Earach may be known to be occasioned by cold from the season of the
year, the preceding regimen, or from the patient’s own account, if it
proceed from any external exciting cause. If the pain be deep-seated
without heaviness, distension, or heat, such cases are to be cured by
calefacient remedies, as hot oil of rue, or of nard, or hot oil of bays,
or that of marjoram, that called _foliatum_, or that called _spicatum_,
or common oil with euphorbium, or pepper, or castor, or the ointment
called _commagenum_, or opobalsam poured into the auditory foramen; and
oil in which garlic or onion has been boiled is of service when injected.
Pain from a hot intemperament is judged of by a certain sensation of heat
without heaviness or tension. You may cure it by the opposite remedies;
by injecting the white of an egg triturated, as in affections of the
eye; and woman’s milk, along with some of the anodyne collyria, or the
juice of perdicias (_pellitory of the wall?_), with a small quantity of
rose-oil, and rose-oil itself, or rose-oil and vinegar, or the juice
of the nightshade, or of coriander, or of kingspear, or oil in which
earthworms or millepedes have been boiled; or almond-oil, either by
itself, or having three living buccinæ boiled in it, is of great natural
efficacy. Pain from viscid and thick humours you may judge of from the
heaviness of head, or of the ear itself, and from the previous regimen.
When it is without heaviness, this state alone of hearing indicates
a windy spirit that cannot get vent. In both these cases we must use
remedies of a deobstruent and incisive nature, such as the aphronitrum
with vinegar and honey, and sheep’s gall with common oil, or the oil of
almonds, and the tepid juice of leeks and onions with honey; or triturate
common marjoram with honey and a woman’s milk, and inject it. For
stronger coldness inject goat’s gall with the juice of leeks; and when
the pain is great and of long duration, and when difficulty of hearing is
present, we must use these remedies, namely, the juice of dragon-herb, of
wake-robin, and of bryony, and the like. When the pain is occasioned by a
windy spirit, it may be greatly remedied by applying a cupping-instrument
previously heated in hot water, and affixed near the ear. But if there
be heaviness, distension, and heat, with a pulsatory pain or fever, you
may be sure that the ear is inflamed; and you must, in the first place,
have recourse to phlebotomy, then foment frequently with hot sweet oil
by means of the ear specillum wrapped in wool. We must also inject into
the ear the fat of a goose or of a fox, or the ointment basilicon, with
the oil of roses, of privet, or of iris, and apply externally cataplasms
of a paregoric and digestive nature; but when the pain compels us we may
use those things which are moderately narcotic, for there is no little
danger, owing to the nearness of the brain to the inflamed auditory
nerve. The following is an excellent paregoric: Of opium, p. j; of
castor, p. ij. Inject it warm with a woman’s milk, or the white of an
egg, or tepid sweet wine. And the trochisk of saffron, that called aster,
and the antidote of Philo is often of service to them. You must foment
frequently, either with common oil or some of the hot fomentations,
and apply to the ear wool steeped in it, taking care not to touch the
inflamed part. When the pain continues and an abscess is about to form,
use the remedy from the juice of linseed, injecting it softened with oil
of roses or of chamomile. When the pain is occasioned by poisonous water
which has got into the foramen of the ear, and if it be in considerable
quantity it will be necessary to suck it out either with the mouth or
by a reed; but if in small quantity, it may be wiped away with the ear
specillum wrapped in wool; and then some of the attenuant oils may be
injected, or else rose-oil, or the white of an egg, or a woman’s milk.
Everything applied to the ear should be moderately warm.
_For ulcers with inflammation._ Triturate equal parts of lycium
(_catechu?_) and meconium with honey, and inject.
_For severe pain, pus, and difficulty of hearing._ Of whitened
almonds, xx in number; of aphronitrum, dr. iij; of opium, dr. iij; of
frankincense, dr. iij; of saffron, dr. iv; of galbanum, dr. ij; of myrrh,
dr. j; triturate with vinegar, and inject. When there is pain, dissolve
it in oil of roses, and when there is a discharge of pus, in mulse or
oxymel, and when there is deafness, in vinegar. Recent ulcers are cured
by horned poppy dissolved in vinegar, by the collyria from it, and by
those formed from roses, saffron, and myrrh, in like manner as running
ulcers without pain are cured by the recrement of iron triturated with
vinegar during the heat of the dog-star.
