The teeth are pained without inflammation of the gums, sometimes from
pain attacking the body of the teeth, and sometimes from the nerve
which enters them being affected. Wherefore they require the strongest
remedies; the greater part of which are prepared from the most acrid
vinegar. When the gums are pained from inflammation, the best application
is oil of lentisk retained in the mouth in a tepid state. But see that
it is new; for the older it is so much the worse is it for this purpose.
This general rule ought to be observed, to evacuate first whatever humour
prevails in the general system.
_For inflammation of the teeth._ Wash with vinegar in which have been
boiled galls, or the root of winter-cherry, or the seed or leaves of
henbane, or pennyroyal, or the juice of nightshade, or the root of
capers, or the leaves of myrtle, or poley, or the root of the wild
cucumber, or the leaves of rue with oxymel, or hartshorn, or the vinegar
of squills, or pellitory with hyssop. To the eaten part of the tooth
apply storax with opium, or galbanum, or sulphur vivum with lycium; or,
let the patient inhale the steam from the seed of henbane through a small
funnel. And the antidote of Philo, if applied round the tooth, removes
the pain. When there is a defluxion on the teeth, rinse with a decoction
of myrtle, lentisk, and galls, or of Syrian sumach, or of the flowers of
the wild pomegranate, or of its rind. Sprinkle also of salts two parts;
of burnt alum extinguished in vinegar and pulverized, one part; then wash
with wine. For bloody gums, sprinkle fine alum, or rinse with aloes in
wine, or with the root of bramble boiled in wine, or Syriac sumach. When
the gums both bleed and are affected with a rheum, burn pickled tunny in
a pot until it be reduced to ashes, with which touch the parts. Loose
teeth are fastened by being sprinkled with aloes, or Syriac sumach, or
fissile alum, or galls, or the root of bramble, either by themselves or
boiled in wine.—_Another_: Pulverize the bark of green nuts, and to the
expressed juice add Minnæan myrrh and fissile alum, and mix together, and
use, by pouring it into the mouth, and put upon the gums of the pained
tooth, which it will cure.—_Another_: Triturate together garlic, pepper,
and stavesacre; put into a linen cloth; make small balls of it, and
change frequently; by which means you will purge the humour in the head,
and effect a cure of the teeth.
_For loose teeth, running gums, and for every spreading ulcer in the
mouth._ Of burnt chalcitis, dr. xij; of calamine, dr. viij; use in powder
with vinegar.
_How to remove the teeth without pain._ Apply flour with the juice of
spurge, and above it an ivy leaf, and leave it for an hour. They will
spontaneously break in pieces.
_A dentifrice, also for parulis, or gumboil._ Of that kind of alum called
plinthitis, oz. iv; of sal ammoniac, oz. iv; of myrrh, of costus, of
pellitory, of each, dr. iv; of pepper, eighty grains.
_For parulis._ Of sulphur vivum, of pepper, of fissile alum, equal
parts. Parulis is an inflammation in a part of the gums, which, not
being resolved, suppurates. Haring suppurated, and being divided with
a scalpel, it is to be kept separate with a tent. Epulis is a fleshy
excrescence from inflammation on the innermost dens molaris, being
attended sometimes with fever and pain. It must be repressed; and,
therefore, we must use the species of verdigris called _xyston_, either
by itself or with an equal part of galls, or burnt sori, or burnt alum,
or galls alone, or the flakes of copper triturated with vinegar for a
sufficient number of days and dried.
_A dentifrice._ The burnt roots of birthwort, burnt hartshorn, with some
mastich.—_Another_: White salts mixed with honey, and wrapped in the
leaves of the fig-tree, and burnt until reduced to ashes.—_Another_:
Buccinæ filled with salt and burnt; land snails burnt with honey;
unwashed wool burnt with a little salts. With each of these, for the sake
of fragrance, let there be mixed the schænanth, or spikenard, Indian leaf
(_malabathrum_), or cyperus, or iris.
_An application which will whiten the teeth, repress swelling of the
gums, and produce fragrant breath._ Of pumice-stone, of roasted salts, of
iris, of each, dr. iv; of cyperus, dr. v; of spikenard, dr. j; of pepper,
dr. vj; pulverize, and use.
_For teeth set on edge._ Painful feeling in the teeth is relieved by
chewing purslain, or by rubbing oil of unripe olives, or by lees of oil
boiled in a copper vessel to the consistence of honey, and rubbed in
after being long kept.
_For worn teeth._ For worn teeth, apply, of bay-berries, of fissile alum,
of the climbing birthwort, equal parts.
_For corroded gums._ Of the flowers of roses, dr. viij; of galls, dr. iv;
of myrrh, dr. ij. Erosions and running from the gums are cured by washing
with asses’ milk, the decoction of olive leaves, or vinegar of squills;
or by the following dry applications: the rust of iron, and flowers of
the cultivated pomegranate. For swelling and fungous flesh of the gums,
the juice of purslain retained in the mouth, the brine of pickled olives,
warm oil of unripe olives, or lentisk oil, or oil of apples, or lees
of oil, are applicable; and the following powders: the rust of iron or
copper, the roots of birthwort, the seed of plantain, diphryges, calcined
copperas, pomegranate flowers.
_For fissures of the lips._ Rub with boiled lees of oil. Or this: Of
geese fat, with honey and turpentine, equal parts; of the flowers of
roses, of the sordes of unwashed wool, of rose-oil, a small quantity.
_On the disease called ranula._ Ranula is an inflammatory swelling which
forms below the tongue, particularly in children; wherefore rub the part
with equal parts of misy and scraped verdigris (_xyston_) in powder; and
to the chin apply the plasters called _antherum_, _sphærium_, and the
_parygrum_ from eggs. But, in adults, divide the veins below the tongue
in the first place.—_Another_, (it answers likewise with aphthæ): Of
scraped verdigris, of galls, of chalcitis, equal parts. With must it
will form a gargle.—_Another_: Having previously rubbed with the flour
of tares and honey, anoint with galls triturated in honey, or with the
flowers of roses in like manner, or rinse the mouth with a decoction of
olive leaves.
_For inflammation of the tonsils._ If the tonsils and uvula be inflamed
in a fever, the most proper gargles are the decoctions of bran, or of
roses, or of dates, or of Sebesten plums, or of dried lentil. When the
inflammation is at its acme, or is on the decline, we may mix with
them some honey, which we must not do at the commencement, nor during
its increase, lest, by its acrid nature, it attract a defluxion. If it
suppurate and burst, the patient must gargle with honied water, or with
the decoction of lentil, or of roses, persevering until it is completely
resolved; or we may give him to gargle some of the mixtures for rinsing
the mouth. If pestilential ulcers in the tonsils take place, we may
use the afore-mentioned remedies, and particularly apply the gargle
from mulberries with hot water, or hydromel, having the flowers of
roses sprinkled upon it, or costus or sumach, either in powder, or in
a decoction; or a decoction of the dried leaves of horned poppy. It is
bitter, and it answers best if you dissolve the juice, as we use it for
collyria, in honied water. It may also be used with advantage by blowing
in the dry herb, or applying it upon the finger. Care must be taken not
to touch it with the hand, or, at least, it should be very gently. The
trochisk of Andron is also of service. After the irritation from these
things is removed, they should use a gargle of liquorice, or that from
Scybelitic wine, and of saffron, and of Chian mastich, and of myrrh,
and afterwards of starch and tragacanth. When the ulcer has stopped
spreading, they may use a gargle of milk and Samian earth.—_Another, for
antiades_: Pound sweet pomegranate along with its peel, and mix six parts
of its expressed juice with one of honey, boil to the consistence of
honey, and anoint.—_Another_: Of immature galls, oz. ij; of fissile alum,
oz. j; of burnt sal ammoniac, oz. j; touch with it in powder.—_Another_:
Of galls, dr. viij; of misy, dr. ij; of roasted salts, dr. v; use in
powder. Antias is a scirrhous swelling of the tonsils.
