SECT. XLIX.—ON FISTULA.
Fistula is a callous sinus formed for the most part from abscesses, and deriving its appellation from the pipes of reeds (fistulæ). If, therefore, it terminate with a bone, it cannot be cured without a surgical operation, unless in process of time a scale of the bone come off spontaneously. But if it does not terminate with a bone, it is to be cured by the applications for removing callosities, and the agglutinative medicines. The applications for removing callosities are such as these: the root of spondylium scraped around and applied removes the callus of fistulæ. And in like manner black hellebore applied removes the callus in two or three days; also lees of oil boiled and injected; sori in a crude state, or burnt and injected with some diluted wine, or sori and crocomagma with hydromel. Or make collyria by mixing elaterium with turpentine, and apply. Or syringe with the juice of the root of laserwort. This melts down the callus: of verdigris, dr. xij; of ammoniac, dr. ij; mix with vinegar, and form into an oblong collyrium.
A collyrium which I use for removing the callosities of fistulæ. Mix with vinegar equal parts of ammoniac perfume, of copperas, of verdigris, of misy, of chalcitis, and of gum.—Another, from the surgical works of Heliodorus: Of calamine, of misy, of copperas, of burnt copper, of gum, of each, dr. iv; of crude chalcitis, dr. iij; mix with the urine of a young person not come to manhood, and form collyria. Put this collyrium into the fistula, and apply externally the inner part of bread soaked in water, changing it until the inflammation subside, and the eschar fall off.—Another, which I received in Alexandria: Of the roots of alkanet, of toasted misy, of chalcitis, of verdigris, of fissile alum, of copperas, of aloes, of each, oz. j; triturate along with fine cantharides in vinegar, and make collyria.—Another: Of copperas, dr. ij; of chalcitis, of verdigris, of each, dr. j; mix with ammoniac and use, and when the callus is thrown off, cleanse with verdigris and eight times the quantity of the purest honied water; but after the discharge of the callus, incarnants must be used. An incarnative collyrium: of aloes, of myrrh, of ammoniac, of the cinders of egg shells, equal parts; having triturated with water form collyria, and apply.—Another: Of myrrh, of aloes, of frankincense, of pomegranate rind, equal parts, mix with water; but some use bull’s gall. The oil of unripe olives is incarnative when injected. I knew a person who injected cedar-rosin into fistulæ, and succeeded surprisingly. After it is incarnated we must have recourse to the agglutinative medicine, according to the plan described for other sinuses. “When the fistula is narrow and long,” says Galen, “and does not appear to me to contain callus internally, but only sordes, I first inject lye into it, and then allowing it to remain in the fistula until I expect that the sordes has fallen completely off, I afterwards apply the medicine.” It was the one from the oil of palma Christi, mentioned above.
Commentary. We shall have occasion to refer to the Hippocratic treatise ‘De Fistulis,’ in the Sixth Book.