_To remove the hard sordes of the ears._ Dissolve nitre in vinegar, and
inject with water, and having wiped it dry, inject nitre dissolved in
vinegar with rose-oil.—_Another for sordes_: Mixing cardamom and a little
nitre with dried figs freed from their stones, make collyria, which put
into the ear, and remove after three days. It brings away much sordes,
and gives much relief. It also applies to fungous flesh, chronic pains,
and ulcers. Or of aloes, of frankincense, of myrrh, of each, dr. j; of
misy, dr. iv. Make a trochisk of it with vinegar, and, when you are going
to use, dissolve it in vinegar and rose-oil, and inject. In the same
manner the trochisks of Andron, Heré, and that of Musa may be used.
_For chronic ulcers._ Mix gum juniper with honey, and anoint.—_Another_:
Blow in misy what has been burnt and levigated. Before using those things
which are injected into the ear, syringe it first with oxycrate in
oxymel, or in mulse, or in a decoction of some repellent article, such as
dried lentil or roses.
_For bloody ears._ Wash with the decoction of bog-rush, and inject the
juice of knot-grass, with a little vinegar, or lycium, or lees of oil, or
acacia, or the juice of leeks.
_For fungous flesh._ Wash nitre in hot water, and use with equal parts of
flakes of copper and sandarach. Clean the eschars which are formed by it
with honey.
_For vermes in the ears._ Wash with a decoction of wormwood, of centaury,
or of leeks; inject the juice of the green leaves, or of the fruit of
capers, or cedar-gum, or old human urine, or white hellebore with honey,
or the juice of calamint, or scammony with vinegar, or the juice of
wormwood. Oil poured into the opening of the ear, so as to make them
ascend to the top, answers well. But a better application is vinegar and
oil. It also applies to animalcules which fall into the ear.
_For calculi and the like which have fallen into the ear._ Having wrapped
some wool about an ear specillum, dip it into turpentine-rosin, gum, or
some glutinous substance, and thus draw it out; but if it does not yield,
pour frequently warm oil into the passage; and if it do not fall out or
is left behind, use the other means to be described in the Surgical part
of this work.
_On noises._ If noises occur in fevers at their crisis, they ought not
to be interfered with, for they will commonly cease of themselves; but,
if they remain after the disease, having fomented with the decoction
of wormwood, inject vinegar and rose-oil, or the juice of radish with
rose-oil, or that of black hellebore with vinegar. For chronic noises
occasioned by thick and viscid humours (which you may know from their
coming on not suddenly, but gradually), syringe with vinegar, nitre,
and honey.—_Another_: Of white hellebore, dr. ij; of castor, dr. ij; of
saffron, dr. iij; of nitre, dr. xvj. Make trochisks, which triturate in
vinegar, and use.
_For chronic noises and hissing sounds._ Triturate euphorbium with oil of
privet, heat and use. When, from increased sensibility, they experience
the sensation of vapours or spirits carried upwards, triturate castor and
the seed of hemlock with vinegar, and inject.
_On difficulty of hearing and deafness._ Those cases which are
congenital, or which, although not congenital, are inveterate, and
attended with complete deafness, are incurable; and those which, although
not complete, are inveterate, prove also incurable, or difficult to cure.
Those which are formed by a bilious humour ascending upwards, you may
easily cure by evacuating with cholagogue medicines; and sometimes the
complaint goes off spontaneously, when bile is discharged downwards.
Deafness, or difficulty of hearing, occasioned by crude and thick
humours, you may cure by opening a vein, by purging freely with hiera,
and by using masticatories, errhines, and natural or salt baths. It is
also proper to inject into the ear those things which are recommended
above for noises. But the following are particularly applicable: Inject
the urine of a goat and the gall of a goat together, or the gall singly;
or the juice of rue with honey; or castor with the oil of dill; or the
medicine œsypum with nard ointment; or the gall of a goat with galbanum;
or this: Of castor, dr. ij; of nitre and white hellebore, of each, dr. j.
_For contusions of the ears._ Hippocrates recommends us to apply nothing
to them; but since we are often compelled by those who have sustained the
injuries to do something, we may use the following: Of myrrh, of aloes,
of frankincense, of acacia, equal parts; anoint with vinegar or the
white of an egg. Or, pound in a mortar the inner part of warm bread with
honey, and apply as a cataplasm. Or this: Of bitumen, of frankincense,
of aloes, of the flesh of snails, of African bulbi, equal parts,
triturate with vinegar, and apply. When there is inflammation, triturate
with oily grain (_sesame_), or with chondrus boiled in vinegar, and apply
as a cataplasm; but let the cataplasm be light, and not bandaged at
all, or but slightly; and let wool dipped in oil be introduced into the
passage.
_On parotis._ Parotis is an affection of the glands about the ears,
being sometimes occasioned by humours from the head which are impacted
in it, and sometimes by those collected from the rest of the body during
the crisis of a fever. If it be deep-seated, and do not occasion a
swelling, we may assist nature by applying attractive remedies, either
by putting on a cupping-instrument or using frequent fomentations. For
if the matter be determined inwardly, there is no ordinary danger; but,
if it inflame and swell out to a tumour, we must, on the contrary, use
soothing and digestive cataplasms, such as that from barley-flour, that
from wheat, or from the flour of linseed with honied water, or boiled
with the decoction of fenugreek, or of marshmallows, or of chamomile, and
that from dock and axunge without salt. But if it appear that there is a
fulness of blood, we must first evacuate by phlebotomy, if the strength
permit: but if the swelling be not dissipated, we must use suppurative
medicines, such as wheat-flour, with the decoction of dried figs and
oil, and the application made from pollen and that from leaven. When the
aposteme is converted into pus, we may evacuate it either by opening it,
or produce its rupture by means of an acrid medicine, such as that called
smilium, or that from garlic. The milder kinds of parotis are discussed
by a fomentation of salt water, or the composition from Aperanus. This
medicine is calculated to discuss the converted pus, and to prove very
anodyne. For inveterate cases of parotis, we may apply the ashes of burnt
buccinæ, or purpuræ, with honey or axunge, or figs boiled in sea water,
or horehound with salts. Hard ones are softened by the composition of
Mnasæus, and that of Ariobarzan; but one of the best applications is
that formed from the juice of linseed. But before using these, we are to
apply cataplasms of ammoniac, mixing with them liquid pitch, bull’s fat,
bdellium, storax, or hart’s marrow.
* * * * *
COMMENTARY. The following ancient authors treat of diseases of the ear:
Hippocrates (de Affectionibus, et alibi); Galen (Sec. Loc. iii); Celsus
(vi, 7); Oribasius (de Loc. Aff. iv); Aëtius (vi, 74 et seq.); Alexander
(iii); Scribonius Largus; Marcellus (de Med. 9); Nonnus (74 et seq.);
Cælius Aurelianus (de Tard. Pass. ii, 3); Actuarius (Meth. Med. iv, 10);
Pliny (Hist. Nat. xxviii, 48); Octavius Horatianus (i, 7); Mesue (de Ægr.
Aurium); Avenzoar (i, 4); Serapion (2); Avicenna (i, iii, 4); Albucasis
(ii); Haly Abbas (Theor. ix, 14; Pract. v, 62); Alsaharavius (Pract.
iii); Phases (ad Mansor. ix; Contin. iii.)
For relieving earach Hippocrates recommends the warm bath and
fomentations; and when these do not succeed, phlegmagogues and
masticatories are to be used.
Celsus gives very judicious directions for curing pain of the ears, but
his treatment is little different from our author’s. When the pain is
not violent he recommends abstinence alone; but if severe, venesection,
purging, hot cataplasms from linseed and fenugreek, or sponges squeezed
out of hot water. When the inflammation is particularly violent, poppies
are to be added to the injections, which must be tepid; and when the
ear is filled with them, soft wool is to be put over it to contain the
injection. He mentions various compound applications, which contain
poppies, castor, myrrh, alum, saffron, and the like.
Our author copies from Galen. He recommends the following simple
application: Having scooped out the heart of an onion, fill it with
oil, and having heated it in ashes, put it into the ear. He gives
prescriptions for various injections and other compositions, which are
similar to those of our author and Celsus.
Aëtius on this head is more brief and less distinct than our author.
Alexander, Actuarius, and Octavius Horatianus treat of these complaints
very properly, but not differently from Celsus and our author. Alexander
states correctly that inflammation within the ear sometimes spreads
to the brain, and proves fatal. He enjoins caution in using opiate
applications to the ear, as he has seen dangerous effects from them by
their inducing stupor. He particularly approves of introducing steam
into the ear, by means of a tube connected with a vessel containing some
boiling decoction.
Marcellus gives a long list of empirical applications, from which,
perhaps, something valuable might be extracted. He recommends, like
some of the other authorities, a solution of alum in hot vinegar, with
some honey. We shall see in the twenty-sixth Section that alum was much
used for allaying the pains of toothach. Among the ingredients in his
injections we remark tepid milk, opium, castor, spikenard, saffron,
opobalsam, millepedes, &c.
The treatment directed by the Methodist Cælius Aurelianus is little
different from that of the other sects. He approves of putting tepid
oil into the ear; of stuffing it with wool; of using fomentations,
cataplasms, leeches, and scarifications; and when the disease becomes
chronic, of shaving the head, and applying acopa, dropaces, malagmata,
and so forth.
Serapion and Rhases treat the complaint exactly like our author.
Avenzoar relates a case of inflammation seated in the meatus, which he
cured by filling it with oil of eggs. He further recommends bleeding
and the other remedies already mentioned. Avicenna treats of diseases
of the ear most minutely and scientifically, but at too great length
for us to do justice to his account of them. For pains from a hot cause
he recommends camphor-oil, or oil of violets with camphor. Mesue also
treats of these complaints very minutely. When the pain is violent, he
recommends injections containing poppies, henbane, mandrake, nightshade,
and the like. Haly Abbas, in such cases, also approves of rose-oil, with
opium, the juice of mandrake, &c. Alsaharavius varies his treatment
according to the nature of the exciting cause. When it is caused by
congestion of blood in the organ, he recommends bleeding, abstinence
from wine, a restricted diet, and pouring warm oil into the ear. When it
arises from a cold cause he approves of oil of costus, of spikenard, &c.,
and of applying to the ear a cataplasm of hot flour.
_On ulcers of the ears._ Aëtius and Alexander give various prescriptions
for these cases. The fullest account, however, is contained in Galen
(sec. loc.) When there is a discharge of pus, attended with pain,
Octavius recommends alum, mixed with honey and oil. When ulcers of the
ears are recent, Mesue recommends injections of honied water, wine and
honey, vinegar and honey, or the like, by a syringe. They are to be
dried by means of olibanum, or sarcocolla dissolved in wine. He also
praises myrrh, aloes, alum, and red arsenic, as ingredients in the
applications to ulcers of the ears. When the ulcers are chronic, they are
first to be cleansed by such applications as the decoction of wormwood
in wine, or oxymel of squills, with a small quantity of the flowers of
copper; then they are to be dressed with the usual incarnants; and,
lastly, they are to be dried or cicatrized by compositions containing
aloes, myrrh, and frankincense. When the ulcers are foul, he and Serapion
recommend escharotics, such as the scoria æris. Haly’s applications are
quite similar. For sanious discharge he recommends us to wipe the ear
with a piece of cloth wrapped round a probe, and dipped in an astringent
solution. He directs us to remove fungous flesh by an operation, or with
the ointment of flos æris. In this case Celsus recommends applications,
consisting of verdigris and honey, or frankincense, or squama aris
triturated with red arsenic. These powerful ingredients enter into some
of the compositions recommended by Rhases.
