SECT. I.—ON ELEPHANTIASIS.

Well, in my opinion, did Aretæus the Cappadocian say, that the power of remedies ought to be greater than those of diseases; and that for this reason elephantiasis is incurable, because it is impossible to find a medicine more powerful than it. For if cancer, which is, as it were, an elephantiasis in a particular part, is ranked among the incurable diseases by Hippocrates himself, how much more is not elephantiasis incurable, which is, as it were, a cancer of the whole body? But the black bile from which this affection is formed, having a double origin, (for it arises either from the melancholic and feculent part, and, as it were, dregs of the blood, or from yellow bile, both being overheated); the first variety of the black bile produces the reddish elephantiasis, which is the more mild, or to speak more truly, less malignant variety; the others which are more malignant, being accompanied with ulceration of the whole body and falling off of the extremities, are produced by the latter variety, or that from yellow bile overheated. Wherefore, those who are already overpowered by the disease, must be abandoned; but when the affection is in its commencement, so as that none of the extremities has fallen off, nor the surface of the body become ulcerated, nor the hard swellings appeared, and the face merely appears foul, but not altogether unseemly, we must attempt the cure. For not a few, by merely burning the head, have prevented many who were beginning to be affected from being overpowered by this disease. Wherefore, at the commencement of the disorder, we must have recourse to venesection repeatedly, more especially if in spring, when the complaint is most apt to occur, and has its exacerbations. After an interval of a few days, say nine or ten, we may purge them with the pottage of colocynth, not once only but frequently, proportioning the dose of the medicine to its strength. Purging with hiera also suits well with them. After the interval of about ten days again, we must give them the vinegar of divided milk, not in less quantity than three heminæ, nor in greater than five, and on the following days they are to be supported with milk that is not divided into parts, or new-drawn milk; by which means, if the affection yield, the same food may be continued; but if it remains in the same state, after eating acrid things, they must be made to vomit with radishes and frumentaceous articles of food. After these things, purging with white hellebore is proper, twice if possible when in spring, but once only if in autumn. Those, however, who are thoroughly overpowered by the complaint, must be neither bled nor put on a course of hellebore. For neither can a translation of the disease from the superficies to the inner parts, nor a diminution of the offending matter, be any longer accomplished by these means; but the matter is to be determined to the stomach and bowels, and alteratives (metasyncritica), used to dry and constrict the skin. Dry-cupping is also to be applied over the mouth of the stomach and to the hypochondria, and dropaces used to the same places; but after a short interval, the same process is to be repeated, beginning by purging with hiera, and omitting the venesection, which would prove rather deleterious than beneficial. This process is to be repeated three or four times in a year, more especially in the seasons of spring and autumn. The draughts before meals, most suitable for them, are a cyathus of vinegar, with a cyathus of cedria, and two cyathi of the juice of unripe cabbage—they are given mixed together, morning and evening; or, the dried leaves of the herb ironwort, to the amount of a drachm in one cyathus of wine; or, a drachm of hartshorn and a cyathus of the vinegar of squills, is given after the morning walk every day; and other things are to be administered at the same season, such as drs. v of washed squills in honied water, or in honey, as a linctus; or Cyrenaic juice, to the amount of a bitter vetch, mixed with honey and butter; or, dr. ss of the shavings of hartshorn, with two cyathi of wine; or, drs. iij of Æthiopian cumin, with honey, as a linctus. But a more suitable remedy is a drachm of the theriac trochisk, triturated in a cyathus of fine wine, and drunk; and a drachm of the trochisk of squills may in like manner be taken in a draught. And they praise the juice of calamint as a most effectual remedy when drunk, and say that the dose to commence with is three cyathi, which may be increased to six. But of all others the theriac of vipers is the most effectual remedy, both in a draught and when rubbed in externally. But where plenty of these animals can be procured, nothing answers so well as eating the flesh of the vipers boiled in white broth, with much water, salts, leeks, and dill, to the separation of their back-bones, their head and tail being first cut off to the extent of four fingers’ breadth, and their entrails and skin taken away. And theriac salts are in the same celebrity when taken with other food. By using them thus, it happens that the scales, or, as it were, the bark, falls off from the skin.