Celsus treats of fistulæ with more than his wonted minuteness. This is his definition: “Id nomen est ulceri alto, angusto, calloso.” He has described all the complications of it with great accuracy. He directs us to commence by making an inspection with a probe or sound, so as to ascertain the state of the parts and of the discharge. If a soft body is felt at the bottom, we conclude that the fistula terminates in the flesh, but if a hard one is felt, we know that it ends with a bone. If the probe slide readily over the bone, it is free from caries, but if it does not so, and yet no inequalities are felt on it, caries has taken place, but it is still smooth: if it feel unequal and rough, the bone is eaten with caries. For a simple and recent fistula, not deep-seated or in a joint, the plaster for recent wounds will be sufficient, provided salt, or alum, or the scales of copper, or verdigris, or any of the other metals, be added to it. The application is to be made upon a piece of linen, and a sponge soaked in vinegar is to be put over it, and is to be removed on the fifth day. The patient must live upon nutritious food. If the fistula is at a distance from the præcordia, emetics with radishes are said by him to be proper. When the fistula is old it becomes callous, and requires stronger applications, containing such ingredients as calamine, atramentum sutorium, verdigris, galls, lime, orpiment, or realgur. He mentions as a very ready application a solution of ammoniac in vinegar, with some verdigris added to it. However, he remarks, any other caustic will accomplish the same purpose. If the fistula is long and transverse, an incision is to be made at its commencement, after which the collyrium may be applied. When the fistula is double, or consists of still more passages, he recommends us to blow in with a writing pen the medicines in the form of powder, or to apply them dissolved in wine, mulse, or vinegar. But whatever the internal dressing be, he recommends us to apply on the outside of it something of a refrigerant and repressing nature, as the parts around are generally affected with inflammation. When the dressings are removed the fistula is to be syringed with wine if the discharge of the pus is copious, with vinegar if its edges are callous, but with mulse, or a decoction of tares, if the passage be clean. By the means we have been describing it will generally happen, he says, that the inner coat of the fistula will slough off, and leave the ulcer in a clean state. Agglutinants are then to be applied, especially a sponge smeared with boiled honey. When the sides of the fistula are clean there need be no apprehension lest they do not adhere, since, he remarks, we often see in ulcerations of the fingers that without great care one finger is apt to adhere to another.
In the ‘Euporista’ of the Pseudo-Dioscorides, it is recommended first to dilate the fistula with a piece of sponge, and then to use a stimulant application containing verdigris, ammoniac, &c.
Aëtius gives an excellent account of fistula, but it is mostly borrowed from Galen. We can afford room only for a few extracts. When a fistula extends obliquely, nothing can be done without making a free incision, for which purpose he directs us to introduce a sound and cut along it. His directions for examining into the nature of a fistula are such as ample experience alone could have dictated. He seems to be decidedly of opinion that, except in cases of a recent fistula, or when it is not deep-seated, an incision ought always to be made at first; after which applications for removing the callus may be used. When, however, the patient refuses to submit to an operation, and the case is recent, the cure may be attempted by means of escharotics and incarnants, such as verdigris, misy, alum, &c., mixed with frankincense, aloes, and myrrh.
Oribasius briefly recommends white hellebore, a mixture of equal parts of verdigris and ammoniac, and a few other such articles, as applications for fistulæ.
Scribonius Largus mentions several compound applications containing misy, chalcitis, verdigris, alum, &c.
Marcellus gives one consisting of ceruse, ammoniac, and oil.
Actuarius gives a brief but distinct account of the nature and treatment of fistula, but it is taken almost entire from our author.
Avicenna inculcates that a fistula is only to be cured by a free incision, or by removing the callous sides of it by burning with fire or caustic medicines, such as arsenic, ammoniac, sulphur, the flour of copper, or mercury. This in fact is the sum of the medical practice in such cases. There is nothing particularly interesting in Haly Abbas. Alsaharavius truly states that a diseased bone is the common cause of fistulous ulcers not healing, and inculcates that in this case there can be no hope of recovery until the carious portion be removed. Rhases, upon the authority of the celebrated Antyllus, directs us to use corrosive applications when a fistula cannot be operated upon with the scalpel. He intimates that this is particularly the case when the disease is seated in the groins.
The earlier modern surgeons, such as Gulielmus de Saliceto, Arnoldus, Rogerius, Rolandus, and Guy of Cauliac, in imitation of the Arabians, direct fistula to be treated by the application of septics, the actual cautery, or incision. Rogerius recommends a tent spread with quicklime and soap, or with arsenic. Guy of Cauliac, like Avicenna, speaks favorably of sublimed quicksilver or corrosive sublimate.
SECT. L.—FOR SORES WHICH BREAK OUT AGAIN.
