Little additional information is to be got from the Arabians; and yet Avicenna, in particular, has treated the subject in a very masterly manner. The causes of apoplexy, he says, are either obstruction or repletion; and these are produced either by blood or a pituitous humour. We need scarcely remark that this accords with the modern division into sanguineous and serous apoplexy. Even in pituitous apoplexy he admits of venesection. He approves of vomiting when it can be produced easily. Neither Serapion nor Avenzoar makes mention of venesection. Serapion commences his treatment with an emetic. When connected with plethora, Alsaharavius recommends general bleeding, opening the temporal veins, cupping the legs, restricted diet, applications to the head, such as oil of roses and vinegar, and acrid clysters. Haly’s account is minute and judicious. He attributes the affection to obstruction within the brain occasioning a loss or diminution of the powers of sensation or of voluntary motion. It is produced, he says, by phlegm mixed with bile or blood; and sometimes arises from repletion with wine, which case generally proves fatal. He justly remarks, that one of the most common symptoms is stertorous breathing. If the face be ruddy or livid, he directs us to open the cephalic vein, or vena saphena, and abstract blood according to the patient’s strength; to apply ligatures to the extremities, vinegar and rose-oil to the head; and to give clysters. He also approves of emetics. When the disease has partly subsided, he approves of the bath. He treats separately of paralysis, describing many varieties of it. In paralysis of the face he recommends stimulant liniments, ligatures, gargles, and sternutatories. According to Rhases, apoplexy arises from congestion of blood or of viscid phlegm in the brain. He remarks correctly, that when attended with stertor it is difficult to cure. When the memory is affected, he directs us to apply a sinapism to the occiput.
The paralysis of the extremities after colic, mentioned by our author, and after him noticed by Avicenna and Haly Abbas, was, no doubt, the same disease as the palsy after colica pictonum described by modern authors. De Haen has given a masterly description of this disease. (Rat. Med.)
Rhases states decidedly that the skin of paralytics may retain its sensibility, although the muscular motion be lost. In a word, he maintains that the nerves of sensibility and motion may be affected separately. He remarks, however, that a part can scarcely retain its powers of motion when the sensibility is entirely gone. He says that he had known several cases of paralysis cured by a natural diarrhœa. His general remedies are bleeding, purging, and rubefacient applications. He, and several of the authorities referred to by him, recommend the warm salt-water bath for the cure of paralysis.
SECT. XIX.—ON CONVULSIONS, OR SPASMS.
The consideration of spasms naturally follows that of paralysis, because both are affections of the nerves; and, for the same reason, we shall next treat of tremors. When, therefore, spasms come on at the commencement of the complaint, or nearly so, and are protracted, they have their origin in plethora; but when they supervene after copious sweatings, vomitings, discharges from the bowels, hemorrhages, watchfulness, hunger, or much and violent exercise, they proceed from depletion. If they suddenly attack a person in health, they must necessarily proceed from plethora. But when from ardent fevers the nerves and whole body are dried, and then spasms come on owing to the dryness, this is one of the worst possible cases, and is almost incurable. Wherefore, we must, in the first place, bind gently the limbs which are contracted, and resist their inordinate motions, and rub them with oil of rue, Sicyonian or old oil, or the like; and the patients must take propomata of honied water. In convulsions from depletion, warm oil, or oil and water, are to be poured upon the patients, and if nothing contra-indicate, they may be put into a bath. We may use a tepid hip-bath with oil, and the gentlest friction. For food, they must take spoon-meats of chondrus and alica; and we may allow them a thin watery wine of easy diffusion if they have no fever. Then we must use the juice of ptisan and promote sleep. Spasms occasioned by plethora or inflammation, we may cure by diminishing the fulness, and removing the inflammation by suitable remedies. Spasms come on also during the agitations of violent vomitings, which cases are benefited by drinking infusions of the root of cotton-thistle, or of the white thorn, or of the Egyptian thorn; but some give the juice of the slender centaury to drink when the convulsions arise from plethora; and one should not only drink it, but rub the skin externally with castor and Sicyonian oil. If they do not cease, cupping-instruments, with scarifications, should be applied; when the legs are affected, along the ischium and the last vertebra; and when the arms are convulsed, to the back, to its first vertebra, and the one above the shoulder. When the rest of the body is not affected, but one of the lips, eyebrows, or tongue, is contracted, the symptom is to be reckoned dangerous and alarming, although the parts affected be but small in size. Wherefore you must abstract blood from the hind-head, and from over the first vertebræ.
Commentary. See Hippocrates (Aphor. v, 70); Galen (Comment.; de Loc. Aff. iii; Meth. Med. xii); Celsus (ii, 1); Cælius Aurelianus (Morb. Acut. iii, 6); Aretæus (de Morb. Acut. i, 6); Leo (ii, 17); Nonnus (38); Octavius Horatianus (ii, 10); Aëtius (vi, 38); Oribasius (Synops. viii, 16); Avicenna (iii, 2, 5, 6, 7); Serapion (i, 27); Avenzoar (ii, 3, 10, and i, 10, 3); Alsaharavius (Pract. i, 2, 21); Rhases (Divis. i, 16, and Contin. i.)
Aëtius and Oribasius treat of spasms in nearly the same terms as our author. We shall give an account of the doctrines of Aretæus and Cælius Aurelianus in the next section. The principles of our author’s treatment are mostly derived from Galen. The Arabians adopt his views without the slightest modification.
SECT. XX.—ON TETANUS AND ITS VARIETIES.
Tetanus also, being a spasm, takes place from the muscles of the body, and more particularly those about the spine, being as it were congealed by a cold humour, fixing both within and without; and hence they are incapable of bending themselves. But when the parts of the body are bent forwards, the affection is called emprosthotonos; when backwards, opisthotonos; and, when the parts are stretched equally both ways, the affection is called tetanus. Pelops says that these affections consist of a tension and contraction of the muscles and nerves about the neck, by which stooping, nodding, and turning of the head are performed; that if the affection be seated in the posterior muscles of the neck, the disease is, from this circumstance, called opisthotonos; when in the anterior, emprosthotonos; and if both are affected, tetanus. The cause, he says, is a flatus, and thick and nebulous air filling the muscles. He says that it is very cold and congealed, and that this is the cause of the difficulty of motion; and that, therefore, dry fomentations, and not moist, are most suitable to them. And these are the varieties of tetanus. “But,” he adds, “the cure of all is the same, and does not change with the varieties. Wherefore, the most potent remedy for them all is a fever supervening, when there was none at the commencement.” The symptoms are a moaning respiration, pulse rare and small, and sometimes a sardonic laugh comes on; the face is red, and their eyes appear larger than natural; their urine is either wholly suppressed, or it resembles common water, or is somewhat bloody, and contains certain bubbles; the belly is dried up; they cannot sleep; and often, from the violence of the spasms, they are in danger of falling out of their beds; they sometimes have singultus, and pains in the head, or between the shoulders and loins; and some have tremors. The disease is occasioned sometimes, though rarely, by fatigue, by lying upon the ground, lifting of weights, a fall, a wound, a burn, and a blow, or any other thing which can bring on such an injury of the nerves. The disease is to be cured like convulsions from depletion.
