_materiel_ of which is a moderate quantity of good blood. Wherefore we
procure a moderate supply of it by a sufficiency of food, and produce
a proper temperament of the sore by food of wholesome juices, and a
suitable temperament of the part in which the sore is seated. With regard
to the discharge, that which is thin renders the sore more humid, and
that which is thicker makes the sordes adhere to it; on that account it
requires applications that are moderately desiccant and detergent; such
as frankincense, the flour of barley, that of beans and tares, iris,
birthwort, calamine, panax, and pompholyx. When one incarnative remedy
does not answer another must be tried. But if the sordes of the ulcer
appear greater, and the ulcer more humid, it is to be understood that the
medicine has not dried properly, and its powers are to be increased by a
mixture of honey. If it is clean, but with less moisture than natural,
the medicine has dried more than was proper, and we must apply a cerate
mixed with more oil. It sometimes happens when the application is too
strong, that the flesh is melted down, so that the ulcer appears foul and
moist, like those which have been imperfectly dried; but that from the
melting of the flesh becomes more hollow, its lips are callous, and it
is red and inflamed; and sometimes the patient has very acute pain. But
the other, which arises from the applications being less desiccant than
proper, is attended with none of these characters. Wherefore the caries
of wood, more especially of such as is possessed of a moderate degree
of astringent and detergent qualities, as that of the elm, purges and
incarnates clean ulcers; or anemone may be applied for the same purpose.
Having shaven down the bark of the pine and pounded it with cerate, and
rubbed it upon pledgets, apply it to hollow ulcers, more especially to
such as are recent, for it will fill them. The compound medicines for
ulcers which are clean, are, that from snails, that ascribed to Manetho
from the lees of wine, that from aloes, the dry powder called meletera,
that containing equal parts of starch, of manna, of halica, and of
tares; and in like manner, the composition from frankincense and that
called aphroditarium. But when the ulcers are fouler the powders called
cephalic are to be applied, and of those applications that are made upon
pledgets, that called trophos, the isis and the athena, and that from
distaff-thistle (atractylis,) and moreover that called Italicum, and any
others of tried efficacy.
* * * * *
COMMENTARY. The resemblance here pointed out between an ulcer too
strongly stimulated and one too little is highly deserving of attention.
Our author appears to have borrowed his description from Oribasius, who
however abridges it from Galen. Galen and Aëtius give a somewhat fuller
account than our author, but their principles of treatment are the same.
They remark that frankincense in humid intemperaments engenders flesh,
but in dry ones only pus. Pompholyx burnt and washed; calamine and
the shells of oysters are said to be incarnant and dissiccant without
pungency. Galen inculcates that the greatest difficulty in treating these
ulcers, is to find out the nature of the intemperament of the part, and
correct it.
Celsus gives the following list of incarnants: Carnem alit et ulcus
implet resina pinea, ochra attice, vel asterace, cera, butyrum. He
recommends the use of hot water; an application consisting of butter,
roses, and a small portion of honey; or the tetrapharmacum with roses. He
approves of giving wholesome and nutritious food, such as fowls, venison,
pork, and even wine. The list of the Pseudo-Dioscorides contains nearly
the same articles as that of Celsus. (Euporist. i, 186.)
Octavius Horatianus recommends a composition of equal parts of honey,
turpentine, rosin, and wax, melted in a vessel; or a mixture of powdered
rosin, wax, and fat.
Scribonius Largus recommends basilicon, and a composition consisting of
calf’s marrow, the fat of geese, butter, stag’s marrow, wax, turpentine,
honey, and roses.
Avicenna remarks, that in treating hollow ulcers we must not use very
desiccative applications, as they dry up the fluids which are necessary
for forming flesh; nor for the same reason, very astringent applications,
nor abstergents of any greater strength than to remove the sordes. Rhases
recommends a mixture of equal parts of olibanum, aloes, sarcocolla,
and dragon’s blood. Camphor is an ingredient in one of his incarnative
applications. Alsaharavius makes mention of an application from olibanum,
like that of Rhases.
All the ancient authors say that round ulcers are more difficult to
heal than those of any other shape; and Cassius Medicus and Alexander
Aphrodisiensis assign various reasons for this, the most probable of
which seems to be, that in this case the sound parts are further removed
than in any other.
Apollonius Dyscolus states that ulcers are prevented from healing by
pregnancy, by disease of the spleen, and by varicose veins. (Histor.
Mirab. 42.)
SECT. XLI.—MEDICINES FOR CLEANSING FOUL ULCERS.
Foul ulcers, whether hollow or level with the surface, may be properly
cleansed by birthwort in honey, turpentine with an equal portion of rose
oil and honey, or instead of rose oil butter may be substituted, with
Illyrian iris and honey; and by pickled olives applied. To nervous parts,
turpentine melted with butter may be applied. When the sores are very
foul and spreading, horehound with honey is a good application, which
removes the eschars. The following are compound applications: Of boiled
lees of oil, of scummed honey, of the species of alum called phormion,
equal parts.—_Another_: Of the dried serapias, called also triorchis, of
Illyrian iris, of dried horehound, of birthwort, of each, dr. viij; of
the flour of tares, dr. x; use in a powder and with honey. And for foul
ulcers the Egyptian cerate is useful, also those from salts when melted,
the Indian, that called athena, the green plasters diluted, the powder of
dried pumice stone, those from tares, the trochisk called melanchlorus,
and in like manner that called criogenes.
* * * * *
COMMENTARY. The following are the most important articles in Celsus’s
long list of substances for cleansing ulcers: Purgant, ærugo,
auripigmentum, quod ἄρσένικον a Græcis nominatur; (huic autem et
sandarachæ in omnia eadem vis, sed validior est) squama æris, thus,
resina, et pinea, et terebinthina liquida, misy, chalcitis, galla,
sulphur, pix, oleum, ruta, ammoniacum, &c. Hippocrates makes mention
of many of these, namely, arsenic, verdigris, flowers of copper,
frankincense, myrrh, hellebore, &c.
Scribonius Largus recommends honey, Illyrian iris, and a compound
application containing arsenic, scales of copper, elaterium, and burnt
paper.
One may find in Galen and Aëtius many compound applications, but as they
are all formed from much the same ingredients as those of our author, it
will be unnecessary to take further notice of them. Aëtius commends a
combination of turpentine and honey.
Avicenna and Haly Abbas recommend the same applications as our author.
They make no mention of arsenic. Alsaharavius gives very particular
directions for treating these ulcers; when the edges are hard, he directs
us to rub them until they become red, or to cut them off and apply to
the sore the green ointment; and when the ulcer is covered with much
sordes, he recommends us to dress it with the Egyptian ointment. Rhases
mentions antimony as an excellent application for cleansing foul ulcers.
He properly recommends us to consider whether the foulness of the ulcer
be the effect of too much or too little stimulation. He relates a case of
the former description, in which the sore got worse under the application
of the green ointment. (Cont. xxviii.)
SECT. XLII.—FOR WORMS IN ULCERS.
For worms which form in ulcers, the first thing to be done is to stop the
humidity and the putrefaction which occasion them. Worms may be killed by
all the things in general which are described for those in the ear. But
for those which form in ulcers Archigenes says, mix equal parts of ceruse
and poley with liquid pitch, and anoint with it.
* * * * *
COMMENTARY. Aëtius recommends dried plantain, the ashes of the wood of
figs, and the juice of calamint. Galen and Avicenna also mention calamint.
Pliny mentions the gall of frogs.
SECT. XLIII.—ON FUNGOUS ULCERS.
The fungous flesh of ulcers is to be removed by medicines which are
powerfully desiccant, such as diphryges sprinkled upon it, the squama
æris, all the testacea burnt, both the echini (the hedgehog and
sea-urchin,) burnt entire. But the following things are moderately
cleansing, and repress the fungous flesh: the flower of the Asian stone,
and still more powerful than it, the sori and chrysocolla, chalcitis
and misy (when burnt they are less caustic,) and the flos æris in like
manner; but verdigris is the most powerful of all. Salts, when burnt,
consume the foul flesh, and in like manner charpie that has been soaked
in strong brine and dried, consumes fungous flesh that is moderately
large. But verdigris with the squama æris is powerfully repressing. Of
the compound applications the powder called rhodium, and the psarum, and
that named yellow, repress fungous growth without being pungent. But the
trochisks called phaustiani, when levigated and sprinkled on the sore,
and the dry medicine (or powder) called heliocaes, make fungous flesh
slough off to the bottom. But the application consisting of equal parts
of calx viva, squama æris and manna, answers with fungous flesh; with
honey it cleanses such as resemble a mushroom, and with cerate it proves
incarnating.
_A powder for keeping down fungous flesh_: Of litharge, of chalcitis,
of verdigris, of plumbago, equal parts.—_Another_, which represses
strongly without being pungent, and applies also to spreading ulcers,
and more especially the epulis of the gums, and whitens the teeth: Of
quicklime, lb. j; of arsenic, oz. vj; having triturated the dried arsenic
with water, add the lime washed like calamine, and, having rubbed them
together dry and use. And of the trochisks, that called pantolmios, and
those described for polypus, are excellent for repressing fungus in
ulcers. But the green plasters, more especially the one from Cappadocian
salts, and in like manner the isis, are most effectual in preventing
fungous flesh in ulcers.
* * * * *
COMMENTARY. The powerful applications mentioned by our author will be
found amply sufficient to fulfil every intention in conducting the
treatment of these ulcers. Many of them are mentioned by Hippocrates.
Galen lays it down as a rule that these fungous excrescences are to be
repressed by powerfully desiccative substances, such as misy, chalcitis,
or more especially verdigris; when burnt and washed they become mild
detergents. (Meth. Med. iii.)
Aëtius gives many useful prescriptions for such preparations, but they
are entirely formed of the ingredients which enter into those of our
author.
Celsus gives a long list of caustics highly applicable in such cases:
Adurunt, auripigmentum, atramentum sutorium, chalcitis, misy, ærugo,
calx, charta combusta, sal, squama æris, veratrum et album et nigrum,
cantharides, sandaracha, alumen scissile, &c. Pliny speaks of a
composition of unwashed wool, with barley flour, and verdigris.
Octavius Horatianus recommends the Phrygian stone pulverized, and a
powder consisting of the recrementum plumbi, verdigris, aloe, and
quicklime.
Rhases and Avicenna copy from our author. Haly Abbas speaks of removing
the superfluous flesh with an instrument.
SECT. XLIV.—ON SPREADING ULCERS, PUTRID ULCERS, AND PHAGEDÆNA.
Spreading and putrid ulcers are to be bathed with vinegar and oxycrate,
an astringent wine, cold water, sea-water, or the decoction of lentil,
of pomegranate rind, of the flowers of the wild pomegranate, of lentisk,
of myrtles, of Egyptian thorn, or some other astringent and desiccant
medicine. Cataplasms are to be applied to them of the flower of tares and
liquid alum, the inner part of bread made of similago, an old goby fish,
or some other old pickle, unwashed flesh, and liquid turpentine; these
things are to be all pounded together in equal proportions. Or the parts
may be anointed with equal proportions of birthwort, and the juice of
the leaves of the Palma Christi, and half the quantity of verdigris, made
with water to the thickness of honey; but if the eschar is not removed
an equal proportion of elaterium is to be mixed with the verdigris.
For putrid ulcers sori levigated and sprinkled on them is an effectual
remedy, and above is to be put dried charpie; or the round birthwort and
galls in equal quantities may be rubbed in with oil; or the root of the
wild cucumber, or of cabbage, or of beet, or the leaves of dock are to
be bound in a piece of linen, and put into ashes; when they are softened
triturate with salt and apply; they will cleanse powerfully. Or apply
green olive leaves boiled in wine with honey; or apply chalcitis, or
parsley seed levigated, or apply linseed triturated with copperas, or use
an application of thyme, dried grapes and boiled figs, or of fig leaves
triturated with honey; or of nitre, cumin, and fine flour with honey;
or of the root of the wild cucumber, or of squill boiled with honey; or
of sori, dr. xij; of chalcitis, dr. x; of misy, dr. iv; triturate with
half an hemina of the strongest vinegar until it is dried, and taking
it off use by dipping a specillum in it, and rubbing it over the ulcer,
and placing above it a double pledget out of wine and oil. But if it is
inflamed apply henbane with polenta, or cabbage with honey.
_For putrid and spreading ulcers on all parts of the body._—Of quicklime,
of chalcitis, of each dr. ij; of arsenic, dr. j. This may be used for
pterygia of the fingers, for phagedæna and carbuncle, with honey if on
the genital organs, but dry if on any other part of the body. Above apply
an oblong pledget with rosin.