The regimen is to be as follows: After sleep, having been first rubbed, and the bowels evacuated, let the patient have recourse to gestation and vociferation, then to friction and gymnastic exercises of all kinds, partly by leaping, but more especially by using the halcteres and leather bag. Having wiped off the sweat, let him be rubbed with the grease of a boar, of a wolf, of a goat, or of some winged animal, or with fresh butter; and after a short interval let him bathe, having his body anointed with the juice of fenugreek, of ptisan, or with a little ammoniac dissolved in vinegar. After the bath, having got his body wiped, let him anoint with the oil of lentisk, of wild vine, or of myrtles; and with a little wine, containing alum and ammoniac, so as to be of the thickness of the sordes of baths. Having had his body rubbed again with soft rags, let him rest for half an hour, after which, having drunk water, let him make himself vomit by putting his fingers or a feather down his throat. Having vomited, let him drink the wine of wormwood or of marjoram. The food should be barley bread, or a cake of dried barley flour, and of potherbs, the beet, the lettuce, the radish, leeks, and cabbage sweetened in two waters, and capers. Of sea animals, he may take oysters, pelorides, urchin, all shell fishes, limpets boiled with beets, and old pickle in place of medicine. But let him abstain from wine during the whole continuance of the complaint, and from venery; only he may take a little thin watery wine at the time of his recovery from the purging, at which season all acrid substances must be abstained from, except condiments. Give him ptisan, eggs and chondrus, milk and honey, with bread, mallows, dock, skirret, and fishes with tender flesh; and of fowls, those which contain wholesome juices; and of fruits, the fig, grape, and raisins: but of sweetmeats, those which are prepared from pine kernels, toasted almonds, or bastard saffron. He may take food twice a day, as it is injurious to subsist upon one meal. After taking care of the internal parts, let him use detergent ointments (smegmata) in the bath, from the decoction of beet, or of fenugreek with aphronitrum, soap, or myrobolan, and sometimes apply depilatories. Purslain triturated with vinegar is detergent and also the slender houseleek, and the roots of dock boiled in vinegar, and alum with salts, and red arsenic in equal proportions with wine and oil of lentisk. Also the composition for alphos, consisting of alcyonium, nitre, myrtle, sulphur, and the dried leaves of the wild fig, being rubbed in dry with vinegar; and that from the burnt shell of the cuttle-fish, and pumice, nitre, and burnt Cimolian earth, gum, unripe galls in equal quantity, sprinkled dry, or rubbed in with vinegar. And this one is admirable: Of the roots of dock a bunch to the amount of a handful, of natron, dr. xl; of frankincense, dr. xxv; of sulphur, dr. xxv; it is rubbed in with Egyptian vinegar. And this one is efficacious: Of arsenic, dr. x; of sulphur vivum, dr. viii; of costus, dr. xii; of quicklime, dr. iv; of wax, dr. iv; of dried bay berries, dr. xii; these things are mixed with the juice of white poplar leaves, or with a thick decoction, and they are rubbed in, having the consistence of honey.—Another: Two fasciculi of the roots of dock are to be boiled in vinegar, pounded in a mortar and triturated, then of alcyonium, lb. j; of aphronitrum, oz. viij; of sulphur vivum, lb. j; of the burnt shells of cockles, oz. iv; of chamæleon with its roots, oz. iv; these things are pounded together until they are of the consistence of the sordes of the baths, and are then rubbed in often in the sun, if summer, but if winter, in the bath, until it occasions sweating. And the dry smegma of Æsculapius would agree excellently with these cases, and all the smegmata about to be described, even unto those for alphos, and also those now mentioned, are applicable for those complaints. And the tumid excrescences, whether inflammatory or ulcerous, are to be rubbed with Indian buckthorn: or horned poppy, or aloe, or the Andronian trochisk, or that of Polyides; and let cataplasms be applied of chondrus with the juice of knot-grass or plantain; or of pellitory of the wall, triturated; and the leaves of the green Melisian herb, when pounded with axunge and applied, are wonderfully efficacious, for they redden the parts, but the redness is easily repressed by the application of bread; or of the cerate made from almond oil. By this means their natural colour is restored. When the parts are ulcerated, plasters are suitable: that from diphryges, and the apple one with wine, that called coracium, that made from oxymel, the Andronian trochisk, pompholyx and calamine. It is a symptom that the whole disease is becoming more moderate when the first ulcers are cicatrized. For the dyspnœa of persons labouring under elephantiasis give a draught of five or six slaters in three cyathi of honied water. And some of the general remedies described for dyspnœa will be applicable for them. Of the natural baths we must select, as being most particularly useful, the aluminous and chalybeate, and if possible, such as are cold. It is also particularly serviceable to drink them. And the use of the sand of the sea-shore has the same effect, and so have all the sudorifics. But since this affection is one of those which are easily communicable, no less so than the plague, they are to be removed as far as possible from cities, and lodged in inland and cold situations, where there are few inhabitants, if this can be accomplished; for so they may descend from thence to surrounding places. This is proper partly on their own account and also on account of those whom they might come in contact with. For they themselves will thus enjoy the use of a more commodious air, and they will not communicate the evil to others.

Commentary. Consult Lucretius (vi, 1112); Celsus (iii, 25); Pliny (Hist. Nat. xxvi, 5); Scribonius Largus (102); Cælius Aurelianus (Pass. Tard. iv, 1); Marcellus (De Med. xix); Serenus Samonicus (11); Octavius Horatianus (i, 32); Isidorus (Orig. iv, 8); Vegetius (Mulom. i, 9); Aretæus (Curat. Morb. Chron. ii, 13); Plutarch (Symp. viii, Quest. 9); Galen (ad Glauc. ii, 10; de Causis Morb. 7); Oribasius (Morb. Curat. iii, 62; Synops. vii, 5); Pseudo Dioscorides (Euporist. i, 105); Aëtius (xiii, 120); Actuarius (Meth. Med. ii, 11, and iv, 15); Nonnus (Epit. 233); Psellus (op. medicum); Leo (vii); Myrepsus (De Med. comp.); Avicenna (iv, 3, 3, 1); Serapion (v, 14); Avenzoar (ii, 7, 12, 26); Albucasis (Chirurg. i, 49); Haly Abbas (Theor. viii, 15, Pract. iv, 3, ix, 69); Alsaharavius (Pract. xxxi, 2); Rhases (ad Mansor, v, 35, ix, 93, Contin. xxxv, 26.)

We owe the earliest notice which we have of this disease to the poet Lucretius, who briefly mentions it in the following lines:

Celsus says that elephantiasis is a chronic disease, almost unknown in Italy, but very common in certain countries. He calls it an affection of the whole body, even of the bones. The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. Baths are to be rarely used; fatty, glutinous, and flatulent articles of food are to be avoided, but wine is to be allowed, except at the beginning. The body is to be rubbed with pounded plantain.

According to Pliny, elephantiasis was never known in Italy until the days of Pompey the Great, when it was imported from Egypt, and raged for a time, but soon became extinct. He describes it as affecting the face in particular with hard, rough, black maculæ, which sometimes spread to the bones, the toes and fingers being swelled.

Serenus Samonicus, who is said to have flourished about the beginning of the third century, thus describes the disease:

His remedies are the juice of the bark of the juniper, the ashes and blood of the weasel, mint, and various external applications, consisting of ceruse, Egyptian paper, roses, &c.

Scribonius Largus recommends sulphur with common oil for lepra, “et quam elephantiam dicunt,” but he gives no description of the latter.

It is greatly to be lamented that Cælius Aurelianus’ account of elephantiasis has come down to us in an imperfect state. His description is entirely lost, and his detail of the treatment is in a mutilated state. It appears, however, that his views were similar to those of Celsus, and that he considered it to be a malignant disease, affecting principally the skin. He approves of rubbing stimulant ointments into the skin, and of using medicinal baths, especially the aluminous and chalybeate. When the applications produce ulceration of the skin, he directs us to treat it upon general principles. He makes mention of vomiting by radishes, and latterly by means of the white hellebore. He approves of a sea voyage and change of scene. He says the first author who described elephantiasis was Themison, the same person that is damned to everlasting fame in one of the lines of Juvenal: “Quot Themison agros autumno occiderit uno.” (Sat. x, 221.) If this statement be correct, it is clear that Celsus cannot be of so early a date as is generally believed, that is to say, the Augustan age, for Themison flourished towards the end of the first century, P. C. He was the founder of the Methodical sect. Cælius also blames Themison for recommending bleeding and vomiting unseasonably, and disapproves of his directions respecting the applications to the skin. It appears that he also disapproved of the theriac of vipers, and of giving to drink water in which red-hot iron had been extinguished. There can be no doubt, from the circumstances which he mentions, that the disease was thought contagious in his time.

Octavius Horatianus, who lived under the emperor Valentinian, gives a pretty full detail of the treatment, but his description of the symptoms is defective. He makes mention, however, of maculæ, which affect principally the face; he contends that the whole system is attacked with the disease, and that the flesh is corrupted. His remedies are much the same as those recommended by the other authorities, namely, bleeding, purging, vomiting, the theriac of vipers, and rubbing with the usual applications for scabies. He also speaks favorably of the natural and the sea-water baths.

