SECT. XIX.—ON GANGRENE AND SPHACELUS.
When the inflammation is neither resolved nor converted into pus, it often passes into gangrene and sphacelus, of which we shall now treat. Wherefore, we give the name of gangrene to mortifications arising from the violence of the inflammation, when they are not yet formed but forming; and if such a state is not speedily cured, the affected part readily dies, and the disease seizing upon the surrounding parts, kills the person. But when the parts thus affected become totally insensible, the affection is no longer called gangrene, but sphacelus. This affection happens also to the bones when the flesh that surrounds them engendering noxious humours impregnates the bones therewith, and causes them to putrefy. When, therefore, the part is completely mortified, it must be speedily cut away, where it joins the sound part. Gangrene is to be cured by evacuating as much as possible of the blood in the affected part; and we may either procure the discharge of the corrupted blood by opening a vein, when the vein of the part is large, or we may divide the whole skin by many and deep incisions, so that the blood may be permitted to escape; and we may apply some of the medicines suitable to mortifications. These are, the flour of tares, or of darnels, or of beans with oxymel. When wishing to apply stronger ones we may add salts, or use the trochisk of Andron, or the like. Old walnuts are good applications for gangrene. The nettle also cleans them, and the juice of spurge, when applied in season and in proper quantity. The decoction of bitter lupines, poured on the part, is also beneficial. Some after the incision, for the sake of security, apply the cautery, in which cases we must use salt with leeks: afterwards, in order to remove the eschar, we may apply a cataplasm of bread, or of barley, or of wheaten flour boiled in water and oil; or the dry cephalic powder with honey, and the tetrapharmacon; and that called the Macedonian may be used. The eschars may be properly removed by bread triturated with parsley, or basil, or by iris, panacea, or birthwort, or by the sweet-flag with honey, or by frankincense. And the medicine of Machærion takes away the eschars in a proper manner, and the iris spread upon pledgets with honey; but in soft bodies the flour of tares, with honey, is sufficient.
From the works of Oribasius, for gangrene. Of scraped verdigris, of vermilion, of stone alum, equal parts; triturate in water and anoint. The flour of darnel, with radish and salts, and sometimes with vinegar, will, when applied as a cataplasm, be proper for the scarified parts; also dried grapes deprived of their stones with the bark, and with salts and oxymel; the inner parts of walnuts, and myrtle leaves boiled in wine and triturated with honey. Radish, with vinegar, breaks the eschars even to the bone.
Commentary. See the authors referred to in the 17th Section.
Paulus copies freely from Oribasius (Synops. vii, 27.) Upon comparing Oribasius with our author we have ventured to give an interpretation of the last sentence not justified by the text as it now stands, and at variance with the translation of Cornarius. Oribasius does not say that the flour of darnel will scarify the parts (how could he?) but that it will be a proper application after the parts are scarified.
Galen (ad Glauc. and Comment. in Hippocr. App. vii. 50,) is the great ancient authority on mortification, and from him Oribasius, Aëtius, Paulus, and all the subsequent writers on this subject have copied. He lays it down as the great rule of treatment, to evacuate the blood which is impacted in the part and prevents the diastole of the arteries. To accomplish this end he directs free incisions to be made, after which the actual cautery is to be applied, at the line of separation between the sound and diseased parts.
Celsus is a strong advocate for this practice, which has been revived lately and is much used in France. (See Encyclopédie Méthiodique, art. Gangrène, and Cross’s Sketches of the Medical Schools in Paris.) He states, however, that when the disease goes on spreading, amputation of the mortified limb is the “auxilium unicum.” At the commencement he approves of venesection, if the strength permit, and of a restricted diet; and, afterwards, astringent food and drink are to be given. He also recommends, for gangrene, applications containing arsenic, quicklime, chalcitis, and the like (v, 22.)
The practice of the Arabians is little or nothing different from that of the Greeks. Avicenna at the commencement approves of Armenian bole and terra sigillata with vinegar; but if these have not the effect he directs us to empty the part by scarifications, leeches, or opening the veins which lead to it. He then recommends us to apply the flour of beans and the other remedies mentioned by the Greeks. When the disease proceeds, free incisions and the actual cautery must be had recourse to. Alsaharavius recommends us to bleed at first, if the strength permit; then to use powerful caustics and escharotics such as arsenic, quicklime, and sublimed quicksilver; or if these do not succeed, the actual cautery. He approves of early incisions, and of amputation, if the mortification spread. He describes a species of gangrene which seizes the hand and spreads upwards; and relates a case of it in which he refused to amputate for fear of hemorrhage. The same case is related by Albucasis, which certainly amounts to a strong presumptive proof that Alsaharavius was the same person as Albucasis. Rhases inculcates in the strongest terms that when an inflammation threatens to terminate in mortification, it is to be treated by scarifications, stimulant applications, and the cautery.
The earlier modern surgeons followed the ancient practice of applying the cautery in cases of gangrene.
SECT. XX.—ON HERPES.
When yellow bile, unmixed with any other humour is fixed in a part, the affection is called herpes: but if it is thicker and rather acrid it ulcerates the whole skin as far as the subjacent flesh, and is called herpes exedens; but if it is thin, less acrid and hot, it raises small blisters on the surface of the skin like millet-seeds, and hence has been called herpes miliaris. According to Oribasius, a mixture of phlegm, with yellow bile, produces the herpes miliaris. Wherefore we may evacuate the whole body with cholagogue medicines, and apply cooling and desiccant things to the affected part. At the commencement, therefore, we may apply cataplasms from vine shoots, bramble, and plantain; but afterwards we may add lentil to them, sometimes with honey and polenta. And the cataplasm recommended for phlegmons from defluxion may be applied without the house-leek. But ulcerated parts are to be rubbed with trochisks dissolved in must, or in a thin and austere wine, not very old, or in a watery oxycrate. Administer also horned poppy, and similar things in water; and when these do not prove effectual, vinegar may be added. But wine diluted with the juice of plantain or strychnos is of great service, or linseed bruised and boiled in wine and oil may be applied; or Cimolian earth, mixed with the juice of strychnos may be applied by anointing: and take of litharge, oz. iv; of the juice of leeks, vij cyathi, and of the juice of beet an equal quantity, triturate and anoint. But when these ulcers have become chronic, the trochisk of Musa and that of Andron will be convenient applications.—Another: For herpes phlyctænodes: having triturated the dross of lead in austere wine and anointed with it, apply above it beet leaves boiled in wine, or of wax, oz. iv; of myrtle oil, oz. xvj; of the dross of lead, oz. iv; anoint with one half of wine. When it has stopped from spreading, use the cerate from the dross; or apply boiled lentil with honey. For herpes, under the skin, mix the dross of lead with the juice of levigated rue, or myrtle cerate, instead of the rue.—Another: Of old unwashed wool wrapped round a dead pine and burnt, dr. xij ss; of wax, dr. xxv; of the dross of lead half an acetabulum; of goat’s tallow cured and washed in water, dr. xxxj; of myrtle oil, oz. v.—Another: To those which spread rapidly: of the rind of the sweet pomegranate, dr. vj; of litharge, dr. vj; of unwashed wool about a dead pine and burnt, dr. iij; of wax, dr. xij; of ceruse, dr. viij; of fissile alum, dr. j; add to wine and myrtle oil.