_An universally applicable powder for all spreading sores, and those
of the mouth, for hemorrhages, and for repressing fungous flesh._ Of
chalcitis, of misy, of both in a crude state, dr. xx; of squama ferri,
dr. vj; of immature galls, dr. viij.
_For spreading and putrid sores._ Of salts, dr. ij; of any species of
alum which has been burnt, dr. j; of squama æris, of burnt pumice stone,
equal quantities. Scraped verdigris, with burnt misy mixed with liquid
pitch; and the flakes of iron with oil also answer well.
_For spreading ulcers of the pudendum._ These things will apply to
them, and also the composition called meliterium, the powder of the
wild myrtle, and that from paper; also the composition from oxymel
called coracion, the trochisk of Andron and the like, will answer with
all spreading ulcers. The same things also apply with phagedæna; for
phagedæna is an ulcer that spreads by eating.
_For foul and fetid ulcers._ The Lemnium sigillum (Lemnian earth) mixed
with vinegar, oxymel, oxycrate, or wine, until it is of the consistence
of clay, may be rubbed on them with advantage; or the leaves of cypress,
its shoots, and tender balls (pilulæ), or the ashes of dried gourd burnt,
or of the burnt bark of the plane tree, or of burnt dill in like manner,
or of foul wool burnt, or of plaintain; also woad by itself or with
polenta, or the dried root of hog’s fennel.
* * * * *
COMMENTARY. It will be remarked that the milder applications mentioned in
this section are all powerful desiccants and astringents. Most of them
are mentioned by Dioscorides as possessing these properties.
Galen recommends the compound applications mentioned by our author,
containing verdigris, squama æris, &c.
For these spreading and putrid sores Aëtius, among other prescriptions,
gives one which would no doubt be applicable in the worst cases: “Of
crude misy, of crude chalcitis, ā dr. viij; of ochre, dr. iij; of
sandarach, dr. iv; of quicklime, dr. ij; of the scales of copper, of
alum, ā dr. ij; of diphryges dr. iij; m.” These caustic and escharotic
medicines enter into the composition of many of his applications. Some
of them contain astringents and desiccants, such as sumach, galls, alum,
fossil salts, frankincense, calamine, birthwort, pomegranate rind, &c. In
short the ingredients in his applications correspond with Celsus’s list
of corrosive substances: Rodunt, alumen liquidum, sed magis rotundum,
ærugo, chalcitis, misy, squama æris, sed magis rubri, æs combustum,
sandaracha, galla, thus, auripigmentum, calx, nitrum et spuma ejus,
alcyonium, resina, squama ferri, atrumentum sutorium, veratrum, &c.
The other authorities give only combinations of these substances; for a
full account of which preparations we refer the reader to Galen. (Med.
sec. gen. iv.)
Octavius Horatianus recommends lentils boiled and mixed with honey; the
leaves of cabbage, coriander, or ivy, all mixed with honey.
The Arabians, although they supply nothing new, add their authority
in confirmation of the remedial virtues which the Greeks assigned to
the substances mentioned above. Avicenna and Rhases recommend arsenic,
copperas, misy, sori, chalcitis, flos æris, quicklime, alum, galls,
ammoniac, the trochisk of Andron, &c. When a part becomes black and
putrid, Haly Abbas directs us to open a vein leading to it, if the age
and state of the patient permit, and afterwards to apply odoriferous
things, such as camphor, &c.
SECT. XLV.—ON ULCERS REQUIRING CICATRIZATION.
By drying and constringing the flesh of ulcers requiring cicatrization
to such a degree as not only to dissipate the preternatural superfluity,
but also to touch upon that which is in its natural state, we may render
the surface of the sore like skin, and make the ulcer cicatrize. This is
promoted by immature galls, the moderately desiccant bark of pomegranate,
and whatever else is desiccant without being possessed of pungent
astringency. And such things as these promote cicatrization: myrrh,
litharge, and oysters if burnt, for they must be sprinkled on the sore
dry. And these things often produce cicatrization: pine bark with myrtle
cerate, ivy flowers with cerate, the root of the lily with rose-oil,
dried pine-rosin, burnt pumice stone, the flakes of copper; they are to
be used in equal proportions dry. The following also repress: mix a small
quantity of manna and of diphryges with levigated pumice, and use; or
of litharge p. j; of diphryges p. ss, apply on a pledget with cerate.
Birdlime with frankincense cicatrizes old ulcers, also verdigris with an
equal portion of diphryges and with myrtle cerate, or the small centaury
applied fresh. To the more humid apply the root of cypress. To those
about the anus and pudendum, more particularly if inflamed, use levigated
aloes, either in a dry state or with water, or squama æris; or soften
chrysocolla in the sun with wax, and apply.
_A dry application for producing cicatrization._ Of oysters, dr. xij;
of manna, dr. vj; of calamine, dr. iv. It applies also to spreading
sores.—_Another_: Of birthwort, dr. vj; of pine bark, dr. vj; of manna,
dr. vj; of pumice, dr. iv; of Colophonian rosin, dr. iv; of iris, dr.
iv.—_Another_: Of hart’s horn burnt, dr. iv; of pine-bark, oz. vj:
of ceruse, oz. iv; of scraped verdigris, oz. ix; of calamine, dr.
xviij.—_Another_: Of the flowers of pomegranate, of copperas, of each,
dr. xvj; of squama æris, of fissile alum, of each dr. viij; of galls, dr.
j.—_Another_: Of ceruse, of litharge, of each, oz. viij; of the dross of
lead, of galls, of dried myrrh, of each, dr. iv.
_A cicatrizing application._ Take of fissile alum, oz. j; and having
levigated it, macerate in a sextarius of water: when dissolved in the
water soak pledgets in it, and having dried them apply.
_A plaster for cicatrizing the more simple ulcers._ Of wax, dr. xl; of
litharge, dr. xxxv; of diphryges, dr. viij; of myrtle-oil, half a hemina.
The plaster called phœnicinum, that from calamine, the myrsinatum, and
the like, are also applicable in such cases. For ulcers of difficult
cicatrization: Of wax, of myrtle-oil, of each, dr. vj; of calamine, oz.
vj; of lead, of frankincense, of each, dr. ij; of fissile alum, of burnt
copper, of each, oz. j; of scraped verdigris, dr. ij; dissolve them
singly. For chronic ulcers, and such as are of difficult cicatrization:
Of calamine, dr. viij; of chrysocolla, dr. viij; of fissile alum,
dr. viij; of verdigris, of the flakes of copper, of each, dr. j; of
pine-rosin, dr. xl; of wax, dr. c; of myrtle-oil, q. s.—_Another_: Of
wax, of pine-rosin, of each, oz. vj; of calamine, oz. vj; of crude
chalcitis, oz. iij; of myrtle-oil, q. s. The calamine and the chalcitis
are to be triturated with wine during the season of the dog-star; use it
upon a broad compress, and apply above it a pledget and sponge out of
wine.—_Another_: Of burnt copper, oz. ij; of fissile alum, oz. ij; of
sal ammoniac, dr. ij; of wax, oz. vj; of Colophonian rosin, oz. vj; of
myrtle-oil, oz. ij; the dry things are to be triturated in the vinegar in
the sun for twenty days, and when it becomes of the consistence of honey,
having melted the wax, mix it and soften. The medicine from pumice-stone,
the isis, and the like, are also applicable in such cases.
* * * * *
COMMENTARY. Celsus gives the following list of the more active articles
of this class: Crustas ulceribus tanquam igne adustis inducunt, præcipue,
chalcitis, utique si cocta est, flos æris, ærugo, auripigmentum, misy, et
id quoque magis coctum.
For a variety of applications suitable to this class of ulcers, we refer
the reader to Galen’s 4th book of ‘De Med. sec. gen.’ The ingredients
of them are powerfully desiccative, astringent, and escharotic. Many of
our author’s prescriptions will be recognized in it. For an account of
the isis, and the other compound medicines mentioned towards the end of
this section, we refer the reader to Galen (l. c.) and to the Seventh
Book of this work. Galen, in another place, and after him Aëtius, give
the following important directions for the use of these applications. The
ulcers to which this mode of treatment is applicable, being very foul
and filled with a vitiated discharge, are first to be wiped clean with
a soft linen cloth, and then the cavity of them is to be filled with
the medicine, and a splenium (oblong compress) applied externally. Then
having put a piece of linen above the splenium and bound it on, we are to
place over it a sponge squeezed out of cold water or wine, endeavouring
to keep the sponge cold during the whole time of the treatment, which
may easily be done by pouring cold water upon it without loosing the
bandages. They are not be removed until the third day. Galen states
that the articles which answer best in such applications are galls,
pomegranate-rind, alum, chalcitis, misy, and the like.
A similar mode of treatment, without any material alteration, is
described by the Arabians. Haly Abbas remarks, that cicatrizing medicines
are powerfully desiccative with some astringency, such as galls, alum,
and the like.
SECT. XLVI.—ON THE MALIGNANT ULCERS CALLED CHIRONIAN AND TELEPHIAN.
Old ulcers which are difficult to get cicatrized are called chironian, as
if requiring Chiron himself to cure them; and telephian, from Telephus
having long laboured under such a sore. We must attend then whether
the whole body being in a state of cacochymy, sends such defluxions to
the ulcer, and the prevailing humour is to be evacuated by appropriate
remedies. Or if it is a varix which sends these humours to the legs, the
ulcer being in it, it is to be cured as will be described in the Surgical
part of this work; or the humours are to be evacuated by venesection,
taking away blood frequently, and then using topical applications which
have the property of extirpating the disease without being pungent. These
therefore are simple applications; those from pumice and diphryges, and
flakes of copper, verdigris, and lime moderately washed; sprinkle fissile
alum levigated, or of unwashed wool, dr. iv; of dried grapes, dr. iv; of
natron, dr. ij; having previously anointed with honey, sprinkle of flakes
of copper, dr. x; of alum, dr. ij; and having softened in the sun with
dr. x of wax, apply.
These are compound medicines. _A plaster for chironia._ Of ceruse, oz.
viij; of fissile alum, oz. ij; of the flakes of copper, dr. ij; of sal
ammoniac, of frankincense, of scraped verdigris, of pomegranate rind,
of each, oz. ij; of quicklime, oz. j; of wax, lb. j; of myrtle-oil, lb.
j. ss; triturate the dry things with wine. At first it removes callus;
and it is laid by and kept, and at last when used, being softened with
myrtle-oil, it cicatrizes.—_Another_: Of litharge, lb. j; of oil, lb.
ij; of black chamæleon, of the roots of birthwort, of immature galls, of
each, oz. j; of galbanum, of ammoniac perfume, of frankincense, of each,
oz. ij; prepare, stirring with the roots of green reeds.
_From Archigenes, for chironia, and malignant ulcers in the legs and
breast, for struma, and parotis._ Of the fat of an ox lb. iij; of
turpentine, oz. v; of manna, oz. vij: of the earth called sarda which
painters use, oz. v: having put the soluble and dry articles together
and melted, use.—_Another_, of Archigenes: Of wax, oz. iv; of oil of
unripe olives, of manna of frankincense, of diphryges, of the flakes
of copper, of each, dr. iv; having triturated the powder with vinegar,
and made of the thickness of honey, mix with the cerate, and use upon
a pledget.—_Another_, for the malignant ulcers of women, and of other
persons having a soft skin: Of Tuscan wax, dr. viij; of bulls’ fat,
of turpentine, of burnt lead, and of pepper, of each, dr. j; use on a
pledget with rose-oil or myrtle-oil.
* * * * *
COMMENTARY. Celsus describes the chironian ulcer as being large, and
having hard, callous, and swelled edges, with a copious discharge of thin
sanies. It is attended with no inflammation, the pain is moderate, it
does not spread, and therefore it is not dangerous, although not readily
cured. Sometimes, he says, it becomes covered with a thin cicatrix, and
then again the ulcer breaks out. It occurs mostly in the feet and legs.
From this description it is evident that by the chironian ulcer Celsus
meant merely an ill-conditioned ulcer, and that he distinguished between
it and the _cacoethes_, or malignant ulcer, which last he held to be
nearly allied to the carcinoma. However, most of the Greek authors apply
the term malignant to the chironian ulcer. For the cure of it Celsus
recommends an application consisting of squama æris, lead burnt and
washed, calamine, wax, and a small quantity of roses.
