think that this is the same
as the herpes circinatus of his arrangement. Rayer rather supposes it
to be the _dartre squameuse centrifuge_ Alibert. His general treatment
consists of abstinence, opening the belly, food intermediate between the
glutinous and saltish, and if there is no fever, exercise, austere wine,
and the like. The ulcers (vesicles?) are to be washed with hot water, or,
if they spread, with hot wine; they are then to be opened with a needle,
and dressed with applications for eating away putrid flesh. When the sore
is cleaned, gentle applications are to be used.
For the zona or herpes, Scribonius Largus recommends applications
containing alum, galls, chalcitis, misy, quicklime, &c.
Pollux defines herpes to be inflammatory and pungent pustules, which
spread most commonly about the neck, but sometimes affect also the hands
and feet.
Galen gives a very full account of the nature and treatment of herpes.
According to him the complaint arises from yellow bile separated from
the blood and fixed in a part. When it is thickish it ulcerates the
skin down to the bone, and forms the disease called by Hippocrates
_herpes exedens_. But if thinner, it only burns as it were the surface,
when it is called by the generic term of herpes. Of the other two
varieties, the one, as has been said, is called _exedens_, and the other
_miliaris_, because it is attended with many small bullæ (phlyctænæ)
like millet-seeds. As our author’s treatment is entirely derived from
him we shall not enter into any detailed exposition of his practice.
We may mention, however, that he decidedly recommends purgatives for
proper herpes. When the ulceration is of a malignant nature and attended
with putridity it requires the most acrid medicines, and such as in
power resemble fire, namely, misy, chalcitis, arsenic, quicklime, and
sandarach. For, he adds, these medicines burn like fire, and often when
they fail, we must have recourse to fire itself.
Aëtius gives an accurate account of herpes, but it is professedly
borrowed from Galen. Like him he divides the disease into three
varieties, the herpes proprius, the herpes exedens, and the herpes
miliaris, the last being characterized by an eruption of vesicles
(phlyctænæ). We shall here notice what Dr. Bateman says respecting
this division of herpes:—“The ancient division of herpes into three
varieties, miliary (κεγχρίας), vesicular (φλυκταινώδης), and eroding
(ἐσθιόμενος), may be properly discarded, for there appears to be no
essential difference between the first two, which differ only in respect
to the size of the vesicles.” This is evidently an incorrect account of
the ancient division, in which no distinction was made between the herpes
miliaris and the herpes phlyctænodes.
Palladius makes mention of only two varieties of the disease, namely, the
proper, and the eroding herpes. (De Febribus 2.)
Leo briefly refers to Galen’s account of the disease (vii, 3.)
Actuarius mentions only the proper herpes, and the herpes miliaris. This
is, perhaps the best division of any, as the herpes exedens is evidently
a disease of a very different nature from the other varieties.
The Pseudo-Dioscorides recommends strong stimulant applications
containing sori, misy, sulphur, onions, &c.
Avicenna seems to confound herpes with myrmecia, which detracts from the
value of his account of it. (iv, 3, 1, 7.)
Rhases describes separately the formica miliaris or herpes miliaris,
and the herpes esthiomenos or exedens. For the former he recommends
astringent applications, for the latter strong caustics. In his
‘Continens’ he directs the herpes miliaris to be treated with cholagogues
and astringent applications.
Serapion in like manner describes two varieties of the disease, but his
account of it contains nothing particularly interesting.
Haly Abbas adopts the division laid down by Galen (Theor. viii, 10.) His
treatment also is quite similar (Pract. iii, 29.)
In the translation of Alsaharavius the three varieties are described by
the names of formica or erysipelas muscina, formica corrosiva (herpes
exedens?), and formica miliaris. He describes the formica corrosiva as
being a dangerous complaint, spreading deeper and deeper. His treatment,
although amply detailed, contains nothing remarkable (Pract. xxix, 9.)
The earlier modern writers on medicine being the servile copyists of the
Arabians, describe herpes by the name of formica, as a disease nearly
allied to erysipelas, and like it arising from corrupted bile. See Guy of
Cauliac (ii, 1), and Theoderic (iii, 16). For the herpes esthiomenos or
lupus they recommend the application of arsenic or the actual cautery.
SECT. XXI.—FOR ERYSIPELAS.
Galen, giving the name of erysipelas, more especially to the swelling
formed of a hot and thin blood, to that which is formed of both blood
and bile, he applies an appellation from the prevailing humour, calling
it erysipelatous inflammation when blood prevails, and inflammatory
erysipelas when yellow bile prevails. But in general the swelling formed
of hot blood and bile is called by him erysipelas. Whatever division
we adopt, it will make no great difference as to the treatment. But it
is proper to know that erysipelas is a most dangerous disease, more
particularly about the head; so that if active treatment be not resorted
to, it will sometimes prove fatal to the patients by suffocation. At
its first appearance then we must open a vein at the elbow, especially
the humeral, or, if it cannot be seen, any one that appears. But if
any thing prohibit venesection we must have recourse to purging by
cholagogue medicines. The same treatment may be applied to erysipelas
of other parts, or we may administer strong clysters. And we are to rub
the parts affected by erysipelas with cooling things, in order to repel
the defluxion, and with moderately heating and moistening things so as
to dissipate that which is collected, before the parts become livid
or black; but the parts which are anointed are to be kept constantly
in a wet state, by frequently changing the applications, which may
be done by cleansing them with soaked sponges: for the heat of the
part by converting them into vapour soon renders it dry. As I have
said, erysipelas at the beginning requires such things as are cooling
and moistening, without astringency; such as house-leek, purslain,
and fleawort; the marsh lentil, endive, and gourd; the nightshade,
henbane, lettuce, and horned poppy. And parsley, and the leaves of
rhamnus by themselves, and made into a cataplasm with bread, are proper
applications; also cerates used with very cold water; but we may mix with
them some opium, the juice of poppy, cicuta, and mandragora, and thus
form them into compound applications. And a cerate may be made of white
wax mixed with four parts of rose-oil, prepared from the oil of unripe
olives without salts, the ingredients being pounded in a mortar, and as
much cold water poured in as it can receive. But if you add a little
thin and transparent vinegar, you will render the medicine still better:
but polenta, with some of the aforementioned cooling herbs, cool very
properly, and fat dates with any of them. And the part may be anointed
with ceruse, Cimolian, or potter’s earth, with the juice of strychnos, or
litharge with rose-oil, or chalcitis with oil and must; or ceruse, with
vinegar and buckthorn; or acacia, with vinegar. When the effervescence
subsides we may use these simple applications, native sulphur and mint,
with vinegar and rose-oil; or rue with worm-wood; vinegar and oil, or
litharge with the juice of leeks and beet; or compound ones, as this
trochisk, more especially to the head: of litharge, of ceruse, of
saffron, of native sulphur, of opium with must; and in common, for all
parts, of Sinopic vermilion, of chalcitis, of roasted misy, of verdigris,
of copperas, of fissile alum equal parts, use with vinegar.—_Another_:
Of native sulphur, of ceruse, of opium, of acacia equal parts; use with
vinegar. A cataplasm for erysipelas, herpes, abscess, parotis, and
burning: of the tender leaves of fresh marsh-mallows, lb. j; having
boiled in water and oil, triturate properly, and adding of rose-oil,
oz. iv; of litharge, of ceruse, of each, oz. iiss; triturate again with
the juice of coriander, or of house-leek, or of strychnos, then adding
crumbs of bread so as to form a plaster, apply it. And use this plaster:
of oleum cicinum, i. e. castor-oil, lb. j; of oil of myrrh, lb. j; of
wax, oz. v; of litharge, oz. iv; of scraped verdigris, oz. ij; the
verdigris and litharge are to be triturated with vinegar. A cerate for
erysipelas and burns: of white wax, oz. iv; of rose-oil, oz. iij; six
eggs, of pellitory of the wall, oz. iv. When the inflammation ceases or
becomes chronic, before the part becomes livid, apply a cataplasm of raw
barley-meal; but if it has already become livid, incisions must be made
in the part, and cataplasms moreover applied, and hot sweet water poured
on it, and sometimes sea-water or brine; and sometimes these ingredients
are to be mixed with the cataplasm, and then we must use the aforesaid
compound medicines with caution: for should these symptoms continue, a
transition to suppuration or mortification takes place.
* * * * *
COMMENTARY. Hippocrates in his ‘Prognostics’ has stated the danger of
an erysipelas being translated to an internal part. He also states that
gangrene supervening upon erysipelas is dangerous. He has not, however,
given any very particular account of the disease. In one of his aphorisms
he states that cold is useful in erysipelas when not ulcerated, but
prejudicial when it is ulcerated. His commentators, Theophilus and
Damascius, confirm this statement. (Scholia in Hip. et Galen, ii, 456).
Celsus recommends bleeding if the strength permit, and then repellent and
refrigerant applications, especially ceruse with the juice of solanum
(nightshade), or Cimolian earth with river water, and the like. When
refrigerants fail to produce the effect, sulphur, ceruse, and saffron are
to be pounded with wine and applied. If the part become putrid he directs
us to use corrosive applications or the actual cautery. Afterwards the
sore is to be cleansed with honey and rosin, and treated upon general
principles.
We have stated in the preceding Section that the ignis sacer of
Scribonius Largus is not herpes. That it was erysipelas seems probable
from the similarity between his applications for it and those which
Celsus and the other authorities recommend for erysipelas. Thus for ignis
sacer he recommends Cimolian chalk, diluted with the juice of solanum,
or the solanum by itself, or with bread; or a mixture of sulphur vivum,
ceruse, and litharge.
We may remark further in this place that the _ignis sacer_, or St.
Anthony’s fire of the middle ages, would appear to have been some variety
of erysipelas.
Galen’s account of erysipelas is particularly deserving of attention. In
the 14th Book of his ‘Meth. Med.,’ he is at pains to state the nature
of the disease, and the difference between it and phlegmon. The common
symptoms of both are heat and swelling. But they differ, first and
principally in colour, which is red in phlegmon, but pale or yellow, or
a compound of both, in erysipelas. Throbbing is also a characteristic
symptom of a great phlegmon, for it is deep-seated, whereas erysipelas is
rather in the skin. Erysipelas, he pointedly inculcates, is occasioned
by a bilious humour. This humour being thin, readily passes the fleshy
and rare parts, and flows to the skin, where, unless it be particularly
watery, it is unable to pass the pores, and, consequently, is retained.
