When the faculty of smell is impaired, but the speech remains
uninjured, it is to be suspected that the anterior cavities of the
brain are affected, being impaired either by a simple intemperament,
or a collection of noxious humours. But if the voice be at the same
time impaired, and have become thick, it is to be conjectured that the
affection proceeds from certain noxious humours obstructing the ethmoid
bones. Having ascertained the intemperament of the brain from the
symptoms often mentioned, use the opposite remedies. Evacuate the humours
by masticatories, and more particularly by powerful errhines; but apply
attenuant aromatics as for catarrh. But if you suspect a plethora of the
whole body, in the first place evacuate it by venesection, or by purging
with hiera. Do so likewise for polypus and ozæna. Then use the topical
applications. Theriac also is drunk with great advantage. Polypus is a
preternatural tumour formed in the nose, resembling the flesh of the
polypus. The sarcoma is a substance of the same kind; but ozæna is a
putrid ulcer formed by a defluxion of acrid humours.
_For polypus and sarcoma._ Of the flakes of copper, dr. viij; of
copperas, dr. vj; of sandarach, dr. iv; of black hellebore, dr. ij. Blow
in, and use confidently, as being an excellent remedy; for in thirteen
days it will prove of manifest service. Copperas alone with vinegar is of
use.—_Another_: Of the rind of pomegranate, dr. xij; of copperas, dr. x;
of chalcitis, dr. viij; of bull’s gall, of amomum, of myrrh, of calamint,
of horehound, of each, dr. iv; of saffron, dr. ij; of white hellebore,
dr. iv. Use in a powder.—_Another_: Touch with levigated diphryges (_husk
of brass?_), and distend the nostrils with the pledget from lamp-wicks.
_For ozæna._ Of misy, chalcitis, and myrrh, of each, dr. vij; of
copperas, dr. vj; of fissile alum, of galls, and of the flakes of copper,
of each, dr. iv; of round alum, dr. ij; of frankincense, dr. j; of
vinegar, one sextarius. Boil the whole in a vessel of copper, and when
of the consistence of honey, use upon tents.—_Another_: Of verdigris and
flakes of copper, equal parts. Use in a dry state.
_For fetid smells of the nose._ Of myrrh, of acacia, and of amomum, of
each, dr. j; mix with boiled honey, and direct that it be glued to the
extremity of the septum narium.—_Another_: Of amomum, of myrrh, of dried
roses, equal parts; mix with nard ointment, and anoint with it. The
malagma of hedychroum with wine produces the same effects.
_For ulcers in the nose._ Of whitelead, lb. j; of litharge, oz. iij; or
of the dross of lead, oz. iij; of burnt lead, (see that all be washed);
mix with wine and myrtle oil.
_For those ulcers called sweet._ Of litharge, dr. iv; of fresh rue, dr.
iv; of fissile alum, dr. ij; mix with myrtle oil and vinegar.
_Sternutatories._ White hellebore, castor, pepper, fuller’s herb,
either alone or together. They must not be blown in, but applied with a
feather or the end of a finger to the innermost parts of the nose. If
the sneezing continue too long from the use of the medicine, it may be
appeased by injecting into the nostrils some nard, or rose-oil, or sweet
oil. Sweet-scented things, likewise, appease sneezing, as anise, and the
pounded chaff of basil. In all these cases the head must be dried by
detergent ointments (_smegmata_) of nitre and pumice-stone, or we may
use that which is called Æsculapium, and the soap of Constantine, the
Cappadocian salts, and the like.