Some sores which have become cicatrized, often after no long time become inflamed and break out again; for a bone being diseased, sometimes the flesh which covers it heals up readily and appears sound, but in a short time a strong defluxion taking place from the corrupted bone below, inflammation supervenes, and pus is formed which corrodes the cicatrix. What then is the cure of such ulcers? Dry the diseased bone to such a degree that it may exfoliate. But the diseased part of the bone may easily be brought up if you apply a cataplasm, consisting of fig leaves triturated with fine dried barley flour and wine. Or you may apply equal parts of the reed of henbane and of copperas triturated together. The root of hog’s-fennel speedily removes the laminæ of bones.
Commentary. This chapter is copied from Aëtius, who gives some additional prescriptions, such as one consisting of the scales of copper, frankincense, alum, sal ammoniac, pomegranate rind, and ceruse, with or without cerate; and another consisting of red arsenic finely triturated with bear’s fat.
Avicenna recommends strong attractive applications, such as a plaster of the leaves of the black poppy with fig leaves; and another containing the atramentum sutorium (sulphate of copper.)
SECT. LI.—ON ULCERS IN THE JOINTS.
The joints being drier than the fleshy parts, they therefore require when ulcerated more desiccative applications. Wherefore the trochisk of Polyides, when rubbed with wine until of the consistence of the sordes of baths, is an excellent application; and in like manner all equally desiccative medicines. And we have seen them benefited by bathing with sea-water and brine frequently. Wherefore we must use the most desiccative applications to the joints.
Commentary. This is copied from Oribasius. (Synops. vii, 19.)
SECT. LII.—THOSE THINGS WHICH EXTRACT SHAFTS, JAVELINS, THORNS, AND THE LIKE.
Javelins, reeds, and shafts, and thorns, are extracted by the two pimpernels, the round birthwort, ammoniac with honey, the fruit of henbane triturated and sprinkled upon the part. Mix the pounded root of calamus with honey, put it into a piece of linen, and use in great quantity; it will speedily extract them.
Commentary. This subject will be more fully treated of in the Sixth Book.
Our author copies from Oribasius. (Synops. vii, 17.)
Most of the articles here enumerated are mentioned by Dioscorides as possessing strongly attractive properties. Avicenna, Rhases, and Haly Abbas, speak of similar articles, without any new remedies of consequence. See in particular Haly. (Pract. iv, 24.)
The applications mentioned by Pliny are ridiculous. (H. N. xxx, 42, and xxxii, 43.)
SECT. LIII.—ON HEMORRHAGE FROM VEINS AND ARTERIES.
In cases of hemorrhage from parts, the contrary position to that for sinuses will be the proper one, that is to say, the upright, but that must not be in too great a degree, for there is danger of pain being excited, and of the blood bursting forth from the vessel again; for nothing produces hemorrhage and increases inflammation more than pain. Wherefore apply your finger immediately to the part from which the blood flows, putting it gently upon the orifice of the opening in the vessel, and pressing it so as not to excite pain, for by this means you will restrain the bleeding, and block up the opening with a thrombus, and should the bleeding vessel be deep-seated you will thereby ascertain most correctly its situation and magnitude, and whether it be an artery or a vein. After this, if the vessel be small we must use some of the styptics. The best of these are the obstruents, composed of roasted rosin, of fine flour of wheat, and of gypsum, and such like, mixed up with the white of an egg and applied upon the down of a hare. When the vessel is large seize it with a hook, stretch and twist it moderately. When the bleeding is stopped, endeavour if it is a vein to restrain the blood without a ligature, by the same medicines. But if it is an artery, one of two things must be done, either apply a ligature around it, or cut the vessel asunder, by which means you will restrain the blood. Sometimes, too, we are obliged to apply a ligature to large veins, and also occasionally to cut them asunder transversely. We are sometimes driven to this necessity with regard to veins which arise from a deep-seated place, more especially when they run through a narrow passage or important parts, for thus the portions will be retracted on either side, and the wound will be blocked up and covered by the parts above it. But the safer practice is to do both these things, applying a ligature to the root of the vessel and then dividing it. Having done these things, the wound is to be incarnated as quickly as possible, before the ligature slip from the vessel. For if it is not speedily incarnated, but the emptied portion is dilated, the disease called aneurism is formed. You may know whether it is a vein or an artery that pours forth the blood, from this, that the blood of an artery is brighter and thinner, and is evacuated by pulsations, whereas that of the vein is blacker and without pulsation.