The cure of the varieties of tetanus. In treating tetanic spasms, we must begin with phlebotomy, and wrapping the parts in wool which has been dipped in oil, namely, the Sicyonian and castor with old oil; or a broad bladder containing hot oil may be applied to the tendons. Cupping, with scarifications, is to be applied; for dry cupping is hurtful. The neck, both sides of the spine, the muscular parts of the breast, the hypochondria, and the region of the bladder or kidneys, should be cupped. We must not be sparing of the detraction of blood, nor yet take away too much at a time, but at intervals. The sweats should be absorbed by the wool dipped in oil, lest the patient happen to catch cold. If the attack of tetanus continue long, the patient must be put into a hip-bath of oil twice a day, but not allowed to remain long in it; for, of all applications, the bath of oil is the most debilitating. Let him drink tepid hydromel boiled to the one half; and the robust may take a drachm of opopanax; or, if not so much, three oboli, or at least one obolus, if we are afraid of its proving injurious to the stomach. We must also give gum ammoniac; or the Cyrenaic juice, to the size of a tare, made up with well-boiled honey, may be swallowed. Two spoonfuls of the root of laserwort may be given in three cyathi of honied water, or in its decoction; or one drachm of myrrh, in honied water, or the decoction of hyssop. But the least dangerous and most effectual remedy is castor, to the extent of two or three spoonfuls, in divided doses. And it will do no harm, if you give it after a meal; but the drink and the other things should be taken slowly and by degrees; for if swallowed with difficulty, the drink regurgitates at the nose, the violent agitations of which bring on convulsions. The anus should be smeared with oil of rue, along with opopanax, and the same things are to be given in a clyster. The affusion of cold water being, as Hippocrates says, exceedingly hazardous, and, for that reason, I suppose, rejected by succeeding authorities, we too are disposed to condemn.
A liniment. Of nard (valerian), one sextarius; of wax, oz. ij; of malabathrum, of amomum, of storax, and of mastich, of each, oz. j; of castor, of adarce, of euphorbium, of pepper, of each, oz. j; of spikenard, of opobalsam, of each oz. j.
A potion for opisthotonos. Of the root of panacea, of white pepper, of costus, of myrrh, of poppy juice, equal parts. Give to the size of the vetch called aracus at bedtime. It is also a remedy for orthopnœa. Let the diet be attenuant, of easy diffusion, and by all means not excrementitious.
Commentary. Consult all the works referred to in the preceding Section; also, Celsus (iv, iii); Haly Abbas (Theor. ix, 10, 11, Pract. v, 31); Alexander Aphrodisiensis (Prob. i, 53.)
Hippocrates, Plato, Galen, Horatianus, and Avicenna agree in stating that a fever coming on tends to remove the tetanic affection. Cælius Aurelianus seems to question the truth of this ancient aphorism. According to Hippocrates, tetanus generally proves fatal within four days, or, if not, recovery takes place. He disapproves of the cold affusion in cases of traumatic tetanus (Aph. v, 21); Alexander Aphrodisiensis, however, speaks rather favorably of it.
Aëtius, Oribasius, and Nonnus, like our author, recommend bleeding, emollient fomentations, and the bath of oil. Archigenes (ap. Aëtium) directs the bath to be prepared by adding a fifth part of oil to the water.
The treatment recommended by Celsus is judicious and not unlike our author’s. He expresses himself hesitatingly about venesection, and forbids the early use of wine. He approves of opening the bowels.
Aretæus says that tetanus is a painful spasm, sometimes proving speedily fatal, and always difficult to cure. Like the moderns, he mentions the three varieties of it, namely, emprosthotonos, opisthotonos, and tetanus. The disease, according to his account, may arise from a variety of causes, such as a wound of a muscular or nervous part, abortion, and excessive cold. When it arises from the two causes first mentioned, it is said to be generally fatal. His description of it is given in his usual graphic manner. He advises the physician not to compromise himself by meddling with the case when the disease is fairly established. His treatment is altogether soothing and relaxant. He recommends us to lay the patient upon a soft warm bed, and, from whatever cause the complaint arise, to begin with abstracting blood from the arm. Then soft liquid food is to be given, and the whole body wrapped in wool moistened with some calefacient oil; or bladders half filled with tepid oil are to be applied to the parts most affected. He directs us to cup the back part of the neck, but cautions against exciting irritation by the application of heat. To the wound he recommends suppurative applications containing frankincense, turpentine-rosin, and the like; for he remarks (and the fact is confirmed by the experience of the late M. Larrey, who recommends a similar mode of practice) that, when tetanus supervenes, the sore becomes dry. He praises castor and assafœtida as antispasmodics; and, if these cannot be swallowed, they are to be given in an injection. He advises also hiera to be given in an injection.
Cæelius Aurelianus enumerates nearly the same causes as Aretæus, and describes all the symptoms of the disease with the greatest precision. His treatment also is nearly the same as that of Aretæus, namely, emollient applications to the neck, venesection, and oily clysters. He even enjoins the bath of oil, which has fallen into disuse in modern practice, most probably solely on account of the expense with which it would be attended. He also permits sometimes the use of the common bath, but not of cold water. He allows wine in certain cases. He condemns Hippocrates for giving both wine and emetics, and having recourse to venesection, without due discrimination. He blames him also for recommending the affusion of cold water, inasmuch as he himself had pronounced cold to be injurious to the nerves, bones, &c. Galen, however, remarks, in his Commentary upon this Aphorism of Hippocrates (sect, v, 21), that cold, in this case, is not the direct cause of the benefit derived from this remedy, but (if we understand him right) that the shock which it imparts to the system proves beneficial, by rousing the vital heat and energies of the patient. Hippocrates, however, as stated above, forbade the cold affusion in traumatic tetanus. Our author’s opinion of this practice is just such as the profession in general now entertain, after it has received another trial upon the recommendation of the late Dr. Currie. (See ‘Medical Reports,’ and Larrey’s ‘Mémoires de Chirurgie’, t. 1.)
Octavius Horatianus recommends bleeding, emollient applications, purgative clysters, the tepid bath, antispasmodics, and soporifics. The use of the last-mentioned class of remedies does not appear to have been sufficiently understood by the ancients; at all events they were less partial to them in this case than the moderns.
The Arabians enjoin nearly the same treatment as the Greeks. Avicenna and Mesue join the preceding authorities in recommending strongly the use of castor and assafœtida as antispasmodics. Avicenna, like all the others, praises the bath of oil. Serapion speaks of a bath prepared with emollient herbs. Haly Abbas describes minutely the two varieties as occasioned by repletion and inanition. For the former, he approves of purging with hot drastic purgatives, of rubbing the part affected with hot oils, and of using the warm bath with friction after it. He also approves of castor. For the other variety, he praises the affusion of plain water in which lettuces, barley, &c. have been boiled. He recommends the internal use of milk and other demulcents, and the bath of oil, and rubbing the body with oil of violets. The treatment recommended by Alsaliaravius is very similar. Rhases mentions Hippocrates’ proposal of the cold affusion; but, like our author, he rather disapproves of it. He himself recommends bleeding, when there are symptoms of repletion, emollient applications to the neck, the bath of oil, the application of leeches to the part affected, purging with aloes, &c. and the administration of antispasmodics, such as castor, assafœtida, and the like.
SECT. XXI.—ON TREMBLINGS.
Trembling is generally occasioned by a weakness of the nerves (old age is a proof of this); but there are many particular causes which occasion it; for it arises from a cold intemperament, from draughts of cold water, more especially if taken unseasonably during a fever, also from a redundance of cold and viscid humours, and from the too liberal use of wine. Those, therefore, who have tremblings from any obvious error in regimen, must abstain from the things which prove injurious to them. And, again, when the tremor remains during fevers, we must first rub the body with Sabine oil; but in the remissions of the attacks with old or Sicyonian oil. Let the extremities after being anointed, be wrapped in soft wool, and then let cupping instruments be applied along the spine, from the first vertebra to the loins; these parts, together with the hypochondria, being previously covered over with raw barley-meal. Let them also be wrapped with wool out of old or Sicyonian oil. But if the fever continue, every alternate day let them be put into a hip-bath of oil, or oil and water, and use soft frictions. But if the affection be prolonged, and cold is suspected, they should take a propoma, or sweet potion, of honied water and castor, and be carried about in warm places; and we ought to give them food of easy distribution, at first spoon-meats, and afterwards such fowls and fishes as have tender flesh. When the fever is gone, they must be washed, avoiding the cold bath and wine. But, if there be a fulness of thick and viscid humours, we must use remedies of an incisive and attenuant nature. They are these: Of the shoots of rue, of cow-parsnip, as much as can be contained in three fingers; of castor, of nitre, of each two oboli. Give every day one spoonful with oxymel, for three days while fasting; or of panacea and pepper, five grains; take in a draught of a cyathus of honied water. The following simple things in proportion relieve tremors: Castor, the brain of a hare eaten, the decoction of the root of marshmallows, of the leaves of water plantain, dr. iv, in honied water, hemp agrimony with water. When the cold prevails, we may use the liniment of Zosimus, and the restoratives, liniments, and rubefacients described above for paralysis, also exercises and frictions. Those who have tremblings from drinking wine must abstain from wine altogether, until a complete cure take place.
