Ulcers on the pudenda and about the anus, when free from inflammation,
require very desiccative applications, such as that from burnt paper,
dried burnt dill, and burnt gourd. For humid and recent ulcers, aloes
is a good application, when sprinkled on them dry in a fine powder. But
the medicine which gives least pain, and is as efficacious as any other,
is pompholyx. If the ulcers are more humid, the bark of the pine by
itself and bloodstone are proper; but if the ulcers are also deep, manna
must be mixed with them; and if the ulcer be spreading, we must apply
a cataplasm of dried lentil with pomegranate-rind, and use the plaster
called Coracum from oxymel, the trochisk called Bithynus, and that from
paper. Fissures in the privy parts and anus are remedied by roasted rosin
(_colophony?_) rubbed with rose-oil, so as to become of the consistence
of bath-sordes, and having the yelk of an egg and opium mixed; or the
ashes of the dried leaves of ivy burnt, when pounded with rose-oil in a
leaden mortar, may be applied. And the trochisk from wine and oil and
that from Phrygian stone are excellent applications for fissures and foul
ulcers about the corona glandis, more especially when the prepuce cannot
be drawn back.—Another simple application, which also blunts acrimony:
Of cadmia burnt and washed, oz. ij; of the rose-leaves stripped of their
nails (i. e. the white parts of the leaves), oz. vj; sprinkle it dry,
having first wiped the part with wine.—The following is an application
for condylomata: Of chalcitis, of uncleansed wool, of cerate, of hart’s
marrow, of bramble-leaves, equal parts, with cerate; and that from wine
and oil in like manner. But if a concealed ulcer is found on the penis
within its opening (_the urethra_), which is discovered from pus or
blood being evacuated without urine, it may be cured by first washing it
with honey diluted with much water, and then with milk, and then mixing
with the milk the collyrium of aster; or the white trochisk, or that
from lotus is to be put into a leaden mortar, and the parts anointed, by
dipping a feather in it; and then a small twisted tent of scraped linen
may be anointed with it and applied. A most excellent application is the
one containing of galls, of pompholyx, of starch, and of aloes, equal
parts, triturated with rose-oil and the juice of plantain.
_For pains of the privy parts._ Apply equal parts of butter and of rosin,
both properly melted; or apply equal parts of myrrh and of roasted rosin
(_colophony or fiddlers’ rosin?_) triturated with the juice of the
plantain.
_For swelling of the penis._ Of tender vine-leaves, dr. j; of ceruse,
dr. v; triturate and apply; bathe with cold sea-water; enjoin rest; and
apply bandages to the penis. The lixivial ashes of vine-twigs applied
with vinegar cure thymous tumours of the penis, and do not permit them
to increase again; and so in like manner the ashes of the burnt bark
of willows. In general the thymus, myrmecia, and acrochordon will be
eradicated by strongly corrosive applications, and become dead when
treated with septics. But, in particular, elaterium when applied with
salts is useful, also unripe figs with vinegar, nitre, and flour, and
the juice of the fig when rubbed in; the burnt head of an anchovy
pickled, verdigris calcined with native sulphur, the juice of tithymallus
(_spurge?_) when rubbed in, the leaves of basil with copperas, or the
fruit of the large sunflower applied with wine.
_For inflammation of the anus._ Of ceruse, oz. iv; of pompholyx, oz.
j; or of soft cadmia, of frankincense, oz. j; of the juice of endive,
one hemina; mix, adding the juice by degrees until it be all consumed,
and then having made a cerate of two ounces of wax, and one pound of
rose-oil, mix; and having shaved the part, soften with this strongly.
Inject by an instrument for extricating pus, and apply a bandage above.
It is of use for inflammatory fissures, and ulcers of the anus attended
with heat or pruritus.
_For erysipelas about the anus._ Of diachylon plaster, lb. j; of
rose-oil, q. s; of pure bread, lb. j; of saffron, oz. j; of opium, oz.
j. The saffron and opium are macerated in must, and the bread in water;
then, when they are pounded, the diachylon and rose-oil are put into them
and allowed to soften. It is also applicable to gout attended with the
greatest heat.—_Another, applicable also to inflammation of the anus_:
Triturate ceruse with wine and rose-oil in a leaden mortar with a leaden
pestle, anoint with it; or, having triturated ceruse, the white of an
egg, and rose-oil in the same mortar until it become of the consistence
of bath-sordes, anoint with it.