The most excellent of all the incarnative medicines which we know, is that used with safety for hemorrhages from the meninges of the brain, and which may be used in wounds of the neck, even for those of the jugular veins; for it will restrain the bleeding from them without a ligature. It contains of the fattest frankincense, p. j; and of aloes, when applied to soft bodies, p. ss; but when too hard, an equal quantity, and instead of the frankincense manna is to be substituted. These are to be mixed with the white of an egg until they become of the consistence of honey, when it is to be applied upon the soft down of a hare to the vessel and the whole wound; and a bandage is to be put on externally, the first four or five turns of which we are to make upon the bleeding vessel, and from thence extend to the root of it. Then having loosed it on the third day, if the medicine should still be properly applied to the wound, we are to put on another one all around, soaking it, as it were, and then bandaging. But if the first pledget come away of itself, the finger is to be pressed gently upon the root of the vessel, so as to prevent all discharge, and it is to be removed softly and another pledget applied. Thus it is to be treated until the vessel heal up, the upright posture being still preserved, but so as not to excite pain. Those things which form sloughs render the part more exposed than it was naturally, owing to the falling off of the sloughs; for in many cases a hemorrhage which can hardly be restrained supervenes upon the falling off of the sloughs. And yet we must have recourse to them when a great necessity compels us. A great necessity for using escharotics, or cauteries with fire, occurs when the bleeding proceeds from the vessels being corroded by mortification; and indeed, when in such affections we cut off the whole mortified part, it is safer to burn, as it were, its root, or to use escharotic medicines. This happens more especially upon the pudendum and fundament. The object of escharotics is to produce heat with astringency, as in chalcitis, misy, and copperas. Those from quicklime are stronger indeed, but owing to the want of astringency in the lime, the eschars from them fall sooner away; but it is better that they should remain longer, for thus will flesh have time to form previously at their root, and become as it were a cover to the vessels. In such cases of hemorrhage matured woad (isatis sativa) when sprinkled upon the part is excellent for restraining the bleeding, or burnt galls, but they must first be heated in the fire, and extinguished in vinegar or wine. The following Simples stop hemorrhages: Aloes, frankincense, manna, Samian earth, the rust of iron, the ashes of burnt wool finely powdered, the dung of an ass or of a horse, a small quantity of bitumen, pomegranate-rind, diphryges, galls, dried myrtle, all kinds of alum whether crude or burnt, roasted rosin, the bark or green leaves of the vine, and the down of the peels of the plane tree, more especially when the vessels throw off their crusts. In particular, hemorrhage from the nostril is to be restrained by the application of the fruit of the sharp rush, the juice of nettle leaves, chalcitis, burnt anthyllis, the down of a hare, the middle part of a ferule when burnt with vinegar, an ass’s dung dry or moist, the juice of leeks with frankincense applied upon lamp-wick. The following are compositions for restraining all kinds of hemorrhage: Having soaked a fresh sponge in liquid pitch, and smeared it with bitumen, burn it in a new pot. Mix together of the ashes of it, p. ij; of lead, p. j; of antimony, p. j.—Another: Sprinkle on the part equal quantities of the manna of frankincense, and sulphur vivum.—Another: Of chalcitis, dr. viij; of frankincense, or of its manna, dr. xvj; of roasted rosin, dr. viij; of burnt gypsum, dr. viij.—Another, an escharotic styptic: Of chalcitis, of burnt copper, of copperas, of roasted misy, equal parts. And the medicine called the Rhodian, and that called the yellow, are excellent styptics.