Marcellus the Emperic, who is supposed to have flourished in the reign of Theodosius, recommends, like Serenus, mint, juniper, and mezereon, for elephantiasis. He describes it as being attended with hard excrescences of the extremities, eruptions on the face, and disease of the bones. He speaks of its being endemic in Ægypt.

The disease, elephantiasis, according to Isidorus, is so called from its resemblance to the elephant. The skin in it is hard and rough, from which it gets its appellation, because the surface of the patient’s body resembles that of an elephant; or because it is a mighty affection, as the elephant is one of the largest of animals.

Vegetius, the great ancient authority on veterinary surgery, describes elephantiasis as it affects cattle. The symptoms are hardness and roughness of the skin, squamæ, eruptions on the feet and head, and a fetid discharge from the nose. He approves of bleeding, and the other means recommended by the regular surgeons.

We shall next give the descriptions of the Greek authorities.

Aretæus gives a most elaborate but surely somewhat overstrained description of elephas, which he paints in colours the most hideous and disgusting. We shall endeavour to convey to the reader an idea of his sketch, stripping his picture of its flowery ornaments, and contracting its bulk. The disease is called elephas, he says, from its magnitude, leontium or morbus leoninus, from the supposed resemblance of the eyebrows to those of the lion; and satyriasis, from the venereal desires with which it is attended. The disease is described as escaping notice at first, being deep-seated and preying upon the vitals, but afterwards it is determined to the superficies, commencing sometimes with the face, and at other times with the extremities. The belly is dry, because, as he ingeniously remarks, the distribution of the food is performed regularly, and the vitiated parts strongly attract the chyle to them as a pabulum to the disease. There are large callous eminences on the skin, and the veins appear enlarged, owing to a thickening of the vessels and not to a plethora of blood. The hairs of the head, pubes, and other parts of the body, drop off. The face in particular is affected with callous tubercles or warts, and it is not uncommon for the tongue, and most parts of the body, to be also covered with them. The eyebrows are thickened, stripped of their hair, and hang down like those of the lion. The general appearance of the skin, covered as it is with hard tubercles, and intersected with deep fissures, is said to bear some resemblance to that of the elephant. Sometimes particular members, such as the nose, feet, fingers, the whole hand, or the pudenda, will die and drop off; and it is not uncommon for incurable ulcers to break forth on different parts of the body. Dyspnœa, and a sense of suffocation, are occasionally present. He says, it is dangerous to have any intercourse with persons labouring under the disease, no less so than in the case of the plague, as both are readily communicated by respiration. He directs us, at the commencement, to abstract blood freely, because blood is the pabulum morbi. He recommends us to purge with hiera, and to procure vomiting by radishes, but more particularly by the white hellebore, upon which he bestows a glowing and eloquent eulogy. Like our author, he approves of the theriac of vipers. He makes mention of many external applications of a detergent nature, and in particular praises a soap used by the Celts for cleaning their clothes. He also commends natron, alcyonium, sulphur, alum, ammoniac with vinegar, and the like, for the same purpose. When the flesh is livid, he directs us previously to make deep incisions in it. The diet is to be plain and digestible; sulphureous baths are to be used: the patient is to swim frequently in sea-water, to take a sea voyage, and otherwise not neglect suitable exercise.

Plutarch informs us that it was disputed in his time whether or not elephantiasis was a new complaint.

Galen, as far as we can recollect, has nowhere treated very particularly of elephantiasis, but in his work ‘De Causis Morborum’ he has briefly mentioned that in this disease the nose becomes flattened, the lips thick, and the ears extenuated, the whole appearance resembling that of a satyr: and in his work entitled ‘De Curatione ad Glauconem’ he ranks elephantiasis with cancerous swellings, and says that the disease is common about Alexandria, owing to the heat of the place and the food of the inhabitants, which consists principally of lentils, snails, pickles, the flesh of asses, and the like, all which things have a tendency to engender the melancholic humour. The temperature of the place likewise, he shrewdly remarks, determines the superfluities of the system to the skin. He recommends the treatment which we have already had occasion to mention, namely, bleeding, purging, and the theriac of vipers. In the ‘Isagoge,’ the black and white hellebores are particularly commended. Galen elsewhere calls it contagious. (Lib. ii, Simpl. de carne viperæ.)

Oribasius gives no description of the disease, but briefly recommends the theriac of vipers, and in certain cases purging and bleeding for the cure of it.

The account given by Aëtius is principally taken from Archigenes, and is very circumstantial. The disease, he remarks, has been called by the several names of elephantiasis, leontiasis, and satyriasis. Suspicions, he says, have been entertained of its being contagious, and he is of opinion that it is unsafe to hold intercourse with those who are ill of the disease, as the air becomes contaminated by the effluvia from their sores, and by their respiration. The disease, he says, is insidious, for it begins in a concealed manner internally, and does not make its appearance on the skin until it is confirmed. Men are more subject to it than women, and intemperate climates predispose to it. The first symptoms of the disease are torpor, slow respiration, constipated bowels, urine like that of cattle, continued eructations, and strong venereal appetites; and when it is determined to the skin, the cheeks and chin become thickened and of a livid colour, the veins below the tongue are varicose, and eminences are formed all over the body, but especially on the forehead and chin. The body becomes increased in bulk, and is borne down by an intolerable sense of heaviness. Those affected with it become pusillanimous, and shun the haunts of men. Though the disease, when confirmed, is of the most hopeless description, he forbids us to abandon the sick at the commencement. His treatment is almost the same as our author’s: venesection at the beginning, purging with colocynth or hiera, and vomiting with radishes or white hellebore. Some, he says, having remarked that eunuchs escaped taking this complaint, have castrated themselves as a preventive. He makes mention of all the medicinal substances recommended by our author, namely, iron-wort, Cyrenaic juice, the theriac of vipers, &c. For the cutaneous affections he recommends a great many external applications, containing white hellebore, sulphur, rue, natron, aloes, and even arsenic. He also speaks of cataplasms, depilatories, and detergent ointments. He is very particular in directing that the diet be light and wholesome.

Actuarius calls elephantiasis a cancer of the whole body, which preys upon all the flesh, and derives its origin from black bile corroding everything like fire. The first symptoms of it are a falling off of the hairs of the eyebrows and chin, tumours on the face, an alteration of the appearance of the eyes, a change of the voice, turgidity of the sublingual veins, and afterwards cutaneous eruptions of an intractable nature. He then states that elephantiasis, lepra, psora, and impetigo are diseases of different gradations of malignity. In another place he has given the treatment, which is exactly the same as that recommended by Aretæus, namely, bleeding, purging with hellebore, detergent and desiccative applications to the skin, &c.