_For hemorrhage from the nose._ Of bleeding from the nose in fevers we
have treated in the Second Book; but we shall now treat of it when it
arises from any other cause, and is difficult to restrain. Triturate
chalcitis, and apply upon the tent formed from lamp-wicks, or the one
called priapiscus, soaked in water, and press it into the nostrils; or
burn an eggshell, and add to it of galls one half; or touch it with
Indian lycium, or blow in the ashes of burnt ass-dung, or press out
the juices from it, and inject into the nose; or let the person smell
to the vapour of lapis molaris heated and plunged into vinegar; or use
the following obstruent preparation: Of the manna of the frankincense
tree, p. j; of aloes, p. ss; mix with the white of an egg, and use,
by means of a tent made of lamp-wicks, having added externally to it
the down of a hare; or apply to the nostril the preparation called
Lysimachium; or apply for a length of time a large dry cupping-instrument
to the hypochondrium of the side from which the blood flows; or stuff
the ear firmly; or apply sponges out of cold water to the forehead; or
apply a cupping-instrument with scarifications so as to detract blood;
and sometimes it will be proper to let blood from a vein, if this be
not contra-indicated; and to apply ligatures to the extremities, more
especially the arms and thighs, as if for venesection. Direct motion
to be made with them, exerting the hands by rubbing, and the feet by
walking; for when the veins there are filled with blood, the parts
about the nose will have a smaller supply of it. But a sponge soaked in
cold oxycrate and bound externally to the bleeding nostril will often
accomplish the purpose. It is best, however, to stuff the nose first with
a long tent in the form of a wedge.
* * * * *
COMMENTARY. Consult Hippocrates (de Affect. et alibi); Galen (de Med.
sec. loc. iii); Celsus (vi, 8); Cælius Aurelianus (de Mor. Tard. ii,
1); Oribasius (Loc. Aff. iv, 45); Alexander (iii, 8); Aëtius (vi, 90);
Actuarius (Meth. Med. iv, 12); Nonnus (92); Scribonius Largus; Marcellus
(de Med. 10); Octavius Horatianus (i, 11); Serapion (ii); Mesue (de Ægr.
Narium); Avicenna (iii, 4); Albucasis (ii, 24); Haly Abbas (Theor. ix,
15; Pract. v, 68); Avenzoar (i, 5); Alsaharavius (Pract. ii); Rhases (ad
Mansor. iv, 45; Divis. 40; Contin. iv.)
_Of polypus._ Hippocrates describes five species of polypus. The first
is represented to be like a piece of torn flesh hanging in the nostril,
and is to be extracted. The second consists of hard flesh which fills
the nostril, and is to be treated by the cautery, with the application
afterwards of the flos æris to the part. The third is a round and soft
piece of flesh growing from the cartilage, and is to be extracted by
a ligature, which operation he describes minutely. The fourth is of a
stony hardness, and is to be cut all round with a scalpel, then burnt,
and the part touched with flos æris. The fifth grows from the top of the
cartilage, and is to be burnt.
Galen gives various prescriptions from Archigenes, Asclepiades, Lampon,
and others, for removing polypus. The most active ingredients in them
are copperas, burnt copper, verdigris, alum, chalcitis, and arsenic. One
of the simplest of Galen’s prescriptions consists of arsenic, quicklime,
and white hellebore, which are to be triturated together and applied.
Another, named from Antonius Musa, is a powder consisting of equal
parts of arsenic and copperas. We can from experience speak of the good
effects of a similar application; and would, therefore, wish to call the
attention of the profession to this method of curing polypus. That it
may prove dangerous if misapplied cannot be doubted, but in the hands
of a cautious surgeon such an application will be found both safe and
effectual.
Celsus forbids us to meddle with the disease when it is of a cancerous
nature. But when soft it is to be cured by an operation. He adds that
it may sometimes be made to drop off, if touched by means of a tent or
pencil with the following composition: ‘Minii Sinopici, chalcitidis,
calcis, sandarachæ, singulorum, p. j; atramenti sutorii, p. ij.’ We need
scarcely say that all these ingredients are powerfully caustic.
Scribonius gives prescriptions similar to those of Galen.
Octavius Horatianus says he has seen the tumour drop off after such
applications as arsenic with honey have been used.
Aëtius gives prescriptions for removing polypus without incision or
burning. One of the most simple of his compositions is a powder composed
of alum, ginger, red arsenic, burnt copper, and galls.
Alexander, like the others, recommends escharotics, such as misy,
copperas, and chalcitis. Marcellus makes mention of the same.
The Arabians imitate the practice of the Greeks. Serapion gives a
prescription containing arsenic, copperas, black hellebore, &c. Avicenna
describes the treatment by ligature, extraction, burning, and septic
applications. He prefers the operation. Mesue treats with great precision
of the different modes of cure. When the tumour is not large it may be
removed, he says, by septic applications. His prescriptions contain
arsenic, alum, flos æris, &c. Haly says that when a polypus is hard and
cancerous it is incurable, but when soft, it may be removed by applying
septic substances, such as flos æris, arsenic, and the like. Alsaharavius
describes the two species of polypus, the cancerous and the fleshy. For
the latter, besides the operation, he recommends us to introduce a thread
smeared with the Egyptian and green ointments. Several of the authorities
quoted by Rhases approve of the septic applications prepared with
arsenic, vitriol, oil of oleander, alum, and the like.
The ancient method of removing polypus with septics is mentioned by Guy
of Cauliac, and other surgical writers of that age.
_For ozæna_ Celsus recommends stimulant and escharotic applications
containing copperas, lees of oil, turpentine-rosin, squills, &c. They are
to be applied by means of a specillum or probe wrapped round with wool.
The prescriptions given by Galen from Archigenes and Asclepiades contain
misy, chalcitis, burnt copper, orpiment, red arsenic, alum, red nitre,
myrrh, saffron, &c. The other Greek authors do but copy from him on this
subject.
Avicenna recommends such aromatics as amomum, cloves, and roses, with
camphor, hellebore, and the like. Haly makes no mention of escharotics,
but recommends aromatics, such as marjoram, cloves, amomum, myrrh,
and such like substances. He directs us to purge with hiera, and to
gargle with mustard. The substances which enter into the compositions
of Alsaharavius are very similar to this. The ingredients in Rhases’
applications are mostly desiccants and aromatics; but a few of them
contain escharotics, such as vitriol and red arsenic.
_On ulcers._ Galen’s prescriptions contain burnt lead, burnt antimony,
ceruse, litharge, and the like. Avicenna and Rhases praise the powder of
Ruffus, which contains alum, galls, cyperus, myrrh, saffron, and arsenic.
For the sweet ulcers Avicenna recommends the same applications as our
author. Those of Haly are nowise different.
_Sternutatories._ Similar lists of substances for exciting and appeasing
sneezing are given by Aëtius, Nonnus, Avicenna, and others.
_On bleeding at the nose._ Most of the remedies mentioned in this Section
are taken from Galen (sec. loc. and Meth. Med.) Aëtius repeats his
directions (vi, 94.)
Avicenna has surpassed every other author in the accuracy with which
he details the phenomena and treatment of epistaxis; but his account
is too long for us to do justice to it. His local applications consist
of styptics, incrassants, and caustics. He very properly inculcates
the propriety of producing revulsion and evacuating the general system
by bleeding at the arm, which, he says, should be carried the length
of producing deliquium animi. He directs us to apply ligatures to the
testicles and extremities, to place the patient in water cooled with ice,
and to pour the same upon his head. He says a man will lose from twenty
to twenty-five pounds of blood before he dies. Haly’s treatment agrees
in most respects with that of Avicenna. He directs us to pour water upon
the head, to apply to the forehead a plaster of galls, roses, &c., or
a piece of cloth soaked in the infusion of roses cooled with snow and
vinegar. He also makes mention of general bleeding, and the application
of a cupping-instrument to the nape of the neck. Alsaharavius cautions
us not to stop a critical epistaxis. Like Haly, he recommends us, as a
general practice, to bleed from the arm if the strength be good, to apply
a cupping-instrument to produce revulsion, to pour cold water upon the
head, and to snuff up the nostrils water impregnated with the virtues of
such astringents as galls, alum, camphor, roses, &c. One of the styptic
powders recommended by Rhases contains quicklime, vitriol, galls, and red
arsenic. He also directs snow to be applied to the head. In extreme cases
he approves of the cautery.
Respecting the manna thuris, mentioned in this Section, see Bernard’s
Nonnus (96.) Dale thus explains it: “Manna thuris, offic. sunt micæ,
fragmenta, pollen, et farina thuris, quæ ex collisione, dum in saccis
vehitur, colliguntur. Alii autem per mannam thuris grana ejusdem
intelligunt.” (Pharmacol. 381.)