Commentary. The writers on phlegmon treat immediately afterwards of herpes and erysipelas. Fabricius ab Aquapendente, Dr. Bateman, and most of our modern authorities on this subject, are of opinion that the ignis sacer of Celsus and the other Latin authors was herpes. Scribonius Largus, however, distinguishes the ignis sacer from zona, which, he says, was called herpes by the Greeks. The ignis sacer of Octavius Horatianus likewise appears to be erysipelas. And Isidorus states decidedly that the ignis sacer was erysipelas:—“Erysipelas est quam Latini sacrum ignem appellant, id est, execrandum, per antiphrasin. Siquidem in superficie rubore flammeo cutes rubescunt. Tunc mutuo rubore quasi ab igne vicina invaduntur loca ita est etiam febris excitatur.” (See a learned dissertation on the ignus sacer in Burman’s edition of Serenus Samonicus, ‘Poet. Latini Minores.’ ii, 335.) Having thus stated the doubts which prevail respecting the ignis sacer of the ancients, we shall return to Celsus’s account of it, which certainly, as already mentioned, seems to apply to herpes. He describes two varieties of it. The first is reddish, or a mixture of redness and paleness, and in it the skin is covered with a great number of small pustules. The disease spreads, the part first affected either healing, or becoming ulcerated from the rupture of the pustules and discharging a humour intermediate between sanies and pus. The breast and sides are mentioned as being frequently the seat of this complaint, and hence Bateman concludes that it is the herpes zoster. The second variety is described as consisting of a superficial ulceration of the skin, broad, somewhat livid, but unequal; the middle part healing as the extremities spread, and the part about to become affected becoming swelled, hard, and of a colour compounded of black and red. It affects principally old and cachectic persons, especially their legs. We cannot understand what could have led Dr. Bateman to think that this is the same as the herpes circinatus of his arrangement. Rayer rather supposes it to be the dartre squameuse centrifuge Alibert. His general treatment consists of abstinence, opening the belly, food intermediate between the glutinous and saltish, and if there is no fever, exercise, austere wine, and the like. The ulcers (vesicles?) are to be washed with hot water, or, if they spread, with hot wine; they are then to be opened with a needle, and dressed with applications for eating away putrid flesh. When the sore is cleaned, gentle applications are to be used.
For the zona or herpes, Scribonius Largus recommends applications containing alum, galls, chalcitis, misy, quicklime, &c.
Pollux defines herpes to be inflammatory and pungent pustules, which spread most commonly about the neck, but sometimes affect also the hands and feet.
Galen gives a very full account of the nature and treatment of herpes. According to him the complaint arises from yellow bile separated from the blood and fixed in a part. When it is thickish it ulcerates the skin down to the bone, and forms the disease called by Hippocrates herpes exedens. But if thinner, it only burns as it were the surface, when it is called by the generic term of herpes. Of the other two varieties, the one, as has been said, is called exedens, and the other miliaris, because it is attended with many small bullæ (phlyctænæ) like millet-seeds. As our author’s treatment is entirely derived from him we shall not enter into any detailed exposition of his practice. We may mention, however, that he decidedly recommends purgatives for proper herpes. When the ulceration is of a malignant nature and attended with putridity it requires the most acrid medicines, and such as in power resemble fire, namely, misy, chalcitis, arsenic, quicklime, and sandarach. For, he adds, these medicines burn like fire, and often when they fail, we must have recourse to fire itself.
Aëtius gives an accurate account of herpes, but it is professedly borrowed from Galen. Like him he divides the disease into three varieties, the herpes proprius, the herpes exedens, and the herpes miliaris, the last being characterized by an eruption of vesicles (phlyctænæ). We shall here notice what Dr. Bateman says respecting this division of herpes:—“The ancient division of herpes into three varieties, miliary (κεγχρίας), vesicular (φλυκταινώδης), and eroding (ἐσθιόμενος), may be properly discarded, for there appears to be no essential difference between the first two, which differ only in respect to the size of the vesicles.” This is evidently an incorrect account of the ancient division, in which no distinction was made between the herpes miliaris and the herpes phlyctænodes.
Palladius makes mention of only two varieties of the disease, namely, the proper, and the eroding herpes. (De Febribus 2.)
Leo briefly refers to Galen’s account of the disease (vii, 3.)
Actuarius mentions only the proper herpes, and the herpes miliaris. This is, perhaps the best division of any, as the herpes exedens is evidently a disease of a very different nature from the other varieties.
The Pseudo-Dioscorides recommends strong stimulant applications containing sori, misy, sulphur, onions, &c.
Avicenna seems to confound herpes with myrmecia, which detracts from the value of his account of it. (iv, 3, 1, 7.)
Rhases describes separately the formica miliaris or herpes miliaris, and the herpes esthiomenos or exedens. For the former he recommends astringent applications, for the latter strong caustics. In his ‘Continens’ he directs the herpes miliaris to be treated with cholagogues and astringent applications.
Serapion in like manner describes two varieties of the disease, but his account of it contains nothing particularly interesting.
Haly Abbas adopts the division laid down by Galen (Theor. viii, 10.) His treatment also is quite similar (Pract. iii, 29.)
In the translation of Alsaharavius the three varieties are described by the names of formica or erysipelas muscina, formica corrosiva (herpes exedens?), and formica miliaris. He describes the formica corrosiva as being a dangerous complaint, spreading deeper and deeper. His treatment, although amply detailed, contains nothing remarkable (Pract. xxix, 9.)
The earlier modern writers on medicine being the servile copyists of the Arabians, describe herpes by the name of formica, as a disease nearly allied to erysipelas, and like it arising from corrupted bile. See Guy of Cauliac (ii, 1), and Theoderic (iii, 16). For the herpes esthiomenos or lupus they recommend the application of arsenic or the actual cautery.
SECT. XXI.—FOR ERYSIPELAS.
Galen, giving the name of erysipelas, more especially to the swelling formed of a hot and thin blood, to that which is formed of both blood and bile, he applies an appellation from the prevailing humour, calling it erysipelatous inflammation when blood prevails, and inflammatory erysipelas when yellow bile prevails. But in general the swelling formed of hot blood and bile is called by him erysipelas. Whatever division we adopt, it will make no great difference as to the treatment. But it is proper to know that erysipelas is a most dangerous disease, more particularly about the head; so that if active treatment be not resorted to, it will sometimes prove fatal to the patients by suffocation. At its first appearance then we must open a vein at the elbow, especially the humeral, or, if it cannot be seen, any one that appears. But if any thing prohibit venesection we must have recourse to purging by cholagogue medicines. The same treatment may be applied to erysipelas of other parts, or we may administer strong clysters. And we are to rub the parts affected by erysipelas with cooling things, in order to repel the defluxion, and with moderately heating and moistening things so as to dissipate that which is collected, before the parts become livid or black; but the parts which are anointed are to be kept constantly in a wet state, by frequently changing the applications, which may be done by cleansing them with soaked sponges: for the heat of the part by converting them into vapour soon renders it dry. As I have said, erysipelas at the beginning requires such things as are cooling and moistening, without astringency; such as house-leek, purslain, and fleawort; the marsh lentil, endive, and gourd; the nightshade, henbane, lettuce, and horned poppy. And parsley, and the leaves of rhamnus by themselves, and made into a cataplasm with bread, are proper applications; also cerates used with very cold water; but we may mix with them some opium, the juice of poppy, cicuta, and mandragora, and thus form them into compound applications. And a cerate may be made of white wax mixed with four parts of rose-oil, prepared from the oil of unripe olives without salts, the ingredients being pounded in a mortar, and as much cold water poured in as it can receive. But if you add a little thin and transparent vinegar, you will render the medicine still better: but polenta, with some of the aforementioned cooling herbs, cool very properly, and fat dates with any of them. And the part may be anointed with ceruse, Cimolian, or potter’s earth, with the juice of strychnos, or litharge with rose-oil, or chalcitis with oil and must; or ceruse, with vinegar and buckthorn; or acacia, with vinegar. When the effervescence subsides we may use these simple applications, native sulphur and mint, with vinegar and rose-oil; or rue with worm-wood; vinegar and oil, or litharge with the juice of leeks and beet; or compound ones, as this trochisk, more especially to the head: of litharge, of ceruse, of saffron, of native sulphur, of opium with must; and in common, for all parts, of Sinopic vermilion, of chalcitis, of roasted misy, of verdigris, of copperas, of fissile alum equal parts, use with vinegar.—Another: Of native sulphur, of ceruse, of opium, of acacia equal parts; use with vinegar. A cataplasm for erysipelas, herpes, abscess, parotis, and burning: of the tender leaves of fresh marsh-mallows, lb. j; having boiled in water and oil, triturate properly, and adding of rose-oil, oz. iv; of litharge, of ceruse, of each, oz. iiss; triturate again with the juice of coriander, or of house-leek, or of strychnos, then adding crumbs of bread so as to form a plaster, apply it. And use this plaster: of oleum cicinum, i. e. castor-oil, lb. j; of oil of myrrh, lb. j; of wax, oz. v; of litharge, oz. iv; of scraped verdigris, oz. ij; the verdigris and litharge are to be triturated with vinegar. A cerate for erysipelas and burns: of white wax, oz. iv; of rose-oil, oz. iij; six eggs, of pellitory of the wall, oz. iv. When the inflammation ceases or becomes chronic, before the part becomes livid, apply a cataplasm of raw barley-meal; but if it has already become livid, incisions must be made in the part, and cataplasms moreover applied, and hot sweet water poured on it, and sometimes sea-water or brine; and sometimes these ingredients are to be mixed with the cataplasm, and then we must use the aforesaid compound medicines with caution: for should these symptoms continue, a transition to suppuration or mortification takes place.