Galen furnishes us with an account of the manner in which Thessalus the
Methodist proposed to cure all chironian and malignant ulcers. Thessalus
lays it down as a rule for the treatment of all sores which are difficult
to cure, or which break out again when healed, to remove the exciting
cause, whether local or constitutional, by means of proper alteratives.
He adds: “In cases of chronic ulcers which cannot be got healed, we
must remove the parts which prevent adhesion, and convert the sore into
the state of a recent ulcer; and then having allayed the inflammation
proceed accordingly. Those sores which heal up and break out again during
their exacerbations, and when ulcerated, are to be cured like recent
inflammations by soothing applications until the irritation subside,
after which cicatrizing applications are to be used, and then the
surrounding parts are to be covered with a malagma of mustard, or some
other rubefacient and alterative, to remove the indolence. If this is not
sufficient, we must attend to the general health, attempting to effect a
change of the system by repeated exercise, gestation, a diet increased
or diminished according to circumstances, and at the commencement by
administering an emetic of radishes, or even the white hellebore.”
(Galen, Meth. Med. iv.) Although Galen, who all along displays a strong
hostility to the _Thessalian asses_, (so he calls the Methodists,) has
animadverted in severe terms upon the rules here laid down, they would
appear to be highly proper and ingenious. Galen in another place (Med.
sec. gen. iv) gives from Asclepiades, Andromachus, and others, a great
collection of applications for chironian, malignant, and indolent ulcers.
One by Asclepiades consists of the scales of copper, scraped verdigris,
wax, and larch rosin. Others by Andromachus contain sori, misy,
chalcitis, verdigris, alum, turpentine-rosin, and the like, mixed with
wax. Hippocrates directs us to treat a callous ulcer by applying to it
septic medicines to make the hard parts slough off, after which the edges
are to be brought together. (De locis in homine.)
The directions of Aëtius, more especially respecting the constitutional
treatment, are highly important. In cases where there is a redundance of
blood he recommends venesection, in others both purging and bleeding; and
in certain cases he directs us to pay attention to the state of the liver
and spleen. He relates a case of an ulcer on the hand, which he cured by
opening a vein leading to it. He also directs us to scarify or cut off
the callous edges of the ulcer. He gives various prescriptions for sores
of this description, containing verdigris, sori, chalcitis, burnt copper,
alum, &c.
Octavius Horatianus recommends a plaster consisting of equal parts of
chalcitis, wax, and alum. For phagedænæ Pliny mentions an old shad-fish
triturated with sandarach. (H. N. xxxii, 44.)
The Arabians treat of these ulcers very fully. Avicenna in particular
gives very proper directions for the constitutional treatment. When
the state of the ulcer is occasioned by an intemperament, it is to be
corrected, and if the blood is deficient in quantity or quality, this is
to be remedied by a proper diet; and when on the contrary it is connected
with plethora, venesection is to be had recourse to, and if the veins
leading to it are varicose, it may be proper to open them. When the sore
is kept from healing by a spiculum of bone, we are to cut down and remove
it. His applications consist of the same ingredients as those used by
the Greeks, namely, the flower of copper, copperas, alum, ceruse, lime,
arsenic, &c., mixed with wax and oil. The directions given by Rhases are
less circumstantial, but to the same purpose. He particularly directs us
to remove the callous edges by friction, scarifications, and septics.
He speaks of turpentine as an excellent addition to other ointment.
(Contin. xxviii.) He mentions that in case of malignant ulcer on the leg
connected with varix, Galen opened the enlarged vein.
The _cacoethes_ of Celsus was evidently the disease called _noli me
tangere_ by Theodoricus; a very absurd appellation, which however has
been retained to the present day. Celsus has pointed out its resemblance
to carcinoma, and recommended the only mode of treatment which ever
does any good in these cases, namely, the application of septics, such
as arsenic, quicklime, &c., or the actual cautery. As our limits will
not permit us to enlarge further on this subject at present, we must be
content with referring to No. 108 of the ‘Edinburgh Medical and Surgical
Journal,’ where we have given a full exposition of the ancient principles
of treatment. (See also the Commentary on s. xxvi of this Book.)
SECT. XLVII.—FOR BLACK CICATRICES.
Let the root of the white and black bryony be boiled in oil until they
are reduced to the state of juice, and the oil applied will take away
black scars; and so in like manner calamint boiled in wine, and litharge
washed with white rose-oil. But the scars from lichen, and all other
kinds are made like the other skin by anointing them with the fat of
asses; or the seed of rocket triturated with the gall of a goat, of an
ox, and of a sheep may be rubbed in with litharge; or a lamb’s foot
burnt may be triturated with austere wine for the same purpose; or,
ammoniac perfume may be rubbed in with swines’ gall. These are compound
applications: Of litharge, of mint, of frankincense, equal parts with
honey.—_Another_: of natron, of ammoniac perfume, of sulphur vivum, of
myrrh, equal parts; having triturated with vinegar, white wine, or water,
rub in but a very little, so as not to produce an ulcer.—_Another_: Of
Cimolian earth, of pigeons’ dung, of soap, of frankincense, equal parts
with vinegar. A detergent ointment for black scars: Of Cimolian earth,
dr. xiij; of aphronitrum, dr. v; of white hellebore, dr. v; of the greasy
dregs of nut-ben, dr. iv; scrub with it while in the bath.
* * * * *
COMMENTARY. Avicenna condenses all the information contained in the
authors who preceded him. He sets out with stating that the class of
medicines which are applicable in such cases are the abstergents; of
which he enumerates verdigris, stavesacre, the scales of copper, and even
arsenic. Among the less active ingredients he mentions, like our author,
the fat of asses. We need not give extracts from the other authorities,
as no one has treated of this case so fully as Avicenna.
SECT. XLVIII.—ON SINUOUS ULCERS.
When the skin adjacent to an ulcer is not united with the parts below,
we call such a complaint a sinus. When, therefore, the sinus extends
upwards, the ichor readily flows out from the sore, and adhesion easily
takes place; but when it extends downwards the ichor by remaining within
corrodes the continuous parts, and unless you first make an incision
for its discharge, you will be able to effect nothing; for the sores
can neither be incarnated nor the parts made to unite. But if the sinus
is in any of the limbs, as the arms or legs, one may produce adhesion
without a counter-division by putting the limb in a declining position.
Thus when the sinus is in the arm, and the mouth of the sore is near the
elbow, by placing the hand in an elevated position, you will render the
discharge from the ulcer below easy. And when the sinus is in the thigh,
and has its outlet near the knee, you must make the position declining
by putting a soft pillow below the back part of the knee, so that the
groin may be in a lower position than the knee; and if the sinus does not
require incarnation, forthwith by means of a straight and hollow pipe
having a bladder attached to it, syringe it with honey so diluted with
water that one could drink it, in order to clear away the ichor from the
sinus. For promoting adhesion when about to take place, do it with wine,
or wine and honey, and then proceed to the agglutinating medicine. But
if the sinus being hollow requires incarnation, first inject a little
of the composition from dried paper with much rose-oil, then plug up
the mouth of it with charpie, and afterwards the plaster of iris, or of
Machærion, or of some such, may be melted with liquid rose-cerate, and
injected in like manner. If the sinus is moderately incarnated you may
apply some of the agglutinating medicines, as if you were curing a case
of recent bloody wound. Such are those called the barbarous, dichromos,
and gilvus; and more especially that prepared from the oil of palma
Christi and the metals without wax which is called the dun plaster of
Galen, is applicable. After the application of the medicine, a recent
sponge out of wine and honey, or wine alone, is to be put on particularly
in a soft manner, and the bandaging is to commence at the bottom of the
sinus and end at its orifice. The folds of the bandage should bind the
bottom of the sinus firmly, yet so as not to occasion pain, but ought to
be gradually relaxed towards its orifice; and the plaster which is put
on should be so cut as to leave an opening at the orifice for the escape
of the matter, but another small plaster of the same materials should be
applied to it in a loose state, so as to favour the discharge. This is to
be left on till the bandages are loosed, which is to be done on the third
day, when they are to be taken off and changed, but the application along
the sinus is to be left. You may judge whether the bottom of the sinus
has adhered, from observing if the matter be small and well concocted,
or if there be no discharge at all; and moreover if there be no sensible
pain along the sinus nor swelling, but the whole part is contracted,
dry, and free from pain. But if you see a little well concocted pus at
the orifice, you may still more confidently entertain good hopes. If on
the second or third day a thin ichor be discharged from the sinus, you
need not despair that adhesion has taken place, for often the strength of
the medicine squeezes out from the parts below a thin fluid, which being
discharged the parts become dry and adhere. But if on the third or fourth
day from the commencement the matter appear unconcocted as it runs from
the opening, you may be sure that the sinus has not adhered, and you must
persevere with the same application. When owing to the moisture of the
part it falls off, as is not unlikely, it will not be improper to make
some change in the medicine itself.
_On sinuous ulcers with a thin covering of skin._ When the abscess is too
long opened, owing either to the unskilfulness of the surgeon, or the
timidity of the patient, the skin which lies over it becomes thin and
ragged, and it cannot be removed, then after the syringing which has
been described, we must have recourse to an agglutinating application of
a humid consistence, but of desiccative properties, such as that from
chalcitis called phœnicinum, diluted with old oil, so as neither to be
very hard nor of such a consistence as not to stain the finger; and
afterwards it is to be mixed with moderately old wine, and applied in a
circular form with corresponding bandaging. To skin in this ragged state
honey, as was said, is not one of the least proper applications when
boiled to the consistence of a plaster and applied. It will be better,
however, if after spreading it on the rag you sprinkle over it from a
sieve some myrrh finely pulverized, or aloes, or frankincense, or all
of these together. I have also found the lesser centaury a wonderful
application for the same purpose; next to it is comfrey, after which is
the root of the Illyrian iris, and after these is the flour of tares.
Sometimes during the process of boiling we sprinkle these upon the honey
when the vessel is about to be taken off from the fire. It is better,
however, to do so after it is taken off, and then it is to be stirred
about, and when it becomes tepid applied to the sinus, and bandaged as
aforesaid.
* * * * *
COMMENTARY. Similar directions are given by Galen and Aëtius, but upon
the whole those of our author are superior; and as those of the other
two supply no additional information, it will be unnecessary to multiply
extracts from them. (See Galen, Therap. ad Glauc. ii.)
Actuarius, in like manner, briefly directs that unless the sinus open
downwards, it shall be cut open and dressed with an agglutinative
application. You may think well of the case, he adds, when the part is
dry and free from pain, or when only a little well-concocted pus is
discharged from it.
In the translations of the Arabians, the sinus is described by the names
of _absconsio_ and _caverna_. Avicenna states that the sinus differs
from the fistula in having a larger cavity, and its edges not being
indurated. He lays down very correct rules of treatment, but they are
all copied from Galen. Thus he directs, when the orifice of the sore is
above the cavity of the sinus, that it should be cut open; or, if this
cannot be conveniently accomplished, he recommends us to introduce a tent
smeared with some incarnant or detergent application. Upon the authority
of Dioscorides he recommends the lesser centaury in such cases. His
directions for the application of the bandages are similar to those of
our author.
Celsus, and other of the ancient authorities, do not treat of the sinus
separately from the fistula.
SECT. XLIX.—ON FISTULA.
Fistula is a callous sinus formed for the most part from abscesses,
and deriving its appellation from the pipes of reeds (fistulæ). If,
therefore, it terminate with a bone, it cannot be cured without a
surgical operation, unless in process of time a scale of the bone
come off spontaneously. But if it does not terminate with a bone, it
is to be cured by the applications for removing callosities, and the
agglutinative medicines. The applications for removing callosities are
such as these: the root of spondylium scraped around and applied removes
the callus of fistulæ. And in like manner black hellebore applied
removes the callus in two or three days; also lees of oil boiled and
injected; sori in a crude state, or burnt and injected with some diluted
wine, or sori and crocomagma with hydromel. Or make collyria by mixing
elaterium with turpentine, and apply. Or syringe with the juice of the
root of laserwort. This melts down the callus: of verdigris, dr. xij; of
ammoniac, dr. ij; mix with vinegar, and form into an oblong collyrium.