_For acute pain of the anus._ Of the tender leaves of henbane, of the
tender leaves of purslain, of crumbs of bread soaked in wine, of the
yelks of roasted eggs, equal parts; of rose-oil, q. s. After fomenting
the part with the decoction of roses and melilots, apply this cataplasm.
_An excellent application for inflammation of the anus, and, excrescences
thereof._ Of ceruse, of litharge, of ammoniac perfume, of bdellium,
of each, scr. vj; of turpentine, oz. j; of wax, oz. ss; triturate the
powders with the juice of nightshade, of henbane, or of purslain; and
having mixed the soluble articles, take, and having softened them with
rose-oil, use. And the composition called Phicotyche, and that from
plumbago, are excellent applications for inflammations of the fundament.
And the trochisks from lotus, from winter-cherry, and that from roses are
esteemed applications for the anus and privy parts.
_For excrescences of the anus._ When these excrescences are inflamed, we
must use the general applications already mentioned, and in particular
the following trochisk: Of ceruse, oz. iij; of pompholyx, oz. j; of
litharge, oz. ij; of mastich, scr. iij, add to the juice of henbane.
When they are free from inflammation, sprinkle the ashes of burnt
cypress balls, having first washed the parts with wine, or the ashes of
the burnt peel of dried gourd, or of the bones of dates in like manner,
or the ashes of eggshells and of fennel; or having mixed the juice of
pomegranate leaves with an equal portion of white wine, wash with it for
seven days. For callous excrescences: Triturate quicklime and arsenic
with strong vinegar. It will answer well if you anoint with it in the sun.
_On hemorrhoids or piles._ When piles discharge more than is proper, the
consequence is, that the system is reduced to a watery state, and they
lose their appetite. There is risk both from the hemorrhage becoming too
profuse, and from its being altogether suppressed; and therefore the
treatment is attended with difficulty. Wherefore, when the piles are
numerous, one ought always to be left for the sake of purging the system.
Some also are seated high up and do not make their appearance, which
renders them difficult to be cured. Blind piles discharge nothing, but
are on that account more painful than the others. On them, therefore, rub
the juice of sow-bread, which will open them. For immoderate discharges,
take of the Egyptian thorn, of the leaves of the elder, of mugwort,
of each, oz. v; boil in eight heminæ of water to one-half, and add
of ironwort oz. iv. The herbs are then to be thrown away, and to the
decoction the following things are to be added in powder: Of melanteria,
of round alum, of each, dr. viij; of litharge, dr. iv; of galls, oz.
iij; of misy, dr. ij; of endive, dr. ij. Dissolve this powder in the
decoction, and bathe with it seven times in the day; but on the following
day bathe with an equal quantity of another preparation of the same kind,
and on the third in like manner. If any part of them remain on the fourth
day, pierce it with a needle, and if it has any feeling, or bleeds,
prepare a decoction like the former, but add only one-half of the powder;
but when you have washed until it touch with the powder, that they may be
properly burnt. For the inflammation apply a bread-poultice.—_Another_:
Having soaked pure bread in primary sauce, and haring burnt it in a
new pot, triturate, and apply it, having first bathed with wine. It
is applicable also to excrescences.—_Another_: Of endive, dr. ij; of
chalcitis, dr. j; of misy, dr. j; of copperas, dr. iij; of fissile alum,
dr. ix; of burnt copper, dr. j; of melanteria, dr. j; use in a powder.
The food for those who have immoderate discharges should be such as
forms but little blood, and is not excrementitious, of a desiccant
and astringent nature, such as chondrus soaked in oxycrate, rice, and
halica, and of pot-herbs, intybus, succory, and purslain, and of wines
such as are astringent. For blind piles, food of an opposite description
is proper, but particularly the fish called calamary, the cuttle-fish,
polypus, the torpedo, and the cartilaginous fishes; for these things
raise a tumult in the blood. Emmenagogues are also proper remedies in
this case.