Some applications, seemingly of little efficacy, are recommended for elephantiasis in the ‘Euporista’ of the Pseudo-Dioscorides.

Nonnus, as usual, abridges our author’s detail of the treatment, and omits the description. He says it arises from a melancholic humour, which corrodes the extremities. According to Psellus, the disease is produced by melancholy adust and the lees of putrid blood.

The account of elephantiasis given by Leo is brief and imperfect. The disease, he says, is produced by a melancholic humour, which has become putrid, and corrodes the extremities. It is, he adds, almost incurable, but may be benefited by purging with the dodder of thyme, by the theriac, and burning the head at the bregma. The affection, he says, is also called satyriasmus.

Myrepsus merely mentions some of the common remedies for elephantiasis, such as arsenic, turpentine, litharge, &c. He gives no description of the disease.

We now proceed to the Arabians.

Avicenna gives a very circumstantial account of elephantiasis, under the name of juzam or judam, which his translator renders by lepra. He calls it a cancer of the whole body, which arises from black bile, and is sometimes attended with ulceration, and is sometimes without it. The disease, he says, is contagious: it is produced by living upon the flesh of asses, lentils, &c., and is endemic in Alexandria. It is sometimes called leonina, because the face assumes the stern appearance of the lion’s. He states that, although it begins internally, its first symptoms are manifested on the extremities. He then describes minutely the symptoms, namely, redness of the face, inclining to lividity; falling off of the hairs, enlargement of the veins, affection of the breathing, thickening, and discoloration of the lips; and afterwards ulceration of different parts of the body, corrosion of the cartilages of the nose, then falling off of the nose and extremities, loss of voice, &c. The treatment he gives with great minuteness, but as it is little different from that of the Greeks, we need scarcely enter upon it. Suffice it to say that he mentions early bleeding, purging with hellebore, colocynth, scammony, &c.; the theriac of vipers, the application of the cautery to the head, and so forth. Enough has been said to show that this description applies to the elephantiasis of the Greeks. Considerable confusion, however, has arisen in consequence of his translator applying the term elephantia to a very different disease, namely, to an enlargement of the leg with varicose veins, now generally known by the name of the Barbadoes leg. This complaint he directs to be treated at first with local bleeding and astringents; but when ulceration takes place, it is to be remedied only by amputation.

Serapion, in like manner, describes the elephantiasis of the Greeks by the name of lepra. The face, he says, is swelled, livid, and covered with hard pustules, the hairs of the eyebrows fall off, the whole aspect becomes hideous, the voice is changed, the perspiration becomes vitiated, and ulceration seizes different parts of the body. The disease, he says, takes its origin from the liver, in which the office of sanguification is improperly performed. His remedies are bleeding, hellebore, the theriac, &c.

Avenzoar describes the lepra as a cancer arising from contact with other lepers, or from unwholesome food. He recommends to purge away the melancholic humour with scammony, colocynth, black hellebore, &c. The elephantia he describes as a disease in which the leg is swelled like the leg of an elephant. He considers it almost incurable.

Albucasis gives an account of the operation of burning the head for lepra, i.e. the elephantiasis of the Greeks.

The translator of Haly Abbas, namely, Stephanus Antiochensis, who says he wrote about the year 1127, describes the disease which we have been treating of by the name of elephantia. Like the others, Haly represents it to be a general cancer arising from black bile. He says it proves contagious by respiration. Among the symptoms, he mentions falling off of the ciliary and superciliary hairs, dryness of the nose, which sometimes falls in; in short, he enumerates the same symptoms as the preceding authorities. For the cure he directs us to bleed from the arteries behind the ears, those of the temples, or from a vein in the arm; to give emetics, such as hellebore; to avoid cold; to apply cupping-instruments to the scrobiculus cordis; to administer the theriac, &c. He recommends externally decoctions of beans and vetches at first; and afterwards stimulant lotions, containing arsenic, sulphur, quicklime, and so forth. He also applies the term elephantia, and sometimes elephas, to the swelled leg, which he considers to be a species of varix.

Alsaharavius describes four varieties of lepra, namely, the leonina, elephantia, serpentina, and vulpina. The disease, he says, may be contracted, 1st, by an hereditary taint; 2d, by the use of corrupted food, such as the flesh of buck-goats, cows, &c.; 3d, by contagion, through the medium of the respiration. He describes all the gradations of the disease with greater minuteness than any other ancient author. In its last stage, he says, the nose falls in, the hairs drop off, the voice is lost, ulcers break out on the skin, the extremities mortify and fall away, and the breath is fetid. His treatment varies according to the circumstances of the case, but, upon the whole, it is scarcely at all different from that of the others. By the name of elephantia he also describes the swelled leg, which he pronounces to be a very intractable disease. He directs us, however, to have recourse to bleeding, melanogogues, abstinence from gross food, emetics, and various external applications of a stimulant nature, among which he mentions burying the leg in hot sand.

The translator of Rhases also applies the term lepra to the elephantiasis of the Greeks. The colour of the eye, he says, is changed, the voice becomes rough, the face is swelled, like a bladder, and red with nodes, the hairs fall off, and the extremities at last become swelled and ulcerated. There is nothing peculiar in his treatment. He describes, likewise, the swelled leg by the name of elephantia or elephas. He says that, when tubercles arise on it, it is utterly incurable; but that when simply enlarged, it may be remedied by bleeding in the arm, cupping, emetics, attenuant food, and the like. In his ‘Continens,’ he calls the lepra (elephantiasis) hereditary and contagious. He says, it is a general cancer, arising from black bile. For the swelled leg he recommends, as in his other work, bloodletting and emetics, with stimulant applications, containing pearlashes, sulphur, &c., and also tight bandages.

Such is the history of elephantiasis given by ancient authors.

The earlier of our modern writers on medicine, describe elephantiasis as a species of lepra, of which they enumerate four varieties, namely, elephantia, leonina, alopecia, and tyria. This arrangement is evidently taken from Alsaharavius. Such is the account which Platiarius gives of these diseases. In like manner, the Pseudo-Macer ranks elephantiasis with lepra:

“Est lepræ species elephantiasisque vocatur,” &c. Upon this passage Cornarius makes the following annotation: “Vulgus medicorum Arabas in hoc secuti lepram cum elephantiasi confundunt. Immo lepram pro elephantiasi accipiunt.”