Commentary. See Galen (de Tremore, et alibi); Nonnus (40); Cælius Aurelianus (de Morb. Acut. iii, 7); Mesue (de Ægr. Cap. 5); Serapion (i, 3); Haly Abbas (Theor. ix, 11, Pract. v, 32); Alsaharavius (Pract. i, 2, 24); Rhases (ad Mansor. ix, 8.)
Galen, in the work referred to above, explains the rationale of this affection with his usual penetration, but at too great length to allow of our entering upon an exposition of it. The others treat of it similarly to our author. Thus Haly Abbas mentions various causes of tremors, such as old age, drinking cold water unseasonably, excessive indulgence in wine or venery, inanition, and the like. He recommends aloes and castor, the hot bath, friction with calefacient oils, and other such remedies. Serapion gives a sensible account of the nature of the affection, and recommends fetid or antispasmodic remedies internally, and friction with calefacient oils externally. When it is occasioned by exposure to cold, Rhases recommends the hot bath and insolation. We may mention here that Hippocrates has given a very accurate history of a case of delirium tremens. (Epid. iii, 5.)
SECT. XXII.—ON DISEASES OF THE EYE; AND FIRST OF PAIN, FROM GALEN.
When violent pains in the eyes take place, consider from what diathesis the eye happens to be pained in the inflammations; for they are either occasioned by the pungency of an acrid defluxion, or from the coats being over filled and stretched, or from the distension of thick humours or of flatulent spirits. When the pains proceed from pungency, they are to be cured by evacuating with purgatives, and by injecting into the eye the white of an egg. When the inflammation is concocted, if the body be free of impurities, the most befitting remedies are baths. Inflammations from plethora are to be cured by the detraction of blood, purging the belly, and applying friction to the inferior extremities. Those from distension are to be cured by first evacuating the whole body, then by occasioning a revulsion downwards of the humours, and afterwards by using topical applications of a discutient nature. The eyes must be fomented, and the decoction of fenugreek poured into them. When the vessels of the eye are distended with thick blood, while there is no plethoric diathesis in the general system, the patient must drink wine which has the power of heating, evacuating, and removing obstructions.
On disorder of the eye, and particularly of ophthalmy. Disorder of the eye is a wateriness and heat of it, with preternatural redness, not occasioned by any cause within the body, but by some external one, such as the sun, smoke, dust, or the wind; wherefore it is soon dispelled when the cause is removed. And ophthalmy is a marked disorder, which may be occasioned not only by an external cause, but also without any obvious one, and remains until the third, fourth, or fifth day. It is best cured by avoiding every external exciting cause, by spare diet, drinking water, walking, and by opening the belly.
On inflammation. When inflammation remains in the eyes after evacuation of the general system, we may use ointments for dispelling the rheum, and soothing the irritation, such as the collyrium of Nilus made from roses, the chiac, or the collyrium from nard. When the tunica adnata is inflamed, we may use the collyria called monhemera, injecting them into the eye with the white of an egg. Next day, if the inflammation be not aggravated, we may anoint them with the collyrium of nard, and use a fomentation of the decoction of melilot and fenugreek. When the humour which occasions the ophthalmy is thick, we may use medicines which are neither obstruents nor incrassants, but which, on the contrary, will dissipate, dilute, and evacuate the humours, such as the chiac collyrium. But, if the humours are impacted in the head, we may fix a cupping instrument to the hind head, or scarify, or apply leeches to the forehead, near the eye affected. We must use cataplasms of pure bread soaked in water, with a little rose-oil, or polenta boiled in the decoction of poppy-heads also with rose-oil. We may also use a more efficacious cataplasm from saffron, melilot, the fleshy parts of dates, the tender leaves of coriander, eggs, and roasted wheat and crumbs of bread dipped in a decoction with a small quantity of rose oil, in a decoction of pounded poppy heads. We mix also the seed of the poppy as an anodyne. If compelled by the severity of the pain, we must add a little opium; but, unless the pain be very violent, we must abstain from all narcotics. If the inflammation be moderate, apply aloes by itself, or rub it in with water or the white of an egg. In order that the remedy may be ready for use, take of saffron, dr. vj; of aloes, dr. xvj; of gum, dr. ix; mix with rain water, and make a collyrium. And the saffron collyria, as they are called, are proper for the commencement of ophthalmies. In those cases in which there is an œdematous and white swelling about the eyebrows and tunica adnata, without injury of the coats, the best applications are those called liquid collyria, prepared from saffron, copperas, and honey. And this one is excellent:
A liquid anodyne collyrium. Of the melanteria used by tanners, of Attic honey, of the juice of fenugreek, equal parts. Boil to the thickness of honey, and touch the two angles of the eye with it, by means of the rounded extremity of a specillum or probe.
For a copious defluxion. For a flow of humours, in the commencement abstinence from food is proper, and the drinking of water, and most especially abstinence from venery; the belly should be opened, and the face washed with a watery oxycrate, if the rheum be of a hot nature; but if otherwise, the forehead and eyebrows may be anointed with copperas and honey. Some dissolve the copperas in water, and bathe with it. In defluxions without inflammation, or with inflammation, but so that the affection is seated above the skull, we must use agglutinative applications to the forehead, either simple ones, such as green vine leaves, or the juice of the bramble, or of purslain, or of quinces with some fine polenta, or with gall levigated in wine, or with fine polenta or hemlock, or flea-wort with water, or nightshade, or snails with their shells pulverized, and applied from temple to temple, and, in a word, with things of an astringent and cooling nature, or with the following compound applications: Wheat flour, and myrrh or frankincense, with the white of an egg, may be rubbed in; or Samian earth, with myrrh and manna, in like manner, with the white of an egg; but in colder defluxions, of native sulphur, of bitumen, of pitch, of colophonian rosin, of each, dr. ij; also the trochisk of Musa, that called aster, and the like, are suitable repellents. And the theriac, dissolved in an astringent wine, and rubbed on the forehead, stops cold defluxions, and may be drunk with great advantage. Over the eye apply wool, or a small rag wet in the white of an egg; and new-made cheese, in like manner, when applied to the eye, restrains acrid defluxions in particular; also the astringent collyria, as they are called, when rubbed in or injected into the eye in a watery state, do the same thing. But if the humour be deep-seated, and below the skull, and if fixed there for a length of time, after the general evacuations use errhines and masticatories, shaving the head, and applying rubefacients to it. But to these must be joined the surgical operations for the head, namely, Angiology, Arteriotomy, Hypospathismus, and Periscyphismus, with burning at the vertex down to the bone. But cupping instruments, with scarifications applied to the hind-head, will produce a revulsion of the defluxion. The symptoms of defluxions external to the skull are distension of the vessels of the forehead and temples, forming, as it were, a band to the head, and the complaint being remedied by agglutinative applications of a desiccant nature. When these symptoms are not present, and the defluxion proves of long duration, and sometimes is exasperated by sternutatories, the humour is to be supposed seated below the skull.
On chemosis. The disease is called chemosis when both the eyelids are everted in consequence of a violent inflammation, so that the eyes are scarcely covered by them, and the white of the eye is elevated above the black, is red, and occupies a large portion of the black. We must cure it by phlebotomy, purging, the white collyrium of roses, and the spodiac, with milk, or the white of an egg, and we may anoint the eyelids, temples, and forehead with the same, and have recourse to paregoric fomentations and cataplasms. When the inflammation begins to remit, we may rub in the more acrid applications, such as the green one from roses.