_A collyrium which I use for removing the callosities of fistulæ._ Mix
with vinegar equal parts of ammoniac perfume, of copperas, of verdigris,
of misy, of chalcitis, and of gum.—_Another_, from the surgical works
of Heliodorus: Of calamine, of misy, of copperas, of burnt copper, of
gum, of each, dr. iv; of crude chalcitis, dr. iij; mix with the urine
of a young person not come to manhood, and form collyria. Put this
collyrium into the fistula, and apply externally the inner part of bread
soaked in water, changing it until the inflammation subside, and the
eschar fall off.—_Another_, which I received in Alexandria: Of the roots
of alkanet, of toasted misy, of chalcitis, of verdigris, of fissile
alum, of copperas, of aloes, of each, oz. j; triturate along with fine
cantharides in vinegar, and make collyria.—_Another_: Of copperas, dr.
ij; of chalcitis, of verdigris, of each, dr. j; mix with ammoniac and
use, and when the callus is thrown off, cleanse with verdigris and eight
times the quantity of the purest honied water; but after the discharge of
the callus, incarnants must be used. An incarnative collyrium: of aloes,
of myrrh, of ammoniac, of the cinders of egg shells, equal parts; having
triturated with water form collyria, and apply.—_Another_: Of myrrh, of
aloes, of frankincense, of pomegranate rind, equal parts, mix with water;
but some use bull’s gall. The oil of unripe olives is incarnative when
injected. I knew a person who injected cedar-rosin into fistulæ, and
succeeded surprisingly. After it is incarnated we must have recourse to
the agglutinative medicine, according to the plan described for other
sinuses. “When the fistula is narrow and long,” says Galen, “and does
not appear to me to contain callus internally, but only sordes, I first
inject lye into it, and then allowing it to remain in the fistula until I
expect that the sordes has fallen completely off, I afterwards apply the
medicine.” It was the one from the oil of palma Christi, mentioned above.
* * * * *
COMMENTARY. We shall have occasion to refer to the Hippocratic treatise
‘De Fistulis,’ in the Sixth Book.
Celsus treats of fistulæ with more than his wonted minuteness. This is
his definition: “Id nomen est ulceri alto, angusto, calloso.” He has
described all the complications of it with great accuracy. He directs
us to commence by making an inspection with a probe or sound, so as to
ascertain the state of the parts and of the discharge. If a soft body is
felt at the bottom, we conclude that the fistula terminates in the flesh,
but if a hard one is felt, we know that it ends with a bone. If the probe
slide readily over the bone, it is free from caries, but if it does not
so, and yet no inequalities are felt on it, caries has taken place, but
it is still smooth: if it feel unequal and rough, the bone is eaten with
caries. For a simple and recent fistula, not deep-seated or in a joint,
the plaster for recent wounds will be sufficient, provided salt, or alum,
or the scales of copper, or verdigris, or any of the other metals, be
added to it. The application is to be made upon a piece of linen, and
a sponge soaked in vinegar is to be put over it, and is to be removed
on the fifth day. The patient must live upon nutritious food. If the
fistula is at a distance from the præcordia, emetics with radishes are
said by him to be proper. When the fistula is old it becomes callous, and
requires stronger applications, containing such ingredients as calamine,
atramentum sutorium, verdigris, galls, lime, orpiment, or realgur. He
mentions as a very ready application a solution of ammoniac in vinegar,
with some verdigris added to it. However, he remarks, any other caustic
will accomplish the same purpose. If the fistula is long and transverse,
an incision is to be made at its commencement, after which the collyrium
may be applied. When the fistula is double, or consists of still more
passages, he recommends us to blow in with a writing pen the medicines
in the form of powder, or to apply them dissolved in wine, mulse, or
vinegar. But whatever the internal dressing be, he recommends us to apply
on the outside of it something of a refrigerant and repressing nature,
as the parts around are generally affected with inflammation. When the
dressings are removed the fistula is to be syringed with wine if the
discharge of the pus is copious, with vinegar if its edges are callous,
but with mulse, or a decoction of tares, if the passage be clean. By the
means we have been describing it will generally happen, he says, that the
inner coat of the fistula will slough off, and leave the ulcer in a clean
state. Agglutinants are then to be applied, especially a sponge smeared
with boiled honey. When the sides of the fistula are clean there need be
no apprehension lest they do not adhere, since, he remarks, we often see
in ulcerations of the fingers that without great care one finger is apt
to adhere to another.
In the ‘Euporista’ of the Pseudo-Dioscorides, it is recommended first to
dilate the fistula with a piece of sponge, and then to use a stimulant
application containing verdigris, ammoniac, &c.
Aëtius gives an excellent account of fistula, but it is mostly borrowed
from Galen. We can afford room only for a few extracts. When a fistula
extends obliquely, nothing can be done without making a free incision,
for which purpose he directs us to introduce a sound and cut along it.
His directions for examining into the nature of a fistula are such as
ample experience alone could have dictated. He seems to be decidedly of
opinion that, except in cases of a recent fistula, or when it is not
deep-seated, an incision ought always to be made at first; after which
applications for removing the callus may be used. When, however, the
patient refuses to submit to an operation, and the case is recent, the
cure may be attempted by means of escharotics and incarnants, such as
verdigris, misy, alum, &c., mixed with frankincense, aloes, and myrrh.
Oribasius briefly recommends white hellebore, a mixture of equal parts of
verdigris and ammoniac, and a few other such articles, as applications
for fistulæ.
Scribonius Largus mentions several compound applications containing misy,
chalcitis, verdigris, alum, &c.
Marcellus gives one consisting of ceruse, ammoniac, and oil.
Actuarius gives a brief but distinct account of the nature and treatment
of fistula, but it is taken almost entire from our author.
Avicenna inculcates that a fistula is only to be cured by a free
incision, or by removing the callous sides of it by burning with fire
or caustic medicines, such as arsenic, ammoniac, sulphur, the flour of
copper, or mercury. This in fact is the sum of the medical practice in
such cases. There is nothing particularly interesting in Haly Abbas.
Alsaharavius truly states that a diseased bone is the common cause of
fistulous ulcers not healing, and inculcates that in this case there can
be no hope of recovery until the carious portion be removed. Rhases, upon
the authority of the celebrated Antyllus, directs us to use corrosive
applications when a fistula cannot be operated upon with the scalpel. He
intimates that this is particularly the case when the disease is seated
in the groins.
The earlier modern surgeons, such as Gulielmus de Saliceto, Arnoldus,
Rogerius, Rolandus, and Guy of Cauliac, in imitation of the Arabians,
direct fistula to be treated by the application of septics, the actual
cautery, or incision. Rogerius recommends a tent spread with quicklime
and soap, or with arsenic. Guy of Cauliac, like Avicenna, speaks
favorably of sublimed quicksilver or corrosive sublimate.
SECT. L.—FOR SORES WHICH BREAK OUT AGAIN.
Some sores which have become cicatrized, often after no long time become
inflamed and break out again; for a bone being diseased, sometimes the
flesh which covers it heals up readily and appears sound, but in a short
time a strong defluxion taking place from the corrupted bone below,
inflammation supervenes, and pus is formed which corrodes the cicatrix.
What then is the cure of such ulcers? Dry the diseased bone to such a
degree that it may exfoliate. But the diseased part of the bone may
easily be brought up if you apply a cataplasm, consisting of fig leaves
triturated with fine dried barley flour and wine. Or you may apply equal
parts of the reed of henbane and of copperas triturated together. The
root of hog’s-fennel speedily removes the laminæ of bones.
* * * * *
COMMENTARY. This chapter is copied from Aëtius, who gives some additional
prescriptions, such as one consisting of the scales of copper,
frankincense, alum, sal ammoniac, pomegranate rind, and ceruse, with or
without cerate; and another consisting of red arsenic finely triturated
with bear’s fat.
Avicenna recommends strong attractive applications, such as a plaster of
the leaves of the black poppy with fig leaves; and another containing the
atramentum sutorium (sulphate of copper.)
SECT. LI.—ON ULCERS IN THE JOINTS.
The joints being drier than the fleshy parts, they therefore require
when ulcerated more desiccative applications. Wherefore the trochisk of
Polyides, when rubbed with wine until of the consistence of the sordes
of baths, is an excellent application; and in like manner all equally
desiccative medicines. And we have seen them benefited by bathing
with sea-water and brine frequently. Wherefore we must use the most
desiccative applications to the joints.
* * * * *
COMMENTARY. This is copied from Oribasius. (Synops. vii, 19.)
SECT. LII.—THOSE THINGS WHICH EXTRACT SHAFTS, JAVELINS, THORNS, AND THE
LIKE.
Javelins, reeds, and shafts, and thorns, are extracted by the two
pimpernels, the round birthwort, ammoniac with honey, the fruit of
henbane triturated and sprinkled upon the part. Mix the pounded root
of calamus with honey, put it into a piece of linen, and use in great
quantity; it will speedily extract them.
* * * * *
COMMENTARY. This subject will be more fully treated of in the Sixth Book.
Our author copies from Oribasius. (Synops. vii, 17.)
Most of the articles here enumerated are mentioned by Dioscorides
as possessing strongly attractive properties. Avicenna, Rhases, and
Haly Abbas, speak of similar articles, without any new remedies of
consequence. See in particular Haly. (Pract. iv, 24.)
The applications mentioned by Pliny are ridiculous. (H. N. xxx, 42, and
xxxii, 43.)
SECT. LIII.—ON HEMORRHAGE FROM VEINS AND ARTERIES.
In cases of hemorrhage from parts, the contrary position to that for
sinuses will be the proper one, that is to say, the upright, but that
must not be in too great a degree, for there is danger of pain being
excited, and of the blood bursting forth from the vessel again; for
nothing produces hemorrhage and increases inflammation more than pain.
Wherefore apply your finger immediately to the part from which the blood
flows, putting it gently upon the orifice of the opening in the vessel,
and pressing it so as not to excite pain, for by this means you will
restrain the bleeding, and block up the opening with a thrombus, and
should the bleeding vessel be deep-seated you will thereby ascertain
most correctly its situation and magnitude, and whether it be an artery
or a vein. After this, if the vessel be small we must use some of the
styptics. The best of these are the obstruents, composed of roasted
rosin, of fine flour of wheat, and of gypsum, and such like, mixed up
with the white of an egg and applied upon the down of a hare. When the
vessel is large seize it with a hook, stretch and twist it moderately.
When the bleeding is stopped, endeavour if it is a vein to restrain the
blood without a ligature, by the same medicines. But if it is an artery,
one of two things must be done, either apply a ligature around it, or
cut the vessel asunder, by which means you will restrain the blood.
Sometimes, too, we are obliged to apply a ligature to large veins, and
also occasionally to cut them asunder transversely. We are sometimes
driven to this necessity with regard to veins which arise from a
deep-seated place, more especially when they run through a narrow passage
or important parts, for thus the portions will be retracted on either
side, and the wound will be blocked up and covered by the parts above it.
But the safer practice is to do both these things, applying a ligature to
the root of the vessel and then dividing it. Having done these things,
the wound is to be incarnated as quickly as possible, before the ligature
slip from the vessel. For if it is not speedily incarnated, but the
emptied portion is dilated, the disease called aneurism is formed. You
may know whether it is a vein or an artery that pours forth the blood,
from this, that the blood of an artery is brighter and thinner, and is
evacuated by pulsations, whereas that of the vein is blacker and without
pulsation.
The most excellent of all the incarnative medicines which we know, is
that used with safety for hemorrhages from the meninges of the brain, and
which may be used in wounds of the neck, even for those of the jugular
veins; for it will restrain the bleeding from them without a ligature. It
contains of the fattest frankincense, p. j; and of aloes, when applied
to soft bodies, p. ss; but when too hard, an equal quantity, and instead
of the frankincense manna is to be substituted. These are to be mixed
with the white of an egg until they become of the consistence of honey,
when it is to be applied upon the soft down of a hare to the vessel and
the whole wound; and a bandage is to be put on externally, the first
four or five turns of which we are to make upon the bleeding vessel, and
from thence extend to the root of it. Then having loosed it on the third
day, if the medicine should still be properly applied to the wound, we
are to put on another one all around, soaking it, as it were, and then
bandaging. But if the first pledget come away of itself, the finger is
to be pressed gently upon the root of the vessel, so as to prevent all
discharge, and it is to be removed softly and another pledget applied.
Thus it is to be treated until the vessel heal up, the upright posture
being still preserved, but so as not to excite pain. Those things which
form sloughs render the part more exposed than it was naturally, owing
to the falling off of the sloughs; for in many cases a hemorrhage which
can hardly be restrained supervenes upon the falling off of the sloughs.