Commentary. Hippocrates in his ‘Prognostics’ has stated the danger of an erysipelas being translated to an internal part. He also states that gangrene supervening upon erysipelas is dangerous. He has not, however, given any very particular account of the disease. In one of his aphorisms he states that cold is useful in erysipelas when not ulcerated, but prejudicial when it is ulcerated. His commentators, Theophilus and Damascius, confirm this statement. (Scholia in Hip. et Galen, ii, 456).
Celsus recommends bleeding if the strength permit, and then repellent and refrigerant applications, especially ceruse with the juice of solanum (nightshade), or Cimolian earth with river water, and the like. When refrigerants fail to produce the effect, sulphur, ceruse, and saffron are to be pounded with wine and applied. If the part become putrid he directs us to use corrosive applications or the actual cautery. Afterwards the sore is to be cleansed with honey and rosin, and treated upon general principles.
We have stated in the preceding Section that the ignis sacer of Scribonius Largus is not herpes. That it was erysipelas seems probable from the similarity between his applications for it and those which Celsus and the other authorities recommend for erysipelas. Thus for ignis sacer he recommends Cimolian chalk, diluted with the juice of solanum, or the solanum by itself, or with bread; or a mixture of sulphur vivum, ceruse, and litharge.
We may remark further in this place that the ignis sacer, or St. Anthony’s fire of the middle ages, would appear to have been some variety of erysipelas.
Galen’s account of erysipelas is particularly deserving of attention. In the 14th Book of his ‘Meth. Med.,’ he is at pains to state the nature of the disease, and the difference between it and phlegmon. The common symptoms of both are heat and swelling. But they differ, first and principally in colour, which is red in phlegmon, but pale or yellow, or a compound of both, in erysipelas. Throbbing is also a characteristic symptom of a great phlegmon, for it is deep-seated, whereas erysipelas is rather in the skin. Erysipelas, he pointedly inculcates, is occasioned by a bilious humour. This humour being thin, readily passes the fleshy and rare parts, and flows to the skin, where, unless it be particularly watery, it is unable to pass the pores, and, consequently, is retained. When things, indeed, are in their natural state, this bitter bile passes through the pores of the skin by the insensible perspiration, but when it is either too abundant or thicker than usual, it is retained by the skin, which it inflames and causes to swell: hence the reason why erysipelas chiefly affects the skin or the prolongation of it which lines the internal cavities. He states that the great indication of cure is refrigeration or cooling, but that there is danger of carrying this plan too far, lest the humour should be driven to some vital part: wherefore cooling applications are to be used until the part change its colour, but are not to be continued until it become black or livid. It is necessary, therefore, as soon as a change of colour in the affected part is remarked, to exchange them for those of a contrary nature. His cooling applications consist of strychnos (solanum?) and the other articles mentioned by our author. When the part becomes livid, he directs us to make incisions, and afterwards to apply cataplasms and fomentations with hot water, to which salt or vinegar may sometimes be added. It is only at this time that quicklime may safely be added to the applications; for it would prove highly prejudicial at first. With respect to the general treatment, he approves strongly of cholagogues, but does not think bleeding necessary in ordinary cases. When erysipelas arises from ulcers or any obvious causes, he recommends scarifications and cataplasms of barley flour. He recommends much the same plan of treatment in his ‘Therapeut. ad Glauc.’ ii. He speaks highly of early incisions.
Aëtius, as he professes, merely copies from Galen.
Oribasius recommends, at first, such things as are cooling without astringency; namely, henbane, nightshade, &c. When the inflammation subsides, he directs us, before the part becomes livid, to apply a cataplasm of barley flour; but when it does become livid, he recommends free incisions, and afterwards cataplasms and fomentations with fresh water, or water with salt and brine.
Actuarius states the danger of carrying refrigerant and repellent applications too far, and recommends something discutient to be added to them.
Octavius Horatianus approves of bleeding (unless contra-indicated by the want of strength), and of cholagogues, with free incisions and fomentations.
Avicenna states that bleeding in general does no good, unless the humour be seated between the two skins. He approves most of cholagogues and of applications strongly refrigerant; only he cautions us not to carry this plan too far, lest the disease be determined to an internal part, or terminate in gangrene.
Serapion treats of the disease very accurately by the name of al massire, but in nearly the same terms as Galen. He approves decidedly of cooling and repellent applications at the commencement. Serapion and Avicenna notice the eruption of bullæ in erysipelas.
Haly Abbas directs us, when erysipelas is not attended with swelling, to use cooling and repellent applications to the part, and to administer gentle cholagogues, such as myrobalans, tamarinds, and prunes. But if swelling be present, and if there is nothing to contra-indicate venesection, he recommends us to bleed and apply cataplasms.
Alsaharavius describes three varieties of erysipelas; namely, the erysipelas properly so called, the ignis Persicus, and the erysipelas inflativa. The first variety, he says, is attended solely with redness of the cuticle. It is to be treated by bleeding, purging, and local applications of a cooling and humid nature. In the ignis Persicus, the heat and redness are strong, and black blisters rise on the part. It is to be treated by bleeding at the commencement, and scarifications. The erysipelas inflativa arises with a sudden swelling, and blisters, like those produced by fire. It is to be treated by bleeding and cooling applications, containing ceruse, litharge, &c. The ignis Persicus would appear to have been some variety of anthrax, or the malignant pustule.
None of the ancient authorities express themselves so decidedly favorable to bleeding as Rhases. Like the others, he attributes it to heated bile. He, and most of the authors quoted by him in his ‘Continens,’ approve of cooling applications, but he cautions against carrying this practice too far. He remarks that vesicles like those from burning often arise on the part.
Fabricius ab Aquapendente is a strong advocate for the ancient theory, of which he gives a full explanation. The system, he says, being loaded with vitiated bile, the more important organs cast it off: it is, therefore, sent outwardly, and is detained by the cuticle when its pores are obstructed. He attempts to reconcile the contrary opinions of the ancients with regard to venesection. He himself approves decidedly of bleeding when the disease is seated in the head or neck.
None of the ancient authorities seem to have entertained the same apprehensions as most of the moderns do against liquid applications in cases of erysipelas. When this prejudice became general we do not exactly know. Heister mentions that, in his days, some surgeons disapproved of liquid applications, but, as he thought, without any good reason. He himself recommends camphorated spirit of wine. The earlier modern surgeons, as, for example, Brunus and Theodoricus, decidedly recommend cold applications at the commencement. When the disease is not thereby resolved, they direct us to have recourse to leeches and scarifications. They approve much of cholagogue purgatives, but do not recommend bleeding unless inflammatory symptoms run high.