On hyposphagma and emphysema. Hyposphagma is a rupture of the veins of the tunica adnata, occasioned most frequently by a blow. Bathe the eyes with the blood of the wood-pigeon, or of the common pigeon, or the warm milk of a woman in which a little frankincense has been triturated, and inject brine, more particularly that from Cappadocian salts, and use a fomentation from the decoction of hyssop. Swellings about the eyes from blows are remedied by repeated fomentations with oxycrate, or a sponge out of oxycrate may be applied to them, or a liniment may be used, consisting of equal parts of burnt lapis specularis, and pigeon’s dung, triturated with wine or vinegar. Or a cataplasm may be applied of new cheese, or of the rind of radishes, or of dried grapes without the stones. Each of these is to be mixed with oxycrate or honied water. The same remedies apply also to emphysema.
On prurient emphysema and psorophthalmia. Emphysema is an œdematous swelling of the eyelids; but psorophthalmia is a scabious eruption of the eyelids attended with pruritus, arising from a saltish and nitrous humour. They are remedied by oxycrate, the decoction of lentils, and a fomentation of roses. The following is a liquid collyrium: Of copper, dr. vj; of calcined misy, and myrrh, of each, dr. iij; of saffron, dr. iss; of pepper, dr. j; of Chian wine, and Cretan sweet wine, of each 1½ cyathus; boil to the thickness of honey. This is the collyrium of Erasistratus called panchrestos, which applies to cynanche, ulcers in the mouth, and on the privy parts, and to the earache. They are to be rubbed with oil into the patient’s eyebrows when he is going to sleep. Acid, saltish, and acrid things are to be abstained from.
On sclerophthalmia and xerophthalmia. Sclerophthalmia is a hardness of the eye with difficulty of motion, pain, and redness, without wateriness. For this the eyes are to be fomented frequently with sponges out of hot water; and at bedtime the white of an egg with rose-oil, or the fat of geese, may be applied to the eyelids. Let them avoid everything of a cooling and hardening nature; let the head be covered and anointed, and the belly kept open. Xerophthalmia is a pruriginous affection of the eyes without rheum. It is to be cured by baths, unguents, and a wholesome diet. Applications of an acrid nature are suitable to both, as they promote a flow of tears, by which the hardness will be softened, and the dryness rendered more humid. Such are the panchrestos of Erasistratus, and those called dicenteton and stratioticum.
On ectropion, or eversion of the eyelids. This complaint is an eversion of the eyelid, occasioned either by a scar or fungous flesh. When it is occasioned by fungous flesh, and is of long duration, roast scraped verdigris, pulverise it and apply, or use burned lead washed with sulphur vivum, or apply both in equal parts, namely, the verdigris and the lead. Ectropion from a cicatrix, if at all remediable, must be cured by a surgical operation.
On ægilops and anchilops. Ægilops is an aposteme between the great canthus of the eye and the nose, which breaking and being neglected, ends in a fistula that extends to the bone. Before the aposteme breaks out into an ulcer, it is called anchilops. A very good application is horned poppy and saffron, applied with the juice of perdicias (pellitory of the wall?) They must be frequently changed, and till then it will not turn to pus.—Another: Alica, boiled in vinegar and properly triturated, not only cures the disease at the commencement, but, after suppuration, it bursts the abscess and penetrates to the bone. By using it, you may cure not only ægilops but anchilops.—Another: Garden rue, levigated and boiled with protostactos and applied, answers excellently for ægilops, penetrates to the bone, proving stimulating at first, but afterwards not so; and, what is wonderful, it does not leave an ugly scar.—Another: Pulverize snails with their shells and apply them; and sometimes aloes or myrrh may be added before the ægilops is converted to pus; and after the abscess bursts it dries up the pus.
On trachoma. Trachoma is a roughness of the inner surface of the eyelid, an intense degree of which has the appearance of clefts, and is called sycosis. When it becomes chronic and callous, it is called tylosis. We must use collyria for it, namely, the one from wine, and that prepared from the two stones; or the eyelid may be rubbed with the bloodstone itself (hæmatites,) much washed in water. But the collyrium called harmation, with a little of the cycnarius, or the saffron collyrium, answer well with these, and with cases of psorophthalmia without ulceration, when rubbed upon the everted eyelid. But if the callus be hard and do not yield to these things, we must turn the eyelid out and rub it down with pumice-stone, or the shell of the cuttle-fish, or fig-leaves, or by the surgical instrument called blepharoxyston.
On chalazion. Chalazion is a concretion of an indolent humour in the eyelid, for which pound ammoniac with vinegar, and anoint along with galbanum. It likewise has a good effect when joined with cerate and turpentine.
On hordeolum, or stye. Hordeolum is a small oblong aposteme on the tarsus of the eyelid. We may foment it with white wax; or throwing away the head of a fly, we may rub the part with the rest of its body; or wash with the decoction of barley.
For lice in the eyebrows. Having first cleared away the pediculi, wash the part with tepid sea-water, and use the under-mentioned application to the tarsus: Of fissile alum, two parts; of stavesacre, one part; triturate, and use.
On madarosis, or milphosis. This affection is a falling off of the hairs of the eyelids. Wherefore, after attending to the general health, use the detergent ointments called calliblephara. Of Cannel-coal, of Celtic saffron, of ladanum, equal parts; pulverize, and use.—Another: Of antimony, calcined and cleaned, dr. j; of lead, burned and cleaned, dr. iv; of saffron, dr. iv; of Indian nard, dr. iij; pulverize, and use.—Another: Of the burnt bones of dates, dr. iij; of Celtic nard, dr. ij; pulverize, and use. This also cures scabious eyes.
That of Neopolites for milphosis and chronic affections of the eyelids. Of antimony, of cadmia, of chalcitis, of foreign misy, of each, equal parts; beat together coarsely, mix with honey; when roasted, triturate, and use.
On ptillosis. Ptillosis is a callous thickening of the eyelids, of a red colour, and often accompanied with a falling out of the hair. In addition to those already mentioned, the following is an excellent application: Rub with mice dung burnt, and triturated in honey.
For a falling off of the hairs of the eyebrows. Anointing the fingers with oil, or geese fat, rub them upon lead, and anoint with this.—Another, which also darkens the hairs: Triturate blunt Pontic walnuts with the fat of goats or of bears.—Another, which also applies to alopecia of the chin: Of henbane, dr. ij; of mice dung, dr. j; of maiden-hair, dr. j; of the ointment of iris, four spoonfuls. Pound well together, mix the ointment, and, having first fomented, anoint. If you previously shave the part, it will be the more efficacious.
For trichiasis of the eyelids. Having first torn out the hairs which irritate the eye, anoint the part immediately with the blood of a frog by itself, or with the ashes of white chameleon, or the blood of bugs; or the juice of the fumitory, which grows among barley, mixing it with gum, or the ashes of pickled limpets with cedar rosin (gum vernix?), or the ashes of the lotos; or liquid alum, called phorimum; or the blood of a tick taken from a dog. It is very efficacious.
Agglutinative medicines. The following substances agglutinate the hairs when bent inwards: Bitumen, mastich, colophonian rosin, glue, the glutinous part of snails.
On encanthis and rhyas. Encanthis is an excrescence of the natural flesh at the great canthus, but rhyas is a wasting of it. You may treat encanthis with the remedies mentioned for ectropion, and similar caustic, or septic applications; but the whole substance must not be consumed, lest rhyas be produced, for it must only be reduced to its natural size. Rhyas, when the whole flesh is consumed, either by an awkward surgical operation or medicines, is incurable. But if part of it only be lost, you may restore it by moderately astringent and incarnating applications, such as that from saffron, horned poppy, and aloes; and the saffron collyria, and henbane boiled in wine and applied, and a small quantity of alum with wine.