Guido de Cauliaco’s account of the disease is also nearly the same as that of Alsaharavius. He states decidedly that the disease is contagious, and recommends bleeding, purging, the actual cautery, the theriac of vipers. (vi, 1.) Rogerius remarks that the disease is contracted per coitum. (i, 15.) And here, by the way, we may be permitted to state that we have long been convinced that the syphilis of modern times is a modified form of the ancient elephantiasis. This opinion is maintained by several of the writers of the Aphrodisiacus, and also by the learned Sprengel, who gives a very interesting disquisition on Syphilis in his ‘History of Medicine.’

It appears that the disease in its ancient form is still prevalent in certain parts of the world; as, for example, in the Sardinian States, where it is still looked upon as being both contagious and hereditary. It is also endemic in Norway: nay, it is reported to have broken forth with all its ancient character in the province of New Brunswick. In the East, elephantiasis and leontiasis are still considered as aggravated forms of leprosy. (See Heber’s Travels, ii, 50; and Niebuhr’s Travels, xxvii, 11.) We may be allowed to add, in conclusion, that a great mass of misapprehension has prevailed in modern times regarding the elephantiasis of the Greeks and Arabians. We trust the above sketch will remove the difficulties which formerly beset this subject.

SECT. II.—ON LEPROSY AND PSORA.

Both these affections consist of an asperity of the skin, with pruritus or wasting of the body, having their origin from a melancholic humour. But leprosy spreads over the skin more deeply in a circular form, throwing out scales which resemble those of fishes. But psora is more superficial and variously figured, and throws out furfuraceous bodies. In these cases we must premise venesection when the body appears more than usually plethoric; but, if not, we must by all means purge with those things which evacuate black bile. Externally we may use in common either of the hellebores; and have washed lime dried, and, when going to use it, we may dilute it in water until it attain the thickness of the wrestler’s sordes, and anoint.—Another: Of sage, of the tears of Æthiopian olive, of each, dr. viij; of the bark of capper’s root, of gum, of each, dr. xiij; anoint with vinegar, in the sun. Anemone, when applied, and the root of the white vine particularly, remove psora. But the following are compound remedies: Of the flour of darnel, one chœnix; of the white cardamom, dr. iv; of the scum of natron, dr. j; of copperas, dr. viij; of the middle roots of asphodel, dr. iv; having triturated them in vinegar, and made of the thickness of a cerate, anoint, having first applied nitre to the part; and having removed it, (which do about the third day,) and washed with cold water, again anoint.—Another: Of the juice of kings’ spears’ roots, oz. vj; of sulphur vivum, of manna, of each, dr. x; of natron, dr. viij; anoint, mixing with vinegar. The following simple remedies are particularly applicable for psora: Stavesacre, bitter lupins, cardamom with vinegar, the root of lily with honey, turpentine rosin, sulphur, chick peas, goat’s dung; and these compound ones—mix equal parts of chalcitis and misy with wine, and anoint the more humid kinds of psora.—Another: Boil the tender leaves of rose-bay in a sextarius of oil until they are dried, and, throwing away the leaves, add to the oil oz. iij of white wax, and, after it is dissolved, cool and sprinkle upon it oz. j of sulphur vivum, and anoint in the sun or in the bath. Some boil also squills with the rose-bay.—Another: Of diachylon, oz. ij; of wax, oz. ij; of oil of roses, oz. j; of litharge, oz. iij; of ceruse, oz. iij; of liquid pitch, oz. vj; of the dross of silver, oz. ij; of siricum, oz. ij; of vinegar, what will be sufficient for the trituration of the dry things.—Another: Of ceruse, oz. ss; of starch, oz. ss; of lead, oz. j; of red lotuses, or of alkanet, oz. ij; of wax, oz. vj; of oil of roses, oz. ix; boil the alkanet properly with the oil of roses, and then add the other things.—Another: Take ten eggs, or as many as are required, and having macerated in the most acrid vinegar until their shell become tender; boil in the vinegar the yelks of them; having triturated with rose-oil and what remains of the vinegar a moderate quantity of litharge, anoint, when of the consistence of the sordes of oil in baths.—Another: Three yelks of eggs out of vinegar; of rose-oil, oz. vj; of sulphur vivum, oz. iij; having triturated the yelks of the eggs and the sulphur with the vinegar, add the cerate. And litharge triturated with vinegar and rose oil, until it be of the consistence of a plaster, cleanses the most acrid kinds of psora; and the detergent ointments from dock, and the most of those for elephantiasis, answer well in general with leprosy and psora.

Commentary. See Hippocrates (de Usu Humidorum, Epidem. ii); Galen. (Meth. Med. xiv; de Causis Sympt. iii, 6; et alibi); Oribasius (Morb. Curat, iii, 58); Aëtius (xiii, 134); Actuarius (Meth. Med. ii, 11); Nonnus (Epit. 234); Pseudo-Dioscor. (Euporist. i, 128); Leo (vii, 15, 18); Pollux (Onomasticon, iv, 9); Æschylus (Choeph. 274); Alexander Aphrodisiensis (Prob. i, 146, and ii, 42); Celsus (v, 28); Scribonius Largus; Octavius Horatianus (i, 31); Serenus Samonicus; Marcellus (de Med. xix); Isidorus (Orig. iv, 8); Psellus (op. Medicum); Vegetius (Mulom. iii, 71); Geopon. (xviii, 15); Serapion (v, 2); Avicenna (iv, 7, 2, 9); Avenzoar (ii, 7, 4); Haly Abbas (Theor. viii, 16; Pract. iv, 4); Alsaharavius (xxxi, 1, 2, 3, 4); Rhases (ad Mansor. v, 31 et seq.; Divis. 117, et seq.); Contin. (xxxvi.)

As in the preceding chapter, we shall here give a separate account of the views of the Greeks, Latins, and Arabians, beginning, in this instance, with the Greeks.

Hippocrates makes only casual mention of these diseases, and has nowhere marked their distinguishing characters. In one place he calls leprosy a blemish rather than a disease; and in another he remarks that some varieties of it itch before rain. He speaks of vinegar, and of lime and water as remedies for it. It is proper to apprize the reader that the two works quoted above from the Hippocratic Collection are, most probably, not genuine.

Galen also is very deficient on the subject of lepra, having nowhere given a complete description of it, although he notices it incidentally in many parts of his works. In one place he calls elephas, leuce, and alphos cognate affections. Alphos, he says, is much more superficial than leuce. In another, he attributes these complaints to the melancholic humour which becomes fixed in the skin. In the ‘Isagogue,’ which, however, seems not to be a genuine work of his, it is said that lepra is an affection of the skin, which becomes whiter and rougher than natural, the roughness resembling that from prominent psydracia. Psora is said to partake more of the nature of ulceration. Both are represented as arising from a saltish phlegm, and as being cured by phlegmagogues, and ointments rubbed into the skin. It is also stated that leuce is distinguished from lepra by there being no roughness of the skin in the former disease. In another place he mentions psora as a disease most inveterate to cure. (Facult. Natur. i, 13.)