SECT. XXII.—ON PHYMA, BUBO, AND PHYGETHLON.
According to Galen, phyma, bubo, and phygethlon, are affections of the glands: bubo being an inflammation of a gland; phygethlon, an inflammatory erysipelas, or an erysipelatous inflammation of a gland; and phyma, an inflammation of a gland passing rapidly into suppuration. But, according to others, all tumours of the nature of apostemes, which arise in any part of the body, are called phymata. For Hippocrates says, “Those in whose urethra phymata form are relieved when they suppurate and burst.” Wherefore those buboes which are occasioned by accidents, either ulcers or pains, are not dangerous; but those which occur in fevers, more especially in the pestilential, are of a very bad description, whether they are formed in the groins, the armpits, or neck. But those of the first kind, as is the case in every other inflammation, we must endeavour to put back with cooling and astringent applications, either applying a sponge out of oxycrate, or wool out of wine and raw oil, or oil of roses, or oil of apples, or oil of lentisk, or oil of myrtles; and then we are to apply diaphoretics. But if the whole body is plethoric, it is to be evacuated. If free from superfluities, we must manage the ulcer arising from it in the manner to be described when treating of ulcers. When the gland is in a state of inflammation, it is to be mitigated by wool soaked in some of the emollient oils, and the whole limb is to be wrapped therewith. When the tumour has suppurated, we must not be in haste to open it, but endeavour to dissipate it by the medicines in the form of cerates, such as that prepared from apyranon, and that from herbs called botanica. When resolution is not thereby accomplished, we must forward the rupture as in the other abscesses, and cure it in like manner as them. In those buboes which arise in fevers or from a collection of humours, we must abstain from all repellents, lest the matter should be repelled and regurgitate to the deep-seated parts; but we must begin at once with discutients. When nothing prohibits, such as the age or strength of the patient, venesection from the arm is to be had recourse to, and fomentations applied to the part, either from the decoction of camomile, or of dill, or of some such; but the materials of the other applications may be transferred from our account, in the Third Book, concerning parotis, and from what has been lately delivered, more especially respecting phlegmons. And in like manner the cure of phygethlon may be learned from what has been stated respecting them and erysipelas. But the herb aster atticus, which, on this account, they call bubonium, not only in the form of a cataplasm, but also when bound round the part as an amulet, is believed to be of use for buboes. Phymata may be discussed by the following applications in particular: maiden-hair; orache; pellitory of the wall; the root of marsh-mallows, boiled in wine; ammoniac, softened with honey, and applied; birdlime, with the rosin cerate. But bee-glue, bitter lupins applied with vinegar, the root of the wild cucumber added to turpentine, and in like manner root of capers, and nitre with leaven, or figs, promote the rupture of these tumours.
Commentary. The account here given of these glandular inflammations is taken from Galen (ad Glauc. ii.) See also ‘de Tumoribus’ and ‘Comment. in Hippocrat. Epid.’ vi.
Celsus describes phyma as resembling furunculus, but as being larger, and turning to pus. According to Rayer, his description of phyma applies better to the boil than his account of anthrax. (Malad. de la Peau, p. 229.) The phygethlon, he says, is a tumour not high, but broad, and containing something resembling a pustule. It occurs mostly in the armpits, neck, or groins. He proposes applications of a repellent and refrigerant nature; but if the swelling is hard, digestives must be had recourse to, such as dried figs bruised, &c. He also recommends a composition of sal ammoniac, galbanum, bee-glue, and mistletoe, with a small proportion of myrrh. His treatment is considerably different from our author’s. When matter is formed, he directs us to let it out by medicines or the lancet, but he decidedly forbids the use of cerates. In another place, however, he recommends an application containing lime, spuma nitri, round pepper, galbanum, and salt mixed with rose cerate.
Scribonius Largus recommends a malagma containing pitch, aphronitum, pine-rosin, wax, bay-berries, axunge, ammoniac, Illyrian iris, galbanum, and white pepper, for discussing phygethlon.
Oribasius and Actuarius mark the distinction between these affections in the same terms as Galen, and direct us to treat them with emollient, concoctive, and discutient applications. For concocting phymata, the Pseudo-Dioscorides recommends southernwood, boiled with raw barley flour; figs, boiled with yeast, &c.; and for breaking them, the juice of thapsia, with sulphur; cantharides, mixed with turpentine, &c. (Euporist, i, 156.)
Nonnus’ account is mostly abridged from our author’s. Thus, he recommends at first venesection, and sponges squeezed out of oxycrate and the like; then digestives are to be applied; and afterwards cataplasms and such things as will favour the rupture of the abscess, namely, compositions containing bee-glue, bitter lupins, vinegar, nitre, yeast, or figs and pitch.
Avicenna describes these affections by the name of althaum. It is remarked by his translator that the Arabian recommends the same medicines as Paulus, but neglects the distinction which the latter properly makes between the bubo when attended with pestilential fever and when without it.
The phyma seems to have been merely an acute inflammation of a gland, terminating in suppuration. The phygethlon was an erysipelatous inflammation of a gland. These complaints are well defined and described by Fabricius ab Aquapendente (1, i, 23.) Dr. Willan uses the term phyma in a different sense from that of our author. The term occurs in Marcus Antoninus (ii, 16), where see the note of Gataker.
SECT. XXIII.—ON FURUNCULUS.
Furunculus is an apostematous swelling, formed of thick humours in the fleshy parts of the body most especially; being mild when it is formed in the skin only, but of a malignant character when it rises up from a deep-seated part. Furunculus may be discussed and concocted by wheat, chewed and applied; by Egyptian mastic; by raisins, deprived of their stones, and triturated with salts, and applied—(this either discusses or breaks the swelling); or apply dried figs boiled in hydromel; or rosin may be mixed with the figs and applied; or the figs themselves, when they are fat, may be split open and applied; or leaven with nitre; or linseed with honey; or the leaves of henbane, triturated with butter: of compound applications, that which is prepared from leaven and fine flour, and that which is particularly named Dothienicon, are very applicable. Foment with soft sponges frequently dipped in hot water, and then apply the medicines.
Commentary. In this and the two following Sections, see the authorities on phlegmon.
The furunculus, according to Galen, is an inflammatory affection which is of a malignant nature when deep-seated, and differs from phyma only in hardness. (De Tumoribus.)
Furunculus, says Celsus, is an acute tubercle, attended with inflammation and pain, more especially when converted into pus. After it has been opened, and the pus discharged, there appears part of the flesh below converted into pus and part corrupted, of a whitish or reddish colour, which they call the ventricle or belly of the furunculus. He says that the disease is not attended with danger, and that medicines are necessary solely for removing it the more expeditiously. For this purpose he particularly commends galbanum. If repellent applications do not succeed, suppurative ones may be used; and, failing these, rosin or leaven. When pus is formed, no further treatment is required. According to Rayer, Celsus’ description of furunculus applies to the malignant pustule and not to the boil. (Malad. de la Peau, 233.)
The simple remedies recommended by our author are borrowed from Oribasius.
It is to be remarked that Galen, Celsus, Pliny (Nat. Hist. xxiii, 7), Octavius Horatianus, and Avicenna concur in recommending figs for furunculus or the boil. It was with a lump of figs that the prophet Isaiah cured Hezekiah’s boil.