When things, indeed, are in their natural state, this bitter bile passes
through the pores of the skin by the insensible perspiration, but when
it is either too abundant or thicker than usual, it is retained by
the skin, which it inflames and causes to swell: hence the reason why
erysipelas chiefly affects the skin or the prolongation of it which
lines the internal cavities. He states that the great indication of
cure is refrigeration or cooling, but that there is danger of carrying
this plan too far, lest the humour should be driven to some vital part:
wherefore cooling applications are to be used until the part change its
colour, but are not to be continued until it become black or livid. It is
necessary, therefore, as soon as a change of colour in the affected part
is remarked, to exchange them for those of a contrary nature. His cooling
applications consist of strychnos (solanum?) and the other articles
mentioned by our author. When the part becomes livid, he directs us to
make incisions, and afterwards to apply cataplasms and fomentations with
hot water, to which salt or vinegar may sometimes be added. It is only
at this time that quicklime may safely be added to the applications;
for it would prove highly prejudicial at first. With respect to the
general treatment, he approves strongly of cholagogues, but does not
think bleeding necessary in ordinary cases. When erysipelas arises from
ulcers or any obvious causes, he recommends scarifications and cataplasms
of barley flour. He recommends much the same plan of treatment in his
‘Therapeut. ad Glauc.’ ii. He speaks highly of early incisions.
Aëtius, as he professes, merely copies from Galen.
Oribasius recommends, at first, such things as are cooling without
astringency; namely, henbane, nightshade, &c. When the inflammation
subsides, he directs us, before the part becomes livid, to apply a
cataplasm of barley flour; but when it does become livid, he recommends
free incisions, and afterwards cataplasms and fomentations with fresh
water, or water with salt and brine.
Actuarius states the danger of carrying refrigerant and repellent
applications too far, and recommends something discutient to be added to
them.
Octavius Horatianus approves of bleeding (unless contra-indicated by
the want of strength), and of cholagogues, with free incisions and
fomentations.
Avicenna states that bleeding in general does no good, unless the humour
be seated between the two skins. He approves most of cholagogues and of
applications strongly refrigerant; only he cautions us not to carry this
plan too far, lest the disease be determined to an internal part, or
terminate in gangrene.
Serapion treats of the disease very accurately by the name of _al
massire_, but in nearly the same terms as Galen. He approves decidedly
of cooling and repellent applications at the commencement. Serapion and
Avicenna notice the eruption of bullæ in erysipelas.
Haly Abbas directs us, when erysipelas is not attended with swelling, to
use cooling and repellent applications to the part, and to administer
gentle cholagogues, such as myrobalans, tamarinds, and prunes. But
if swelling be present, and if there is nothing to contra-indicate
venesection, he recommends us to bleed and apply cataplasms.
Alsaharavius describes three varieties of erysipelas; namely, the
erysipelas properly so called, the ignis Persicus, and the erysipelas
inflativa. The first variety, he says, is attended solely with redness
of the cuticle. It is to be treated by bleeding, purging, and local
applications of a cooling and humid nature. In the ignis Persicus, the
heat and redness are strong, and black blisters rise on the part. It is
to be treated by bleeding at the commencement, and scarifications. The
erysipelas inflativa arises with a sudden swelling, and blisters, like
those produced by fire. It is to be treated by bleeding and cooling
applications, containing ceruse, litharge, &c. The _ignis Persicus_ would
appear to have been some variety of anthrax, or the malignant pustule.
None of the ancient authorities express themselves so decidedly favorable
to bleeding as Rhases. Like the others, he attributes it to heated bile.
He, and most of the authors quoted by him in his ‘Continens,’ approve of
cooling applications, but he cautions against carrying this practice too
far. He remarks that vesicles like those from burning often arise on the
part.
Fabricius ab Aquapendente is a strong advocate for the ancient theory,
of which he gives a full explanation. The system, he says, being loaded
with vitiated bile, the more important organs cast it off: it is,
therefore, sent outwardly, and is detained by the cuticle when its pores
are obstructed. He attempts to reconcile the contrary opinions of the
ancients with regard to venesection. He himself approves decidedly of
bleeding when the disease is seated in the head or neck.
None of the ancient authorities seem to have entertained the same
apprehensions as most of the moderns do against liquid applications in
cases of erysipelas. When this prejudice became general we do not exactly
know. Heister mentions that, in his days, some surgeons disapproved
of liquid applications, but, as he thought, without any good reason.
He himself recommends camphorated spirit of wine. The earlier modern
surgeons, as, for example, Brunus and Theodoricus, decidedly recommend
cold applications at the commencement. When the disease is not thereby
resolved, they direct us to have recourse to leeches and scarifications.
They approve much of cholagogue purgatives, but do not recommend bleeding
unless inflammatory symptoms run high.
SECT. XXII.—ON PHYMA, BUBO, AND PHYGETHLON.
According to Galen, phyma, bubo, and phygethlon, are affections of
the glands: bubo being an inflammation of a gland; phygethlon, an
inflammatory erysipelas, or an erysipelatous inflammation of a gland;
and phyma, an inflammation of a gland passing rapidly into suppuration.
But, according to others, all tumours of the nature of apostemes, which
arise in any part of the body, are called phymata. For Hippocrates says,
“Those in whose urethra phymata form are relieved when they suppurate and
burst.” Wherefore those buboes which are occasioned by accidents, either
ulcers or pains, are not dangerous; but those which occur in fevers, more
especially in the pestilential, are of a very bad description, whether
they are formed in the groins, the armpits, or neck. But those of the
first kind, as is the case in every other inflammation, we must endeavour
to put back with cooling and astringent applications, either applying
a sponge out of oxycrate, or wool out of wine and raw oil, or oil of
roses, or oil of apples, or oil of lentisk, or oil of myrtles; and then
we are to apply diaphoretics. But if the whole body is plethoric, it is
to be evacuated. If free from superfluities, we must manage the ulcer
arising from it in the manner to be described when treating of ulcers.
When the gland is in a state of inflammation, it is to be mitigated by
wool soaked in some of the emollient oils, and the whole limb is to be
wrapped therewith. When the tumour has suppurated, we must not be in
haste to open it, but endeavour to dissipate it by the medicines in the
form of cerates, such as that prepared from apyranon, and that from
herbs called botanica. When resolution is not thereby accomplished,
we must forward the rupture as in the other abscesses, and cure it in
like manner as them. In those buboes which arise in fevers or from a
collection of humours, we must abstain from all repellents, lest the
matter should be repelled and regurgitate to the deep-seated parts; but
we must begin at once with discutients. When nothing prohibits, such as
the age or strength of the patient, venesection from the arm is to be
had recourse to, and fomentations applied to the part, either from the
decoction of camomile, or of dill, or of some such; but the materials
of the other applications may be transferred from our account, in the
Third Book, concerning parotis, and from what has been lately delivered,
more especially respecting phlegmons. And in like manner the cure of
phygethlon may be learned from what has been stated respecting them and
erysipelas. But the herb aster atticus, which, on this account, they call
bubonium, not only in the form of a cataplasm, but also when bound round
the part as an amulet, is believed to be of use for buboes. Phymata may
be discussed by the following applications in particular: maiden-hair;
orache; pellitory of the wall; the root of marsh-mallows, boiled in wine;
ammoniac, softened with honey, and applied; birdlime, with the rosin
cerate. But bee-glue, bitter lupins applied with vinegar, the root of the
wild cucumber added to turpentine, and in like manner root of capers, and
nitre with leaven, or figs, promote the rupture of these tumours.
* * * * *
COMMENTARY. The account here given of these glandular inflammations is
taken from Galen (ad Glauc. ii.) See also ‘de Tumoribus’ and ‘Comment. in
Hippocrat. Epid.’ vi.
Celsus describes phyma as resembling furunculus, but as being larger,
and turning to pus. According to Rayer, his description of phyma applies
better to the boil than his account of anthrax. (Malad. de la Peau, p.
229.) The phygethlon, he says, is a tumour not high, but broad, and
containing something resembling a pustule. It occurs mostly in the
armpits, neck, or groins. He proposes applications of a repellent and
refrigerant nature; but if the swelling is hard, digestives must be
had recourse to, such as dried figs bruised, &c. He also recommends a
composition of sal ammoniac, galbanum, bee-glue, and mistletoe, with a
small proportion of myrrh. His treatment is considerably different from
our author’s. When matter is formed, he directs us to let it out by
medicines or the lancet, but he decidedly forbids the use of cerates. In
another place, however, he recommends an application containing lime,
spuma nitri, round pepper, galbanum, and salt mixed with rose cerate.
Scribonius Largus recommends a malagma containing pitch, aphronitum,
pine-rosin, wax, bay-berries, axunge, ammoniac, Illyrian iris, galbanum,
and white pepper, for discussing phygethlon.
Oribasius and Actuarius mark the distinction between these affections
in the same terms as Galen, and direct us to treat them with emollient,
concoctive, and discutient applications. For concocting phymata, the
Pseudo-Dioscorides recommends southernwood, boiled with raw barley
flour; figs, boiled with yeast, &c.; and for breaking them, the juice of
thapsia, with sulphur; cantharides, mixed with turpentine, &c. (Euporist,
i, 156.)
Nonnus’ account is mostly abridged from our author’s. Thus, he recommends
at first venesection, and sponges squeezed out of oxycrate and the like;
then digestives are to be applied; and afterwards cataplasms and such
things as will favour the rupture of the abscess, namely, compositions
containing bee-glue, bitter lupins, vinegar, nitre, yeast, or figs and
pitch.
Avicenna describes these affections by the name of _althaum_. It is
remarked by his translator that the Arabian recommends the same medicines
as Paulus, but neglects the distinction which the latter properly makes
between the bubo when attended with pestilential fever and when without
it.
The phyma seems to have been merely an acute inflammation of a gland,
terminating in suppuration. The phygethlon was an erysipelatous
inflammation of a gland. These complaints are well defined and described
by Fabricius ab Aquapendente (1, i, 23.) Dr. Willan uses the term phyma
in a different sense from that of our author. The term occurs in Marcus
Antoninus (ii, 16), where see the note of Gataker.