Oribasius thus distinguishes leuce, alphos, melas, lepra, and psora from one another. Leuce is occasioned by a pituitous and viscid blood, which, in process of time, renders the colour white. Alphos arises in like manner, but the superficial skin only is affected, and not the whole flesh. When a pituitous humour is the cause of the complaint, it puts on the appearance of alphos, and when the melancholic, of melas. Lepra affects mostly the deep-seated parts, and psora the superficial. For all these complaints he recommends a mixture of lime and water and some other such things.

In the ‘Euporista,’ generally ascribed to Dioscorides, there is given a long list of medicinal articles for lepra, such as the flour of darnel with sulphur, hellebore with vinegar, verdigris, cantharides, &c.

Aëtius, copying from Archigenes, thus marks the difference between lepra and its cognate diseases. Lepra differs from leuce and alphos, inasmuch as lepra is distinguished by roughness and a sense of itching, and yet the skin only is affected, and when it is removed, the flesh below is discovered to be sound; but in leuce, the flesh below assumes an unnatural degree of whiteness, while the surface of the part is very smooth, and when rubbed it soon becomes red, especially in those who are readily cured; and alphos is altogether superficial, having the appearance of a scale fastened to the skin. Lepra differs from psora, inasmuch as in psora the substances which appear on the skin are of a furfuraceous nature, while in lepra they resemble the scales of a large fish. He omits the constitutional treatment so judiciously stated by our author, but his local applications are little different. They contain hellebore, sulphur, misy, verdigris, liquid pitch, cantharides, natron, copperas, myrrh, galls, vinegar, &c., mixed in various proportions.

Actuarius states that lepra is next to elephantia in malignity, and that it is distinguished from psora by spreading deeper and having scales of a circular shape like those of fishes; whereas, psora is more superficial, and its scales are furfuraceous and of no determinate shape. Both are attended with asperity of the skin, and itching. Leuce holds the same place to alphos that lepra does to psora, that is to say, leuce is more deep-seated, and affects the colour of the hair, while alphos is more superficial, and the hair is in general unchanged. For all these affections he recommends an application containing copperas, black hellebore, arsenic, and cantharides, mixed with oil, cedar resin, or rose oil.

Psellus states correctly that the scales in leprosy assume a circular shape.

Nonnus marks the distinction between these diseases very accurately. Lepra arises from a corroding humour, and hence scales fall from the surface of the skin, and it is attended with pruritus. But lepra is more deep-seated, and affects the skin circularly; whereas psora is more superficial and variously figured. Leuce and alphos albus and niger, he says, are allied; but leuce is deeper seated, so as to change the colour of the hairs, whereas the alphi are more superficial affections.

Pollux, like most of the others, states that in leuce, when the skin is pricked, it does not bleed, and that the disease is difficult to cure. Alphos and melas, he says, are easily cured.

Although Myrepsus has not described these diseases, he gives prescriptions for various compositions to remove them. The most active ingredients in them are hellebore, natron, sulphur, quicksilver, sal ammoniac, quicklime, bay-berries, &c.

Alexander Aphrodisiensis mentions psora among the contagious diseases, but says that lepra and leuce are not contagious.

Chrysostom alludes to the common opinion that psora is a contagious disease. The poet Æschylus gives a short description of leprosy in his ‘Chöepheræ’ by the name of lichenes. (l. 277.)

Celsus nowhere uses the terms lepra and psora, and therefore there is considerable difficulty in comparing his account of these cutaneous affections with the descriptions of the Greeks. Alphos, melas, and leuce, he describes very intelligibly, connecting them together by the generic term of vitiligo. We shall give his own characteristic description of these diseases:—“Ἄλφος vocatur ubi color albus est, fere subasper, et non continuus, et quædam quasi guttæ dispersæ esse videantur: interdum etiam latius, et cum quibusdum intermissionibus serpit. Μέλας colore ab hoc differt quia niger est et umbræ similis: cætera eadem sunt. Leuce habet quiddam simile alpho, sed magis albida est et altius descendit; in eâque albi pili sunt, et lanugini similes. Priora curationem non deficillimam recipiunt: ultimum vix unquam sanescit.” Another class of cutaneous affections he connects by the generic term of impetigo, and it is to be remarked that they are all squamous diseases, and not pustular, like the complaints to which Drs. Willan and Bateman have applied the term. His second species of impetigo (as Bateman remarks) appears to be the psora of the Greeks:—“Alterum genus pejus est, simile papulæ feræ, sed asperius rubicandiusque, figuras varias habens: squamulæ ex summâ cute discedunt, rosio major est, celerius et latius procedit, certioribusque etiam quam prior temporibus et fit et desinit. Rubra cognominatur.” His third species bears some resemblance to the lepra nigricans of Willan and Bateman:—“Tertia etiamnum deterior est: nam et crassior est et durior, et magis tumet, in summâ cute finditur, et vehementius rodit, ipsa quoque squamosa sed nigra, &c. Nigræ cognomen est.” His account of the fourth species seems to refer to the lepra vulgaris:—“Quartum genus est quod curationem omnino non recipit distans colore: nam sub-albidum est et recenti cicatrici simile: squamulas habet pallidas, quasdam subalbidas, quasdam lenticulæ similes: quibus demptis nonunquam profluit sanguis.” For all these diseases he recommends a composition containing sulphur, natron, and rosin.

Scribonius Largus describes several compositions, “ad lepram, quæ quasi impetigo est cum prurigine cutis,” and for scabies. They contain sulphur, Æthiopian cumin, vinegar, frankincense.

Serenus Samonicus makes mention of a few popular remedies for scabies, prurigo, and papulæ, but he gives no description of these complaints.

Octavius Horatianus recommends for scabies (meaning, we suppose, the psora of the Greeks,) bleeding, purging, frequent baths, and external applications containing natron, frankincense, and sulphur. He does not mention lepra by name, nor does he seem to allude to it at all.

Marcellus recommends for lepra a composition containing equal parts of natron, frankincense, litharge, and sulphur pounded with vinegar.

Vegetius says that the scabies of cattle “contagiosa est et transit in plures.” Probably Virgil alludes to the scab of sheep in this line: “Nec mala vicini pecoris contagia lædant.” (Ecl. i.) He mentions, as remedies for it, sulphur, litharge, pitch, hellebore, &c. (Georg. iii, 449.) See also Geopon. (xvi, 18, xviii, 15); Columella (viii, 5); and Gratius (Cyneget. 412).