Avicenna and Rhases treat furunculus judiciously by bleeding and purging, which prevent the formation of a large abscess. When there is throbbing in the tumour, they direct us to use maturative applications. When it is ripe, and does not break readily, they recommend us to open it. Haly Abbas says, that boils arise from gross and depraved humours. (Theor. viii, 11.) Alsaharavius also ascribes them to a full and unwholesome diet. He mentions that he often succeeded in stopping the formation of the furunculus by cauterizing it with a piece of myrtle or any other wood. When the pain is violent, he recommends an application of the leaves of henbane and poppies with the yelk of an egg. When the boil is indolent, he approves of a stimulant plaster. (Pract. xxix, 4.)
SECT. XXIV.—ON TERMINTHUS.
Oribasius says, that terminthus is a species of phyma, but that a dark bulla lies over it, which having burst, the part below appears as if excoriated, and when it is divided, the pus is found. But Dioscorides of Alexandria says, “Terminthi are eminences formed in the skin, round, of a dark green colour, like the fruit of turpentine.” These, therefore, are to be cured like other phymatous swellings, by applying the remedies there described.
Commentary. Aëtius gives the same account of terminthus, which is a species of phyma. See Hippocrat. (Epidem. ii, 11; de Humor. xi, 1); Galen (Comment. in Epidem.); Oribasius (Synops. vii, 136.) Avicenna describes these affections by the name of albothin (iv, 7, 3, 1.) He says that they are ulcers produced by black bile; that they appear upon the leg, and are of the same nature as varices.
The terminthus would appear to have been the cutaneous disease to which Willan applied the name of ecthyma.
SECT. XXV.—ON CARBUNCLE OR ANTHRAX.
When the blood having become more melancholic than natural, ferments and fixes in a part, the diseases called carbuncles are formed, which are sloughy ulcers, for the most part beginning with bullæ, like burnt parts, but sometimes without them; and the patients at first rub the part for its itchiness, whether one bulla is formed or several small ones, like millets, which, having burst, a sloughy ulcer takes place, resembling those occasioned by cauteries, the eschar being sometimes of a cineritious colour and sometimes black, along with its being fixed to the base, and in a certain manner nailed to it, and it spreads at the same time, the surrounding flesh is in a fiery state, black in the colour, and shining like bitumen and pitch. Such is the true black bile. But carbuncles that form in the flesh are speedily circumscribed; whereas those which take place in membranes or nerves remain long, and affect sympathetically the parts below, so as to give origin to erysipelatous inflammations. Not a few terminate in suppuration, and most cases are attended with fever.
Carbuncles also sometimes arise from epidemic causes. We must treat them, unless they are very small, by venesection, carrying evacuation as far as to occasion deliquium animi; and after venesection it will not be improper to make deep scarifications in the part, on account of the thickness of the humour. To the affected part we may apply such things as are moderately repellent and discutient, as the cataplasm of plantain and boiled lentil, receiving the tender part of bread baked in an earthen pan, neither very fine nor foul; and above the ulcer we must put some of the strong applications, such as those of Andron, of Polyides, and of Pasion, mixing them with must, until they are of the consistence of the sordes of oil in baths. And so also the dry Massaleotic powder, which may be diluted in like manner. And the root of dracunculus, or of birthwort, or the juice of laserwort, or the Cyrenaic juice may be properly rubbed in, each of these with vinegar. Cases of an erysipelatous nature may be anointed with the applications for erysipelas; but those parts which are suspected of being sympathetically affected are to be wrapped in unwashed wool, out of wine and oil. When the inflammation abates, we must apply to the carbuncles the cephalic cerates spread upon pledgets. That from herbs is an excellent one, and that from natron, and the dry application for spreading ulcers, separately and with rose-oil. When the hardness remains, we must use the one from apples ascribed to Serapion. But we must hasten the suppuration of the carbuncles as much as possible, by changing the cataplasms and medicines twice during the day, and once during the night. In order to root out the carbuncles, and free them from their attachments to the surrounding parts, having divided sour pomegranates, boil in vinegar, and when softened, triturate, put into a linen rag, and apply. When dried, let them be moistened with vinegar. The carbuncle is made to suppurate and burst, by the inner part of old walnuts, or even of that which is not old, and by the leaves and shoots of cypress, or by its young and tender balls (pilulæ), with barley-flour; by raisins deprived of their stones; by dried figs boiled in wine; by the flowers of horned poppy; by the juice of laserwort, with rue and some honey; by liquid pitch with raisins and axunge.
An excellent application for carbuncles. Of litharge, lb. j; of old oil, lb. j; of arsenic, oz. j; boil the oil and litharge until they do not stain, and taking them off the fire, add the arsenic, and then boil it until it become black, and having levigated it in a mortar, use upon pledgets.
For gangrene, old ulcers, those called chironia, strumous ulcers, and the gout: it is a most admirable application for carbuncle, particularly in the eyelids. Of opium, of acacia, of toasted misy, of flakes of copper, of each, dr. ij; of copperas, dr. j; of the seed of henbane, dr. j; triturate in water, and use. They say also that the ointment called tetrapharmacon, having a fifth part of frankincense, is an excellent application. But for carbuncles in the pudenda, take of chalcitis, of copperas, of each, dr. viij; of aphronitrum, dr. ij; triturate with water, and use. Sheep’s dung roasted with honey is also a good remedy. In Alexandria they use the green serapias, which is also called orchis and triorchis, with crumbs of bread, as a cataplasm for carbuncles and all sloughy ulcers; and when the eschar falls off, they cure them as a common ulcer.
Commentary. The carbuncle is briefly treated of by Hippocrates (Epidem. ii, 1), and is frequently mentioned by him as a symptom of the pestilential fever. (Epidem. iii.)
Celsus gives a very minute description of carbuncle. With regard to the treatment, nothing, he says, answers so well as immediate burning, which produces no pain, as the flesh is dead. The sore is to be treated like other burnt parts. Under the use of eroding applications a crust is formed, which, being removed from the living flesh, carries all the corrupted parts along with it, and leaves a clean cavity, which is to be filled up by incarnants. When the disease is superficial, corrosive or caustic substances may be substituted, of such a degree of strength as to produce a separation between the dead and sound flesh. But if these applications fail, recourse must be had to burning. He recommends abstinence from food and wine at the commencement, and directs water to be given freely, especially if fever be present.
Pliny gives an indistinct account of an epidemical anthrax, which, he says, prevailed in the province of Narbonne. (Nat. Hist. xxvi, 4.)
Galen ascribes the carbuncle to a defluxion of hot, black, and thick blood, which gives rise to blisters, ulcers, and eschars. He directs us to apply to the eschars those medicines the properties of which resemble fire, such as misy, chalcitis, arsenic, quicklime, and sandarach. His particular remedies are quite similar to our author’s. (Meth. Med. xiv), and (ad Glauc. ii.) He mentions the carbuncle as a very unfavorable symptom of the plague. (Epidem. iii, and de Diff. Febr. i, 6.)
The account of the carbuncle given by Aëtius is full and accurate, but is entirely derived from Galen. Oribasius, Actuarius, and Nonnus also repeat his doctrines. Actuarius says that the disease is occasioned by melancholic blood overheated. This is much the same as Galen’s theory.
Octavius Horatianus recommends bleeding at the commencement, and external applications of an acrid and caustic nature, or the actual cautery itself. When danger is apprehended from a hot cautery, he directs us to use a cold one.
In the Latin translation of Avicenna the carbuncle is described by the names of pruna and ignis Persicus. It was called pruna from a black slough which is formed in it, resembling a burnt coal. His account of the disease is ample, but mostly copied from Galen and his successors. Rhases approves of venesection at the beginning, and of the actual cautery. He also recommends an application containing mustard and figs. Alsaharavius describes the varieties of anthrax by the names of alcubam and alcoasat. (Pract. xxix, 12.) At the commencement, he approves of general bleeding and leeches, and afterwards of refrigerant and analeptic medicines, to obviate the tendency to sinking. When these things do not succeed, he directs us to use powerful caustics or the actual cautery. Serapion, like Avicenna, describes it under the name of the ignis Persicus.