And yet we must have recourse to them when a great necessity compels
us. A great necessity for using escharotics, or cauteries with fire,
occurs when the bleeding proceeds from the vessels being corroded by
mortification; and indeed, when in such affections we cut off the whole
mortified part, it is safer to burn, as it were, its root, or to use
escharotic medicines. This happens more especially upon the pudendum and
fundament. The object of escharotics is to produce heat with astringency,
as in chalcitis, misy, and copperas. Those from quicklime are stronger
indeed, but owing to the want of astringency in the lime, the eschars
from them fall sooner away; but it is better that they should remain
longer, for thus will flesh have time to form previously at their root,
and become as it were a cover to the vessels. In such cases of hemorrhage
matured woad (isatis sativa) when sprinkled upon the part is excellent
for restraining the bleeding, or burnt galls, but they must first be
heated in the fire, and extinguished in vinegar or wine. The following
Simples stop hemorrhages: Aloes, frankincense, manna, Samian earth, the
rust of iron, the ashes of burnt wool finely powdered, the dung of an ass
or of a horse, a small quantity of bitumen, pomegranate-rind, diphryges,
galls, dried myrtle, all kinds of alum whether crude or burnt, roasted
rosin, the bark or green leaves of the vine, and the down of the peels
of the plane tree, more especially when the vessels throw off their
crusts. In particular, hemorrhage from the nostril is to be restrained
by the application of the fruit of the sharp rush, the juice of nettle
leaves, chalcitis, burnt anthyllis, the down of a hare, the middle part
of a ferule when burnt with vinegar, an ass’s dung dry or moist, the
juice of leeks with frankincense applied upon lamp-wick. The following
are compositions for restraining all kinds of hemorrhage: Having soaked
a fresh sponge in liquid pitch, and smeared it with bitumen, burn it in
a new pot. Mix together of the ashes of it, p. ij; of lead, p. j; of
antimony, p. j.—_Another_: Sprinkle on the part equal quantities of the
manna of frankincense, and sulphur vivum.—_Another_: Of chalcitis, dr.
viij; of frankincense, or of its manna, dr. xvj; of roasted rosin, dr.
viij; of burnt gypsum, dr. viij.—_Another_, an escharotic styptic: Of
chalcitis, of burnt copper, of copperas, of roasted misy, equal parts.
And the medicine called the Rhodian, and that called the yellow, are
excellent styptics.
* * * * *
COMMENTARY. See Celsus (v, 26); Galen (Meth. Med. v, _et alibi_);
Oribasius (Med. Collect. x, 22; Morb. Curat. iii, 36; Synops. vii, 20);
Aëtius (xiv, 51); Actuarius (Meth. Med. vi, 4); Palladius (Comment. in
Hippocr. Epidem. ed Dietz, ii, 189); Albucasis (Chirurg. i, 58); Avicenna
(iv, 4, 2,16); Averrhoes (in Avicennæ Cantic. ii, 2, and Collig. vii,
23); Serapion (v, 16); Haly Abbas (Pract. iv, 21); Rhases (Divis. i, 139;
Contin. xxviii.)
Contrary to what is often stated in modern works on surgery, the ancients
appear to have been very well acquainted with the proper treatment of
hemorrhage. Celsus directs us when a dangerous hemorrhage is apprehended
from a wound, to fill it up with dry pledgets, then to apply a sponge
squeezed out of cold water, and to make pressure with the hand. If the
bleeding does not stop, he directs us to change the pledgets often,
and if dry ones do not answer to soak them in vinegar. For fear of
inflammation he recommends us not to use caustics and escharotics except
in urgent cases. When all other means fail, he directs us to seize upon
the vessels (venæ) which pour forth the blood, and having tied them
in two places about the wound, to cut them asunder, so that they may
contract and still have their mouths shut up. If circumstances prevent
this from being done, they are to be burnt with a red-hot iron. He also
speaks of stopping bleeding by revulsion, as for example, by applying a
cupping-instrument to the hindhead for bleeding in the forehead.
Galen has treated of this subject at great length in the Fifth Book of
the ‘Meth. Med.’ When blood is discharged from a wounded artery, he
directs us to apply a finger to the orifice of the vessel firmly, yet so
as not to occasion pain, and thus a thrombus will be formed that will
stop the flow of blood. When the vessel is deep-seated he advises us to
examine accurately into its situation and size, and to ascertain whether
it be an artery or vein; after which it is to be seized with a hook
and twisted moderately. If the flow of blood is not stopped thereby,
he recommends us, if the vessel is a vein, to endeavour to restrain
it without a ligature by means of styptics, or things of an obstruent
nature, such as roasted rosin, the fine down of wheaten flour, gypsum,
and the like. But if the vessel is an artery, he says, one of two things
must be done,—either a ligature must be applied to it, or it must be cut
across. He adds, we are even obliged sometimes to apply a ligature to
large veins and cut them across. From this extract of Galen’s practice,
it will be readily perceived how much our author is indebted to him. He
makes mention of the ligature in many other parts of his works. He also
recommends the actual cautery.
To stop bleeding, Oribasius directs, in the first place, cooling and
astringent applications to be used, and if these do not succeed,
caustics, such as misy, chalcitis, copperas, or the actual cautery. Upon
the whole, his account of hemorrhage is nearly the same as our author’s,
only he says nothing of the ligature.
Aëtius treats of this subject in the same terms as Galen, recommending
the ligature under the circumstances mentioned by him. Some of his
styptics are powerful escharotics and astringents, such as copperas,
chalcitis, alum, galls, quicklime, rosin, and frankincense. He informs us
that Ammonius, the famous Alexandrian lithomist, used a composition of
arsenic, sandarach, chalcitis, and quicklime.
Actuarius recommends a composition containing burnt copper, chalcitis,
galls, frankincense, &c.
Palladius, in his Commentary on the ‘Epidemics’ of Hippocrates, treating
of hemorrhage says, we often stop the bleeding by applying a ligature to
the divided vessel.
Albucasis mentions four methods of stopping the discharge of blood from
an artery: 1, by the cautery; 2, by dividing the artery across; 3, by
using the ligature; 4, by styptics applied upon a bolster or compress,
and tightly bandaged.
Averrhoes recommends to stop bleeding by styptics, the cautery, or the
ligature. He says distinctly, that when the bleeding cannot be stopped,
the artery or vein is to be secured with a thread.
Avicenna treats of all the modes of stopping hemorrhage with singular
accuracy, but at so great length that we can only afford room for a few
remarks. He recommends stupefying things, cold water, exposure to cold,
escharotics, and the actual cautery. He also directs in extreme cases the
vessel to be cut across, or a ligature to be applied, namely, a flaxen
thread. His description of the process of taking up and tying an artery
has quite a modern complexion. He also recommends the application of a
compress with tight bandaging when the ligature cannot be applied.
Rhases makes mention of the cautery, of the application of snow, of the
ligature, of styptics, and of cutting the vessel across. He mentions that
Galen in certain cases approved of two ligatures, as it sometimes happens
that the inferior portion will pour forth blood. He further speaks of his
having occasionally used two or three ligatures for the sake of greater
security. He also mentions torsion of the artery.
Haly Abbas gives an interesting account of hemorrhage, and makes mention
of bandages and the ligature. He and Serapion agree in recommending
strongly as a styptic a mixture of one part of frankincense, with a half
part of aloes, applied upon the down of a hare. This is the application
called the plaster of Galen, and is much recommended by Zacutus Lusitanus
(Pract. Admin. i, 85), by Scultet (Arsinal de Chirurg. Tab. 33), by
Brunus (Chirurg. Maj. i, 12), and Lanfrancus (Chir. parva. 5.)
The early modern writers on surgery make mention of all the ancient
methods of stopping hemorrhage. Guy of Cauliac recommends the ligature
upon the authority of Galen and Avicenna (iii, 1, 3.) It is also
recommended by Brunus (i, 12), Theodoricus (i, 13), Rolandus (ii, 1),
and Lanfrancus (iii, 1, 9.) It appears, therefore, that the use of the
ligature for stopping hemorrhages was well understood by the ancients,
and had never been lost sight of even in the darkest ages.
SECT. LIV.—ON WOUNDS OF THE NERVES.
When the nerves are wounded or pricked, they experience great
inflammation and pain owing to their great sensibility; and therefore
fever and convulsions supervene upon them, and in some cases delirium,
owing to the continuity of the nerves with the brain. And sometimes
phlegmons and abscesses form in the other parts adjacent to the wound,
arising from the wounded nerve, owing to their continuity with it.
Wherefore we must preserve the wound of the skin from adhering, that
the ichor may escape by it. And in punctures, if they appear blind, the
part must be divided by two incisions intersecting one another. With
regard to the treatment, if the body is plethoric, and the inflammation
strong, it will be proper to begin with venesection; and when the body
appears to be in a state of cacochymy, purging must also be had recourse
to. We must apply to the wound medicines for allaying pain, and for
increasing the discharge, more especially if the cross incisions have not
been practised. It is necessary to know that warm water, which is most
applicable to other inflammations, is inimical in these cases, and it is
better to bathe the part with a thin oil which has no astringency and
is warm to the feeling; for nothing either very cold or very hot can be
applied without detriment. Of medicines turpentine-rosin is beneficial by
itself in the case of children, women, and persons of tender flesh, but
softened with euphorbium for those of a firmer fibre; and if it become
too hard it is to be mixed with some of the thinner oils. To nerves
in a state of inflammation and mortifications, we may use cataplasms
consisting of the flour of barley or of beans, or by boiling that of
tares in trained lye with oxymel. But without boiling we may use the
following cerate for punctures: of wax, oz. iij; of euphorbium, oz. j;
or of pigeon’s dung; for harder parts, of oil, oz. ij; and sometimes
of turpentine, oz. j. When you wish to give the medicine the form of
a plaster, you may add to the preparation from euphorbium, of wax, of
boiled rosin, of oil, and of fat pitch, of each, oz. vj; but you will
make it better by substituting the fattest bee-glue instead of the rosin.
The following is a good remedy for punctured nerves, applying also to
persons bitten by mad animals: Of vinegar one sextarius, of fat pitch,
lb. j; of opoponax, oz. iij; having dissolved the opoponax in the vinegar
triturate it more, and having melted the pitch, boil. This medicine is
applicable to punctures of the nerves not allowing the mouth of the
puncture to close up, as in the case of persons bitten by rabid animals
it does not permit the wound to cicatrize. But it answers only with hard
bodies, and when you wish to apply it to the punctures of children, or
of persons of soft skin, you must melt it in some discutient article
such as the oil of marjoram, of opobalsam, or old oil.—_Another_ suitable
application is basilicon with the addition of natron, or quicklime,
or euphorbium, or sulphur vivum, or wild pigeon’s dung, or opoponax,
or sagapene, or Cyrenaic juice, or castor, adding to a pound of the
ointment an ounce of one of these medicines. It answers well for wounds
of nerves, and more especially punctures. And in the country when one
is not supplied with any other medicines, one may apply fresh and fat
bee-glue to the wound, or leaven more especially if old, by itself or
mixed with bee-glue, or with the juice of tithymal. But cataplasms may
be applied made of oxymel, or of strained lye, with the flour of beans,
or of tares, or of chick-peas, or of bitter lupines, or of barley, or
of the flour of polenta, not only when in a state of inflammation, but
they may be used from the commencement. But relaxing cataplasms are to be
entirely rejected for wounds of nerves. If the nerve is not cut, but laid
bare by a wound, the surrounding skin being divided so that the nerve
appears naked, and is wounded longitudingly and not transversely, we must
use none of the afore-mentioned from euphorbium, nor any thus acrid, for
the nerve being bare will not bear their power which is strong, but one
may use lime that has been washed often in the warm season mixed with
much honey. The preparation from pompholyx, and that from honey melted
with much rose-oil, are also excellent ones. But these things must not
touch the wound, for the nerve is sensitive, of a cold temperament, and
continuous with the most important part. And neither is it proper to
bathe such an ulcer with oil, for it will make it become foul, and we
must only wipe away the ichor with soft wool wrapped about a probe. When
all things succeed agreeably to our wish, there will be no danger in
fomenting with must. For stronger persons the trochisk of Polyides with
sodden must may be used upon a warm pledget. After the exposed nerve has
been covered over, we must apply externally pledgets, with some of those
things which are fitting for narrow wounds, such as that from euphorbium,
or that from pigeon’s dung, taking in also much of the sound parts. When
the wound is transverse there is greater danger of convulsions, but
everything relating to the cure is in this case the same, except that
while the wound is recent some have used sutures and certain of the
agglutinative applications; but the sutures must not be applied very
superficially lest the part below remain ununited, but more deeply,
taking care however that the nerve be not punctured by the needle. It is
to be known once for all, that in wounds of the nerves the medicine which
cures punctures being of a bitter nature, it is not possible to cure with
it the division of the nerve, as the parts cannot endure pungency and
inflammation. And neither does the medicine which cures incisions answer
with punctures. For its strength does not reach the bottom of it, the
incision of the skin being narrow. A spare diet is to be allowed, and
a soft couch; and warm oil is to be applied to the armpits, head, and
neck; but when the wound is in the leg, the medicine is to be applied to
the groins, pubes, and the parts there. Baths, until the inflammation is
on the decline, are to be abstained from, water not agreeing with these
wounds, as we have said. But since some from habit cannot bear to want
the bath, if the wounded part be the hand it must not, if possible, be
wet in hot water, and still less in cold; but when the wound is in the
foot, since it is impossible to preserve it from being wet, when about
to go into the bath apply to the wounded part some of the plasters, and
externally a compress consisting of many folds and moistened with oil;
and again external to that a linen bandage; and after having done these
things when the person affected is about to take his seat in the bath
pour oil once more upon the bandage. When he comes out of the bath take
away all those applications, and have recourse to the treatment described
above. When there is only contusion of the nerve, if along with it there
be contusion of the skin and ulceration, the cataplasm of the flour of
beans and of oxymel will be a fit one, but you may add sometimes the
flour of tares, and some iris; and when the contusion is attended with
pain, you may mix a little liquid pitch with it. If there be no contusion
of the skin, it will be more discutient to bathe frequently with an
oil of a heating nature, I mean that of dill, of rue, of iris, or of
marjoram. When the whole nerve is cut asunder no danger will result from
it, but the part will be mutilated; and the treatment is to be conducted
as in the case of other ulcers. The treatment of the wounds of nerves
by simples is sufficient for accomplishing the whole cure, but some are
in the practice of using compound applications in such cases, as the
plaster from metals, those called barbarous, and the cissinum, that
from groundsel, the melanchlorum, the indicum, harmonica, and athena,
the composition of which, and the manner of using them you will find
described in the Seventh Book. And since some very wealthy people are
fond of using expensive applications to wounds of the nerves, Galen has
described the following for punctures of the nerves: Of cinnamon, oz.