Isidorus gives the following definitions of the complaints we have been treating of: “Lepra vero cutis asperitas squammosa lepidi similis unde nomen accepit: cujus color nunc in nigridinem vertitur, nunc in alborem, nunc in ruborem. Scabies tenuis asperitas et squammata est. Impetigo est sicca scabies; prominens a corpore cum asperitate et rotunditate formæ. Hanc vulgus sarnam appellat.”

Justin applies the terms vitiligo and scabies to the diseases treated of in this chapter. See Hist. (xxxvi, 2.) We now turn to the Arabians.

In the Latin translation of Serapion, lepra and psora are described under the generic term of “impetigines in quibus excoriatur et scinditur cutis;” but they are further distinguished from one another by the specific titles of albaras nigra and pruritus. The former is characterized as arising from the melancholic humour, and as casting off round scales. The latter is said to consist of pustules, which appear on different parts of the body, are variously figured, and cast off furfuraceous scales. The leuce is described by the name of baras, as arising from viscid, pituitous blood, and being produced by a defect of the assimilative faculty. In it the flesh itself is said to be changed to a white colour. If, when pricked with the head of a needle it bleeds, there is a probability of cure; but if it does not bleed, it is incurable. The two alphi are described by the names of morphea alba and nigra. The morphea alba resembles the white albaras (leuce) only that in the latter the affection of the skin is more deep-seated, and the hairs in it are turned to a white colour; but in morphea the only change is in the external appearance of the skin. The morphea nigra (melas?) is said to resemble the albaras nigra (lepra nigricans?) only that it is more superficial.

In the Latin translation of Avicenna by Bullonensis, alphos albus and niger are distinguished by the names of morphea alba (or alguada), and morphea nigra; leuce by that of albaras; and lepra by those of albaras nigra and impetigo excorticativa. The specific differences between them are stated with great precision. The morpheæ are superficial affections of the skin, but the albaras affects also the flesh, penetrating sometimes down to the bone. All these diseases are said to arise from a weakness of the assimilative faculty. In the albaras nigra, or leprosy, the skin is said to be covered with scales, like those of a fish. Like the authorities formerly quoted, Avicenna states that in alguada (alphos albus) the hairs do not change their colour, but that they do so in albaras. The puncture of a needle likewise extracts blood from the guada, but not from the baras.

Avenzoar makes mention of the morphea alba and nigra, but has not described them particularly. These authors seem to have treated lepra and psora like the Greeks, by bleeding, melanogogues, and abstergent applications to the skin, such as the two hellebores, lime, lupines, &c.

In the translation of Haly Abbas, leuce is correctly described by the name of lepra. It is represented as a whiteness sometimes affecting the whole body, and it is said to be occasioned by debility of the assimilative faculty. When the hairs are white, and the skin does not bleed when pricked with a lancet or needle, the disease is incurable. Alphos albus is described by the name of morphea alba, and is distinguished from the former by the whiteness being more superficial, and the colour of the hairs remaining unchanged. In the morphea nigra, that is to say the alphos niger, the colour is said to be black, owing to the prevalence of black bile, and if rubbed a furfuraceous scale falls off, and it becomes red. The lepra nigricans is described by the names of impetigo and sarpedo, as an asperity of the skin, inclining to blackness or redness, and terminating in round scales, like those of fishes. For the cure of lepra, he directs us to abstain from all articles of food which engender phlegm, to take hiera of colocynth, with pepper, &c., and also the theriac of vipers, and various other internal medicines. He recommends various external applications, containing sulphur, arsenic, hellebore, spurge, &c.

Alsaharavius describes three varieties of morphea. 1st. The morphea terrestris, which is attended with furfuraceous scales on the skin, and tingling. This is evidently the psora of the Greeks. 2d. The morphea alba, which consists of a more superficial whiteness of the skin than the albaras (leuce): this is the alphos albus. 3d. The morphea nigra, is like the former, only that the colour is black. This must be the alphos niger. All these affections he treats upon much the same principles as the Greeks, namely, by evacuants, and stimulant applications to the skin, such as sulphur, hellebore, &c. Albaras he describes as a deep-seated whiteness of the skin, and directs us to prick the skin with a needle, and if it does not bleed the disease is to be set down as incurable. This, of course, is the leuce of the Greeks. He treats it upon much the same principles as the morpheæ. He appears not to make any distinction between the leuce and the lepra.

Rhases describes the lepra of the Greeks by the term impetigo; alphos albus by that of morphea alba; alphos niger by that of morphea nigra; and leuce by that of albaras. There is nothing very particular in his treatment of leprosy. It may be worth while to mention, however, that he strongly recommends leeches to the affected part, at the commencement. Scabies, he says, is formed by a salt diet, old wine, and neglect of the bath. For the cure of it, he recommends bleeding, purging, and various external applications, some of which contain quicksilver, nitre, vinegar, and the like. In his ‘Continens’ he gives a full account of these diseases, upon the authority of preceding writers. He gives the names of baras to lepra, and morphea alba to alphos. He recommends stimulant applications containing cantharides, nitre, with vinegar, &c. He says that he had found a mixture of sal ammoniac and oil of eggs an excellent application.

It will be remarked that the leuce of the Greeks, the leuce and fourth species of impetigo of Celsus, and the albaras of most of the Arabians, are the same as the lepra vulgaris of Drs. Willan and Bateman; that the alphos of most of the Greek authorities and of Celsus, and the morphea alba of most of the Arabians, correspond to the lepra alphoides of our English nosologists; that the melas, alphos niger, and common lepra of the Greeks, Celsus’ third species of impetigo and his melas, and the morphea nigra and impetigo of most of the Arabian translators, apply to the lepra nigricans of our modern arrangement; and that the psora of the Greeks, Celsus’ second species of impetigo, and the scabies of Octavius Horatianus, and of most of the Arabian translators, comprehend both the psoriasis and scabies of Willan and Bateman.

Since many of the ancient authorities speak of scabies as being infectious, they must have applied the term to the true itch, with which it is not likely, as Rayer maintains, that they were wholly unacquainted.

The earlier modern writers, such as those of the Schola Salernitana, Platearius, Guy of Cauliac, and Lanfrancus, jumble together the Latin and Arabian names, so as to produce no ordinary degree of confusion. Guy of Cauliac, indeed, maintains that there is little necessity for distinguishing lepra, alphos, melas, impetigo, gutta rosacea, and such like cutaneous complaints from one another, as they are all varieties of the same disease. Lanfrancus, however, is of a different opinion. (i, 3, 6.)

SECT. III.—ON LICHEN.