Procopius mentions the anthrax as one of the symptoms of the great plague which he describes. (Persica, ii.)
For the carbunculus or anthrax, Brunus and the other writers of that age recommend, at first, bleeding and restricted diet, with maturative applications, such as figs and mustard, or the yeast cataplasm, with oil and salt. When the part becomes black, Theodoricus directs us to have recourse to the actual cautery. (iii, 12.) Municks rather disapproves both of purging and bleeding, but strongly commends the actual cautery, which he greatly prefers to the potential. (Chirurg. i.) Vigierius, however, prefers a paste made from quicklime and soap. V. Manget. (Bibl. Chirurg. i, 374.) The learned Schelhammer speaks favorably both of the potential and the actual cautery. (De Humoribus.)
SECT. XXVI.—ON CANCERS.
Cancer occurs in every part of the body; for it takes place in the eyes and uterus (as we have stated when treating of those parts), and in most other parts of the body; but it is more particularly frequent in the breasts of women, because owing to their laxity, they readily admit the thick humours which occasion it. For cancers are formed by black bile overheated; and if particularly acrid, it is attended with ulceration. On this account, they are darker than phlegmons, without being attended with the same degree of heat. The veins are filled and stretched around like the feet of the animal called cancer (crab), and hence the disease has got its appellation. But some say that it is so called because it adheres to any part which it seizes upon in an obstinate manner like the crab. Owing to the thickness of the humour which occasions it, cancer is an incurable disease, for it can neither be repelled nor discussed; not yielding to purging of the whole body, resisting the milder applications, and being exasperated by the stronger ones. It may be possible, however, to prevent incipient cancers from increasing, by evacuating the melancholic humour before it becomes fixed in the part. We may evacuate, first, if nothing prohibit, by venesection, and afterwards by purging at the commencement, with the simpler purgatives, such as giving dodder of thyme to the amount of oz. ivss; in whey or honied water, and afterwards hiera, containing the black hellebore.
The juice of strychnos may be applied to the ulcerated parts without exciting pain, a linen rag being folded and wetted in it, and laid on; but externally to this, we must apply soft wool, which also has been soaked in the juice, and care must be taken that they do not become dry, by frequently pouring on some of the juice. In all carcinomatous ulcers of a chronic nature, one may use the preparation from pompholyx; and those remedies which were mentioned in the Third Book for cancers in the womb may be applied with advantage.
For carcinomatous and malignant ulcers, for rugose ulcers on the fundament, and for inflammations on the pudenda, testicles, and breasts. In a leaden mortar, and with a leaden pestle, having triturated the Lemnian earth with oxycrate and honied water or milk, so that it become black, or having triturated rose-oil, or the oil of unripe olives, or the juice of house-leek, or that of wall-pennywort, or of lettuce, or of fleawort, or of unripe grapes in like manner, anoint with them. The patient’s diet should consist principally of the juice of ptisan and the whey of milk, and from among pot herbs, of mallows, orache, blite, and gourd, of the fishes which live among rocks, and of all kinds of fowls, except those that live in marshes.
From Archigenes, for carcinomatous and malignant ulcers. Levigate equal parts of burnt river crabs and calamine, and sprinkle or apply the ashes of crabs with cerate; or apply the seed of hedge mustard triturated with honey.
Commentary. See Hippocrates (Epidem. v); Galen (de Tumoribus; Meth. Med. xiv; Therap. ad Glauc. ii); Celsus (v, 28); Scribonius Largus; Aëtius (xvi, 43); Oribasius (Morb. Curat. iii, 28); Actuarius (Meth. Med. iv, 16); Avicenna (iv, 3, 2, 15); Serapion (v, 24); Alsaharavius (Pract. xxix, 1, 16); Avenzoar (ii, 7, 27); Haly Abbas (Pract. iii, 32); Rhases (ad Mansor. vii, 9; Contin. xxvii.)
Hippocrates relates a fatal case of cancer in the breast, attended with a sanious discharge, but he does not explain the nature of the treatment.
Our author’s description of cancer is abridged from Galen (de Tumor. l. c.) The treatment is derived from the 14th Book of the ‘Meth. Med.’ He recommends melanogogues to remove the material cause of the disease. In external applications he places little confidence, but prefers those prepared from metallic substances which have been burnt and washed. The only chance of a radical cure consists, he says, in making a complete excision of the part; but in doing this he forbids us to secure the arteries with ligatures, as they will occasion a recurrence of the disease. The part, he says, is loaded with a thick, black, or recrementitious blood. When the cancer is ulcerated, he disapproves of cutting and burning.
Celsus describes carcinoma as an immovable and unequal tumour, attended with swelling of the veins, which are pale or livid. His account of the treatment is so important that it deserves to be given in his own words: “Quidam usi sunt medicamentis adurentibus; quidam ferro adusserunt; quidam scalpello exciderunt: neque ulla unquam medicina profuit; sed adusta, protinus concitata sunt, et increverunt donec occiderent; excisa, etiam post inductam cicatricem, tamen reverterunt, et causam mortis attulerunt: cum interim plerique nullam vim adhibendo, qua tollere id malum tentent, sed imponendo tantum lenia medicamenta quæ quasi blandiantur, quo minus ad ultimam senectutem perveniant, non prohibeantur.” In another place, however, he recommends compositions containing arsenic, copperas, cantharides, galls, &c. (v, 22.) He makes a distinction between the cacoethes, or malignant tumour, and the true carcinoma, but says that the difference between them is to be recognized only “tempore et experimento.” He marks the gradations of malignant disease with singular precision: first, there is cacoethes; then carcinoma without ulceration; and last, there is the fungated ulcer. (The reading in the edition of Milligan is a great improvement.) In doubtful cases he directs us, first to apply caustics or heating medicines, and, if the disease is alleviated, to proceed to the scalpel or burning, according to circumstances; but if it is exacerbated, we are to conclude that it is of a carcinomatous nature, and must abstain from all acrid and vehement applications.
Scribonius Largus recommends for all malignant ulcers, even such as are cancerous, an application consisting of arsenic, p. vj; of squama æris, p. iij; of elaterium, p. j; of burnt paper, p. iij.
Aëtius gives from Archigenes and Leonidas an interesting account of the disease, which he divides into ulcerated cancer, and cancer without ulceration. He describes the disease in the female breast as consisting of a large tumour which is unequal and resisting, extending its roots far, and being attended with varicose veins: its colour is either cineritious, verging to redness or livid; it appears soft, but is in reality very hard; is accompanied with a pungent pain, and gives rise to malignant phlegmons in the armpits. The pains shoot to the clavicle and scapula. An ulcerated cancer, he says, goes on corroding and spreading deeper, nor can it be stopped; it discharges a sanies of an abominable smell, and is aggravated by medicines and handling. The disease he considers as generally incurable. His surgical treatment will be stated in the Sixth Book. He recommends purging with hiera and the theric, Mithridatic antidote, &c. Apparently, in order to mitigate the violence of the pains, he directs us to make an application containing equal portions of plantain, poppy heads, the seed of the wort, and other things of the like kind. For ulcerated cancer he recommends emollient epithemes, such as the one containing litharge, axunge, white wax, oil, and the yelks of eggs.
Oribasius and Actuarius supply nothing of importance that is not to be found in our author. Nonnus, according to Sprengel, is the only ancient author who attributes cancerous ulcerations to acrimony of the bile. But Nonnus merely copies the words of our author.