On ulcers. Of the ulcers in the eyes there is but one genus, but many particular species. For that in the cornea, when hollow, narrow, and clean, is called bothrion. That which is broader than the bothrion, but less deep, is called cœloma. Argemon is the name given to that which arises on the circle of the iris, but affects the surrounding parts, so that the part which is on the external side of the iris is red, but that on the internal white. Epicauma is a foul and impure ulcer with eschars, which, when cleaned away, often give vent to the humours of the eye. There are many other varieties of ulcers, all of which we shall treat of in general terms. If, therefore, the ulcer happen to be attended with inflammation, the cure must be accomplished by such things as are calculated to soothe and digest the inflammation, regard being had to the peculiar nature of the ulcer. Such are the collyria, called libanium, cycnos, and palaria, aster, and the like; and those from starch, Samian earth, and ceruse. But the most sedative collyrium which we are acquainted with is that of Nilamon; and yet we must not persevere long with it, because it is very narcotic. The best of all applications is the collyrium from decoctions not possessed of a narcotic quality. But if the ulcer be attended with a rheum, we must mix some of the collyria for it, such as that from the hydra, the chiac, the yellow cycnos, and such as possess repellent properties without being stimulant. When the ulcers are foul, we must use honied water moderately diluted, and the decoction of fenugreek, by themselves, and along with the collyria for that purpose; when they are acrid, we may use that of Severianus with the diachylon from fenugreek; when not acrid, those from myrrh and nard. When the ulcers are cleaned, they may be cicatrized by means of the collyrium called cleon, in addition to which it will render the scar of the same colour.
On procidentia. Procidentia is a projection of the coat called uva (iris?), formed by an ulceration or rupture of the cornea. When, therefore, it is small, so as to resemble the head of a fly, it is called myocephalon. When it increases more, so as to resemble a grape-stone, it is called staphyloma; when it advances far forward, so as to protrude between the eyelids, it is called melon; and if it has become callous, it is called clavus. If, therefore, the projection is small, like the head of a fly, we must use repellent and astringent applications, such as the chian, that called fuscum, the nard, and the theodotian, and those from olive leaves, and from horn. And we must bind upon them without pressure a piece of sponge which has been soaked in oxycrate, or astringent wine, or the decoction of roses, or the compress called splenium may be used. The best application for procidentia, and all ulcers of the eye, is the collyrium called olympiac or olympus, with the juice of olive, or of knot-grass, or of poley. The same things are applicable to clavus and staphyloma, before they whiten; for after they become white and callous, they are incurable.
On hypopyon. Hypopyon occurs occasionally in the cornea, being sometimes deeply seated, and sometimes more superficially, the matter assuming the shape of a nail, and hence the affection has got the name of onyx. The indication of cure is either to dispel the pus by remedies possessing this property in a moderate degree, such as honied-water, and the juice of fenugreek, and the collyria formed from it, the libyanum, and those from frankincense; or to make it burst, and cleanse the ulcer by means of the more potent remedies, such as those called diasmyrna and the hygidian. For cases of hypopyon without ulceration one may use the following liquid collyrium: Of copperas, and of saffron, of each, dr. viij; of myrrh, dr. iv; of honey, lb. j. The phlyctæna, which is an elevation of the cornea, by a certain humour corroding its fibres, yields to the same treatment as hypopyon.
The liquid collyria of Bassus for hypopyon. Of saffron, of aloes, and of myrrh, of each, oz. j; of wine, oz. iij; of the finest honey, oz. vj. The saffron is to be levigated with a small quantity of the wine, then with the aloes and myrrh; and when it thickens, add the honey, and having mixed together, lay up in a glass vessel, and use twice a day, or, if the case be urgent, three times. It at the same time cleanses the eye and proves incarnating and cicatrizing.
On cicatrices and leucomata. Superficial scars on the eye are called by some cicatrices, and by others nebulæ; but the more deeply seated are called leucomata. The proper remedies for them are those of a detergent and cleansing nature. Wherefore, nebulæ may be cleansed by the juice of anemone, and that of the small centaury, with honey; but the more chronic are reduced by cedar gum, or by copper alone levigated with water for a collyrium, and by the cleansing collyria, such as that from hartshorn, and those called rhinarian, hecatombe, and the like. Leucomata may be cleared away by nitre carefully levigated with some old oil, and properly smeared upon them, and by the shell of the cuttle-fish (sepia) burnt and pounded finely with honey. Among the collyria, the following one proves an excellent and mild detergent: Of mamira, of ammoniac perfume, of Troglodytic myrrh, of crocodile’s dung, equal parts; make a collyrium, and use. Levigate the dung of the land crocodile with water, and anoint, having formed it into a collyrium. You may also succeed well by dissolving Cappadocian salts in water, and then dissolving the collyria for leucoma in it, and injecting it.
Dyes for cicatrices. Of galls and acacia, of each dr. iv; of copperas, dr. ij; use. The following is a collyrium: Of the flowers of the pomegranate, of copperas, of acacia, of gum, of each dr. iv; of antimony and galls, of each dr. ij; triturate with water. When the flowers of the pomegranate are not at hand, you may use the internal membrane between the seeds.
On pterygium. Pterygium is a nervous (membranous?) excrescence of the tunica adnata, arising at the angle of the eye, and advancing to the corona. When it increases greatly, it covers the pupil itself. Wherefore, large and chronic pterygia can only be extirpated by a surgical operation. But the smaller and more recent ones may be worn down by the abstergent applications, such as those used for trachoma and leucoma. Among the simple remedies are burnt copper, and copperas with the gall of swine, which answer well. The following is a more potent remedy: Of copperas, p. i, of gum, p. ss.; triturate with wine, and anoint, or form into collyria. Some mix the gall of a goat with honey, and anoint with it.
For pterygium, hypopyon, and dimness of vision. (From Oribasius.) Of the magnet-stone, of scraped verdigris (xyston), of reddle, of ammoniac perfume, of each dr. iv; of saffron, dr. ij; of Attic honey half a spoonful. It also answers for leucoma.
For carbuncle and carcinoma. Carcinoma is an affection of the cornea, attended with pain, distension, redness of the tunics, and pungent agony, extending to the temples, more particularly if shaken. They loathe their food, and have the pain increased by acrid things. The affection is incurable, but may be alleviated by a milk-diet, farinaceous and otherwise wholesome food, devoid of all acrimony; and the injection of soothing collyria, such as the Spodiac, Severianum, and the like. We must previously attend that the general system be in a proper temperament. Carbuncle also is a malignant ulcer of the sloughy kind, forming sometimes in the ball of the eye, sometimes in the eyelid, as in the other parts of the body. In cases of carbuncle of the ball of the eye, we must first evacuate with a clyster, and then purge moderately with boiled milk, afterwards foment with a sponge, and apply a cataplasm of the flour of tares, or of wheat boiled in honied water, or sometimes we may add pounded iris, and wash the eye with milk. If the ulcer spread, we may apply a cataplasm of lentils with honey or boiled quinces: if it continue spreading, we may use the boiled leaves of the olive, the rind of the pomegranate boiled in wine and pounded with honey. When the ulceration stops, and the eschar falls off by the application of the medicine about to be described, and the ulcers have become clean, we may apply a cataplasm of the roasted yelks of eggs, triturated with saffron and honey, until the ulcer is healed. The medicine is this: Of spodium, dr. iv; of myrrh not much toasted, dr. iij, and oboli iij; triturate in Aminæan wine until it become dry, mix old Cretan sweet wine, and having triturated, lay up the liquid in an earthen vessel, and anoint with it. For carbuncles of the eyelids, having cut an acid pomegranate, boil it whole in vinegar, and, when softened, pound and put it into a linen cloth, and use. Change twice or thrice during the day, and once during the night.
On mydriasis. When the pupil does not appear changed in colour, but much wider than natural, and when it sometimes wholly impairs the vision, and sometimes nearly so, and when every object appears smaller, the affection is called mydriasis. The cause of it is some redundant humour. We must cure it by bleeding from the arm, or purging; but, if not, by dividing the veins in the angles of the eye, and then applying a cupping instrument to the back part of the head, and bathing the face and eyes with sea-water, or, if it be not at hand, with brine or oxycrate. We must also use the remedies which are applicable to phyletænæ or blisters.
On phthisis and atrophy. Phthisis is an affection of the pupil, which is contracted, and appears duller and more rugose than usual, but objects seem larger than natural. The cause of it is condensation, mostly occasioned by dryness. Phthisis differs from atrophy in this, that phthisis renders the pupil contracted, whereas in atrophy the whole eye is smaller and more depressed. We may cure them by exercise, and rubbing carefully the head, the face, and the eyes; by bathing the face with water, and anointing the head with some healing ointment; and smearing the eyes with an attenuant and acrid composition, such as the following: Of ammoniac, dr. j; of crocomagma, dr. iv; of saffron, dr. ij; of verdigris, dr. j. Triturate in water, form and use.
For nyctalopia. In the disease called nyctalopia, the patient sees during the day, but at sunset his vision becomes dimmer, and when night comes on he does not see at all. We must effect the cure by bleeding from the arm and the angle of the eye, then purging or evacuating by a clyster, and afterwards ordering masticatories or sternutatories. Before food, we give hyssop to drink, or rue; but, if the disease do not yield, we must again administer the purgative medicine formed from scammony, and castor, anoint with clarified honey, and make the patient shut his eyelids, so as to retain the liquid application. Or of burnt alum, p. ij; of fossile salt, p. j; triturate with honey and anoint.—Another: Having roasted the liver of a goat, collect the ichor during the roasting and anoint, but give the liver itself to eat; or boil, and direct the vapours to be received with open eyes.
For glaucoma and suffusion. (From Ruffus.) The ancients considered glaucoma and suffusion as the same disease; but by their successors glaucoma has been accounted an affection of the crystalline humour, which is changed by a watery substance to a cerulean colour; but suffusion is reckoned a defluxion of humours concreted between the cornea and the crystalline lens. Glaucoma is in every case incurable. Suffusion may indeed be cured, but not always. We may try to cure suffusion before the disease is completely formed, by taking blood from the arm, by purging and acrid clysters, such as those made from the decoction of centaury, or of the bitter cucumber, and by keeping the bowels for some time in a loose state. Cupping instruments with scarifications may be applied to the hind-head; the patient must drink water during the whole regimen, take attenuant food, and, in process of time, masticatories may be used for a few days with advantage. When the vision is depraved, as, for example, gnats appearing before the eyes, which case proceeds from a cacochymy or from bilious vapours ascending to the head, we may give for a time the bitter medicine from aloes, or purge with it. To the eyes we must make applications at first simple, such as honey and oil, with the juice of fennel, and afterwards compound, such as this: Of sagapene, dr. ij; of Cyrenaic juice, of white hellebore, of each, dr. vj; triturate with eight heminæ of honey. We, says Oribasius, use the following medicine: Of the juice of wild carrots, of germander, of cresses, of each, equal parts; triturate. The following collyria are beneficial, namely, that from the juice of the fennel, that called proteus, the thalasseros and that from opobalsam. The collyria prepared from them are useful, and the decoction of fennel in the commencement answers well as a fomentation, and that from juices, opobalsam, honey, old oil, and the like.
On amaurosis and dimness of sight. Amaurosis is, for the most part, a complete impediment of the sight without any apparent affection about the eye; and dimness of sight is an imperfection of vision arising without any sensible cause. The same mode of cure as that described for suffusion applies generally in this case; but, in particular, blood may be abstracted from the corners of the eye, leeches applied to the temples, and friction of the extremities. In process of time we must have recourse to sternutatories, emetics with an empty stomach, and the application of ointments, at first with equal parts of honey and oil, and afterwards with the under-mentioned composition: Of saffron, two oboli; of the gall of the hyæna, dr. j; of common pepper, eighty-five grains; of fennel juice, dr. xvj; of ammoniac perfume, dr. j. Triturate the dry substances with the juice, add four spoonfuls of honey, prepare and lay up in a copper vessel for use. Before using, let him foment the eyes by immersing them in hot sea-water.
On strabismus, or squinting. Congenital squinting is cured by the application of a mask, so that the children are compelled to look straight forwards; for strabismus is a spasmodic affection of the muscles which move the ball of the eye. And the lamp should be placed fairly opposite, and not so as to shine obliquely. When the eye is turned to the nose, purple flocks of wool should be fastened to the outer angle of the eye, so that by looking steadily at them, the persons affected may correct the state of the eyes.
On ecpiesmus. The eyes are sometimes forced out, so as to remain prominent. When this happens from strangulation, we must let blood from the arm; but if otherwise, we must purge with black hellebore or scammony. When the eyes become prominent from the pain of labour, the complaint is often removed by the cleansing after parturition; hence we ought to promote it; and, in men, after phlebotomy, if it do not abate, we may affix a cupping instrument to the back part of the head, and apply wool smeared with honey, or flocks of it with water, and bind a compress gently above it. Cold salt water poured upon the face is likewise suitable to them, and also the juice of endive and knot-grass, rubbed in with the juice of poppy, and whatever else can repress and contract.
On synchysis, or confusion. Confusion of the sight occasioned by a blow may be cured by bleeding from the arm, and by filling the whole eye with the blood of a newly-slaughtered animal, of a turtle in particular, but, if not, of a pigeon, and then applying soft wool which has been immersed in an egg beaten up with wine and rose-oil, and binding it on the place. The same thing is to be done next day; and on the third, it is to be fomented, washed with milk, and suitable cataplasms applied; after which it is to be anointed with the remedies for old affections, such as Chiac.
For myopia. Those persons are called myopes, or near-sighted, who, from their births, see near objects, but not those at a distance. Such a state is wholly incurable, being occasioned by a weakness of the optic spirit. Old men are affected in the opposite manner to these, for they do not perceive near objects, but see those at a distance.
Commentary. See Hippocrates (Aphoris., de Visu, et alibi); Galen (de Loc. Aff. iv, de Med. Sec. Loc. iv); Aëtius (vii); Alexander (ii); Oribasius (Synops. viii); Actuarius (Meth. Med. iv, 11); Leo (iii); Psellus (Opus Medicum); Palladius (Comment. in Hippocrat. Epidem.); Scribonius Largus; Octavius Horatianus (i, 10); Nonnus (Epit. 45); Serapion (ii); Avicenna (iii, 3, 1, 2); Mesue (de Ægrit. Ocul.); Avenzoar (i, 7); Haly Abbas (Theor. ix, 13, Pract. v, 34); Alsaharavius (Pract. iv); Rhases (Divis., ad Mansor. ix, and Contin. ii); Canamusali (de Oculis, vi); Jesu Haly (Tract. de Oculis.)
On pain, disorder of the eye, ophthalmy, inflammation, and defluxion. The ancients treat of these complaints separately; but, as they are so nearly connected, we shall class them together. By disorder of the eye (taraxis), they meant an inferior degree of ophthalmy, as is remarked by Turnebus. (Bernard’s Nonnus, 45.) It is, therefore, the mild acute ophthalmy of Scarpa. The remedies enumerated by Hippocrates for pains of the eyes are thus given in the language of Celsus: “Sanguinis detractio, medicamentum, balneum, vinum.” Drinking wine might appear to us at first sight not a very likely mode of curing ophthalmies; and yet Galen, in his Commentary on this Aphorism (vi, 31), has related a case in which it effected a cure after every other remedy had failed. Even Scarpa allows the correctness of the aphorism as a rule of practice, and states that wine and the cold bath are proper when the disease is kept up by excessive irritability. Alexander recommends wine and the tepid bath when the inflammation arises from thick and pituitous blood. Philagrius, as quoted by Theophilus in his ‘Scholia on Hippocrates,’ indicates that the wine should be white, sweet, new, and if the patient’s head be delicate, diluted with water. (See further, t. ii, 501, ed. Dietz.) Mesue makes many interesting remarks upon the above-mentioned remedies of Hippocrates. For further explanation of the rationale of this practice, see Schelhammer (de Tumoribus), and Littré (Hippocrat. t. iv, 418.) Another of Hippocrates’ aphorisms is, that a spontaneous diarrhœa is a favorable occurrence in ophthalmy; upon which Galen remarks, that, in imitation of nature’s method of removing the complaint, physicians are in the practice of producing an artificial looseness by means of cathartics and clysters. Lead is an ingredient in several of Alexander’s collyria. For periodical ophthalmy, Hippocrates recommends purging the head and bowels; and in certain cases bleeding, cupping, and restricted diet. Celsus, Galen, and, in short, most of the ancient authorities make mention of narcotics, such as opium and mandragora, but do not approve of them as common remedies. Galen, however, instances ophthalmy as one of the species of inflammation in which opium is admissible. (De Optima Secta, 9.) Alexander, in like manner, cautions against the indiscriminate use of opium to lull the pain. Some of his prescriptions for collyria, however, contain opium. Galen recommends scarifications in chronic defluxions of the eye. Aëtius lays down very proper rules respecting purging, fomentations, venesection, and baths. He properly remarks regarding the use of wine, that it is only applicable when the patient is of a dry and cold intemperament. Celsus is a decided advocate for fomentations with hot water in all cases of ophthalmy.