SECT. XXIII.—ON FURUNCULUS.
Furunculus is an apostematous swelling, formed of thick humours in the
fleshy parts of the body most especially; being mild when it is formed
in the skin only, but of a malignant character when it rises up from a
deep-seated part. Furunculus may be discussed and concocted by wheat,
chewed and applied; by Egyptian mastic; by raisins, deprived of their
stones, and triturated with salts, and applied—(this either discusses or
breaks the swelling); or apply dried figs boiled in hydromel; or rosin
may be mixed with the figs and applied; or the figs themselves, when they
are fat, may be split open and applied; or leaven with nitre; or linseed
with honey; or the leaves of henbane, triturated with butter: of compound
applications, that which is prepared from leaven and fine flour, and that
which is particularly named Dothienicon, are very applicable. Foment with
soft sponges frequently dipped in hot water, and then apply the medicines.
* * * * *
COMMENTARY. In this and the two following Sections, see the authorities
on phlegmon.
The furunculus, according to Galen, is an inflammatory affection which is
of a malignant nature when deep-seated, and differs from phyma only in
hardness. (De Tumoribus.)
Furunculus, says Celsus, is an acute tubercle, attended with inflammation
and pain, more especially when converted into pus. After it has been
opened, and the pus discharged, there appears part of the flesh below
converted into pus and part corrupted, of a whitish or reddish colour,
which they call the ventricle or belly of the furunculus. He says that
the disease is not attended with danger, and that medicines are necessary
solely for removing it the more expeditiously. For this purpose he
particularly commends galbanum. If repellent applications do not succeed,
suppurative ones may be used; and, failing these, rosin or leaven. When
pus is formed, no further treatment is required. According to Rayer,
Celsus’ description of furunculus applies to the malignant pustule and
not to the boil. (Malad. de la Peau, 233.)
The simple remedies recommended by our author are borrowed from Oribasius.
It is to be remarked that Galen, Celsus, Pliny (Nat. Hist. xxiii, 7),
Octavius Horatianus, and Avicenna concur in recommending figs for
furunculus or the boil. It was with a lump of figs that the prophet
Isaiah cured Hezekiah’s boil.
Avicenna and Rhases treat furunculus judiciously by bleeding and purging,
which prevent the formation of a large abscess. When there is throbbing
in the tumour, they direct us to use maturative applications. When it
is ripe, and does not break readily, they recommend us to open it. Haly
Abbas says, that boils arise from gross and depraved humours. (Theor.
viii, 11.) Alsaharavius also ascribes them to a full and unwholesome
diet. He mentions that he often succeeded in stopping the formation of
the furunculus by cauterizing it with a piece of myrtle or any other
wood. When the pain is violent, he recommends an application of the
leaves of henbane and poppies with the yelk of an egg. When the boil is
indolent, he approves of a stimulant plaster. (Pract. xxix, 4.)
SECT. XXIV.—ON TERMINTHUS.
Oribasius says, that terminthus is a species of phyma, but that a dark
bulla lies over it, which having burst, the part below appears as if
excoriated, and when it is divided, the pus is found. But Dioscorides of
Alexandria says, “Terminthi are eminences formed in the skin, round, of
a dark green colour, like the fruit of turpentine.” These, therefore,
are to be cured like other phymatous swellings, by applying the remedies
there described.
* * * * *
COMMENTARY. Aëtius gives the same account of terminthus, which is a
species of phyma. See Hippocrat. (Epidem. ii, 11; de Humor. xi, 1); Galen
(Comment. in Epidem.); Oribasius (Synops. vii, 136.) Avicenna describes
these affections by the name of _albothin_ (iv, 7, 3, 1.) He says that
they are ulcers produced by black bile; that they appear upon the leg,
and are of the same nature as varices.
The terminthus would appear to have been the cutaneous disease to which
Willan applied the name of ecthyma.
SECT. XXV.—ON CARBUNCLE OR ANTHRAX.
When the blood having become more melancholic than natural, ferments
and fixes in a part, the diseases called carbuncles are formed, which
are sloughy ulcers, for the most part beginning with bullæ, like burnt
parts, but sometimes without them; and the patients at first rub the
part for its itchiness, whether one bulla is formed or several small
ones, like millets, which, having burst, a sloughy ulcer takes place,
resembling those occasioned by cauteries, the eschar being sometimes of
a cineritious colour and sometimes black, along with its being fixed
to the base, and in a certain manner nailed to it, and it spreads at
the same time, the surrounding flesh is in a fiery state, black in the
colour, and shining like bitumen and pitch. Such is the true black bile.
But carbuncles that form in the flesh are speedily circumscribed; whereas
those which take place in membranes or nerves remain long, and affect
sympathetically the parts below, so as to give origin to erysipelatous
inflammations. Not a few terminate in suppuration, and most cases are
attended with fever.
Carbuncles also sometimes arise from epidemic causes. We must treat
them, unless they are very small, by venesection, carrying evacuation as
far as to occasion deliquium animi; and after venesection it will not
be improper to make deep scarifications in the part, on account of the
thickness of the humour. To the affected part we may apply such things
as are moderately repellent and discutient, as the cataplasm of plantain
and boiled lentil, receiving the tender part of bread baked in an earthen
pan, neither very fine nor foul; and above the ulcer we must put some of
the strong applications, such as those of Andron, of Polyides, and of
Pasion, mixing them with must, until they are of the consistence of the
sordes of oil in baths. And so also the dry Massaleotic powder, which may
be diluted in like manner. And the root of dracunculus, or of birthwort,
or the juice of laserwort, or the Cyrenaic juice may be properly rubbed
in, each of these with vinegar. Cases of an erysipelatous nature may be
anointed with the applications for erysipelas; but those parts which are
suspected of being sympathetically affected are to be wrapped in unwashed
wool, out of wine and oil. When the inflammation abates, we must apply
to the carbuncles the cephalic cerates spread upon pledgets. That from
herbs is an excellent one, and that from natron, and the dry application
for spreading ulcers, separately and with rose-oil. When the hardness
remains, we must use the one from apples ascribed to Serapion. But we
must hasten the suppuration of the carbuncles as much as possible, by
changing the cataplasms and medicines twice during the day, and once
during the night. In order to root out the carbuncles, and free them
from their attachments to the surrounding parts, having divided sour
pomegranates, boil in vinegar, and when softened, triturate, put into a
linen rag, and apply. When dried, let them be moistened with vinegar.
The carbuncle is made to suppurate and burst, by the inner part of old
walnuts, or even of that which is not old, and by the leaves and shoots
of cypress, or by its young and tender balls (pilulæ), with barley-flour;
by raisins deprived of their stones; by dried figs boiled in wine; by the
flowers of horned poppy; by the juice of laserwort, with rue and some
honey; by liquid pitch with raisins and axunge.
_An excellent application for carbuncles._ Of litharge, lb. j; of old
oil, lb. j; of arsenic, oz. j; boil the oil and litharge until they do
not stain, and taking them off the fire, add the arsenic, and then boil
it until it become black, and having levigated it in a mortar, use upon
pledgets.
_For gangrene, old ulcers, those called chironia, strumous ulcers, and
the gout: it is a most admirable application for carbuncle, particularly
in the eyelids._ Of opium, of acacia, of toasted misy, of flakes of
copper, of each, dr. ij; of copperas, dr. j; of the seed of henbane, dr.
j; triturate in water, and use. They say also that the ointment called
tetrapharmacon, having a fifth part of frankincense, is an excellent
application. But for carbuncles in the pudenda, take of chalcitis, of
copperas, of each, dr. viij; of aphronitrum, dr. ij; triturate with
water, and use. Sheep’s dung roasted with honey is also a good remedy. In
Alexandria they use the green serapias, which is also called orchis and
triorchis, with crumbs of bread, as a cataplasm for carbuncles and all
sloughy ulcers; and when the eschar falls off, they cure them as a common
ulcer.
* * * * *
COMMENTARY. The carbuncle is briefly treated of by Hippocrates (Epidem.
ii, 1), and is frequently mentioned by him as a symptom of the
pestilential fever. (Epidem. iii.)
Celsus gives a very minute description of carbuncle. With regard to
the treatment, nothing, he says, answers so well as immediate burning,
which produces no pain, as the flesh is dead. The sore is to be treated
like other burnt parts. Under the use of eroding applications a crust
is formed, which, being removed from the living flesh, carries all the
corrupted parts along with it, and leaves a clean cavity, which is to
be filled up by incarnants. When the disease is superficial, corrosive
or caustic substances may be substituted, of such a degree of strength
as to produce a separation between the dead and sound flesh. But if
these applications fail, recourse must be had to burning. He recommends
abstinence from food and wine at the commencement, and directs water to
be given freely, especially if fever be present.
Pliny gives an indistinct account of an epidemical anthrax, which, he
says, prevailed in the province of Narbonne. (Nat. Hist. xxvi, 4.)
Galen ascribes the carbuncle to a defluxion of hot, black, and thick
blood, which gives rise to blisters, ulcers, and eschars. He directs us
to apply to the eschars those medicines the properties of which resemble
fire, such as misy, chalcitis, arsenic, quicklime, and sandarach. His
particular remedies are quite similar to our author’s. (Meth. Med. xiv),
and (ad Glauc. ii.) He mentions the carbuncle as a very unfavorable
symptom of the plague. (Epidem. iii, and de Diff. Febr. i, 6.)
The account of the carbuncle given by Aëtius is full and accurate, but
is entirely derived from Galen. Oribasius, Actuarius, and Nonnus also
repeat his doctrines. Actuarius says that the disease is occasioned by
melancholic blood overheated. This is much the same as Galen’s theory.
Octavius Horatianus recommends bleeding at the commencement, and external
applications of an acrid and caustic nature, or the actual cautery
itself. When danger is apprehended from a hot cautery, he directs us to
use a cold one.
In the Latin translation of Avicenna the carbuncle is described by the
names of pruna and ignis Persicus. It was called pruna from a black
slough which is formed in it, resembling a burnt coal. His account of
the disease is ample, but mostly copied from Galen and his successors.
Rhases approves of venesection at the beginning, and of the actual
cautery. He also recommends an application containing mustard and figs.