The Arabians agree with the Greeks in representing the disease as being produced by black bile. They were, no doubt, led to form this opinion from remarking that the blood in the part is thick and black, which they considered owing to its not being properly purged of its recrementitious sediment. The moderns deride this theory, but they have substituted nothing satisfactory in its stead. Van Swieten thinks more favorably of the ancient doctrines. (Comment. § 485.) Avicenna speaks highly of a milk diet. Serapion likewise approves of milk deprived of its butter, and of a vegetable diet. He speaks of no other treatment as being likely to prove remediable, with the exception of excision and the cautery. Haly Abbas rather approves of excision when the disease is seated in a part which admits of this operation. However, like Galen, he disapproves of tying the arteries. The characteristic symptoms of the disease, he says, are a stony hardness and distension. The account given by Alsaharavius is nothing different. Rhases has little confidence in excision. After ulceration has taken place he approves of using a cooling application, containing ceruse, tutty, rose-oil, the juice of nightshade, and some other such things of a cold nature. He mentions a case of cancer of the breast, in which the whole mamma was extirpated, but the disease returned on the other side. One of his authorities, Antyllus, describes the cancerous sore as having a tendency to spread inwards, its edges being thick, large, and everted, and the discharge thin and acrid. When the disease cannot be got completely extirpated, he forbids us to meddle with it.
Theodoricus and all the earlier modern writers on medicine, call the cancer by the name of apostema melancholicum, and recommend the same treatment for it as the Greeks and Arabians.
SECT. XXVII.—ON ŒDEMA.
Having treated of swellings formed by hot humours, we shall now treat of those from the opposite, beginning with the œdema. For as erysipelas is formed by a bilious humour, so is œdema by a pituitous, being a loose swelling devoid of pain. We are aware also, that œdematous swellings occur in the feet, in dropsical affections, in phthisis, and in cachexia, but in them the œdema is a symptom of the complaint under which the person is labouring, and requires no very particular treatment; for it will be sufficient in general to rub the limbs sometimes with vinegar and rose-oil, and sometimes with oil and salts, or the salts may be added to the vinegar and rose-oil. When the œdema is occasioned by a pituitous humour being determined to the part, a sponge soaked in oxycrate may be properly applied with a bandage loosely put on, beginning below and terminating above. The sponge ought to be new, but if such a one is not at hand, that which is may be cleaned with natron, or more especially with what is called strained lye. If the swelling do not thereby subside, we may mix some alum. And a very convenient application is a tender wick of a lamp, soaked in such a fluid, and applied. A good remedy also is horned poppy. When the œdema has become chronic, having first anointed the part with oil, and then applied a sponge out of lye, bind it firmly, and you will effect a cure. Every kind of earth discusses and represses œdematous swellings, more especially the Ægyptian, and also the matured woad.
Commentary. See Galen (ad Glauc. ii; de Tumoribus); Aëtius (xv, 1); Oribasius (Morb. Curat. iii, 51); Leo. (vii, 5); Actuarius (Meth. Med. iv, 16); Nonnus (251); Serapion (v, 23); Avicenna (iv, 3, 2); Haly Abbas (Theor. viii, 11; Pract. iii, 30); Alsaharavius (xxix, 13); Rhases (ad Mansor. vii, 12.)
Our author’s account of this disease is taken from Galen, Oribasius, Aëtius, and, in fact, all the Greek, Latin, and Arabian authorities adopt his views, without any material alteration. They all concur in recommending cooling and astringent applications, with suitable bandages; and, in certain cases, friction. Rhases recommends that the limb should be buried in heated sand. He also approves of various cooling and astringent applications with bandages. In the translation of Alsaharavius, the œdema is described by the name of apostema flegmaticum; in those of Avicenna, Haly Abbas, and Serapion, by that of undemia. The celebrated Paracelsus used the term undemia for œdema. In some late works we have seen it stated that the undemia was a species of erysipelas, but this is evidently a mistake.
SECT. XXVIII.—ON EMPHYSEMA.
Emphysema is formed by a flatulent spirit, collected sometimes under the skin, sometimes under the periosteum, or the membranes which surround the muscles. And it is also sometimes collected in the stomach and intestines, or between them and the peritoneum, in those kinds of dropsy which are called tympanitic; and it differs from œdema in this, that the parts do not pit upon pressure like it, and that it sounds like a drum. The density of the body co-operates in preventing the flatus from being dissipated, at the same time that the flatus also is of a thick nature. Wherefore, the indication of cure is to rarefy the body, and attenuate the thick air; which is to be accomplished by means of attenuant and heating remedies. When the complaint is seated in the stomach and intestines, this is to be brought about by a fine oil, having rue, cumin, or parsley seed boiled in it. And sometimes a large cupping instrument without scarificators, applied two or three times to the navel, will discuss it. When the muscles from contusion are inflated, so as to sound like an emphysema, the parts will not bear very heating and acrid applications. Wherefore, at the commencement, we must use paregorics liberally, and, when the disease is on the decline, discutients. Thus we may use sodden must with a small quantity of oil, applying them warm upon unwashed wool, or mixing the cerate of unwashed wool. And we must take care that the heat be preserved, for it is not expedient that the part be cooled. When the patient has been soothed, we are to mix vinegar and nitre or aphronitrum, and afterwards some lye; and lastly, we may use discutient plasters, for the removal of the complaint such as the following: having boiled the sordes of the oil used in baths, strain it first, so that it may become pure, and again throw it into the pot, and having triturated slaked lime like flour, sprinkle until it become of the consistence of clay, and use. A still more effectual application is the compound medicine from sycomores.
Commentary. See Galen (Meth. Med. xiv); (Therap. ad Glauc. ii); Aëtius (xv, 2); Oribasius (Synop. vii); Actuarius (Meth. Med. ii, 12); Nonnus (252); Scribonius Largus (§ 119); Avicenna (iv, 3, 2, 20); Serapion (v, 23); Alsaharavius (Pract. xxix, § 1, 14); Rhases (Divis. 127, Cont. xxvii.)
Our author has copied closely from Galen. The great indications of cure, as laid down by him and acknowledged by all subsequent authorities, are to rarefy the containing parts and attenuate the spirit. By spirit, as we stated in another place, the ancients meant a thick air or gas. The indications which we have mentioned are best fulfilled by friction with oils, in which calefacient medicines, such as cumin, parsley, anise, and the like, have been boiled. When, however, any inflammation is suspected, he properly forbids us to use acrid or heating medicines. When the pain of the bowels is violent in cases of tympanites, he allows medicines containing opium, which are to be given by the mouth if the small intestines be affected, but are to be administered in a clyster if the large intestines be the seat of the disease. When the disease is in a muscular part, he directs us to use a combination of attenuants and emollients. In certain cases he recommends dry-cupping. Oribasius, Aëtius, Actuarius, and Nonnus, adopt the views of Galen, without any alteration.
For tympanites, Scribonius recommends cumin internally.
Avicenna, like our author, in ordinary cases recommends combinations of attenuants and calefacients, dry-cupping and the like, for dispelling the spirit; but when the disease arises from contusion of the muscles, he directs us to use resolvents and paregorics. Serapion approves of similar treatment. Alsaharavius recommends attenuant and calefacient remedies externally and internally. In the translation of his works, the disease is called inflatio. Rhases recommends friction with calefacient oils; he remarks that the disease occurs most commonly in the stomach and intestines. He calls it by the name of apostema inflatum.
SECT. XXIX.—FOR SPRAINS AND CONTUSIONS.
Sprains of the joints and contusions are remedied by unwashed wool, or a sponge soaked in vinegar and oil, and applied; by the tender parts of boiled bulbous roots with honey, by the leaves of the chaste tree, salts, and roasted nitre, triturated with cerate. The affusion of sweet water, or of hot sea water, may be used. But after the inflammation and pains have subsided, apply rubbing to the sprained parts.
Commentary. See Aëtius (xiv, 71); Oribasius (Synops. vii, 14); Actuarius (Meth. Med. ii, 35); Scribonius Largus (§ 209); Rhases (Divis. i, 140.)