Lichen is formed by the mixture of a thin and acrid ichor with other gross humours, and passes readily into leprosy and psora; wherefore it requires to be treated by the most desiccative applications. After general depletion, if necessary, the following simple medicines will be proper: chick-peas, hellebore, the urchin which dwells among rocks, pitch mixed with cerate and rosin, the dung of the land crocodile, that of starlings fed solely upon rice. And many have cured the complaint when occurring on the chin, or other parts of the body, by this application alone: take several grains of wheat and place upon a stithy red-hot, and taking the fluid which flows from them while yet warm, anoint the part affected with lichen. The lichen of children is to be rubbed frequently with human saliva. The gum of the plum tree, when rubbed in, is beneficial in these cases. When the complaint is protracted, the leaves of the chaste tree, triturated with vinegar, are to be applied, or the leaves of capers in like manner. The following are compound applications: Dissolve sulphur with rosemary in vinegar, or with ammoniac, and anoint. A trochisk for lichen: Of artificers’ glue, dr. iv; of frankincense, dr. iij; of vinegar half a cyathus; dissolve in vinegar, and anoint.—Another: Of chalcitis, of gum, of each, dr. viij; of sulphur vivum, of misy, of each, dr. vj; of the flakes of copper, of acacia, of each, dr. ij; anoint with vinegar.—Another: Of sulphur vivum, of spuma nitri, of each, dr. iv; of the seeds of rosemary, lx; triturate with vinegar, and anoint only the part which is affected, not touching the sound skin. When dry, wash it away with cold water.—Another: Of white hellebore, dr. viij; of the flour of lupines, of burnt shell-fishes called buccina, of natron, of each, one chœnix; rub with it dry. They call that variety of lichen agrius which is nowise remedied by moderately desiccative applications, and is exacerbated by more acrid ones. These cases are therefore to be treated by applications which are sufficiently strong, without being pungent, such as this: of horned poppy, of frankincense, of alcyonium, of bitumen, of sulphur, of gum, of each, oz. j; anoint with vinegar. Boil African pitch with vinegar, and, when dissolved, anoint.—Another, for lichen and prurigo: Of copperas, of sulphur vivum, of natron, of frankincense, equal parts; use for lichen with vinegar, and for prurigo with wine.—Another, for lichen: Of ammoniac perfume, of the flour of bitter vetch, of the flour of lupines, equal parts; add to vinegar.

Commentary. See Hippocrates (de Humor., de Affect.); Galen. (Isagoge, de Med. sec. loc. v); Oribasius (Morb. Curat. iii, 59); Aëtius (viii, 16); Actuarius (Meth. Med. ii, 11); Marcellus (19); Nonnus (236); Celsus (v, 28); Pliny (H. N. xxvi, 2); Serapion (v, 2); Avicenna (iv, 7, 3, 3); Alsaharavius (Pract. xxxi, 7); Rhases (Divis. 117); Haly Abbas (Pract. iv, 10.)

Dr. Bateman states, that the exact acceptation of the term lichen cannot well be ascertained from the writings of Hippocrates; but Dr. Willan affirms that he restricted it to a papular eruption on the skin.

In the ‘Isagoge,’ usually ascribed to Galen, two varieties are described, the lichen mitis, and the lichen agrius, in both of which scales are formed upon the skin, which appear almost ulcerated when they are removed. They are to be cured by cholagogues internally, and liniments externally.

Galen remarks the tendency of the disease to pass into lepra and scabies. To prevent this, he directs desiccative and detergent applications, for the preparation of which he gives various prescriptions. One of these, which bears the name of Pamphilus, is a powerful escharotic, composed of orpiment, realgar, burnt copper, and cantharides. (Med. sec. loc. v.) He says it affects principally the chin, but is apt to spread over the face.

Oribasius, Aëtius, Actuarius, and Nonnus, treat of the complaint in nearly the same terms as our author. Their translators improperly render it by impetigo. Leo ascribes the origin of the disease to hot and corrupted blood.

Celsus describes the lichen of the Greeks by the name of papula, of which he mentions two varieties. In the first, he says, the skin is merely roughened by small pustules, is reddened and slightly corroded; the middle is somewhat smoother, and it spreads slowly, generally in a round shape. This description would seem to apply to the lichen circumscriptus of Drs. Bateman and Willan, although the latter author thinks that it possessed a wider signification. The second variety, he says, is called ἀγρία by the Greeks, and in it the skin is more rough, red, and corroded. The more it departs from the circular form the less tractable is it, and, unless removed, it is said to pass into impetigo. From this account it is clear that the lichen of the Greeks, in its original form, was different from impetigo. Celsus recommends friction with the saliva of a fasting person, and also mentions a composition containing natron, frankincense, sulphur, &c.

The translator of Serapion improperly renders the name of this affection by the term impetigo. His remedies are nearly the same as our author’s, namely, the saliva of a person fasting, compositions containing hellebore, natron, the ashes of starlings, &c.

In the translation of Avicenna it is likewise described by the name of impetigo. It is called a species of dry achor, by which is no doubt meant papula. It is stated that it has a tendency to pass into lepra or psora. The remedies which are recommended are human saliva, the chaste tree, capers, leeches (which are not mentioned by the Greeks), likewise gum arabic dissolved in vinegar, mustard and vinegar, salt water, the roots of king’s spear, &c. Haly Abbas recommends stimulant liniments of a similar kind.

Rhases briefly recommends lotions of vinegar and ammoniac, and, when it becomes inveterate, leeches, strong friction, &c. His translator also misapplies the term impetigo to it.

The lichen appears to be the cutaneous complaint which Alsaharavius describes by the name of alcoab. He represents it as a superficial ulceration, and mentions four species of it.

Dr. Willan confirms the statement of the ancient authorities, that the disease has a tendency to pass into lepra and psora. The species called lichen tropicus by Dr. Willan, seems to be the hidroa of Hippocrates (Aph. iii, 21); the sudamen of Pliny (xxiii, 45); one of the essere of Haly Abbas (Theor. viii, 17); one of the alsara of Alsaharavius (Pract. xxx, 8); and the hasef of Avicenna (iv, 7, 3, 8). See also Galen’s ‘Commentary’ (v, 261); ed. Basil. Galen says it is attended with pruritus, asperity, and ulceration. Avicenna and Rhases particularly commend bleeding, cleansing the skin, and the cold bath. Most of Rhases’ authorities in his ‘Continens,’ recommend for the asaf, or sudamen, cooling and astringent applications, containing roses, myrtles, galls, sandals, camphor, and the like. They attribute the complaint to profuse perspiration. In certain cases, Rhases directs us to allay the pruritus or tingling, with hot water and the flesh of melons. He also approves of purging with tamarinds and myrobalans. (Cont. xxxvi.) See also ad Mansor. (v, 30). Mercurialis is of opinion that Virgil alludes to the sudamina in the following lines: