The use of the spleen being to attract from the liver the melancholic
humour, which is, as it were, the lees of the blood, if its attractive
power be weakened, or the passage obstructed by which this was formerly
attracted, the black jaundice is formed, blood in an unpurified state
being distributed over the whole body; and if there be weight and
distension about the spleen, or if there be also pain, obstruction
is indicated; but if there be none of these, it is weakness of the
attractive power. But vomiting of black bile taking place without fever,
or any other symptom of malignity, indicates a weakness of the retentive
faculty of the spleen. A weakness of the expulsive faculty will bring
on anorexia, the melancholic superfluity being no longer carried to the
orifice of the stomach and exciting the appetite. When the melancholic
humour is infarcted in the spleen, in the first place inflammation of it
occurs, indicated by heat, pain, and tightness, but afterwards it passes
into scirrhus, the heat and pain having ceased, while the swelling and
hardness remain. Persons thus affected have fetor of the mouth, their
gums are corroded, and ulcers in their legs are difficult to heal.
When the liver sympathises, dropsy takes place, as formerly mentioned;
wherefore intemperaments of it are to be cured like those of the liver.
But when inflammation is present, we must bleed from the left arm at the
elbow, or at the extremity of the hand, in order that revulsion may take
place from as great a distance as possible, and also because of some
natural alliance between these parts. Then we are to apply a cataplasm
of attenuants which are not manifestly caleficient, intermixing some of
the astringents with them. Such is that natural substance called the
flower of salt. And this is an admirable cataplasm: Of fenugreek, oz. iv;
of barley-flour, of cresses, of each, oz. j; of fat figs, lb. j; of the
herb vervain dried, oz. j; macerate the figs in the most acrid vinegar,
and boil with the other things already bruised together, and then boil
again; or apply goat’s dung boiled with raw barley-meal in oxycrate;
and, if you choose, it may receive also some flower of salt. But having
first used a fomentation of oil of privet with a little vinegar, use the
emollient ointments; and first the more simple, such as this: Of wax,
lb. iss; of the fat of bulls, lb. j; of nitre, oz. iij; of turpentine,
of the fruit of the chaste-tree, of the bark of the root of capers, of
each, oz. v; having boiled the soluble ingredients, sprinkle the powders
above. And the malagma of Nileus is an excellent one. If the inflammation
is converted into scirrhus, we must use the most powerful applications so
as to stimulate the skin, such as the one from goats’ dung, and that from
citrons, also that of Macherion, the barber’s, the one from bay-berries,
and that from willows. This one I have found to answer upon trial: Of
arsenic, oz. ij; of sandarach, oz. ij; of wax, of turpentine, of each,
lib. j; of dry pitch, lb. j; of galbanum, oz. j; of opopanax, oz. j; of
the bark of the root of capers, of nut ben, of each, oz. iv; of ammoniac
perfume, scr. vj; of the oil of nard, and of privet, oz. v. And ammoniac,
when rubbed over the spleen with vinegar, is often of great use, and
also, when drunk to the amount of three or four scr. with one scr. of
castor, while sitting in the hip-bath, having previously chewed dried
figs and spit them out. Or of ammoniac, p. j; of castor, p. j; give one
drachm of these things, and it will be of great service for scirrhus;
and, in like manner, the bark of capers, triturated with vinegar and
applied. The same, when drunk with vinegar or oxymel, evacuates thick and
viscid humours, and sometimes blood. And the bark of the willow is rubbed
in similarly. And the ashes of the brazier’s shop, when applied with raw
barley-meal in oxymel, is of use; and the juice of centaury, when applied
externally, and when taken in a draught; and the decoction of bitter
lupines, when drunk with rue and pepper; and its flour, when applied as a
poultice; and the water in which heated iron has been often extinguished,
when given to the amount of three cyathi to such as have fever; and to
such as are free from fever, to the amount of one cyathus with wine and
vinegar; or the root of the wild dock with squills, to the amount of
three oboli; or of wall germander, and of wild thyme, an acetabulum; all
these may be given with oxymel; or, give two oboli of the juice of the
pimpernel having a blue flower (_anagallis cærulea?_) with oxycrate; or
vinegar of squills, or oxymel. These are compound medicines: Of the root
of panacea, of ammoniac perfume, of the rind of the root of capers, of
fuller’s herb, of the inner part of baked squills, equal parts; give one
drachm. It is also of use in asthmatic and dropsical cases.—_Another_: Of
the fruit of tamarisk, dr. iv; of pepper, dr. iv; of spikenard, dr. ij;
of ammoniac perfume, dr. ij; triturate with vinegar of squills, and give
one drachm in oxymel.
_For scirrhus of the spleen._ Of sow-bread, dr. xx; of bryony, dr. iij;
of dittany, dr. ij; of baked squills, dr. viij; of fuller’s herb, dr. vj;
of the root of capers, dr. vj. Give a trochisk to the amount of three
oboli in oxymel. And the trochisk from heath is also applicable. The
food should be attenuant, acrid, and dry; little drink should be taken;
but exercise, friction, and sinapisms should be had recourse to, and
sometimes cupping with scarifications.
* * * * *
COMMENTARY. Hippocrates describes several diseases of the spleen in
his work, ‘de Internis Affectionibus.’ He states that in scirrhus the
spleen is sometimes larger and sometimes smaller than natural. It is an
affection which continues long, but is not fatal. Sometimes, he says,
it terminates in dropsy, and sometimes in suppuration, when he approves
of burning the side. He also recommends diuretics and purging with
hellebore. The description which he gives of the symptoms of enlarged
spleen, in his work ‘On Airs, &c.,’ is very curious. Dr. Coray considers
that it applies to scurvy. (See Notes, &c. 29.)
Aretæus remarks correctly that the spleen is very subject to scirrhus,
but little so to suppuration. Scirrhus, he says, is removed with
difficulty.
For scirrhous enlargement of the spleen, Celsus recommends unction,
friction, and sudorifics. He forbids all sweet things, milk and cheese.
He approves of pickled and salted things, acids, the vinegar of squills,
a decoction of wormwood, and water in which a red-hot iron has been
extinguished. Emollient ointments are to be applied externally.
Cælius Aurelianus says that some had directed the spleen to be cut out
when it is much diseased, but he holds the proposal as mere words of
course, and believes that the operation had never been performed.
Octavius Horatianus recommends as general remedies for complaints of
the spleen, bleeding, purging, and fomentations with wool soaked in
equal parts of oil and vinegar. When it becomes indurated he approves of
vinegar of squills, friction, gestation, dropaces, salt baths, &c.
Most of our author’s remedies are taken from Galen, who treats fully
and scientifically of diseases of the spleen. He states, as a general
principle of treatment, that the proper medicines in cases of indurated
spleen are such as are of an incisive and attenuant nature. He,
therefore, approves of the mixture of bitter with austere things.
Alexander forbids strong purging in the beginning of an inflammation
either of the liver or spleen.
The Arabians treat of these affections similarly to the Greeks. Haly
Abbas remarks that the spleen can bear much stronger medicines than the
liver, and recommends in the indolent diseases of it various bitter and
very acid medicines. In inflammation he very properly bleeds. These are
his general principles of treatment, the detail of which he explains at
great length. Avicenna and Alsaharavius treat of these diseases more
minutely than any other of the ancient authorities. Rhases recommends
camel’s milk in cases of indurated spleen. He joins Archigenes in
directing the application of sinapisms and leeches to the side.