The Arabians treat ophthalmy upon the same principles as the Greeks, without supplying much additional information. Mesue, like our author, recommends bleeding by opening the temporal artery, which operation he describes minutely. When the bleeding cannot be stopped otherwise, he directs us to secure the vessel with a silk thread. He also makes mention of leeching and the actual cautery. He is very minute in his directions about his collyria. One of his anodyne collyria consists of the juice of hyoscyamus, mandragora, and opium; and another contains camphor, saffron, hyoscyamus, and the like. The use of narcotics, however, is forbid by Jesu Haly. Rhases also rather disapproves of them. Avicenna makes mention of bleeding by the temporal arteries, the angular vein of the nose, and the frontal. When the usual remedies do not succeed, he approves of the cautery; and, in certain cases, recommends strongly the use of stimulant applications, such as æs ustum, copperas, and arsenic. Galen, in like manner, makes mention of arsenic, and also of misy, sori, and chalcitis (substances resembling our sulphate of copper) among his remedies for diseases of the eye. Having ourselves had occasion to use arsenic in certain malignant diseases of the eyelids, and not having found that it produced any serious disorder in the ball of the eye, we would call the attention of modern oculists to this medicine as one from which, when properly managed, the best results may be expected. When the ophthalmy is of a cold nature, Avicenna approves of treating it by an attenuant diet, the bath, and white wine. In certain cases he directs us to pour cold water on the head. Haly Abbas describes three varieties of ophthalmy. The first arises from manifest causes, such as the sun, dust, and the like; and is to be cured by bleeding, purging, and cooling lotions, containing rose-oil, camphor, &c. In the second, the symptoms are more severe, being attended with greater redness and pain. It also is to be cured by bleeding, cupping, and emollient collyria. The third variety is chemosis. Alsaharavius treats of the disease at great length. When it is connected with a bilious cause, he directs us to purge, use the bath, apply vapours to the eye, and soothing collyria. Serapion, like Haly, describes three varieties of the disease by the names of tarkinisis, noutelinie, and kermufil. Jesu Haly recommends general bleeding, purging, and fomentations, with the decoctions of fenugreek and fennel, for ophthalmy. It remains to be mentioned that Galen, Alexander Aphrodisiensis, and all the Arabian authorities have placed ophthalmy in the list of contagious diseases. See, in particular, Alex. Aph. (Prob. i, 35), and our brief sketch of the history of ancient opinions on contagion in the Second Book, Sect. XXXVI. The celebrated Fracastorius confidently maintains that ophthalmy is contagious. (De Morb. Contag.) And we may further mention that all the authorities of the middle ages speak of ophthalmy as being contagious.
On chemosis. By chemosis, modern oculists (as, for example, Scarpa) understand that state of ophthalmy when blood, owing to a rupture of one or more vessels, is effused into the cellular membrane which connects the conjunctiva to the anterior hemisphere of the eye. Our author’s account is mostly taken from Oribasius, who, in his turn, borrows from Demosthenes. Galen and Octavius Horatianus, without saying anything of the general treatment, merely recommend us to apply upon a clean linen cloth flies pounded with the yelk of an egg. Chemosis is Haly’s third variety of ophthalmy, for which he recommends copious and repeated bleeding, cupping, gentle laxatives, cataplasms containing poppies when the pain is violent, and other soothing collyria. Alsaharavius, in like manner, recommends depletion and emollient fomentations. Serapion, among other things, mentions soothing fomentations. In chemosis, according to Rhases, all the symptoms of ophthalmy are particularly strong and violent; the eyelids being swelled and everted, and the white of the eye appearing black. He recommends local and general bleeding, purging, and astringent applications.
On hyposphagma and emphysema. Hyposphagma is not described by any particular name in modern surgical works. Besides the local applications mentioned by our author, Aëtius properly recommends general treatment, we mean bleeding, purging, and the like. Avicenna also makes mention of venesection and arteriotomy. Haly describes the disease by the name of tumor oculi as his first variety of inflatio. Alsaharavius uses the same term. Serapion treats of it by the name of sanguis divisus in oculo, recommending treatment similar to our author’s. See also Celsus (vi, 6.)
The emphysema appears to have been a sort of œdema seated below the eyelid. Aëtius remarks that it occurs principally in old men. We have often seen it in them. He recommends fomentations by means of a sponge, rubbing the eyelid within with honey, pouring hot water on the head, using baths, drinking wine, and even bleeding at the arm. This last measure is omitted by our author, and must be unnecessary in general. It is described by Haly Abbas as his second variety of inflatio oculi. He says it is an œdematous swelling principally affecting old men in summer. He recommends collyria of a sharp penetrating nature, and various other applications.
On psorophthalmia, sclerophthalmia, and xerophthalmia. For these affections Aëtius gives various prescriptions containing calamine, burnt copper, chalcitis, and the like. Similar ones may be found in Galen (sec. loc.) Galen, like our author, recommends fomentations, by means of a sponge, with hot water or the decoction of poppies. One of Alexander’s prescriptions for psorophthalmia contains arsenic. Celsus describes the symptoms and treatment of xerophthalmia very minutely: “Neque tument, neque fluunt oculi, sed rubent tantum, et cum dolore quodam graves sunt, et noctu præ gravi pituita inhærescunt.” He gives the sum of his treatment in this short sentence: “In hoc vitio multum ambulare, multum exerceri, lavari sæpe, ibique desudare, multâque frictione uti necessarium est.” He also prescribes gargles, food of a middle quality, and various compound collyria, such as the rhinion which contained burnt copper, myrrh, Phrygian stone, &c. This affection, the dry ophthalmy, had been described by Hippocrates (Aph. iii, 12, 14.) Most probably, as Sichel suggests, it was the same as the catarrhal ophthalmy. See Littré (Hippocrat. t. iv, 418.) Celsus recommends this collyrium also for the psorophthalmia, which he describes by the name of scabri oculi. For this last-mentioned affection he recommends various stimulant applications; and, when other remedies are not at hand, directs us to apply bread pounded in wine. The psorophthalmia is the prurigo oculi of Haly Abbas, for which, among other things, he recommends a composition containing pepper, sal ammoniac, saffron, spikenard, camphor, &c. He describes sclerophthalmia by the name of durities oculi, and recommends for it bleeding, gentle purgatives, emollient collyria, &c.
On ectropion. Aëtius, in like manner, recommends compositions containing ærugo æris, misy, and chalcitis. None of the subsequent authorities supply any additional information. Alsaharavius in particular gives a very accurate account of the disease, which, when it arises from a fungous excrescence growing from the inner side of the eyelid, he directs us to burn with caustics; but, when it arises from a cicatrix, it is to be cured only by a surgical operation. This will be found described in the Sixth Book. In place of the caustics recommended by the ancients, Scarpa directs the argentum nitratum to be applied.