_On the uvula._ When the uvula is inflamed, we must use the gargles
recommended for inflammation of the tonsils, and those of a moderately
astringent nature, such as the juice of pomegranate, applied by means
of a small spoon, or the surgical instrument invented for the purpose;
and these things may be applied either by themselves, or with moderately
boiled honey, or the liquorice root may be mixed with the pomegranate
juice. The juice of the liquorice root enveloped in honey also answers
well. The swelling may be repressed by the following substances:
blood-stone, the Phrygian stone burnt, agerat, the composition from
Phrygian stone used for complaints of the pudenda; also Samian earth,
Eretrian, Sinopic reddle, the Lemnian earth, the oil of unripe olives
by itself, or with some of these; and the fruit of the Egyptian thorn,
and fissile alum. The seed and leaves of roses act more mildly, but
still more so gum traganth, sarcocolla, and starch, which we must use,
if pained when repressed by astringents. When the swelling is of equal
thickness throughout, in which case we call the disease columella, we
must trust to the gargles prepared from myrrh, saffron, and cyperus,
and avoid all pressure, and rather anoint with a feather. The following
composition answers well: Of Syrian sumach, dr. viij; of saffron, dr. iv;
of costus, dr. viij; of rose-seed dr. iv. It may also be applied to the
gums. But a thread of a sea-purple colour which has been bound round the
neck of a viper, and strangled her, has wonderful effects as an amulet in
relieving affections of the tonsils and neck, as Galen testifies.
_For hemorrhages from the mouth._ Apply the pounded leaves of leeks; or,
dip a new piece of sponge in raw pitch, burn, pulverize, and use. It is
also beneficial to rinse the mouth with a cold decoction of green or
dried roses, that of vine tendrils, or of the leaves of lentisk, or of
bramble, or of quinces, or of roses, or of grape-stones, or of lentils.
* * * * *
COMMENTARY. All the authors referred to in the twenty-third section may
be consulted.
_On the teeth._ Galen, in particular, deserves to be consulted on
diseases of the teeth, which he has treated of very fully in the
fifth book of his work ‘De Med. sec. loc.’ He very properly combats
the opinion, which we still sometimes hear maintained, that the teeth
themselves are devoid of sensibility. He states that, once having
toothach, he felt his tooth not only painful but throbbing. One of the
best of our modern writers on the teeth, Eustachius, justly remarks that
the teeth have a nerve of considerable magnitude distributed upon them,
and are in fact possessed of exquisite sensibility. When the teeth ach,
Galen says the strongest medicines are indicated, in order to repel and
discuss the exciting cause. Most of these are to be prepared with acrid
vinegar. He then gives from Archigenes a long list of compositions for
allaying the pain of toothach, from which most of those mentioned by
our author are taken. One of the articles which most frequently occurs
in them is alum, a solution of which in the spirit of nitre was lately
much cried up as a cure for toothach. Of the great number of substances
recommended to be put into the hole of the carious tooth it is difficult
to form a judgment, as most of them are now never tried in such cases.
Some of them seem plausible applications. One consists of pellitory with
myrrh; another of opium and pepper; others contain ginger, poppy-juice,
hyoscyamus, galbanum, castor, &c. He approves of hot fomentations, and
of the heated flour of barley or linseed applied to the cheek. He speaks
favorably of filling the hole in the tooth with hot wax. When part of a
tooth projects, it is to be filed down with an iron file. For pains of
the gums he recommends fomentations with vinegar, in which henbane has
been boiled. Of dentifrices he has treated at considerable length, and it
is from him that our author takes his list.
Scribonius Largus mentions alum among his remedies; and we may remark, by
the way, that this medicine is recommended for toothach by many of the
earlier modern authorities. (V. Guido de Cauliaco, vi, 2.)
Celsus delivers very judicious instructions for the treatment of
toothach. He circumscribes the use of wine, enjoins restricted diet, and
food which does not require mastication; then fomentations of hot water
by means of sponges are to be applied to the tooth, and so forth. If the
pain is more violent, the belly is to be opened, hot cataplasms applied,
and some warm liquid retained in the mouth, and often changed. The liquid
may be a decoction of some narcotic, such as poppies, mandragora, and
hyoscyamus. He praises hot oil applied by means of a probe wrapped round
with wool. He also mentions compositions containing pellitory, alum,
bitumen, and mustard. He directs us not to be in haste to extract the
tooth.
Aëtius gives a variety of applications for removing teeth without an
operation. One of them contains red arsenic; another sori and the juice
of spurge. Modern dentists are ignorant of such remedies. His account
of the nerve which supplies the teeth with sensibility is accurate, but
borrowed from Galen.
Octavius Horatianus, like our author, affirms that the juice of spurge
(tithymallus) will make the teeth fall out. For the same purpose he
likewise praises the power of pellitory and mugwort. After Hippocrates he
approves of the application of small bags containing salts or millet.
The medicinal substances recommended by Marcellus, the Empiric, are
the same as those already mentioned. He praises strongly a composition
consisting of acrid vinegar, alum, and cedar rosin, boiled to the
consistence of honey and applied to the carious tooth. To prevent hollow
teeth from falling out he directs us to fill the hole with the gum which
grows upon the ivy. The juice of poppies pounded in a woman’s milk and
applied to a carious tooth is said to remove the pain instantly. As a
dentifrice he recommends finely-powdered glass with spikenard.
Cælius Aurelianus recommends abstinence, rest, and rinsing the mouth with
some astringent decoction containing white poplar, mandragora, poppies,
henbane with vinegar, hot oil, milk and honey, and the like. He applies
bags containing hot flour. If the pain does not abate, venesection is
to be had recourse to, a cupping-instrument applied near the affected
part, and the belly opened afterwards by a clyster. Sometimes the
gums are to be scarified or separated from the teeth by means of a
scarificator. Respecting anodyne medicines, he remarks that they diminish
sensibility, but do not remove pain. He says, like the other authorities,
that the juice of the tithymallus, or spurge, breaks the teeth—“dentes
infringit.” He disapproves very much of early extraction, and mentions
that Herophilus and Heraclides of Tarentum relate cases of persons who
had died in consequence of this operation. He says that in the temple of
Apollo at Delphos there hung a tooth-extractor of lead, which was meant
as a hint not to exert great force in extracting teeth. For bleeding of
the gums he recommends alum with honey, and the like.
Serapion, like the Greek authorities, mentions a variety of remedial
means for diseases of the teeth. One of his prescriptions consists of
burnt alum, with vinegar, salt, and sumach. When the pain is violent he
directs us to fill the hole with opium or some other narcotic. Avicenna
recommends general bleeding, the application of leeches to the gums,
opening the ranal veins, and cupping below the chin. His compositions
contain opium, burnt alum extinguished in vinegar, galls with vinegar,
and the like. He mentions the juice of tithymallus, and several other
substances, as possessing the property of making the extraction easy.
Avenzoar recommends in particular bleeding from the ranal veins. Mesue’s
general treatment is very judicious, but similar to that of our author
and the others. He also makes mention of alum and vinegar. He says that
some apply the actual cautery to the tooth. Haly directs us to heat two
needles red hot, and then, having dipped their extremities in oil, to
burn the hole of the tooth with them. He recommends us to fill the hole
with a composition consisting of pellitory, sal ammoniac, opium, and
wax. Some of his applications contain arsenic. That this article would
deaden sensibility, and might destroy the vitality of the diseased parts,
we can readily suppose, but of course it would require to be used with
extreme caution. Certainly not more than two grains should be used, and
every precaution ought to be taken to prevent the patient from swallowing
his saliva. Haly, like most of the others, makes mention of alum.
Alsaharavius recommends general bleeding, cupping, scarifications, and
leeches; then warm vinegar, or some warm anodyne infusion, is to be held
in the mouth; or the part fumigated with the vapour of water in which
opium, camphor, or henbane has been boiled. He speaks also of the actual
cautery. Rhases recommends bleeding, cupping, alum in vinegar, opium,
henbane, &c.
The dentifrices and applications to the gums recommended by the Arabians
are similar to those of the Greeks. See in particular Haly Abbas (Pract.
v, 78); Rhases (Cont. v); and Alsaharavius (Pract. viii, 2.) Like our
author’s, theirs contain such astringents and aromatics as balaustine,
sumach, galls, spikenard, wild mint, cinnamon, salt of gem, and the like.
The pumice-stone in particular was much used for this purpose; but, as
Dr. Hill remarks, it is apt to hurt the enamel.
_On ranula._ Aëtius, Actuarius, and most of the other authorities
recommend similar applications. They consist of astringents and
escharotics.
Avicenna calls the ranula an enlargement and induration of the sublingual
gland. He approves of nearly the same treatment as our author. He
recommends in particular burnt vitriol and hermodactylus with the white
of an egg. Alsaharavius recommends, in the first place, applications
containing nitre, sal ammoniac, and the like. If these do not succeed,
caustics are to be applied, so as to occasion a blackening of the part.
If this does not answer, an operation must be performed. Rhases makes
mention of an application containing green copper, vitriol, &c.
For an account of the manner in which the veterinary surgeons treated
ranula in cattle, see Columella (vi, 8), and Vegetius (Mulom. iii, 3.)
They recommend the tumour to be opened and stimulants applied to it, such
as garlic pounded with salt.
The disease which Hippocrates describes by the name of ὑπόγλωσσις appears
to have been somewhat different from the one we have been treating of.
The hypoglottis of Hippocrates was an inflammatory swelling of the tongue
ending in abscess. When matter forms, he directs us to open the abscess.
It is also described by Aretæus.
_For inflammation of the tonsils and of the uvula._ Since, as Galen
remarks, the same treatment applies to inflammation of the tonsils and
uvula, we shall treat of both together.
Aretæus has described inflammation of these parts with great accuracy
and minuteness. He has also given a very circumstantial account of the
ulcers which occur there. Some, he says, are common, mild, and not
dangerous; others are uncommon, pestilential, and fatal. The latter
are described as being covered with a livid or black crust. The ulcer,
he says, is apt to spread to the tongue, or it passes down the trachea
and proves fatal by occasioning suffocation. The disease, he says, is
brought on by cold acrid substances, and sympathy with disease of the
stomach or lungs. Children are most subject to it. It is endemial in
Syria and Egypt. He gives a striking description of death occasioned by
suffocation. With regard to the treatment, when the parts are inflamed,
swelled, and threaten suffocation, he advises copious bleeding from the
arm, acrid clysters, purgatives, ligatures to the extremities, astringent
and emollient applications to the parts, cupping the hind-head or breast,
and other such means. Respecting the pestilential ulcers, when attended
with inflammation and sense of suffocation, he approves of clysters,
venesection, gargles, fomentations, ligatures to the extremities,
cupping, and so forth. When the disease is spreading, he directs us to
burn the sore with powerful caustics, such as alum with honey, chalcitis
and the like. Sometimes, as he remarks, the uvula and parts there are
eaten down to the bone.
Galen gives a long and very interesting account of these complaints
intermixed with curious extracts from Archigenes. The general treatment
consists of venesection, acrid clysters, and purgatives. The local
applications are mostly of an acrid and austere nature.
When the tonsils suppurate, Aëtius directs us to open the abscess. He
gives an interesting description of pestilential ulcers, which, however,
is not very different from that of Aretæus. He approves of bleeding at
the arm, suppositories, clysters, ligatures to the extremities, and
so forth. The subsequent Greek authors follow him and Galen in their
descriptions.
Marcellus, the Empiric, recommends for swelled uvula various escharotic
applications containing chalcitis, flos æris, alum, &c.
Celsus delivers a brief account of ulcers of the internal fauces. He
speaks in rather equivocal terms of warm cataplasms, fomentations and
fumigations; but is, upon the whole, inclined to permit the use of them
if there be no danger of cold afterwards. He very properly forbids
such things as will irritate the parts. He does not approve much of
gargles of vinegar, although recommended by Archigenes, whom he calls,
“multarum rerum auctor bonus.” He prefers emollient gargles at first, and
afterwards repellent ones.
The Arabians treat inflammation of these parts like the Greeks. Avicenna
follows closely our author’s plan of treatment. Mesue approves of
bleeding, clysters, and so forth. Rhases mentions bleeding and gargles
with vinegar, the water of roses, and other astringents. In inflammation
of the uvula, Haly Abbas recommends general bleeding, gentle purgatives,
and astringent gargles containing alum, pomegranate flowers, sal
ammoniac, and the like; and when these do not succeed, he advises us
to have recourse to the operation. (See Book Sixth.) Alsaharavius
recommends a plan of treatment perfectly similar, and, like Haly, directs
us to have recourse to excision when other remedies fail. Alexander
Aphrodisiensis says, however, that those who have had the uvula cut off
die of consumption; and attempts to account for the operation having this
effect. (Probl. ii, 3.)
Avicenna and the other Arabians make mention of the amulet recommended by
Galen.
SECT. XXVII.—ON ANGINA, OR QUINSEY, AND THE COMPLAINTS ALLIED TO IT;
IN WHICH THE SUBJECT OF THOSE WHO HAVE BEEN STRANGLED OR OTHERWISE
SUFFOCATED IS TREATED OF.
When the parts within the throat are inflamed, the disease is called
_synanche_; when those without it, _parasynanche_. In like manner,
when the parts within the windpipe are inflamed, the disease is called
_cynanche_; and when those without it, _paracynanche_. All these
complaints are attended with orthopnœa and pain, with difficulty of
breathing, and in some cases with fever. There is redness of the face
and neck, and swelling in some cases, and sometimes the mouth is kept
constantly open, and they cannot swallow drink. Cases of cynanche are
sometimes attended with a sense of suffocation. This disease attacks
children but rarely, and then only from injuries of the spinal vertebræ
occasioned by a fall, which case, being incurable, is not to be meddled
with. In the others, we must immediately bleed from the arm, and take
away not a great quantity at once, but in divided quantities; for from
a rapid evacuation there is danger of suffocation, owing to the matters
rushing to the affected part, if the patient should faint. Should they
not be immediately relieved by it, we must open the veins below the
tongue; or make incisions into the tongue itself, if it be swelled and
protrude out of the mouth. The bowels are to be evacuated by acrid
clysters; hot water is to be poured upon the feet, and the extremities
firmly bound with ligatures. The neck is to be wrapped in unwashed wool,
or in wool smeared with oil, and a cataplasm of raw barley-meal applied.
At the commencement we may use the gargles described for inflammation of
the tonsils, or the simple medicine from mulberry, with the decoction of
sumach; but the best remedy is that from wild mulberry, and after that
the compound application from mulberry, or the parts are to be anointed
with the composition from walnuts. When the disease is at its height, we
may add a little nitre or sulphur vivum, unless the acrimony prohibit
their use. And dog’s dung, dried and powdered, and rubbed in with honey,
is a most excellent application, more especially the white kind; also
the dung of wild swallows, in like manner. When the complaint is of long
standing, we may use the liniment from besasa, or wild rue, sometimes
increasing and sometimes diminishing its strength, by the mixture of
other medicines. Cupping-instruments or leeches are to be applied to the
chin and neck, and the patients must use the stronger gargles from iris,
hyssop, gith, southernwood, liquorice, dried figs boiled in honied water,
or in the juice of rue with milk, or mustard with oxymel. If irritation
arise from the use of them, we must give warm oil of the finest kind,
or rose-oil by itself, or with the juice of ptisan or of fenugreek, to
gargle with. The food should be honied water until the third day, after
which the juice of ptisan, with some of the sweet drinks, and then the
yelks of eggs in a liquid state. They may use spoon-meats made from
chondrus, when deglutition is unobstructed, and take food suitable to
their strength. When the disease is on the decline, we may get them to
take exercise and the bath. The parts are to be enveloped in a cerate
of the oil of rue; and we must have recourse to the other means of an
analeptic nature.
In suspended animation, such as have the foam already at their mouth we
must do nothing to, agreeably to the precept of Hippocrates (Aph. ii,
43); but the others may be resuscitated by pouring into their mouths
vinegar and pepper, or the fruit of the nettle pounded in the strongest
vinegar. It is with difficulty that they swallow it, but they must
be compelled; and when the redness about the neck is dispelled, they
immediately look up and recover. The same means are to be used towards
those who have been wrecked in the sea; and, in fine, towards all
those whose respiration has been suspended; for their heat is thereby
resuscitated.
* * * * *
COMMENTARY. See Hippocrates (de Victu Acutorum, 39; de Prognos.; de
Morbis, ii, iii); Galen (de Med. sec. loc. vi; de loc. Affect. iv);
Aretæus (de Morb. Acut. i, 7); Alexander (iv, 1); Aëtius (viii, 48);
Oribasius (Morb. Curat. iv, 71); Leo (iv, 10); Actuarius (Meth. Med.
iv, 14); Celsus (iv, 4); Nonnus (123); Scribonius Largus (16); Cælius
Aurelianus (Morb. Acut. iii, 1); Octavius Horatianus (ii, 6); Marcellus
(de Med. 15); Serapion (ii, 18); Avicenna (iii, 9); Mesue (de Ægr.
Gutturis); Avenzoar (i, 10); Haly Abbas (Pract. i, 26, and vi, 2);
Alsaharavius (xi, 2); Rhases (ad Mansor. ix, 54, and iv, 25; and Contin.
vii).
The plan of treatment recommended by Hippocrates can scarcely be
improved upon: general bleeding, opening the veins below the tongue,
giving warm gargles and linctuses, shaving the head, wrapping the neck
in soft wool, or applying fomentations to it, giving honey and water,
or ptisan not cold, and administering clysters or purgative medicines.
According to Le Clerc, he performed bronchotomy in extreme cases. He
refers, we suppose, to lib. iii, 11, ‘de Morbis,’ but the language is
not so precise as to make it quite certain that bronchotomy was there
meant to be described. Sprengel supposes that he only introduced a tube
by the nostrils into the trachea. He describes a species of cynanche in
which there is no external swelling, and which proves fatal in the course
of a day, or at least of a very short time. (Prog.) Cynanche, he says
elsewhere, is apt to be determined to the lungs. (Aph.) Fever, again he
says, attending ulcerated sore throat is bad. (Prog.) When the tonsils
are swelled and red, he says it is dangerous to scarify them. (Ibid.) His
commentator Stephanus remarks that when the disease becomes indolent the
part may be burned or cut.
Aretæus states that the parts affected with synanche are the tonsils,
epiglottis, fauces, uvula, the upper part of the trachea, and, if
the inflammation spread, the tongue and jaws. He makes a distinction
between cynanche and synanche. The former is attended with swelling
of the parts and other well-known symptoms, of which he has given a
striking description. In synanche (which he attributes to the _pneuma_
being over-heated and over-dried), the parts, on the contrary, are
contracted, and there is a strong sense of suffocation. This disease,
he says, generally proves soon fatal, unless swelling and inflammation
of the parts supervene, or erysipelas of the breast occur; in imitation
of which, he states that a good physician will apply a sinapism or
cupping-instrument to the chest to produce revulsion. In treating of the
former variety of the disease, he begins with administering two clysters
to evacuate the bowels and produce revulsion; he bleeds in the arm from a
large orifice so as _nearly_ to bring on deliquium animi, and he approves
also of bleeding by opening the veins below the tongue: he recommends
applications at first of an astringent nature, but, if suppuration be
expected, he directs hot ones from fenugreek, hot fomentations, sponges
squeezed out of the decoction of bay or hyssop, and the like, to be used.
In the other variety, he recommends us to determine outwardly by all
possible means, such as by applications containing nitre, mustard, &c. He
says the application of fire would be most suitable in such cases, but
as it cannot be applied from the situation of the disease, he recommends
medicines which resemble fire (caustics), so as to stop the ulceration
from spreading. The caustics and astringents mentioned by him are alum,
galls, pomegranate rind, and in particular calcined _chalcitis_. The
last was a vitriol resembling sulphate of copper. (See the preceding
Section.) He mentions that in this variety some were said to have opened
the windpipe, in other words to have performed laryngotomy. He does not
believe, however, that the operation had ever actually been performed,
and dissuades from attempting it, as it would only increase the evil; and
he apprehended that the wound in the cartilages would never heal. From
his account of synanche, Le Clerc concludes that Aretæus belonged to the
Pneumatic sect; and although Ackerman is doubtful upon this point, we
could point out many passages in his works which have quite satisfied us
on this point. By _pneuma_ was probably meant the vital heat in the body,
acted upon by a spiritual substance within us, the same being a portion
of that principle which the ancient philosophers called nature. It was
truly a _vis medicatrix_. (See Morb. Chron. cur. i, 7.)
Celsus, like Aretæus, describes the two varieties of the disease, and
recommends nearly the same treatment.
Galen, and after him Aëtius, give a similar account with great minuteness
and precision. We cannot pretend to do justice to their treatment, and
shall merely mention that, in the second variety, they praise mustard
for a gargle, and elaterium as a purgative. It is worthy of notice that
Galen describes a rare species of this disease, in which the tongue is so
swelled that the mouth cannot contain it. (Meth. Med. i.)
Alexander’s directions are most minute and judicious, but we must be
content with stating that he approves of opening the ranal and jugular
veins, and that his treatment is otherwise similar to that of Galen. This
is the first mention of opening the jugulars that occurs in a medical
author.
Octavius Horatianus we shall merely mention, in order to state that he
has described the two varieties of the disease like the others.
Cælius Aurelianus gives a singularly accurate and circumstantial account
of this disease, but it is so long that we can merely afford room to
point out a few of his leading opinions. He approves of a fomentation
made with a bladder half filled with hot sweet oil. He directs the
patient to inhale the steam of hot water, and to have sponges squeezed
out of it applied to the neck and throat. He approves of cupping the
neck or of leeching it, and also of scarifying the tongue and fauces if
they are much swelled. With respect to the treatment of the other sects,
he blames Hippocrates for making too rapid a detraction of blood, and
also for opening the veins below the tongue, which, he says, will only
aggravate the evil, and may be productive of inconvenience, owing to the
difficulty of stopping the bleeding. But, in particular, he finds fault
with Archigenes for mentioning laryngotomy, and treats the operation as
entirely fabulous and the fiction of that physician. His aversion to
it is so strong that he pronounces it a crime. Before having done with
this author, we may remark that Prosper Alpinus, the modern advocate
for ancient Methodism, does not agree with Cælius in condemning the
Hippocratic practice of opening the veins below the tongue. In his own
case he had experienced the good effects of this practice. (Meth. Med.
vii, 10.)
The Arabians, like their Grecian masters, describe the two varieties of
the disease, and treat them accordingly. For the variety called synanche
by the Greeks, they approve of hot gargles consisting of mustard, pepper,
and the like. This resembles the modern practice of using gargles of
Cayenne pepper. In the following passage, Rhases evidently points at
the contagious synanche: “It happens on certain years in spring that a
bad and destructive species of synanche attacks a great many persons.
Wherefore at such a time it will be proper to anticipate the disease by
venesection, abstracting blood from the legs with cupping-instruments,
opening the belly, and gargling with rose-water, or infusions of sumach,
mulberries, and nuts.” Haly Abbas likewise states that the disease is
sometimes epidemical. Rhases approves of general bleeding, of opening
the sublingual veins, and of using astringent gargles at first, and
afterwards maturative ones consisting of figs, sweet almonds, and the
like. In his ‘Continens’ he seems to allude to bronchotomy. Alsaharavius
describes the two varieties of the disease with great minuteness. He
agrees with the others as to the danger of that variety in which
there is no swelling nor inflammation outwardly. Avicenna and other
of the Arabians follow Alexander in recommending bleeding by opening
the jugulars. The two kinds of angina, mentioned by the ancients, are
described in similar terms by Sydenham, Boerhaave, and Van Swieten. The
first variety, or common quinsey, is well known. The second is of less
frequent occurrence. The modern authorities have found it as fatal as
the ancients gave them reason to expect. The reader will find a very
interesting commentary on Aretæus’ description of malignant sore throat
in a tract, ‘de Recondita Abscessum Natura.’ (Mangeti Bibl. Chirurg. i,
48.) It is the disease now called _laryngitis acuta_.
Haly approves of the treatment recommended by our author in cases of
suspended animation. In treating those who have been in water, he
directs, very improperly we are convinced, the patient to be hung by the
heels, to favour the escape of the water by the mouth. It would appear,
however, from the late experiments of Professor Meyer, that the ancients
were correct in supposing that water is generally found in the lungs of
drowned persons. When a person has hung by the neck for a time, and there
is any prospect of recovery, Haly directs us, as soon as he can swallow,
to make him gargle with oil of violets and tepid water, and to drink
barley-gruel and the like.