j; of dittany, oz. j; of marum, oz. j; of amaracus, dr. ij; of wax,
oz. viij; of opobalsam, oz. x; of turpentine, oz. x.—_Another_: of
cyrenaic juice, oz. j; of wax, oz. iij; of opobalsam, oz. xij. This is
an application for exposed nerves: Of wax used for ointments, oz. iij;
of the ointment called spicatum, or foliatum, or that of nard, oz. xij;
of washed pompholyx, oz. j; of spikenard, oz. j; of amomum, oz. j; of
the leaf (malabathrum), oz. j. And these, Galen says, are superlatively
excellent.
* * * * *
COMMENTARY. Galen has devoted a whole book of his work ‘De Med. sec.
genera’ to the consideration of wounds of tendons, membranes, ligaments,
and nerves properly called, and he also treats of them more generally
in the sixth book of his work ‘Meth. Med.’ He professes to have had
ample experience in the treatment of these cases while attending wounded
gladiators. As our author has given a very comprehensive abstract of
Galen’s principles of cure, it will be unnecessary for us to enter
into any minute detail of them. He states very decidedly that cold
applications, especially cold water, are highly dangerous, and inculcates
that calefacient oils are the most proper applications. He particularly
praises oils medicated with spurge, or sagapene, or turpentine-rosin.
They are to be applied upon soft wool. In certain cases, he says, I have
mixed the powerfully desiccant substances, such as quicklime, misy,
chalcitis, pompholyx, arsenic, and sandarach, with the oils or cerates.
When tendons are cut across he directs us to unite the ends together
by sutures. Wounds of membranes and ligaments are said to be less
dangerous than those of tendons. In general he further recommends either
bloodletting or purging.
Oribasius, Aëtius, and, in short, all the subsequent authorities, like
our author, copy everything from Galen. As a specimen we shall give an
abstract of the method of treatment recommended by Octavius Horatianus,
who, it is probable, belonged to the Methodical sect. He commences with
stating that wounds of nervous parts are in general very dangerous,
and recommends applications of a digestive nature to avert the violent
symptoms and pains. In such cases he directs us to bleed and purge,
forbids all fomentations of warm water, but approves of those made with
tepid oil, after which dressings composed of turpentine-rosin, either by
itself or with some sponge, are to be applied. But for women and children
of a delicate frame he recommends turpentine alone; for others, however,
he recommends turpentine with spurge and oil, to which occasionally may
be added bee-glue, sagapene, assafœtida, and opoponax. He also from
personal experience speaks favorably of an application prepared from lime
washed in water, spurge, sulphur, turpentine, wax, and pitch. He mentions
other preparations from rosin, spurge, with oil and sea water.
The Arabians copy from Galen very closely. Thus Avicenna condemns cold
applications, and recommends calefacient ones. He approves of sutures
when the tendons are cut asunder. Haly Abbas cautions against cold
water, and particularly commends wool dipped in hot oil of violets. When
spasm (tetanus) supervenes owing to the wound of a nerve, he directs us
to divide it asunder lest the affection of it spread to the brain and
prove fatal. Rhases also forbids all relaxing applications. He commends
hot stimulant oils, and basilicon mixed with spurge, natron, lime,
assafœtida, castor, &c.
Gulielmus de Saliceto, Guido de Cauliaco, Severinus, and Lanfrancus in
laying down the treatment of wounded nerves and tendons, follow closely
the principles delivered by their Arabian masters. They approved of
sutures when the tendon is cut across.
SECT. LV.—ON ANCYLOSIS.
Contractions of joints arising from impacted humours, or some nervous
tension, we are accustomed to call ancylæ and ancylosis, which cases
require emollient and relaxing applications. Wherefore, in general, those
things recommended for scirrhous parts, but still more particularly the
applications to paralysed members will be proper, and more especially
pouring upon the part water and oil, in which linseed, fenugreek,
marshmallows, bay, the root of the wild cucumber, and the Sicyonian oil
itself, have been boiled. After bathing we may apply first the more
simple acopa, such as that from poplar, that from fir, the one called
bromium, that ascribed to Basilius, and the pyxis; and after these the
Aristophanian, and that ascribed to Azanites. But the strongest are those
called lysoponium and varium. Of plasters, that ascribed to Amathaon, and
the anicetum. This is a most excellent one: Of bdellium, of calves’ fat,
of ammoniac perfume, of Illyrian iris, of each, dr. xvj; of opoponax, of
galbanum, of the seeds of rosemary, of storax, of frankincense, of each,
dr. viij; of pepper, clx grains; of wax, lb. ss.; of turpentine-rosin,
lb. ss.; of the lees of the oil of iris, q. s.; of wine, q. s.; the
medicine is pounded. It forms a good acopum when diluted with oil of
iris, of privet, or of bay. Intermediate between the acopa and plasters
is the preparation from bacon called polymigmaton. The acopa are to be
used with soft and continued friction, along with gentle attempts to bend
and stretch the affected joint.
* * * * *
COMMENTARY. The principles of treatment here laid down are the same as
those inculcated by all the other authorities. For a complete account of
the formation of malagmata, we refer the reader to Galen (Med. sec. gen.
vii), and to Aëtius (xii, 42.)
Actuarius recommends an acopum composed of old oil, the oils of bay,
iris, and storax, with turpentine, spurge, castor, ammoniac, pepper,
opoponax, galbanum, and stag’s marrow. He remarks that emollient and
relaxing medicines are indicated. (iv, 16.)
Celsus recommends, “ad recenti vulnere contractos articulos, quas ἀγκυλας
Græci nominant,” a malagma consisting of frankincense, rosin, galbanum,
ammoniac, and bdellium, with wax. (v, 18.) Avicenna makes mention of
a similar one. Scribonius Largus gives a prescription for ancylosis
consisting of bdellium, opoponax, ammoniac, galbanum, calves’ fat, &c.
(civ.)
SECT. LVI.—ON RELAXATION OF THE JOINTS.
The joints often become relaxed from protracted febrile complaints, and
from colic, and paralytic affections, especially when a hot and humid
intemperament seizes them; and hence the motion of the joint is impeded.
In these cases the juice of acacia mixed with water may be poured upon
the part; or a decoction of bramble, of myrtle, of lentisk, or of the
bark of elm roots will answer well; or the rind of pomegranate may be
formed into a cataplasm, or myrtle leaves with myrtle ointment may be
applied. For the ligaments require to be strengthened by astringent and
desiccative powers; and such applications are therefore to be made to the
joints, as that from willows, that called oxyrum, and the phœnicinum,
with the addition of an astringent wine or vinegar. Some imagining that
the weakness of the joints proceeds from cold, and having had recourse to
more heating remedies, have only increased the mischief.
* * * * *
COMMENTARY. Our author has correctly stated that relaxation of the
joints is to be cured by astringent desiccant applications. Aëtius makes
mention of the simple articles enumerated here (xiv, 72), and Oribasius
recommends a few of the same. (Synops. vii, 23.) Our author is much
fuller than Oribasius on this head. (Ibid.)
SECT. LVII.—ON WORMS.
There are three different sorts of worms, the round, the broad, and
thirdly, those called ascarides. They are all the offspring of crude
and thick pituitous matters with a suitable putrefaction, such matters
collect in children, and others who take too much food. But they do
not grow from hot, acrid, or melancholic humours; for these being too
strong for nutrition, are inapt for the generation of worms; and, on the
contrary, bilious superfluities are particularly destructive of them.
Or if at any time yellow bile be discharged along with worms, either
downwards or by vomiting, you may be sure that they have been formed
in the intestines, whereas the bilious humour had been collected at
the mouth of the stomach, or in some other part. We shall now describe
the form, generation, situation, diagnosis, and cure of each variety,
beginning with the round.
_Of the round worms._ The form of the round worms must be known to
everybody, because they are more common than any of the others. They are
generated principally in the small intestines, and are very prevalent
in the stomach; wherefore they are often discharged by the mouth, and
sometimes by the nose. They are most common in children, more especially
in fever. For they are formed about the commencement of fevers from a
corruption of the matters; at their acme from the malignant nature of
the disease; and during the decline from a change of the whole system
to a better state. Wherefore Hippocrates says, “it is a good symptom
when round worms are evacuated at the crisis of the disease, and these
speedily die.” Those who have round worms experience pain of the
intestines and stomach, small dry tickling cough, and in some cases
hiccough, sleep with palpitations and irregular startings; and some
start from their sleep with a scream, and again fall over asleep. The
pulse is unequal, and the fever has irregular exacerbations, making its
attacks with coldness of the joints, and coming on three and sometimes
four times in the day or night without any stated form. Children have
mastication and projection of the tongue without cause, and grinding
of the teeth; they shut their eyes and wish to remain silent, and are
offended when disturbed. Their eyes appear bloody, their cheeks red, and
again change to pale. But these things occur at intervals in a short
time. Sometimes the worms crawling up to the stomach occasion nausea,
gnawing pain, and anorexia to the patients. When forced to take food they
can scarcely swallow for nausea, or they vomit what they have taken,
or their bowels are loose with corruption of the food, or are inflated
like a bladder; but the rest of the body is wasted in an unaccountable
manner, there being neither famine nor any extraordinary evacuation. But
one must not expect to find all these symptoms in all cases, but certain
ones, according to prevailing circumstances, and occasionally the most
of them. These symptoms occur from the animals turning themselves about
in the intestines and biting them, and the febrile heat raising noxious
vapours to the brain from putrid humours collected in the belly, in
which case we must sometimes pay attention alike both to the fever and
the worms, and sometimes we must bestow little attention to the fever,
and direct our efforts to remove the worms from the body. Many having
neglected them have been eaten through by them, and have died convulsed.
And others say that they have seen them come out from the groins of the
patient. You may remove them from the body by killing them, and you may
kill them principally by using bitter remedies. When both the treatment
of the fever and of the worms is common, the simple remedies will be
proper. Wherefore the patients must first drink a decoction of camomile,
and of the fruit of the sebesten plum, or these medicines themselves may
be given boiled. We may also give the juice of endive, or coriander seed,
triturated with hot water or with oxycrate; or a decoction of the herb
mouse-ear, or the shavings of hart’s horn, or sinopic vermilion finely
levigated. And they may swallow by degrees two spoonfuls of the oil of
bitter unripe olives, for by its bitterness it kills them, and by its
lubricity it drags them along and evacuates them with the fæces. When
inflammation and distension of the intestines are present, we must have
recourse to a cataplasm of linseed and of the flower of lupines, and
of wormwood, and of the roots of bryony in hydromel, or pour upon the
hypochondria the oil of camomile, wine, and the infusions of the fruit of
wormwood and aloes. When the fevers are not very troublesome we may mix
with the sebesten plums some mint, and give them: and when there is no
fever we may administer the more drastic medicines, such as the decoction
of seriphum, or of calamint, or of fern, or the seed of cardamon, or
a decoction of the root of acid pomegranate reduced to one third, or
of toasted cumin, and of tawny-coloured natron, of each, scr. iij; or
wormseed, or southernwood, or both made into pills with honey, or scr.
iij of bitter lupines, or the levigated seed of cabbage or of rocket, or
wormwood which is often sufficient alone. We may give of washed aloes to
the amount of scr. iij; which is one of our most celebrated remedies; but
to stronger persons we may give them unwashed. And since children will
not take the aloes from a cup, they are to be secured upon their back,
and their mouth being forced open by a spoon, we are to inject in spite
of them the aloes by means of a syringe having a strong pipe, throwing
it in as far as possible. This is an admirable method with children who
can hardly be prevailed upon to take medicines, and in this way we may
often inject soup in cases of anorexia. And cyphi and masuaphium may be
properly administered, and burnt hart’s horn with pepper in honey or
oxymel; and we may also endeavour to give the other medicines in oxymel.
But the vinegar of squills will be still better, especially when given
to adults. Or mustard with oil and vinegar may be given to the amount of
a spoonful. Those whose bowels are troubled with a flux owing to worms
may take a potion of the juice of plantain, or the plaintain itself may
be given in a dry state, for it is of use both for the flux and the
worms. We may apply to them cataplasms of crude barley flour, of fern,
of wormwood, of the flower of lupines, of wormseed, and of southernwood,
and likewise pomegranate rind, acacia, galls, and the flowers of the wild
pomegranate are to be mixed with them. And since many people often loathe
bitter draughts, we may give of those we have mentioned, such as are not
decidedly bitter, and in addition, ground pine and horehound, elecampane,
bay berries, cassia, thyme, pennyroyal, carpesium, cyperus, polypody,
iris, bastard-saffron, madder, Egyptian thorn, with an equal quantity
of pepper, to the amount of scr. vj, to a decoction of mint, the juice
of the root of mulberry, or the decoction of stone parsley, or of other
aromatic seeds. Externally we may use aloes with the oil of apples and
wine. This also whets the appetite, which is a thing to be much attended
to. With the aloes we may often mix wormwood; or the navel may be filled
with bull’s gall along with some of the bitters formerly mentioned; or
the oil of rose-bay may be constantly rubbed in, or cedar-pitch may be
applied alone and along with cerate to the whole belly; or dried pitch
may be levigated and sprinkled on it; or it may be anointed with mint and
gith in rose-oil; or we may mix with them the decoction of seriphum; or
we may triturate peach leaves and apply. We may use stag’s marrow in the
form of an ointment to the navel, pubes, and loins; and, if necessary, we
may apply the cerate of aloes, of wormwood, of the flour of lupines, of
seriphum, of gith, of each, scr. vj; of wax, oz. jss; of oil of camomile
q. s.; triturate the powders with bull’s gall. We may give them frequent
injections of honied water, that the worms may be attracted downwards
by the sweetness of the honey. But if they putrefy in the deep-seated
parts, and are not discharged, but on the contrary raise effluvia,
we must evacuate them by giving aloes, or the medicine called picra,
prepared from it. In certain cases a moderate evacuation, by means of a
suppository, is not unuseful to them.
_Of the broad worm (tænia)._ The broad worm is (if I may say so) a
conversion of the membrane which lines the inside of the intestine
into a living body, which is often either discharged whole, when its
size appears incredible to be seen; or it is evacuated in parts; but
when loosed from its attachment it does not form again. It occurs most
frequently without fever, but sometimes in fever after a protracted
disease, when it brings on constant gnawing pains of the stomach,
and an insatiable desire of food; for the animal which is formed in
the intestines seize the food lying there, so that another supply is
straightway required, and, if not furnished with it, the worm will bite
the bowels. It is accompanied with emaciation of the body and loss of
strength, with anomalous symptoms: but the most unerring symptom is when
certain substances, like the seed of gourd, are discharged with the
fæces. The cure resembles that of the former kind; taking the bitter
draughts, eating garlic, drinking or injecting a decoction of fern, or
of centaury, or of calamint, of dittany, or of pennyroyal. And we may
also inject brine. The patient may also drink this potion, which is
not unserviceable to those who are troubled with other worms, if they
happen to have fever: Of red natron, of pepper, of cardamom, equal parts:
the dose is gr. iij, with wine or hot water.—_Another_, a linctus: Of
pepper, of pure bay berries, of Ethiopian cumin, of mastich, equal
parts; of honey, q. s.; the dose is a spoonful taken in the morning and
at bedtime. But if you wish to make it stronger, add an equal part of
red natron.—_Another_: Of elecampane, of ammoniac perfume, of pepper,
(in another formula, of fern,) of each, dr. v, with hot oxymel; and
after an interval give adults one or two drachms of euphorbium in a
draught.—_Another_: Of fern, an acetabulum; of natron, dr. ij; give it
in a hemina of water, but it will be better if a little scammony be
added to it.—_Another_: Of the bark of the roots of sour pomegranate
stripped of its rind above, dr. iv; of pepper, dr. iv; of cardamom, dr.
vj; of horehound, dr. ij; give it in honey to the patient after he has
previously eaten of garlic, until the affection is completely removed.
Give also of theriac, when not prevented by strong fever.
SECT. LVIII.—ON ASCARIDES.
Ascarides, as we formerly mentioned, are a kind of intestinal worms
resembling earth-worms, being formed about the extremity of the rectum
and the beginning of the sphincter ani, and occasioning a great itching
of the parts. This species is formed by bad diet, cold, and indigestion
of the food. Wherefore they are to be discharged, in children, by
suppositories of honey with a moderate quantity of salts or natron; but
in adults by acrid brine, or a decoction of centaury with natron and
honey, or of colocynth, or of wormwood, or of chamæleon, or of alkanet,
or of bastard saffron, or of hyssop, or of pennyroyal, or of calamint,
or of lupines. After the injections we may anoint the rectum with these
simples: Acacia, or hypocistis with natron, or Syriac sumach with liquid
alum; and in those which are bound, with Lemnian earth in wine, and with
these compound medicines, the trochisk of Andron and the like. And we
may give them an injection of cedar-rosin with a syringe having many
perforations, such as those used for the uterus; or salted flesh is to
be adapted to the part and secured with a bandage, as long as it can be
allowed to remain, and changed often. In general all those infested with
worms derive benefit from fumigations with the hairs of ichneumon. The
food should contain wholesome juices, and such as are easily distributed
over the system, neither increasing the cause which engenders the worms,
nor allowing the strength to sink; and on that account we may give some
diluted wine. And we must give food frequently on that account, and
in order that the worms may not bite the intestines for want of their
food. The best time for taking food is when the worms are full. If
there be a defluxion of the belly you may be sure that the worms are on
the increase, the food not being properly distributed, and we are to
give soups with a mixture of astringents, such as pears, apples, and
pomegranates, more especially such as are acid; and we may apply to the
belly, externally, astringent remedies as mentioned above.
* * * * *
COMMENTARY. On this curious subject consult Hippocrates (Aphor. iii,
26; De Morbis, iv, 27); Aristotle (H. A. v, 9); Celsus (iv, 17);
Cælius Aurelianus (Pass. Tard. iv, 8); Scribonius Largus (36); Serenus
Samonicus; Marcellus (31); Octavius Horatianus (ii, 30); Dioscorides
(pluries); Galen (Meth. Med. xiv; Isagoge;) Aëtius (ix, 39); Oribasius
(Morb. Curat. iv, 90); Actuarius (Meth. Med. i, 21); Nonnus (172);
Myrepsus (8); Avicenna (iii, 16, 5); Serapion (iii, 30); Averrhoes
(Collig. vii, 37); Avenzoar (ii, 7, 22); Haly Abbas (Theor. viii, 28;
Pract. vii, 29); Alsaharavius (Pract. xvii, 2, 9); Rhases (Divis. 169;
Contin. xxvi); Alexandri Tralliani Epistola ap. Alb. Fabricii Bibl. Græc.
xii, 602, and ed. Ideler, 1842.
Hippocrates states that the round and broad lumbrici are often passed
with the first discharges from the bowels of children. This is a fact
very difficult to account for. When, and how did the _seed_ of the worm
get access to the belly of the child? He rejects the opinion that the
rings of the broad lumbricus (tænia) which are passed from the bowels are
its offspring. He says it does not occasion death, but continues to live
as long as the man lives.
Aristotle divides intestinal worms into the lumbrici teretes, the
l. lati, and ascarides. He remarks that the broad produce something
resembling the seeds of the gourd. He believed in spontaneous generation.
The pomegranate seems to have been a popular remedy for intestinal worms.
Cato the Censor gives directions for medicating wine by the addition of
pomegranate and fennel, of which, he says, “Id vinum tinias perpurgat et
lumbricos, si sic concinnes.” (De re rust. 127.)
Celsus treats of the lumbrici lati and teretes. For the cure of the
former he recommends a draught containing lupine and the bark of
mulberry, with the addition of hyssop, pepper, or scammony. He also
recommends emetics with garlic, or pomegranate rind with some nitre.
For the teretes he recommends the same, and also the seed of nettle,
or of cabbage, or mint, or wormwood, or hyssop with mead, or the seed
of cresses with vinegar. He advises, likewise, to eat garlic, and use
clysters of oil.
Scribonius Largus directs first garlic and old soft cheese to be eaten,
and then Macedonian fern to be taken with honey. After four hours a
mixture of aloes and scammony with honied water is to be given, and a
clyster of warm water administered. He also recommends wormseed and the
shavings of hart’s horn. Marcellus mentions the same remedies.
Serenus Samonicus recommends hartshorn, calamint, garlic, southernwood,
coriander, pennyroyal, horehound, &c.
The beginning of the chapter of Cælius Aurelianus on lumbici
unfortunately is lost. He mentions the usual symptoms which accompany
them, namely, occasional deliquium, agitation, grinding of the teeth,
change of colour, convulsions, &c. Worms are discharged by the mouth or
anus, sometimes single, and at other times in great numbers rolled up
in a ball; sometimes dead, and at other times alive; and they are of
various colours. For ascarides he recommends when there is inflammation
of the rectum an injection of oil, to which may sometimes be joined a
decoction of wormwood and centaury. But if bloody scrapings of the bowels
are discharged, he directs us to give a decoction of pomegranate-rind,
and, if the complaint continue, equal parts of burnt paper and of
arsenic, to the amount of six drs., with the infusion of plantain. Surely
there must be some mistake as to the amount of the dose, for so great a
quantity could not be injected with safety. When there is putrefaction
he recommends an injection of salt water, with other suitable remedies.
When complicated with any other disorder he properly directs us to pay
attention to it; after which the animals may readily be discharged by
drinking oil, or a decoction of sebesten plums (myxæ), or of liquorice:
these things, he says, will obviate constriction and swelling, while by
lubricating the bowels they will promote the discharge of the worms.
When complicated with relaxation he recommends astringents externally
and internally, such as vinegar with honey, lupine, the shavings of
hart’s horn, &c. Sometimes, he says, in order to expel them we must have
recourse to acrid substances, such as onions, garlic, mustard, cresses,
cardamus, assafœtida dissolved in vinegar, wormwood, &c. In stating the
detail of the treatment he mentions various other anthelmintics, such
as the hiera of aloes, gentian, mulberries, squills, spurge, alkanet,
colocynth, and scammony. All these things may be given by the mouth or in
injections, with a considerable admixture of oil. For the lumbricus latus
he directs, first, an emetic of oil, and next day a clyster with nitre or
salt. Saltish things are also to be given in drink, with liquorice, or
scammony, or polypody, &c. When the animals are discharged, to prevent a
renewal of the complaint, he recommends friction, vomiting, acrid food,
calefacient plasters, sinapisms, paroptesis, and the like.
Pliny recommends the ashes of hart’s horn for tænia. (H. N. xxviii, 59.)
Dioscorides ascribes anthelminthic properties to various acrid and bitter
substances, such as garlic, cresses, fern, gith, mulberry, pomegranate
rind, lupine, cabbage, nettle, hyssop, mint, calamint, wormwood,
wormseed, rue, coriander, thyme, &c. Similar remedies are recommended in
the ‘Euporista,’ which is falsely ascribed to him.
Galen mentions that bitters in general are destructive of intestinal
worms. The teres, he adds, is killed by the absinthium; but the latus and
ascaris require stronger medicines, such as the filix. The author of the
‘Isagoge,’ a work generally ascribed to Galen, divides intestinal worms
into the broad, the round, and the ascarides. The round are about the
length of a span or somewhat more, especially such as are formed about
the stomach. The ascarides are short, and form in the rectum. The broad,
called also fasciæ or tæniæ, from their resemblance to tape, are said to
be sometimes the length of the intestines. The round are most common in
children, the ascarides before manhood; and these are difficult to remove
except by bitters, elecampane, and acrid food.
Oribasius treats briefly of lumbrici, recommending for the l. rotundus,
southernwood, wormwood, calamint, gith, &c., taken internally or applied
outwardly; for ascarides, the juice of calamint, and cedar rosin, in like
manner; and for the tænia the bark of the root of mulberry, and the roots
of fern in honied water, and also the root of the white chamæleon and
costus.
Aëtius gives a full and accurate detail of the symptoms and treatment
of lumbrici, but as his remedies are much the same as our author’s, it
will be unnecessary to deliver any account of them. He remarks, that
anthelminthics either kill worms by their acrimony, or remove them by
their bitterness, or irritate them so as to expel them, or by lubricating
the parts facilitate the expulsion of them.
Actuarius gives a sensible account of the formation of worms, which he
ascribes to putrefaction or indigestion. White worms, he says, are the
product of indigestion, but the red, and those of any other colour, arise
from putrefaction.
Nonnus merely abridges our author’s account of this subject.
The ingredients in the compositions recommended by Myrepsus, are such as
aloes, scammony, southernwood, and bitter almonds.
Octavius Horatianus gives a good account of worms, but it contains
scarcely anything that is not to be found in our author’s. He says, that
from long experience he had great confidence in a purgative draught
consisting of scammony, the ashes of burnt peas, euphorbium, and nitre,
given in sweet wine. But garlic, and other acrid things, are to be first
eaten.
The Epistle of Alexander Trallian on worms, first published by Hieronymus
Mercurialis, and afterwards by Albertus Fabricius, and again lately by
Ideler, contains an interesting exposition of the ancient views on this
subject. He divides intestinal worms into three genera: the ascaris,
the strongylus or round, and the latus or broad. He remarks that the
small worms (ascarides) are generally found in the large intestines,
the round in the small intestines, and hence they are often vomited up;
while the broad worms (tænia) are sometimes as long as the intestines,
some having been discharged sixteen feet in length. He states that they
are engendered by corruption of the food, and putrefaction of crude
humours. He lays down at great length the plan of treatment, which he
varies according as they are with or without fever. His remedies consist
of cathartic, acrid, oily, acid, and bitter substances. Of purgatives
he mentions aloes, scammony, and hellebore; of acrid articles, garlic,
cresses, and the like; of oily medicines, the oil of roses, castor oil
(oleum ricini), and common oil boiled with rue; of acids, salt and nitre
(soda); and of bitters, southernwood, wormwood, hyssop, fennel, and
the like. For the expulsion of the strongylus he speaks favorably of a
decoction of gagate stone (jet). For ascarides and lumbrici he recommends
a lavement prepared from juniper. He concludes his treatise by stating
that “ten thousand” other things had been recommended as anthelminthics
by the ancients.
Avicenna in his account of worms condenses all the information contained
in the Greek authors, but we do not find that he supplies anything new.
He in particular copies freely from Aëtius and our author. The same may
be said of Serapion, who recommends wormwood, bitter lupines, calamint,
peach leaves, cabbage, onions, thyme, colocynth, &c. Averrhoes says that
the lumbrici in general are removed by bitters, such as wormwood or
wormseed, but that the cucurbitini (tæniæ) require strong medicines. Of
the pineæ nuces he says, “Occidunt vermes qui sunt in ventre.” (Collig.
v, 42.) Probably this hint may have led to the use of turpentines for the
cure of tænia. Avenzoar attributes the formation of worms to ill-digested
food in the stomach, and recommends much the same remedies as the Greeks.
Haly Abbas describes the three species of worms, and details the symptoms
of them. He remarks that these animals are to be killed by medicines of
a hot and dry nature, such as bitters. He recommends wormwood, fern,
and the like, pounded with honey, vinegar, &c. The remedies mentioned
by Alsaharavius are oils, bitters, and drastic purgatives. He treats of
lumbrici very fully. Rhases recommends in general terms bitters; for the
round, wormwood, for the broad, (tæniæ, called by him semina cucurbita)
seriphium, bitter lupines, narcissus, &c. And for the ascarides he
directs us to apply a suppository of wool dipped in the gall of a bull.
He remarks that they occur most frequently in autumn, being engendered
by fruit. He states correctly that they often bring on epilepsy, and
looseness of the bowels. He much commends the oil of unripe olives.
Vegetius recommends nearly the same medicines for removing the vermes of
cattle as those already mentioned, namely, wormwood, cresses, coriander,
fenugreek, and the like, boiled in oil, and administered by the mouth and
in clysters. (Mulom. i, 44; see also Columella vi, 25.)
According to Michaelis and Sprengel the ancient Brahmins were acquainted
with the anthelminthic properties of the dolichos pruriens.
We have stated above that the most celebrated of the ancient _savans_
believed in the _spontaneous generation_ of animals. This doctrine,
although generally rejected at the present time, has been advocated
by many modern naturalists of great eminence, such as Baron Buffon
and Professor Rudolphi. Virey gives a very impartial statement of the
arguments for and against this physiological doctrine. (See Hist. des
Mœurs et de l’Instinct des Animaux, ii, 121.) Mr. Madden, the traveller,
relates that the bark of the pomegranate is still considered in the
east as a specific, not only for ascarides, but also for the tape-worm.
He says, “I have rarely seen it fail in the cure of tænia. They make a
decoction of two oz. of the fresh bark in a pint of water, this they
drink daily till the worm is expelled, which it generally is the third
day.” (Travels in Egypt, ii, 371.)
SECT. LIX.—ON DRACUNCULUS, OR THE GUINEA-WORM.
In India and the upper parts of Egypt a class of worms called dracunculi,
resembling the intestinal, are formed in the muscular parts of the body,
such as the anus, thighs, legs, and in the sides of children, under the
skin; and they move in a perceptible manner. Then in process of time at
the extremity of the dracunculus matter is formed in the part, and the
skin being opened the head of the dracunculus comes forth. But if the
worm be dragged it occasions pains, and particularly when it breaks.
Wherefore some say that it is proper to fix a piece of lead to the worm
in order that its discharge may not take place at once, but gradually
with the weight of the lead. Some disapproving of this practice, inasmuch
as the worm is apt to break with the weight of the lead and occasion
violent pains, direct the part to be put into hot water, in order
that the dracunculus being warmed may come forward, when it is to be
seized with the fingers and dragged forth by degrees. But Soranus is of
opinion that the dracunculus is not an animal originally, but a nervous
concretion, which has only the appearance of moving. Whether this or
the former be the true account of the matter, it appears to Soranus,
Leonides, and others, that they are to be treated with the affusion
of warm water, and digestive cataplasms made of honied water and the
flour of wheat or barley; and they approve of sometimes using a plaster
possessed of similar properties. Wherefore that from bay-berries, and
the one from honey are proper. For by the use of these the dracunculus
or concretion dies and falls out. But when suppuration takes place, if
it does not fall out, the skin is to be divided, and the part being laid
open, that which is contained in it is to be taken out, when a tent is
to be put into the skin, and then the treatment for suppurations is to be
applied.
* * * * *
COMMENTARY. The following authors treat of the vena medinensis, or
dracunculus, now generally called the Guinea worm: Galen (De Loc. Affect.
vi, 3; Isagoge;) Aëtius (xiv, 85); Pollux (Onomast. iv); Plutarch (Symp.
viii, 9); Theophrastus (H. P. ix); Actuarius (Meth. Med. vi, 8; iv, 16);
Avicenna (iv, 3, 2, 21); Avenzoar (ii, 3, 20); Haly Abbas (Theor. viii,
18); Alsaharavius (Pr. xxviii, 12); Rhases (ad Mansor. vii, 24; Cont.
xxvi.)
Galen admits that he had never seen the dracunculus, and that therefore
he could not be positive respecting its origin and nature. He had known
many persons, however, who had seen it, and was inclined to believe that
it is of a nervous nature, and resembles lumbrici only in colour and
thickness. The author of the Isagoge states that dracunculi resemble
varices, and that when they project or move about they occasion great
pain, and are to be removed by making an incision of the skin as for
varices.
Plutarch briefly mentions the dracunculus as being a disease which had
newly attacked the inhabitants of the country adjoining the Red Sea.
Aëtius professes to derive his account of the dracunculus from Leonides.
He says, like our author, that it is formed most commonly in the legs and
muscular parts of the arms in India and Ethiopia, and that the generation
of it is not dissimilar to that of intestinal worms. He adds, that in
process of time suppuration takes place at the end of the worm, when an
opening is made in the flesh, and the head of the dracunculus protrudes.
If dragged out considerable disturbance is produced, especially if the
worm should be broken, for what remains occasions the most excruciating
pains. He directs us, therefore, to put a ligature round the arm, and to
tighten it every day so that the dracunculus may come forth by degrees
without breaking. The part is to be washed with honied water, with oil
in which wormwood or southernwood has been boiled, or with some such
anthelminthic decoction; but all acrid things are to be avoided for fear
of inflammation. He recommends us to forward suppuration by means of
maturative cataplasms, and the other means mentioned by our author.
Pollux calls the dracunculus a piece of _corrupted nerve_ which sometimes
comes from the sores of Ethiopians, but seldom troubles other people.
Actuarius, like our author, mentions that the dracunculi occur most
commonly in the region above Egypt, being generally formed in the
muscular parts, and that in process of time the part becomes livid and
suppurates. They are killed, he adds, by bitter and acrid things.
Avicenna comprehends in his account whatever information could be gleaned
from preceding writers. He says the dracunculus is called _vena medine_,
from Medine, the name of the country where it is most prevalent. It
occasions a blister in the part which bursts, when a red and somewhat
blackish substance protrudes and gradually increases in length. He
directs us to correct the habit which gives rise to it by baths, humid
food, and the like. His treatment is similar to that of Aëtius and our
author, namely, binding a ligature round the arm, fastening a piece of
lead to the worm, using fomentations of warm water, and the like.
Haly Abbas mentions the vena as being a worm which forms principally in
the legs of the inhabitants of warm countries, such as India, Egypt,
Ethiopia, and Lybia.
Avenzoar says that the complaint most commonly attacks negroes, being
formed by gross humours, for dispelling which he recommends internally
various sharp and acrid medicines, such as squills, nettles, colocynth,
&c. He further directs a piece of lead to be bound firmly over the worm
so that it may be made to crawl out gradually, which, however, he says,
will not be accomplished in less time than a year.
Alsaharavius states the danger of breaking the worm (vena). He recommends
the same treatment as Avicenna. The conclusion of his chapter on the
dracunculus decides him to be the same person as Albucasis.
Albucasis recommends us to fasten to the end of the animal a piece of
lead from one to two drs. in weight, and thereby to extract it gradually.
He says that in some cases the animal is as long as fifteen palms, nay,
that he had seen one twenty palms long.
Rhases says that the dracunculus takes place in hot and squalid bodies,
and is formed by the use of potherbs and fruits. He recommends gradually
increased doses of aloes, and when the animal protrudes it is to be
wrapped round a leaden reed one dr. in weight, so that it may be dragged
out gradually. He cautions us not to leave any part of it in the body. He
also approves of incision as described by our author. In his ‘Continens’
he collects the opinions of Galen, Paulus, and others. He says that it
forms most commonly in the bodies of persons who bathe frequently, and
drink much wine. He says that he had seen it extracted by making free
incisions.
See an interesting account of the guinea-worm in No. 66 of the ‘Edinburgh
Medical and Surgical Journal,’ by Mr. Scott, surgeon, Madras.
Bertapalia, Guy of Cauliac, and all the early modern writers on medicine,
repeat the ancient accounts of the vena civilis vel medine. They direct
us to extract it by attaching a small piece of lead to its extremity.
Ambrose Paré adopted Galen’s notion, that it is corrupted animal matter;
but Andry held that it is a real animal. It appears, however, from some
statements which we have seen in the periodicals of the day, that some of
our English surgeons in the East Indies still advocate the doctrine of
Galen; but we are inclined to think that the other opinion is the more
correct one.