_For vermes in the ear._ All the ancient authorities in this case
recommend acrid and bitter injections. Wormwood, hellebore, nitre,
calamint, birthwort, and sulphur are the common ingredients in the
compositions recommended by Galen, Alexander, Aëtius, Oribasius, Celsus,
Mesue, Serapion, Haly Abbas, Alsaharavius, and Rhases.
_On calculi and the like which have fallen into the ear._ Alexander,
Aëtius, and Haly Abbas recommend similar means, and also direct us to
compress the patient’s nose and mouth, and to make him sneeze. Galen,
copying from Archigenes, gives similar directions. This subject is more
fully treated of in the Sixth Book.
_On noises._ These are fully treated of by Galen. (Sec. loc.) He remarks
that they commonly arise from indigestion, excess of wine, violent
vomiting, or the improper application of medicines to the ear. He says
the disease sometimes arises from excessive sensibility, in which case he
mixes with the injections the juice of mandragora, poppies, or the like.
Our author’s applications are taken from Alexander. Celsus treats of this
affection very circumstantially, and modifies his application according
to the circumstances of the case. He recommends particular attention to
the diet, and injections, such as castor with vinegar, oil of iris,
or oil of bays, or myrrh and nitre, with roses and vinegar. When local
applications do not succeed, Haly states that the disease is occasioned
by an affection of the brain or auditory nerve. Alsaharavius treats of
the complaint with singular precision and at great length. (Pract. iii,
4.)
_On deafness._ On this subject Galen gives copious extracts from
Apollonius and Archigenes, from which the aurists of the present day
might derive perhaps some information. In deafness occurring suddenly he
recommends fomentations with the decoction of wormwood. Aëtius copies
from him. Alexander is very particular about the general treatment,
recommending emetics of hellebore, drastic purgatives, errhines, topical
applications, exercise on horseback, change of place, shaving the head,
and applying leeches to it, or a sinapism, or using friction, and even
opening the arteries. Celsus directs us to examine the meatus, and if any
scab of a sore or sordes appear in it, to inject warm oil, ærugo with
honey, or the like; and afterwards to syringe it with tepid water. When
the sordes is hard, it may be first softened by an injection of vinegar
with a little nitre. Haly Abbas directs us to mix mustard with figs, and
apply upon a tent for three days. As an injection he recommends castor
dissolved in oil of dill, and the juice of rue. When it proceeds from
bile, he recommends hot purgatives and things of an attenuant nature.
According to the nature of the exciting cause, Alsaharavius applies
various remedies, such as purging, gargles, fumigations with decoctions
of stimulant herbs, detergent oils, such as those of dill, chamomile, &c.
Aaron, one of the authorities quoted by Rhases, states that deafness
sometimes arises from congestion of blood about the ear; and, in that
case, recommends local bleeding and an attenuant diet, with fomentations
of hot oils, and the like. When it arises from obstruction, he directs
the use of injections containing hellebore, vinegar of squills, &c.
_For contusions of the ears._ Galen gives various prescriptions for this
case. Similar ones occur in Aëtius and Oribasius. Modern aurists forbid
to bandage the ears tightly.
_On parotis._ Celsus properly directs that if the gland swell without any
other disease, applications to produce resolution should be first tried;
but if the system is labouring under disease, that the swelling is to be
brought to a suppuration, and opened as soon as possible. It is from
Galen, however, that all the subsequent authorities copy their account
of parotis. He lays it down as an established rule of practice that no
attempt is to be made to discuss the swelling by repellent applications,
but that suppuration is to be encouraged by the proper means. When
there is plethora of blood, he allows venesection; and, when attended
with pain, he recommends paregoric cataplasms of linseed, fenugreek,
chamomile, and the like. When any hardness remains, he prescribes some
of the malagmata, or emollient plasters. He informs us that Archigenes
applied figs boiled and pounded. Octavius Horatianus and some of the
others mention this application. Of the subsequent authors, although
they contain little additional information, Alexander may be referred to
as one who has treated of the complaint very fully and judiciously. He
recommends bleeding before having recourse to topical applications.
The Arabians adopt the views of the Greeks. Alsaharavius directs the use
of diachylon plaster as a maturative application. When the inflammation
runs high he approves of bleeding.