On ægilops and anchilops. These are different stages of the disease now known by the name of fistula lachrymalis. Galen states that at the commencement it is to be cured by applications which are repellent without being too stimulant. He gives a full account of the treatment recommended by Archigenes. The first application mentioned by him is a cataplasm consisting of tares and honey. Scarpa, by the way, speaks favorably of the practice of Ægineta, Aëtius, and Avicenna. Avicenna treats of the disease with great judgment. His first applications appear to have been intended to produce resolution; and, if these fail, suppuratives are to be applied. When the abscess bursts, the sore is to be reduced to a healthy state by escharotic powders containing alum, limatura æris, sal ammoniac, and the like. When these fail, a surgical operation must be had recourse to. This is described in the Sixth Book. Mesue also has treated of the disease at great length. Haly Abbas describes the disease very correctly. He says, “Aliquando autem ejus sanies ad nares defluit per foramen quod inter oculum est et nasum.” This passage puts it beyond a doubt that the ancients were acquainted with the lachrymal duct. The disease, he says, sometimes occasions caries of the cartilages (os unguis?). When it is recent, he recommends bleeding and laxatives; and when it gets into a fistulous state, he directs us to use applications containing arsenic, sal ammoniac, cantharides, alum, &c. Alsaharavius mentions that the abscess of the lachrymal sack may either burst outwards or into the nose. It would appear, therefore, that he also was acquainted with the natural structure of these parts. One of the applications recommended by Rhases for fistula lachrymalis contains arsenic, quicklime, and vitriol. Another is prepared from litharge, arsenic, and oil. These applications are mentioned by the earlier of the modern authorities on medicine. See Theodoricus (iii, 2.)
The protostactos mentioned by our author was a composition consisting of potass and lime. (See Book Seventh, in voce, κονία.)
On trachoma. This affection does not appear to be noticed in our late treatises on diseases of the eye, and yet in our own practice we have met with some cases of it. Rowley mentions it as an asperity of the internal superficies of the eyelid. Celsus describes it by the name of aspritudo. In severe cases, he says, some scarify the inside of the eyelid with a fig leaf, a rough probe, or a scalpel. But in ordinary cases, he rather approves of using exercises, frequent baths, fomentations with hot water, attenuant food, and escharotics, such as copperas, misy, antimony, and the like. Galen and Aëtius give prescriptions for various collyria. They consist principally of detergent and caustic substances, such as sal ammoniac, squama æris, calamine, and the like. It seems to be the disease which Haly Abbas treats of by the name of lapidositas. (Pr. v, 51.)
On chalazion. We will treat more fully of the nature of this tumour in our notes on Section XVI of the Sixth Book. It appears to be the species of encysted tumour said by Scarpa to be well described by M. Aurelius Severinus. (On Diseases of the Eye, 3.) Rowley describes it as a moveable tumour in the margin of the eyelids. Aëtius recommends us to open the tumour with a scalpel, and apply to it escharotics, such as burnt copper, chalcitis, and red arsenic. By Haly Abbas it is called grando, and the remedy mentioned by our author is recommended by him. Alsaharavius describes it as a gross humour congealed in one of the eyelids. He describes by the name of alsaanac a fatty tumour of the eyelids which we have sometimes met with and extracted. On the chalazion, see Celsus (vii, 7), and Isidorus (Orig. iv, 8.)
On hordeolum. Most of the ancient authors treat of this trifling complaint in much the same terms as our author. Scarpa evidently is mistaken in making the hordeolum and chalazion to be the same complaint. Haly Abbas describes it as being an oblong abscess resembling a grain of barley on the extremity of the eyelid. He recommends general depletion, and nearly the same remedies as our author; also a cataplasm of galbanum. Alsaharavius treats of it in a similar manner. Rhases particularly recommends melted wax as an application to it. He also speaks favorably of the diachylon plaster.
On lice in the eyebrows. Stavesacre is a very ancient remedy for pediculi on all parts of the body. Celsus lays down very minute directions for the constitutional treatment, and recommends a local application containing sandarach, or the red sulphuret of arsenic. Avicenna makes mention of sulphurous baths. Haly Abbas recommends general purging, various stimulant applications, and abstinence from figs. Our author states, in Section LXXXI of the First Book, that figs engender lice. Alsaharavius directs the eyebrows to be rubbed with sal ammoniac, alum, salts, &c. Jesu Haly recommends purging with hiera, the frequent use of the bath, and applications containing stavesacre, sulphur, alum, nitre, sal ammoniac, vinegar of squills, and the like. Rhases recommends a powder containing quicksilver.
On madarosis, or milphosis, and ptilosis. Aëtius, Actuarius, and Nonnus treat of these diseases in similar terms. The calliblephara are fully described by Galen (sec. loc. iv.) Haly Abbas seems to allude to these complaints in the following sentence: “Palpebrarum autem casus ex humiditate fit acutâ aut alopetia, et quidam fit cum palpebrarum grossite et duritie, ruboreque, et dolore.” His remedies are like our author’s. The same may be said of Alsaharavius.
On trichiasis. Our author’s treatment is mostly imitated from Galen. We shall treat more fully of the disease in the Sixth Book. Scarpa places no confidence in the operation of plucking out the hair, and yet it is favorably spoken of by most of the Greek and Arabian authorities, as, for example, Aëtius, Avicenna, Alsaharavius, and Haly Abbas; and also by Rowley, and other modern oculists. Haly, like our author, directs us to touch the part from which the hair has been plucked with the blood of a frog, or of a dog’s tick, or with the milk of a fig, or the gall of a hedgehog. Alsaharavius makes mention of the same remedies, and also of the mode of treating it by agglutinants. According to Actuarius, the disease consists in certain of the ciliary hairs being turned inwards and hurting the eyeball. (ii, 7.)
On encanthis and rhyas. Scarpa removes the encanthis by a surgical operation; but, from our own experience of the effect of septic medicines, such as arsenic, in similar complaints, we cannot doubt the propriety of the ancient practice in certain cases. Galen’s applications contain copperas, misy, sal ammoniac, and the like. Those of Aëtius are nearly the same. He remarks that seamen are particularly liable to the complaint. Haly Abbas recommends general evacuation and escharotic applications.
On ulcers. In the description of the ulcers of the eye our author follows Aëtius. He, however, evidently was much indebted to Galen (sec. loc. iv.) The Arabians copy from Galen, describing like him seven varieties of ulcer, which they treat upon general principles. See, in particular, Haly Abbas (Pract. v, 41.) Opium is one of his medicinal articles. Ceruse, starch, gum arabic, albumen, &c. also occur. See also Jesu Haly (ii, 50,) and Rhases (Cont. ii.) Celsus recommends various compound applications for ulcers of the eye, which he treats of very minutely.
The collyria mentioned in this section will be found described in the Seventh Book of this work.
On procidentia. Galen correctly describes procidentia as arising from ulceration of the cornea and protrusion of the iris. (De Diff. Morb. 13.) Aëtius has treated of it with his usual accuracy. He recommends various escharotic applications containing chalcitis, misy, and the like, which, when properly managed, may probably have answered the purpose equally well with the antimonium muriatum and argentum nitratum used by Scarpa and other modern oculists. Avicenna treats of the complaint like the Greeks. Some of his compositions contain antimony with ceruse, burnt lead, and the like. Haly Abbas describes the disease minutely in nearly the same terms, and recommends nearly the same remedies as our author, namely, such as are of a repressing nature. He properly remarks that it is one of the consequences of ulceration of the cornea. Alsaharavius gives a similar account, and recommends general depletion.
On hypopyon. Aëtius gives much more judicious directions for the treatment of this complaint than our author. He properly recommends general bloodletting at the commencement, and afterwards local, by means of leeches and cupping instruments; and then emollient, paregoric, and discutient applications to the eye. Galen (Meth. Med.) makes mention of an oculist in his time who effected wonderful cures in this complaint by shaking the patient’s head. When this does not succeed, Galen directs us to perforate the coats of the eye, and let out the matter. (See Book Sixth.) Scarpa does not approve of this practice, unless the collection of matter be considerable. However, Plempius and most of the earlier modern authorities in surgery decidedly recommend it. Haly Abbas recommends a discutient cataplasm containing opopanax, ammoniac, and fenugreek. Alsaharavius properly directs bleeding and masticatories at the commencement.