_For procidentia ani._ Of the fruit of heath, of galls, of ceruse, of
acacia, of the juice of hypocistis, of pine-bark, of frankincense, of
Aminæan myrrh, equal parts; apply in a powder, having first bathed with
austere wine.—_Another_: Of the dross of lead, of Syriac sumach, of each,
oz. viij; of the flowers of roses, dr. iv; of Aminæan myrrh, dr. ij; use
like the first.—_Another_: Of pine-bark, of manna, of litharge, of each,
dr. viij; of dried cypress balls, of plumbago, of each, dr. ij; use as
directed above. Bathing with the patient’s own urine while yet warm is
also useful.
* * * * *
COMMENTARY. Consult most of the works referred to in the fifty-fourth
Section.
The first part of this Section is almost entirely taken from Galen (sec.
loc. ix); the remainder seems to be abridged from Aëtius (xiv.) Galen
(Meth. Med. v, 15) insists strongly that diseases of the penis should be
treated with desiccative instead of epulotic applications.
No ancient author has treated so fully of diseases of the genital member
as Celsus (vi, 18.) His description of the ulcers upon it is very minute.
Ulcers, he remarks, are found either upon the prepuce, or on the glans,
or beyond it on the member itself. If dry, they are first to be bathed
with warm water, and then lycium (catechu?) out of wine, or the lees
of oil boiled with the same, or butter with roses is to be applied. If
there is a slight discharge, they are to be washed with wine; then honey
and a fourth part of turpentine-rosin are to be added to the butter and
roses for an application. When there is a purulent discharge it is to be
washed away, and the part dressed with an application containing pepper,
myrrh, saffron, and misy, boiled in austere wine to the thickness of
honey. He mentions various other escharotics containing ærugo, alum, and
the like. When at any time inflammation comes on, a cataplasm must be
applied. Spreading ulcers are to be treated with applications containing
the escharotics we have just mentioned. When a watery sanies runs from
the sore it is to be treated with basilicon (tetrapharmacon) melted with
roses and some frankincense; and it is to be frequently bathed with hot
water and covered up from the cold. The tubercles called phymata are to
be burnt down with medicines or a cautery of iron, and when the crust
falls off, the squama æris is to be sprinkled on the part. Cancerous
sores are to be extirpated by escharotics, as by a composition of
quicklime, chalcitis (sulphate of copper?) and arsenic; or they are to
be cut out and the part burnt. Phagedænic sores in like manner are to be
burnt with medicines or the actual cautery.
Avicenna approves of Galen’s rule of treatment stated above. When sores
are recent, he recommends in particular aloes, and when more humid,
burnt copper. When an incarnant is required, frankincense is to be
mixed. Prurigo is to be cured by venesection, purging, and liniments
containing nitre, alum, sal ammoniac, or even stavesacre with vinegar
or rose-oil. For prurigo, Alsaharavius recommends lotions of sea-water,
decoctions of chamomile, saffron, and camphor pounded with vinegar, and
the like applications. For hard pustules he recommends various corrosive
applications, some of which contain arsenic. Haly Abbas remarks that
ulcers on the genital membranes are attended with the same symptoms as
those on other parts.
_On diseases of the anus._ Celsus has likewise treated very fully of
these complaints. For rhagadia or fissures he recommends first the hot
bath, and afterwards cooling ointments, such as old oil with litharge,
and unwashed wool spread with a composition of liquid cerate and roses.
The regimen is thus tersely pointed out: “Liquida, lenia, pinguia,
glutinosa, meliora sunt.” The tubercle called condyloma is said to derive
its origin from inflammation, and is to be treated at first by making the
patient sit in a hip-bath of water having vervain boiled in it; and then
lentil with some honey, or a composition containing chalcitis, or alum
with ceruse and litharge, or the like, is to be applied. If these do not
succeed, the escharotics, such as verdigris, antimony, &c., or even the
more powerful caustics are to be used. He treats hemorrhoids upon much
the same plan as our author. He begins by inculcating that there is
danger in suppressing them suddenly. They are to be treated at first upon
the soothing plan, by baths, emollient applications, and those directed
for fissures. When these fail, strong caustics are to be applied, such as
the composition consisting of arsenic, squama æris, and quicklime. Next
day they are to be pierced with a needle. In certain cases he prudently
directs bleeding from the arm. Procidentia ani is to be treated in the
first place by fomenting the gut with austere wine and the like, and
replacing it; and then applying the leaves of willow boiled in vinegar, a
linen compress, wool, and a bandage. Fungous ulcers are to be bathed with
tepid water, if in winter, or with cold if at any other season; and then
sprinkled with squama æris, or dressed with a cerate containing the same
with quicklime, &c. If these do not succeed, the parts must be burnt with
potential or actual cauteries.
Galen remarks that diseases of the anus are difficult to cure, because
the part is possessed of great sensibility, and is exposed to be
irritated by the alvine discharges, which contain bile, ichor, and the
like. Styptic substances, which do not produce much irritation, are most
proper for them, such in particular are many of the metals. He gives
a long list of applications recommended by Andromachus, Asclepiades,
and others, the principal ingredients of which are ceruse, litharge,
alum, rose-oil, and the like. For procidentia ani he recommends various
astringent applications containing galls, sumach, roses, pomegranate
rind, burnt lead, litharge, &c.
Aëtius gives a long account of these complaints, but we must be content
with a brief summary of it. He treats procidentia ani in the first place
with astringent applications, containing galls, hypocistis, austere wine,
and the like; but when these things do not succeed, he directs us to burn
the verge of the anus with the actual cautery. Hemorrhoids he advises us
to extirpate with the knife; but when the patient will not submit to this
operation, he directs us to burn them with caustics, such as arsenic,
quicklime, and the like. He recommends various combinations of these
medicines for condyloma, acrochordon, and thymus.
Octavius Horatianus may be consulted with advantage; but as his general
plan of treatment is not very different from that of Celsus, we shall not
give an abstract of it.
For rhagadia Marcellus recommends a composition of litharge and rose-oil.
He gives an interesting description of the process of curing hemorrhoids
by an application containing arsenic, chalcitis, misy, and the like. This
remedy is strongly recommended by the Pseudo-Dioscorides. He says that a
mixture of equal parts of arsenic and sandarach will make them drop off
in half an hour. (Eupor. i, 214.)
The Arabians treat these diseases upon the same principles. Avicenna
describes three kinds of hemorrhoids. The first kind are like warts;
the next are of a bloody nature; and the third are intermediate between
these. He treats them, like the others, either by a surgical operation,
or by powerful caustics, containing arsenic, quicklime, and the like.
When hemorrhoids are gross, and do not yield to ordinary treatment, Haly
Abbas directs us to apply septics, such as arsenic, quicklime, &c.; and
when they become black, to dress them with ceruse ointment, or a mixture
of rose-oil and the whites of eggs. Procidentia ani he treats, like
Celsus, with astringents, such as galls, hypocistis, recrementum ferri,
&c. For fissures he recommends emollient ointments containing ceruse,
basilicon, wax, &c. Alsaharavius also approves of septic applications
containing arsenic, &c. When the piles are old and callous, however,
he prefers the surgical operation. He also prudently recommends gentle
purgatives. Rhases directs, in cases of procidentia ani, when the anus
is swelled, and the gut cannot be got readily replaced, the patient to
be put into a warm bath and emollient applications used; afterwards
astringents are to be substituted, and a bandage applied. He recommends
us to extirpate hemorrhoids with the knife, the cautery, or caustic
medicines; but advises bleeding in the first place. He says that when
dressed with sandarach they speedily drop off. In prolapsus, when the
anus is swelled, he directs us to bathe the parts with a decoction of
mallows, &c., then to smear them with mucilaginous substances; to replace
the gut, and secure it with a bandage.
The primary sauce mentioned in this Section of our author is thus
explained by Lister: “Liquamen optimum. Istud garum a Paulo Ægineta
vocabatur πρωτειον, seu primarium, quod nobilissimum illud esset.” (Ap.
Apicium, vii, 6.) It was called garum nigrum and garum sociorum by the
Romans. (Galen, Med. sec. loc. iii.) It is thus described by Martial:
“Expirantis adhuc scombri de sanguine primo,
Accipe fastosum munera cara garum.”
(Epigr. xiii, 56.)