Aëtius makes mention of all the remedies recommended by our author, with the exception of the affusion of water; which, however, is a method of treatment deserving of attention. Oribasius mentions particularly the affusion of hot sea water. Scribonius Largus recommends a plaster containing litharge, alum, ærugo, ammoniac, &c. Rhases directs us to use attenuant ointments, sedative plasters, and loose bandages, with rest.
SECT. XXX.—ON CONTUSIONS OF THE FLESH AND ECCHYMOSIS.
The flesh being bruised by some weight falling upon it, and the small veins in it being ruptured, blood is poured out from them by exhalation, and collecting under the skin, is called ecchymoma. When the skin is not divided, a soft yielding tumour is the consequence; it is pale, and for the most part unattended with pain. Our object, therefore, is to discuss the contained blood, and that quickly, before it become black; and at first, astringents are to be mixed with the discutients, because the bruised coats of the veins stand in need of condensation. After these things, we must use those applications which are merely discutient without astringency. And by scarifying the ecchymomata at the commencement, we may thus apply the subsequent treatment. For chronic cases of ecchymoma, radish in the form of a cataplasm is a suitable remedy, but it must be taken away when it becomes pungent; or a cataplasm of the juice of radish with crumbs of bread, may be applied. The diseases called hypopion and hyposphagma, are species of ecchymosis, and also the effusion of blood below the nail from a blow; of these, the first two are treated of in their proper places in the Third Book; and the affection of the nail will be handled in the Surgical part of the work.
Commentary. This is taken almost word for word from Oribasius (Synops. vii, 14); Aëtius directs us to scarify the part affected with ecchymosis, and then to apply to it the inside of citrons (xiv, 68.)
Avicenna approves of scarifications, provided the extravasated blood cannot be got otherwise removed. (iv, 4, 2, 3.)
SECT. XXXI.—ON RUPTURE AND TEARING OF THE FLESH.
Rupture is altogether attended with ecchymosis. It is cured by medicines which are moderately heating, as the acopon from black poplars, and such as resemble it. But when the rupture is deep-seated, we must have recourse to such remedies as are more acrid and cutting. The use of the cupping instrument is likewise beneficial to them. Should therefore the whole ecchymosis be discussed, the separated flesh readily unites; but if it continue a long time, and sordes form under it, the ruptured flesh can no longer unite; and we must only apply the lips together, so that a small occasion may readily separate them, and that the intermediate space may be filled with some moisture, and in a certain manner an ecchymosis may be formed as at the commencement, except that it is sooner discussed, as containing a thin humour, whereas that at the commencement was formed of blood. Vulsion takes place when certain fibres are torn asunder, and it only requires soothing applications until the pain is removed; for they cannot be made to coalesce. Wherefore, the round birthwort, if any, is a convenient application to ruptured and torn parts; and in like manner, the root of the large centaury, and the juice of it, rhubarb, costus, and bdellium, drunk with oxymel.
Commentary. These remarks are taken from Aëtius (xiv, 69, 70); or Oribasius (Synops. vii, 14); and they are copied by Nonnus (Epit. 254); and Actuarius (Meth. Med. iv, 16.)
The Arabians treat these accidents upon exactly the same principles. See in particular Avicenna, as quoted in the preceding section.
SECT. XXXII.—ON SCIRRHUS.
Genuine scirrhus is a preternatural swelling, hard and devoid of sensibility; but that which is not genuine is only attended with diminished sensibility. That which is wholly insensible, then, is utterly incurable; but that which is attended only with diminished sensibility is not incurable, and yet it is not easily cured, for it is occasioned by a viscid and thick humour, which is fixed in the hardened parts, so as to be difficult to get discharged. Sometimes, then, the scirrhus is the original complaint, and goes on to increase; but for the most part, it is occasioned by the physicians applying too cooling and astringent remedies to erysipelas and phlegmon.
If one, therefore, apply strongly discutient medicines to indurations of the body, one will indeed produce a visible diminution of the scirrhus in a short time, but will leave the remainder of the complaint in an incurable state; for the thin moisture being dissipated, what remains is rendered dry and hard as a stone. The discutient application, then, ought to be in a certain degree emollient, without possessing manifestly heating and desiccant qualities. Such are all kinds of marrow, more especially that of a stag or of a calf, and the grease of a lion, of a panther, or of bears, or of a bull, and among birds, that of geese, of domestic fowls, or of pheasants: but that of bucks and he-goats is drier. And to these may be added, ammoniac perfume, bdellium, more especially the Scythian, the humid and fatty storax, and the Egyptian mastich. To all other parts of the body, when in a scirrhous state, these things may be applied singly, and in composition; but for tendons and ligaments, we are to dissolve in the strongest vinegar some stone that has been heated in the fire. If possible, the one to be used should be pyrites, or if not it, the lapis molaris or millstone. In this, therefore, the affected part is to be moved, so that it may receive the vapour which arises from it; and afterwards, an emollient medicine is to be applied. A thin oil then, and not water, is to be poured on the part, by all means once a day, and sometimes one may boil in the oil the root of marshmallows, or of wild cucumber. The patients ought to abstain from the use of the bath, at least from the frequent use of it. But when the scirrhus is moderately softened, the softest ammoniac is to be dissolved in very strong vinegar, and the part rubbed with it for several days in succession; after which, we must again have recourse to an emollient application, having the fattest galbanum and opoponax added to it. Such are that from bacon, that ascribed to Amythaon, and those which we are about to describe for scrofula.
Commentary. See Galen (De Tumoribus; Meth. Med. xiv; Therap. ad Glauc. ii); Oribasius (Synops. vii, 34); Aëtius (xv, 3, 4); Leo (vii, 4); Actuarius (Meth. Med. iv, 16); Serapion (v, 23); Avicenna (iv, 3, 2, 12); Haly Abbas (Pract. iii, 31); Alsaharavius (xxix, 1, 15); Rhases (Antid. i, Cont. xxvii, Antidot. i.)
This section is entirely taken from Galen (Ther. ad Glauc. l. c.) Galen’s account, however, is somewhat fuller than our author’s, and contains a case treated upon the principles which he lays down. It was a case of hard swelling in the thigh, arising from an erysipelas which had been improperly treated by astringent and cooling applications. Galen informs us that he began by pouring upon the limb an attenuant oil, namely, the Sabine; after which he caused it to be rubbed with marrows and fats medicated with bdellium, mastich, ammoniac perfume, and the like. After this he bathed the whole limb with a solution of ammoniac in very acrid vinegar. When the swelling had been lessened, but not completely removed by these means, he afterwards applied one of the pitch medicines, and at length effected a cure. In another place he states that scirrhus is sometimes allied to cancer.
Oribasius likewise recommends a combination of emollients with discutients; and Actuarius approves of the same practice.
Aëtius has a valuable chapter upon this subject. Besides the articles mentioned by our author, he recommends various rosins, turpentine, frankincense, and the like. He forbids the use of aluminous, sulphureous, and chalybeate baths. For indurations of tendons he recommends things possessed of attenuant and cutting properties combined with emollients, such as ammoniac dissolved in vinegar with melons.
The Arabians treat of scirrhus in much the same terms as the Greeks. Avicenna properly directs us to bleed when there is congestion of black blood in the part, and afterwards to use applications of a solvent and emollient nature. He and Serapion mention the same identical remedies as those of Paulus. For dissolving hard tumours he recommends an oil containing fenugreek, cyperus, and aromatic reed. Haly Abbas ascribes the formation of scirrhus to the same causes as our author, and recommends relaxant and emollient applications. Alsaharavius directs us to procure evacuations of black bile, and gives prescriptions for various emollient and discutient applications. When the usual remedies do not succeed, he advises recourse to be had to the operation. Rhases divides scirrhus into two varieties, that accompanied with sensibility, and that which is insensible. He mentions that Antyllus approved of extirpation and the actual cautery when the disease is of a corroding and cancerous nature.