Alsaharavius describes the varieties of anthrax by the names of _alcubam_
and _alcoasat_. (Pract. xxix, 12.) At the commencement, he approves of
general bleeding and leeches, and afterwards of refrigerant and analeptic
medicines, to obviate the tendency to sinking. When these things do not
succeed, he directs us to use powerful caustics or the actual cautery.
Serapion, like Avicenna, describes it under the name of the ignis
Persicus.
Procopius mentions the anthrax as one of the symptoms of the great plague
which he describes. (Persica, ii.)
For the carbunculus or anthrax, Brunus and the other writers of that
age recommend, at first, bleeding and restricted diet, with maturative
applications, such as figs and mustard, or the yeast cataplasm, with oil
and salt. When the part becomes black, Theodoricus directs us to have
recourse to the actual cautery. (iii, 12.) Municks rather disapproves
both of purging and bleeding, but strongly commends the actual cautery,
which he greatly prefers to the potential. (Chirurg. i.) Vigierius,
however, prefers a paste made from quicklime and soap. V. Manget. (Bibl.
Chirurg. i, 374.) The learned Schelhammer speaks favorably both of the
potential and the actual cautery. (De Humoribus.)
SECT. XXVI.—ON CANCERS.
Cancer occurs in every part of the body; for it takes place in the eyes
and uterus (as we have stated when treating of those parts), and in most
other parts of the body; but it is more particularly frequent in the
breasts of women, because owing to their laxity, they readily admit the
thick humours which occasion it. For cancers are formed by black bile
overheated; and if particularly acrid, it is attended with ulceration.
On this account, they are darker than phlegmons, without being attended
with the same degree of heat. The veins are filled and stretched around
like the feet of the animal called cancer (crab), and hence the disease
has got its appellation. But some say that it is so called because it
adheres to any part which it seizes upon in an obstinate manner like the
crab. Owing to the thickness of the humour which occasions it, cancer is
an incurable disease, for it can neither be repelled nor discussed; not
yielding to purging of the whole body, resisting the milder applications,
and being exasperated by the stronger ones. It may be possible, however,
to prevent incipient cancers from increasing, by evacuating the
melancholic humour before it becomes fixed in the part. We may evacuate,
first, if nothing prohibit, by venesection, and afterwards by purging at
the commencement, with the simpler purgatives, such as giving dodder of
thyme to the amount of oz. ivss; in whey or honied water, and afterwards
hiera, containing the black hellebore.
The juice of strychnos may be applied to the ulcerated parts without
exciting pain, a linen rag being folded and wetted in it, and laid on;
but externally to this, we must apply soft wool, which also has been
soaked in the juice, and care must be taken that they do not become dry,
by frequently pouring on some of the juice. In all carcinomatous ulcers
of a chronic nature, one may use the preparation from pompholyx; and
those remedies which were mentioned in the Third Book for cancers in the
womb may be applied with advantage.
_For carcinomatous and malignant ulcers, for rugose ulcers on the
fundament, and for inflammations on the pudenda, testicles, and breasts._
In a leaden mortar, and with a leaden pestle, having triturated the
Lemnian earth with oxycrate and honied water or milk, so that it become
black, or having triturated rose-oil, or the oil of unripe olives, or
the juice of house-leek, or that of wall-pennywort, or of lettuce, or
of fleawort, or of unripe grapes in like manner, anoint with them. The
patient’s diet should consist principally of the juice of ptisan and the
whey of milk, and from among pot herbs, of mallows, orache, blite, and
gourd, of the fishes which live among rocks, and of all kinds of fowls,
except those that live in marshes.
_From Archigenes, for carcinomatous and malignant ulcers._ Levigate equal
parts of burnt river crabs and calamine, and sprinkle or apply the ashes
of crabs with cerate; or apply the seed of hedge mustard triturated with
honey.
* * * * *
COMMENTARY. See Hippocrates (Epidem. v); Galen (de Tumoribus; Meth. Med.
xiv; Therap. ad Glauc. ii); Celsus (v, 28); Scribonius Largus; Aëtius
(xvi, 43); Oribasius (Morb. Curat. iii, 28); Actuarius (Meth. Med. iv,
16); Avicenna (iv, 3, 2, 15); Serapion (v, 24); Alsaharavius (Pract.
xxix, 1, 16); Avenzoar (ii, 7, 27); Haly Abbas (Pract. iii, 32); Rhases
(ad Mansor. vii, 9; Contin. xxvii.)
Hippocrates relates a fatal case of cancer in the breast, attended with a
sanious discharge, but he does not explain the nature of the treatment.
Our author’s description of cancer is abridged from Galen (de Tumor.
l. c.) The treatment is derived from the 14th Book of the ‘Meth. Med.’
He recommends melanogogues to remove the material cause of the disease.
In external applications he places little confidence, but prefers
those prepared from metallic substances which have been burnt and
washed. The only chance of a radical cure consists, he says, in making
a complete excision of the part; but in doing this he forbids us to
secure the arteries with ligatures, as they will occasion a recurrence
of the disease. The part, he says, is loaded with a thick, black, or
recrementitious blood. When the cancer is ulcerated, he disapproves of
cutting and burning.
Celsus describes carcinoma as an immovable and unequal tumour, attended
with swelling of the veins, which are pale or livid. His account of
the treatment is so important that it deserves to be given in his
own words: “Quidam usi sunt medicamentis adurentibus; quidam ferro
adusserunt; quidam scalpello exciderunt: neque ulla unquam medicina
profuit; sed adusta, protinus concitata sunt, et increverunt donec
occiderent; excisa, etiam post inductam cicatricem, tamen reverterunt,
et causam mortis attulerunt: cum interim plerique nullam vim adhibendo,
qua tollere id malum tentent, sed imponendo tantum lenia medicamenta
quæ quasi blandiantur, quo minus ad ultimam senectutem perveniant, non
prohibeantur.” In another place, however, he recommends compositions
containing arsenic, copperas, cantharides, galls, &c. (v, 22.) He makes
a distinction between the _cacoethes_, or malignant tumour, and the true
carcinoma, but says that the difference between them is to be recognized
only “tempore et experimento.” He marks the gradations of malignant
disease with singular precision: first, there is cacoethes; then
carcinoma without ulceration; and last, there is the fungated ulcer. (The
reading in the edition of Milligan is a great improvement.) In doubtful
cases he directs us, first to apply caustics or heating medicines, and,
if the disease is alleviated, to proceed to the scalpel or burning,
according to circumstances; but if it is exacerbated, we are to conclude
that it is of a carcinomatous nature, and must abstain from all acrid and
vehement applications.
Scribonius Largus recommends for all malignant ulcers, even such as are
cancerous, an application consisting of arsenic, p. vj; of squama æris,
p. iij; of elaterium, p. j; of burnt paper, p. iij.
Aëtius gives from Archigenes and Leonidas an interesting account of the
disease, which he divides into ulcerated cancer, and cancer without
ulceration. He describes the disease in the female breast as consisting
of a large tumour which is unequal and resisting, extending its roots
far, and being attended with varicose veins: its colour is either
cineritious, verging to redness or livid; it appears soft, but is in
reality very hard; is accompanied with a pungent pain, and gives rise to
malignant phlegmons in the armpits. The pains shoot to the clavicle and
scapula. An ulcerated cancer, he says, goes on corroding and spreading
deeper, nor can it be stopped; it discharges a sanies of an abominable
smell, and is aggravated by medicines and handling. The disease he
considers as generally incurable. His surgical treatment will be stated
in the Sixth Book. He recommends purging with hiera and the theric,
Mithridatic antidote, &c. Apparently, in order to mitigate the violence
of the pains, he directs us to make an application containing equal
portions of plantain, poppy heads, the seed of the wort, and other things
of the like kind. For ulcerated cancer he recommends emollient epithemes,
such as the one containing litharge, axunge, white wax, oil, and the
yelks of eggs.
Oribasius and Actuarius supply nothing of importance that is not to be
found in our author. Nonnus, according to Sprengel, is the only ancient
author who attributes cancerous ulcerations to acrimony of the bile. But
Nonnus merely copies the words of our author.
The Arabians agree with the Greeks in representing the disease as being
produced by black bile. They were, no doubt, led to form this opinion
from remarking that the blood in the part is thick and black, which they
considered owing to its not being properly purged of its recrementitious
sediment. The moderns deride this theory, but they have substituted
nothing satisfactory in its stead. Van Swieten thinks more favorably of
the ancient doctrines. (Comment. § 485.) Avicenna speaks highly of a milk
diet. Serapion likewise approves of milk deprived of its butter, and of
a vegetable diet. He speaks of no other treatment as being likely to
prove remediable, with the exception of excision and the cautery. Haly
Abbas rather approves of excision when the disease is seated in a part
which admits of this operation. However, like Galen, he disapproves of
tying the arteries. The characteristic symptoms of the disease, he says,
are a stony hardness and distension. The account given by Alsaharavius
is nothing different. Rhases has little confidence in excision. After
ulceration has taken place he approves of using a cooling application,
containing ceruse, tutty, rose-oil, the juice of nightshade, and some
other such things of a cold nature. He mentions a case of cancer of the
breast, in which the whole mamma was extirpated, but the disease returned
on the other side. One of his authorities, Antyllus, describes the
cancerous sore as having a tendency to spread inwards, its edges being
thick, large, and everted, and the discharge thin and acrid. When the
disease cannot be got completely extirpated, he forbids us to meddle with
it.
Theodoricus and all the earlier modern writers on medicine, call the
cancer by the name of apostema melancholicum, and recommend the same
treatment for it as the Greeks and Arabians.
SECT. XXVII.—ON ŒDEMA.
Having treated of swellings formed by hot humours, we shall now treat of
those from the opposite, beginning with the œdema. For as erysipelas is
formed by a bilious humour, so is œdema by a pituitous, being a loose
swelling devoid of pain. We are aware also, that œdematous swellings
occur in the feet, in dropsical affections, in phthisis, and in cachexia,
but in them the œdema is a symptom of the complaint under which the
person is labouring, and requires no very particular treatment; for it
will be sufficient in general to rub the limbs sometimes with vinegar and
rose-oil, and sometimes with oil and salts, or the salts may be added to
the vinegar and rose-oil. When the œdema is occasioned by a pituitous
humour being determined to the part, a sponge soaked in oxycrate may
be properly applied with a bandage loosely put on, beginning below and
terminating above. The sponge ought to be new, but if such a one is not
at hand, that which is may be cleaned with natron, or more especially
with what is called strained lye. If the swelling do not thereby subside,
we may mix some alum. And a very convenient application is a tender wick
of a lamp, soaked in such a fluid, and applied. A good remedy also is
horned poppy. When the œdema has become chronic, having first anointed
the part with oil, and then applied a sponge out of lye, bind it firmly,
and you will effect a cure. Every kind of earth discusses and represses
œdematous swellings, more especially the Ægyptian, and also the matured
woad.
* * * * *
COMMENTARY. See Galen (ad Glauc. ii; de Tumoribus); Aëtius (xv, 1);
Oribasius (Morb. Curat. iii, 51); Leo. (vii, 5); Actuarius (Meth. Med.
iv, 16); Nonnus (251); Serapion (v, 23); Avicenna (iv, 3, 2); Haly Abbas
(Theor. viii, 11; Pract. iii, 30); Alsaharavius (xxix, 13); Rhases (ad
Mansor. vii, 12.)
Our author’s account of this disease is taken from Galen, Oribasius,
Aëtius, and, in fact, all the Greek, Latin, and Arabian authorities
adopt his views, without any material alteration. They all concur
in recommending cooling and astringent applications, with suitable
bandages; and, in certain cases, friction. Rhases recommends that the
limb should be buried in heated sand. He also approves of various
cooling and astringent applications with bandages. In the translation
of Alsaharavius, the œdema is described by the name of _apostema
flegmaticum_; in those of Avicenna, Haly Abbas, and Serapion, by that of
_undemia_. The celebrated Paracelsus used the term undemia for œdema. In
some late works we have seen it stated that the undemia was a species of
erysipelas, but this is evidently a mistake.
SECT. XXVIII.—ON EMPHYSEMA.
Emphysema is formed by a flatulent spirit, collected sometimes under the
skin, sometimes under the periosteum, or the membranes which surround
the muscles. And it is also sometimes collected in the stomach and
intestines, or between them and the peritoneum, in those kinds of dropsy
which are called tympanitic; and it differs from œdema in this, that the
parts do not pit upon pressure like it, and that it sounds like a drum.
The density of the body co-operates in preventing the flatus from being
dissipated, at the same time that the flatus also is of a thick nature.
Wherefore, the indication of cure is to rarefy the body, and attenuate
the thick air; which is to be accomplished by means of attenuant and
heating remedies. When the complaint is seated in the stomach and
intestines, this is to be brought about by a fine oil, having rue, cumin,
or parsley seed boiled in it. And sometimes a large cupping instrument
without scarificators, applied two or three times to the navel, will
discuss it. When the muscles from contusion are inflated, so as to
sound like an emphysema, the parts will not bear very heating and acrid
applications. Wherefore, at the commencement, we must use paregorics
liberally, and, when the disease is on the decline, discutients. Thus
we may use sodden must with a small quantity of oil, applying them warm
upon unwashed wool, or mixing the cerate of unwashed wool. And we must
take care that the heat be preserved, for it is not expedient that the
part be cooled. When the patient has been soothed, we are to mix vinegar
and nitre or aphronitrum, and afterwards some lye; and lastly, we may
use discutient plasters, for the removal of the complaint such as the
following: having boiled the sordes of the oil used in baths, strain it
first, so that it may become pure, and again throw it into the pot, and
having triturated slaked lime like flour, sprinkle until it become of the
consistence of clay, and use. A still more effectual application is the
compound medicine from sycomores.
* * * * *
COMMENTARY. See Galen (Meth. Med. xiv); (Therap. ad Glauc. ii); Aëtius
(xv, 2); Oribasius (Synop. vii); Actuarius (Meth. Med. ii, 12); Nonnus
(252); Scribonius Largus (§ 119); Avicenna (iv, 3, 2, 20); Serapion (v,
23); Alsaharavius (Pract. xxix, § 1, 14); Rhases (Divis. 127, Cont.
xxvii.)
Our author has copied closely from Galen. The great indications of cure,
as laid down by him and acknowledged by all subsequent authorities, are
to rarefy the containing parts and attenuate the spirit. By _spirit_,
as we stated in another place, the ancients meant a thick air or gas.
The indications which we have mentioned are best fulfilled by friction
with oils, in which calefacient medicines, such as cumin, parsley,
anise, and the like, have been boiled. When, however, any inflammation
is suspected, he properly forbids us to use acrid or heating medicines.
When the pain of the bowels is violent in cases of tympanites, he allows
medicines containing opium, which are to be given by the mouth if the
small intestines be affected, but are to be administered in a clyster
if the large intestines be the seat of the disease. When the disease is
in a muscular part, he directs us to use a combination of attenuants
and emollients. In certain cases he recommends dry-cupping. Oribasius,
Aëtius, Actuarius, and Nonnus, adopt the views of Galen, without any
alteration.
For tympanites, Scribonius recommends cumin internally.
Avicenna, like our author, in ordinary cases recommends combinations of
attenuants and calefacients, dry-cupping and the like, for dispelling
the spirit; but when the disease arises from contusion of the muscles,
he directs us to use resolvents and paregorics. Serapion approves of
similar treatment. Alsaharavius recommends attenuant and calefacient
remedies externally and internally. In the translation of his works, the
disease is called inflatio. Rhases recommends friction with calefacient
oils; he remarks that the disease occurs most commonly in the stomach and
intestines. He calls it by the name of apostema inflatum.
SECT. XXIX.—FOR SPRAINS AND CONTUSIONS.
Sprains of the joints and contusions are remedied by unwashed wool, or
a sponge soaked in vinegar and oil, and applied; by the tender parts of
boiled bulbous roots with honey, by the leaves of the chaste tree, salts,
and roasted nitre, triturated with cerate. The affusion of sweet water,
or of hot sea water, may be used. But after the inflammation and pains
have subsided, apply rubbing to the sprained parts.
* * * * *
COMMENTARY. See Aëtius (xiv, 71); Oribasius (Synops. vii, 14); Actuarius
(Meth. Med. ii, 35); Scribonius Largus (§ 209); Rhases (Divis. i, 140.)
Aëtius makes mention of all the remedies recommended by our author, with
the exception of the affusion of water; which, however, is a method
of treatment deserving of attention. Oribasius mentions particularly
the affusion of hot sea water. Scribonius Largus recommends a plaster
containing litharge, alum, ærugo, ammoniac, &c. Rhases directs us to use
attenuant ointments, sedative plasters, and loose bandages, with rest.
SECT. XXX.—ON CONTUSIONS OF THE FLESH AND ECCHYMOSIS.
The flesh being bruised by some weight falling upon it, and the small
veins in it being ruptured, blood is poured out from them by exhalation,
and collecting under the skin, is called ecchymoma. When the skin is
not divided, a soft yielding tumour is the consequence; it is pale,
and for the most part unattended with pain. Our object, therefore, is
to discuss the contained blood, and that quickly, before it become
black; and at first, astringents are to be mixed with the discutients,
because the bruised coats of the veins stand in need of condensation.
After these things, we must use those applications which are merely
discutient without astringency. And by scarifying the ecchymomata at the
commencement, we may thus apply the subsequent treatment. For chronic
cases of ecchymoma, radish in the form of a cataplasm is a suitable
remedy, but it must be taken away when it becomes pungent; or a cataplasm
of the juice of radish with crumbs of bread, may be applied. The diseases
called hypopion and hyposphagma, are species of ecchymosis, and also the
effusion of blood below the nail from a blow; of these, the first two are
treated of in their proper places in the Third Book; and the affection of
the nail will be handled in the Surgical part of the work.
* * * * *
COMMENTARY. This is taken almost word for word from Oribasius (Synops.
vii, 14); Aëtius directs us to scarify the part affected with ecchymosis,
and then to apply to it the inside of citrons (xiv, 68.)
Avicenna approves of scarifications, provided the extravasated blood
cannot be got otherwise removed. (iv, 4, 2, 3.)
SECT. XXXI.—ON RUPTURE AND TEARING OF THE FLESH.
Rupture is altogether attended with ecchymosis. It is cured by medicines
which are moderately heating, as the acopon from black poplars, and
such as resemble it. But when the rupture is deep-seated, we must have
recourse to such remedies as are more acrid and cutting. The use of the
cupping instrument is likewise beneficial to them. Should therefore the
whole ecchymosis be discussed, the separated flesh readily unites; but
if it continue a long time, and sordes form under it, the ruptured flesh
can no longer unite; and we must only apply the lips together, so that a
small occasion may readily separate them, and that the intermediate space
may be filled with some moisture, and in a certain manner an ecchymosis
may be formed as at the commencement, except that it is sooner discussed,
as containing a thin humour, whereas that at the commencement was formed
of blood. Vulsion takes place when certain fibres are torn asunder, and
it only requires soothing applications until the pain is removed; for
they cannot be made to coalesce. Wherefore, the round birthwort, if any,
is a convenient application to ruptured and torn parts; and in like
manner, the root of the large centaury, and the juice of it, rhubarb,
costus, and bdellium, drunk with oxymel.
* * * * *
COMMENTARY. These remarks are taken from Aëtius (xiv, 69, 70); or
Oribasius (Synops. vii, 14); and they are copied by Nonnus (Epit. 254);
and Actuarius (Meth. Med. iv, 16.)
The Arabians treat these accidents upon exactly the same principles. See
in particular Avicenna, as quoted in the preceding section.
SECT. XXXII.—ON SCIRRHUS.
Genuine scirrhus is a preternatural swelling, hard and devoid of
sensibility; but that which is not genuine is only attended with
diminished sensibility. That which is wholly insensible, then, is utterly
incurable; but that which is attended only with diminished sensibility
is not incurable, and yet it is not easily cured, for it is occasioned by
a viscid and thick humour, which is fixed in the hardened parts, so as
to be difficult to get discharged. Sometimes, then, the scirrhus is the
original complaint, and goes on to increase; but for the most part, it is
occasioned by the physicians applying too cooling and astringent remedies
to erysipelas and phlegmon.
If one, therefore, apply strongly discutient medicines to indurations of
the body, one will indeed produce a visible diminution of the scirrhus
in a short time, but will leave the remainder of the complaint in an
incurable state; for the thin moisture being dissipated, what remains
is rendered dry and hard as a stone. The discutient application, then,
ought to be in a certain degree emollient, without possessing manifestly
heating and desiccant qualities. Such are all kinds of marrow, more
especially that of a stag or of a calf, and the grease of a lion, of a
panther, or of bears, or of a bull, and among birds, that of geese, of
domestic fowls, or of pheasants: but that of bucks and he-goats is drier.
And to these may be added, ammoniac perfume, bdellium, more especially
the Scythian, the humid and fatty storax, and the Egyptian mastich. To
all other parts of the body, when in a scirrhous state, these things may
be applied singly, and in composition; but for tendons and ligaments, we
are to dissolve in the strongest vinegar some stone that has been heated
in the fire. If possible, the one to be used should be pyrites, or if
not it, the lapis molaris or millstone. In this, therefore, the affected
part is to be moved, so that it may receive the vapour which arises from
it; and afterwards, an emollient medicine is to be applied. A thin oil
then, and not water, is to be poured on the part, by all means once a
day, and sometimes one may boil in the oil the root of marshmallows, or
of wild cucumber. The patients ought to abstain from the use of the bath,
at least from the frequent use of it. But when the scirrhus is moderately
softened, the softest ammoniac is to be dissolved in very strong vinegar,
and the part rubbed with it for several days in succession; after which,
we must again have recourse to an emollient application, having the
fattest galbanum and opoponax added to it. Such are that from bacon,
that ascribed to Amythaon, and those which we are about to describe for
scrofula.
* * * * *
COMMENTARY. See Galen (De Tumoribus; Meth. Med. xiv; Therap. ad Glauc.
ii); Oribasius (Synops. vii, 34); Aëtius (xv, 3, 4); Leo (vii, 4);
Actuarius (Meth. Med. iv, 16); Serapion (v, 23); Avicenna (iv, 3, 2, 12);
Haly Abbas (Pract. iii, 31); Alsaharavius (xxix, 1, 15); Rhases (Antid.
i, Cont. xxvii, Antidot. i.)
This section is entirely taken from Galen (Ther. ad Glauc. l. c.) Galen’s
account, however, is somewhat fuller than our author’s, and contains a
case treated upon the principles which he lays down. It was a case of
hard swelling in the thigh, arising from an erysipelas which had been
improperly treated by astringent and cooling applications. Galen informs
us that he began by pouring upon the limb an attenuant oil, namely, the
Sabine; after which he caused it to be rubbed with marrows and fats
medicated with bdellium, mastich, ammoniac perfume, and the like. After
this he bathed the whole limb with a solution of ammoniac in very acrid
vinegar. When the swelling had been lessened, but not completely removed
by these means, he afterwards applied one of the pitch medicines, and
at length effected a cure. In another place he states that scirrhus is
sometimes allied to cancer.
Oribasius likewise recommends a combination of emollients with
discutients; and Actuarius approves of the same practice.
Aëtius has a valuable chapter upon this subject. Besides the articles
mentioned by our author, he recommends various rosins, turpentine,
frankincense, and the like. He forbids the use of aluminous, sulphureous,
and chalybeate baths. For indurations of tendons he recommends things
possessed of attenuant and cutting properties combined with emollients,
such as ammoniac dissolved in vinegar with melons.
The Arabians treat of scirrhus in much the same terms as the Greeks.
Avicenna properly directs us to bleed when there is congestion of black
blood in the part, and afterwards to use applications of a solvent and
emollient nature. He and Serapion mention the same identical remedies
as those of Paulus. For dissolving hard tumours he recommends an oil
containing fenugreek, cyperus, and aromatic reed. Haly Abbas ascribes the
formation of scirrhus to the same causes as our author, and recommends
relaxant and emollient applications. Alsaharavius directs us to procure
evacuations of black bile, and gives prescriptions for various emollient
and discutient applications. When the usual remedies do not succeed, he
advises recourse to be had to the operation. Rhases divides scirrhus
into two varieties, that accompanied with sensibility, and that which is
insensible. He mentions that Antyllus approved of extirpation and the
actual cautery when the disease is of a corroding and cancerous nature.
SECT. XXXIII.—ON STRUMA OR SCROFULA.
Strumæ are indurated glands forming principally in the neck, armpits,
and groins. Their general treatment therefore is the same as that for
scirrhus, but in particular the flour of bitter lupines is to be boiled
in oxymel and applied (this also answers with phyma;) or apply cows’ dung
boiled in vinegar. This discusses all indurated swellings. But strumæ
may be properly discussed by means of quicklime mixed with honey, the
sordes of baths, oil, or axunge; or, equal parts of quicklime and natron,
and four times the quantity of cardamom and fenugreek may be boiled with
honey for an emollient ointment and applied. This one discusses hard
strumæ, and produces the rupture of suppurated swellings; the flour of
darnel boiled with pigeon’s dung, or linseed and wine: or, green olives,
either wild or cultivated; or, the white cardamus triturated with liquid
pitch and made into an emollient ointment may be applied; or, the ashes
of the dried root of the wild cucumber, and the burnt dried leaves of
the bay, may be mixed with turpentine and applied; or, equal parts of
stavesacre and of natron, with double the quantity of rocket may be
applied, with rosin; or, goats’ or cows’ dung boiled in vinegar; or, the
flour of bitter vetches soaked in the urine of a young person not come
to manhood, and added to melted pitch, wax and oil; or, a dead snake may
be thrown into a pot, and being covered over with gypsum, it is to be
put into a furnace, the ashes of it mixed with equal parts of fenugreek,
and then added to honey and used. And the composition from asps is an
admirable one, also that from fullers’ herb, that from the wild cucumber
and that from cedar rosin. The following one produces suppuration, or
resolution of strumæ: Of myrrh, dr. x; of ammoniac perfume, dr. ij; of
the mistletoe of oaks, dr. viij; of galbanum, dr. iv; of bee-glue, dr. j;
pound in a mortar.
_For strumæ and hardness of the breasts._ Of wrought birdlime, of dry
rosin, of wax, of each lb. j; of galbanum, oz. iij.
_For strumæ ulcerated and not ulcerated._ Of wax, of pine rosin, of
axunge not salted, of horehound, of scraped birdlime, of each oz. vj.
_An application for strumæ._ Of old oil, lb. ij; of wax, lb. j; of
colophonian rosin, oz. iv; of natron, oz. iv; the heads of garlic xij.
Take away the cloves (nuclei) of the garlic, macerate in oil for three
days, then having boiled until they are softened, throw them away, and
melt in the oil those ingredients which are soluble, and after they
are taken off the fire sprinkle on it levigated natron. It also breaks
apostemes.—_Another_: Of the ashes of figs, oz. ij; of fissile alum, oz.
j; of aphronitrum, oz. j; of liquid pitch, oz. vij.
_A septic application for scrofula._ Of fissile alum, of realgar,
of each, dr. iv; of the flakes of copper, dr. j; of orpiment, dr.
j; sprinkle the strumæ with it in a dry state; but if they are of a
cancerous nature, mix with rose oil and use twice a day.
* * * * *
COMMENTARY. See Hippocrates (De Glandulis); Galen (Meth. Med. xiv, 11);
Oribasius (Synops. vii, 29); Aëtius (xv, 5); Actuarius (Meth. Med.
iv, 16); Nonnus (Epit. 124); Celsus (v, 18); Scribonius Largus (153);
Myrepsus (56); Marcellus (36); Serapion (v, 25); Avicenna (iv, 3, 2, 10);
Albucasis (Chirurg. ii, 42); Alsaharavius (Pract. xxix, 1, 23); Haly
Abbas (Pract. iii, 33); Rhases (ad Mansor. vii. 8; Cont. xxvii); Avenzoar
(i, 10, 10.)
Hippocrates mentions struma as being one of the worst diseases of the
neck, originating in inflammation, and being produced by a pituitous and
indolent defluxion.
Galen directs us when scrofulous glands are not situated near large
vessels to extract them with the knife, or consume them with septic
applications. In another place he relates a case in which an imprudent
surgeon, while removing a scrofulous gland of the neck, cut the recurrent
nerves, and thereby occasioned loss of speech. (De Loc. Aff. i, 6.) For
an account of the operation see the Sixth Book.
Part only of our author’s applications are derived from Oribasius.
A very minute account of these complaints is given by Aëtius. He divides
strumæ into the mild and the malignant. The mild are without inflammation
or pain, and are attended with a moderate degree of hardness; the
malignant are accompanied with inflammation, and a throbbing pain,
feel unequal, have enlarged veins, and are exacerbated by handling or
medicines. The latter are said to be incurable. He mentions, upon the
authority of Leonidas, the accident related by Galen. He approves,
however, of the operation in general. Incipient strumæ, he states, may be
discussed like scirrhi, by a combination of emollients with discutients.
He gives a long list of prescriptions for removing scrofulous tumours.
One of them contains arsenic mixed with the fat of a goat or ox. With
regard to the general treatment, he recommends laxatives, restricted
diet, emetics, and the theriac.
Actuarius and Nonnus, as usual, borrow from our author.
Celsus remarks that strumæ occur most frequently in the neck, armpits,
groins, sides, and the female breasts. He represents them as indolent
affections of the glands, which come slowly to maturity and prove very
troublesome to the physician. Some, he says, give white hellebore in
these cases, and use applications for bringing them forward or for
discussing them. Others have recourse to caustics, and when the eschar
is removed, they heal the ulcer upon general principles. When the sore
becomes clean he recommends exercise and a nourishing diet.
Scribonius Largus, Marcellus, and Myrepsus give nearly the same
prescriptions as our author. Arsenic is an ingredient in the septic
applications of Myrepsus.
Avicenna recommends emetics, phlegmagogues, bleeding in the arm,
attenuant food, and avoiding all gross things and repletion. As a
discutient he and Serapion commend the diachylon plaster. Haly Abbas
likewise mentions this application, and also directs the swellings to be
burnt with caustics. Alsaharavius briefly recommends excision or burning.
Serapion evidently copies from our author. Avenzoar gives a very full
account of scrofulous swellings, which, he says, are formed in general of
a gross and viscid phlegm. Except in very particular cases he disapproves
of bleeding. He approves in general of discutient applications; but when
the swelling tends to suppuration, he directs us to promote it; and
when pus is fairly formed he recommends us to let it out, but cautions
the surgeon not to attempt this operation unless he has a practical
acquaintance with anatomy, lest he wound any of the veins, arteries, or
nerves.
Rhases forbids the knife when the scrofula is in the neck or deep
seated. In certain cases he approves of destroying the tunic with septic
applications.
Brunus, and the other surgical writers of that age, in imitation of
the Arabian authorities, direct scrofulous tumours to be treated with
discutients, excision, or septics. A discutient ointment recommended by
Brunus consists of litharge, common oil, and the juice of melons and
fenugreek. His septic medicine is a mixture of arsenic and quicklime,
which is to be applied with honey. (Chirurg. Minor. 19.)
SECT. XXXIV.—ON STEATOMA, ATHEROMA, AND MELICERIS.
These things belong to the class of apostemes, as we said when treating
of them, and each receives its peculiar appellation from the substance
contained in the tumour. Thus one of them is like fat, another like
honey, and the third like pap. The indication of cure in them all is
to discuss the contents, produce the putrefaction of them, or to cut
them out. Some tumours fall under all these three indications of cure,
namely, those which contain a thin fluid, as the meliceris; others come
under two of them only, as the atheroma, for it can only be cured by
excision or putrefaction. But the steotoma admits of no cure except by a
surgical operation, for it can neither be discussed nor made to putrefy.
The diagnosis of each of these may be found in the Surgical part of
the work, while the materials of which the discutients are formed are
mentioned under the head of scrofula. This application is peculiarly
adapted for discussing meliceris: Twenty raisins without their stones;
of squama æris, dr. iij; having first fomented, apply.—_Another_: Of
Cretan cistus, of bdellium, of galbanum, of ammoniæ perfume, of bee-glue,
of turpentine, equal parts; to be pounded together in a mortar. It
applies to scrofula, parotis, furunculus, and phyma. But Archigenes
applies to meliceris aphronitrum, and double the quantity of hellebore,
with hard cerate. But septics cannot be applied while the skin remains
entire; we must therefore in the first place lay bare the meliceris,
atheroma, or strumæ, with caustic medicines, of which the most simple
is that consisting of quicklime (calx viva,) soap, and strained lye.
The following one is more complex, and admits of being kept: Of calx
viva, dr. iv; of red natron toasted, of burnt lees of wine, of each, dr.
ij; of vermilion, dr. j; triturate in lye; and having made it of the
consistence of liquid honey, boil three times, until it is of the proper
thickness, and lay it up in a leaden vessel, pouring in some lye, so
that it may not quickly become dry. It applies to acrochordon, myrmecia,
pterygium, clavus, callus, and excrescences of the gums. The lees of
wine should not be older than two months. Anoint the skin with this, and
when it begins to dry clean it away with a sponge, and anoint again; and
when the skin becomes black, wash away again, and use escharotics. When
the eschars fall off, apply the septic medicines. A septic application
which is not irritating: Of squama æris, dr. iv; of realgar, dr. ij;
of black hellebore, dr. ij; use with rose oil.—_Another_: Of squama
æris, of realgar, of nettle seeds toasted, equal parts; use with rose
oil.—_Another_: Of burnt sea-urchins, of the shell of the cuttle fish,
of arsenic, equal parts; use with rose oil, but rub all the parts around
with cerate and oil. This also is a good application: Of quicklime, p.
ij; of chalcitis, p. j; of arsenic, p. j.
* * * * *
COMMENTARY. See most of the authorities referred to in the preceding
section.
Our author’s definitions seem to be taken from Galen. (De Tumoribus and
Meth. Med. xiv.) Galen states that the steatoma is to be cured solely by
a surgical operation; that the meliceris may be treated by discutients,
septics, or excision with the knife; and that the atheroma admits only of
excision, or the application of septics.
Aëtius may be referred to as an interesting authority upon this
subject. The steatoma, he says, is a preternatural tumour, free from
discoloration, and soft to the touch. He recommends excision for it. The
contents of the atheroma consist of a pultaceous substance surrounded by
a membranous tunic, within which are also sometimes found hairs; nay,
Philoxenus affirms that he had found animals like gnats and flies. The
meliceris also has a membranous coat, and its contents resemble honey. He
approves also of the surgical operation for the meliceris and atheroma,
but permits to attempt their reduction by means of discutients consisting
of such ingredients as ammoniac, ceruse, turpentine, galbanum, vinegar,
&c. He makes no mention of septics; indeed arsenic does not enter into
any of his compositions.
Oribasius and Actuarius lay down the same rules of treatment as our
author. Nonnus as usual epitomises him with some slight alterations. The
active ingredients in one of his septic applications are sandarach and
hellebore. Leo is brief and indistinct.
Celsus marks the differences of these tumours with his characteristic
terseness and precision: “Atheromati subest quasi tenuis pulticula:
meliceridi liquidior humor; ideoque pressus fluit: steatomati pingue
quiddam.” He recommends excision. (vii, 6.)
Avicenna’s plan of treatment is so like our author’s, that we need not
give it in detail. The steatoma is to be removed solely by an operation.
For the two others he permits the use of septic applications, such as
arsenic, quicklime, hellebore, the lees of wine, &c. Haly’s definitions
are similar to those of our author, and he recommends either excision
or the use of septics, such as vitriol. The treatment laid down by
Alsaharavius is quite the same. In the barbarous translation of his works
they are called by the names of _alsahamia_, _asalia_, and _accida_.
(Pract. xxix, 1, 22.)
Vegetius, the veterinary surgeon, describes these tumours as they appear
in cattle. He directs them to be treated by excision. (Mulom. ii, 30.)
It will be remarked from the text, that the ancients were well acquainted
with the caustic powers of the _calx cum kali_. In fact, our author in
this section has given a prescription for the paste now commonly used for
forming issues.
It appears from the works of Fabricius of Aquapendente, that the
practice of treating atheroma and meliceris by septic applications was
sufficiently common in his time. Andreas Laurentius approves of removing
_scrofulous tumours_ in this way when they are deep-seated and have a
broad base. He thus enumerates the septics used in his age: “Secundo
extrahi potest struma caustico, nunc affixo in ejus medio candente ferro,
nunc admotis erodentibus et putrefacientibus ut sandaraca, arsenico,
argento liquido usto, oleo quod ex atramento sutorio igne elicitur,
calce non extincta cum sapone, axungia porcina cum argenti sublimati
portiuncula, pulvere mercurii, erinaceorum cumbustorum, testæ sæpiæ,
auripigmenti.” He also recommends us to tie the base of the tumour with
a thread wet in a solution of arsenic (De strum. nat.) The treatment of
atheroma by caustics is well described in the ‘Bibliotheca Chirurgica’ of
Manget.
SECT. XXXV.—OF FAVI.
The favus is a swelling on the skin, having perforations through which a
honey-like fluid is discharged. Wherefore dried grapes with rue are to
be applied to it; or, the tender leaves of the fig tree with honey; or,
cresses with linseed in honey; or, the root of the garden cucumber with
honey; or, sulphur vivum with cerate or turpentine. You may vary the
treatment of favi by transferring hither what is said in the Third Book
regarding achores.
* * * * *
COMMENTARY. Alexander states that the favus resembles the achores,
differing from them solely in magnitude: for the openings of the pores by
which the fluid escapes resemble the combs of bees, whence it takes it
appellation; but in achores we cannot see the pores by which the fluid
issues.
Aëtius gives a similar description of the complaint, which, he says,
mostly attacks muscular parts, as the limbs, soles of the feet, over the
sixth vertebra of the neck, and the sides. When it attacks the head,
he says, it sometimes spreads to the skull. In this case he directs us
to treat it with acrid applications, and even the actual cautery. For
incipient favus he recommends an application consisting of sulphur,
barley flour and meal.
Nonnus recommends the following application: of litharge, dr. ij; of
alum, dr. iij; of the leaves of rue, dr. ij; of wine and rose-oil, q. s.
Celsus’s description is so important, that we shall give a considerable
part of it in his own language. He mentions two species of the favus,
or κήριον. “Alterum est subalbidum, furunculo simile; sed majus, et cum
dolore majore: quod ubi maturescit, habet foramina, per quæ fertur humor
glutinosus et purulentus; nec tamen ad justam maturitatem pervenit. Si
divisum est, multo plus intus corrupti, quam in furunculo, apparet,
altiusque descendit. Raro fit nisi in capillis. Alterum est minus, super
corpus eminens, durum, latum, subviride, subpallidum, magis exulceratum;
siquidem ad singulorum pilorum radices foramina sunt, per quæ fertur
humor glutinosus, subpallidus, crassitudinem mellis, aut visci referens,
interdum olei: si inciditur, viridis intra caro apparet. Dolor autem, et
inflammatio ingens est, adeo ut acutam quoque febrem movere consuerint.”
For the second species he recommends as external applications a dried
fig, linseed boiled in mulse, and emollient plasters. To the other he
also directs us to make applications containing figs, turpentine, rosin,
&c. But when these have not the effect, he recommends us to cut the
fungous excrescences down to the sound flesh, and then to dress the sore
upon general principles. (v. 28.) The above account of an affection of
the scalp, which we have often met with in practice, is the most accurate
to be found in any author ancient or modern. We are even in doubt whether
the complaint be at all noticed in modern works on surgery. It is not
to be confounded with the Porrigo favosa, or Porrigo scutulata, of Dr.
Bateman.
Avicenna’s description of the achor and favus is far from distinct.
(iv, 7, 3, 1.) The favi appear to be the pustulæ capitis quæ dicuntur
_alsahafa_ of Alsaharavius. (Pract. i, 11.) His description, however,
is by no means distinct. He approves of general evacuants, and
local applications of a stimulant nature, such as sulphur, mercury,
birthwort, &c. Serapion has not described the favus very accurately,
but he has given a full account of the treatment. He properly forbids
strong applications at first. (i, 3.) Rhases recommends much the same
applications as Serapion. (Ad Mansor. v, 16.)
SECT. XXXVI.—ON THE SIMPLE ULCER.
Since a simple ulcer is merely a division, if one will bring together
the parts which are separated, and apply a circular bandage around, the
divided parts will adhere together without more ado. It is necessary,
however, when at one of its lips the ulcer is everted obliquely, to
begin the bandaging there, and turn it to the opposite side. When it is
deranged both ways, it will be proper to use a double-headed bandage, and
thus to bring the lips together; for when nothing has fallen between the
lips, such as a hair, or a sand, or oil, or filth, or the like, the ulcer
will adhere completely. When the ulcer is large, so that the separated
parts cannot be completely brought together by the aforesaid bandaging,
they are to be first united with sutures, and then bandages are to be
thus applied, and those remedies used which are called agglutinants,
which have the power of drying and consuming the collected moisture, and
prevent more from flowing to the part.
* * * * *
COMMENTARY. On ulcers the following ancient authors may be consulted:
Hippocrates (De Ulceribus); Galen (Meth. Med. iii, & iv); Oribasius
(Synops. vii); Aëtius (xiv); Actuarius (Meth. Med. iv, 16); Nonnus
(Epit. 259); Pliny (H. N. xxxii, 44); Celsus (v); Octavius Horatianus
(i, 19, 20); Scribonius Largus (94); Avicenna (iv, 4, 1, 2, 3); Serapion
(vii, 28); Averrhoes (Collig. vii, 32); Haly Abbas (Pract. iv, 18);
Alsaharavius (Tract. xxix, 2, 2); Rhases (Ad Mansor. vii, 3; Divis. i,
138; Contin. xxviii.)
The author of the Hippocratic treatise quoted above particularly praises
wine as a lotion for ulcers; and we may mention that Dr. Hosack, an
intelligent American writer, states it as his opinion, that the surgeons
of the present day might learn from him an important lesson upon its
utility in such cases. He condemns the use of oils and fat.
Of all authors, ancient or modern, Galen has laid down the principles
upon which ulcers ought to be treated with the greatest precision.
He defines an ulcer to be, “a solution of continuity,” a definition
evidently very comprehensive, and including wounds as well as cases of
spontaneous ulceration. His directions for the treatment of a simple
ulcer or fresh wound are similar to those of our author; that is to say,
he directs us to bring the lips of it together, and secure them with a
bandage, or, if that is not sufficient, by sutures or clasps. Wine he
pronounces to be the best of all applications to ulcers, in as far as
they are ulcers.
Our author copies very closely from Oribasius.
In applying the bandage, Aëtius directs us to begin above the sore if
only one simple bandage is to be used, but if two are necessary, as in
fractures, he recommends us to begin at the ulcer and proceed upwards,
and in like manner to begin again at the ulcer and roll downwards. He
forbids us to loose the bandages oftener than every alternate day; and
directs us not to apply water to the ulcer, but to remove the sanies with
a soft, dry linen cloth.
Celsus describes very accurately the treatment of a recent wound or
simple ulcer. He approves, according to circumstances, of bandages,
clasps, or sutures, and his directions respecting the application of them
are highly important, but too long for our limits. After the sore is
dressed he directs us to apply over it a sponge soaked in vinegar, or, if
that cannot be borne, in wine or cold water. This practice is deserving
of imitation. He says afterwards: “Optimum etiam medicamentum quies est:
moveri et ambulare nisi sanis alienum.”
Octavius Horatianus directs us to avoid the bath, the fire, the sun, cold
air, loud cries, intoxication, venery, and passion, lest these should
occasion a rupture of the parts which had adhered.
Avicenna with his usual good sense gives judicious directions for the
treatment of simple ulcers, but his principles are nearly the same as
those laid down by Galen. He defines an ulcer to be “a solution of
continuity, attended with a discharge of sanies or pus.” This seems
to be an unexceptionable definition. He forbids all oily and watery
applications, and recommends us to observe that no body intervene
between the lips of the wound when the bandage is applied. Rhases gives
similar directions. He condemns the practice of those who put oil
into a wound, and who allow the patient to take wine and heating food.
Averrhoes lays down similar rules with considerable precision. Haly Abbas
and Alsaharavius follow the practice of Galen without the slightest
alteration.
Considerable difference of opinion has prevailed respecting the nature
of the clasps (Fibulæ ἄγκτηρες) recommended by Celsus and other ancient
authorities. Rhodius and Le Clerc maintain that no more was meant than
a _simple interrupted suture_, but to this opinion we cannot subscribe.
(See Le Clerc, Hist. de la Méd. iv, 2, 5, and Fabricius of Aquapendente
Œuvres Chirurg. ii, 108.) They would appear to have been metallic clasps
of a peculiar construction.
SECT. XXXVII.—ON AGGLUTINANTS.
Oak leaves applied, and those of the willow and cabbage; the fruit,
leaves, and bark of the mezereon, and the juice of the more austere
plantain, papyrus soaked in oxycrate or wine, and wrapped round in a
circular manner. The following are agglutinants of fresh wounds: the
leaves of the pine and spruce fir, and their fresh bark wrapped round
like a bandage, with water, oxycrate, or wine; and new cheese pounded.
But we must apply externally the leaves of dock, or of vine, or of beet,
or of lettuce. But cheese made of acid milk cures even the larger sores;
and the wild pears repress the discharge. The horse-tail (Hippuris) may
be applied with advantage, even if the tendons are divided asunder; and
the matured woad may be used to indurated bodies even when they occur in
the heads of muscles. The leaves and shoots of cypress, and its recent
and soft balls (pilulæ) may be applied to indurated parts, but we must
mix with it some of the fine dust taken from a wall near a mill. Myrrh
rubbed with water, or frankincense and earth worms, agglutinate even the
divisions of tendons; also, cinquefoil leaves with honey, and garlic
burnt and applied. Old ulcers again are remedied by barley burnt with
cerate, and by ceruse with a quadruple quantity of myrtle cerate. For
ulcers on the head sprinkle dried myrrh, and do not moisten it, for it
will speedily produce adhesion. Or, having triturated dried aloes or
birthwort, and having boiled it with honey in wine until it is of a
proper consistence, spread upon a pledget and apply it. Of the compound
agglutinants are those called the Barbarous, the Golden, that ascribed to
Nicolaus, that from willows and dittany, and others of a similar nature,
which can produce the adhesion even of very large sores.
* * * * *
COMMENTARY. Celsus gives the following list: glutinant vulnus, myrrha,
thus, gummi, præcipueque acanthinum, psyllium, tragacantha, cardamomum,
bulbi, lini semen, nasturtium, ovi album, gluten, ichthyocolla, vitis
alba, contusæ cum testis suis cochleæ, mel coctum, spongia, vel ex aquâ
frigidâ, vel ex vino, vel ex aceto expressa, ex iisdem lana succida: si
levis plaga est etiam aranea.
Our author’s list is copied from Oribasius. Aëtius has a long chapter
on the composition of applications for agglutinating fresh wounds. The
ingredients of them are most various: sumach, litharge, wax, galbanum,
bee-glue, turpentine, alum, chalcitis, &c. Actuarius merely extracts a
few articles from our author’s list.
Avicenna’s list scarcely differs in any one particular from our author’s,
and nearly the same may be said of Haly’s. Isaac (ap. Rhasis Contin.
xxviii) particularly commends bdellium and myrrh, with honey and wine.
Galen has explained at considerable length the principles upon which
these applications should be used. Agglutinants, he remarks, are austere
and astringent medicines, being such as occasion a contraction and
condensation of the fleshy fibres; and they must not possess detergent
properties. They are principally applicable in the case of plane ulcers,
that is to say, ulcers without loss of substance. (See Meth. Med. iii.)
SECT. XXXVIII.—ON PAINFUL AND INFLAMMATORY SORES.
To painful and inflamed wounds desiccant and anti-inflammatory remedies
must be applied. Of liquid remedies the best is wine, but oxycrate
is also a good remedy. But if the ulcer is foul as well as inflamed,
much diluted hydromel may be used. Of dry medicines, those in general
will apply which are mentioned for phlegmons, except such as are oily
and acrid. This is a particularly excellent one: Having boiled the
sweet pomegranate in wine and pounded, apply it. This is an admirable
application and much used, for it applies to ulcers of the head, and
those of the privy parts, and to very painful sores on all parts of the
body, and to inflammations of the eyes. But if the erysipelas or the like
attack an ulcer, we must have recourse to the remedies described for them.
* * * * *
COMMENTARY. Hippocrates gives a long list of applications for inflamed
sores. We have mentioned above that wine was one of his favorite
remedies. If erysipelas come on, he directs us to purge either upwards or
downwards.
Galen explains general principles. Our author copies closely from
Oribasius.
Avicenna and Rhases agree with Paulus in approving of cooling or
desiccative applications, such as a decoction of sweet pomegranate in
Pontic wine. This application is recommended by Haly Abbas, who also
mentions a cataplasm containing opium.
SECT. XXXIX.—ON UNCONCOCTED ULCERS, AND SUCH AS HAVE NOT SUPPURATED.
Recent ulcers, and such as being in an inflammatory state have not
suppurated, may be digested and made to suppurate by these things: of
simple things, tepid water poured on them, wheat flour, or chondrus,
or bread, or glue for books, applied with turpentine, wax, saffron,
frankincense, pitch, rose oil, axunge, or the fat of calves; but the
compound application called tetrapharmacon may be applied upon a pledget
mixed with rose oil. Old and callous ulcers are concocted by these simple
medicines: the dried grape, storax, galbanum, myrrh, Cretan cistus,
pitch, rosin, butter, Egyptian mastich and unwashed wool; and by these
compound ones: Galen’s plaster without wax, dissolved in oil of ricinus,
and applied upon a pledget with old oil, or oleum ricini; and in like
manner those called dichromos and basilicon, and the like.
* * * * *
COMMENTARY. Celsus’s list is not very different from our author’s:
Concoquunt et movent pus, nardum, myrrha, costum, balsamum, galbanum,
propolis, styrax, thuris et fuligo et cortex, bitumen, pix, sulphur,
resina, sevum, adeps, oleum. These articles furnish the ingredients of
most of our modern applications. For further information respecting each
article, the reader is referred to Dioscorides, Galen, and Serapion.
SECT. XL.—ON HOLLOW ULCERS.