Commentary. See Celsus (v, 26); Galen (Meth. Med. v, et alibi); Oribasius (Med. Collect. x, 22; Morb. Curat. iii, 36; Synops. vii, 20); Aëtius (xiv, 51); Actuarius (Meth. Med. vi, 4); Palladius (Comment. in Hippocr. Epidem. ed Dietz, ii, 189); Albucasis (Chirurg. i, 58); Avicenna (iv, 4, 2,16); Averrhoes (in Avicennæ Cantic. ii, 2, and Collig. vii, 23); Serapion (v, 16); Haly Abbas (Pract. iv, 21); Rhases (Divis. i, 139; Contin. xxviii.)
Contrary to what is often stated in modern works on surgery, the ancients appear to have been very well acquainted with the proper treatment of hemorrhage. Celsus directs us when a dangerous hemorrhage is apprehended from a wound, to fill it up with dry pledgets, then to apply a sponge squeezed out of cold water, and to make pressure with the hand. If the bleeding does not stop, he directs us to change the pledgets often, and if dry ones do not answer to soak them in vinegar. For fear of inflammation he recommends us not to use caustics and escharotics except in urgent cases. When all other means fail, he directs us to seize upon the vessels (venæ) which pour forth the blood, and having tied them in two places about the wound, to cut them asunder, so that they may contract and still have their mouths shut up. If circumstances prevent this from being done, they are to be burnt with a red-hot iron. He also speaks of stopping bleeding by revulsion, as for example, by applying a cupping-instrument to the hindhead for bleeding in the forehead.
Galen has treated of this subject at great length in the Fifth Book of the ‘Meth. Med.’ When blood is discharged from a wounded artery, he directs us to apply a finger to the orifice of the vessel firmly, yet so as not to occasion pain, and thus a thrombus will be formed that will stop the flow of blood. When the vessel is deep-seated he advises us to examine accurately into its situation and size, and to ascertain whether it be an artery or vein; after which it is to be seized with a hook and twisted moderately. If the flow of blood is not stopped thereby, he recommends us, if the vessel is a vein, to endeavour to restrain it without a ligature by means of styptics, or things of an obstruent nature, such as roasted rosin, the fine down of wheaten flour, gypsum, and the like. But if the vessel is an artery, he says, one of two things must be done,—either a ligature must be applied to it, or it must be cut across. He adds, we are even obliged sometimes to apply a ligature to large veins and cut them across. From this extract of Galen’s practice, it will be readily perceived how much our author is indebted to him. He makes mention of the ligature in many other parts of his works. He also recommends the actual cautery.
To stop bleeding, Oribasius directs, in the first place, cooling and astringent applications to be used, and if these do not succeed, caustics, such as misy, chalcitis, copperas, or the actual cautery. Upon the whole, his account of hemorrhage is nearly the same as our author’s, only he says nothing of the ligature.
Aëtius treats of this subject in the same terms as Galen, recommending the ligature under the circumstances mentioned by him. Some of his styptics are powerful escharotics and astringents, such as copperas, chalcitis, alum, galls, quicklime, rosin, and frankincense. He informs us that Ammonius, the famous Alexandrian lithomist, used a composition of arsenic, sandarach, chalcitis, and quicklime.
Actuarius recommends a composition containing burnt copper, chalcitis, galls, frankincense, &c.
Palladius, in his Commentary on the ‘Epidemics’ of Hippocrates, treating of hemorrhage says, we often stop the bleeding by applying a ligature to the divided vessel.
Albucasis mentions four methods of stopping the discharge of blood from an artery: 1, by the cautery; 2, by dividing the artery across; 3, by using the ligature; 4, by styptics applied upon a bolster or compress, and tightly bandaged.
Averrhoes recommends to stop bleeding by styptics, the cautery, or the ligature. He says distinctly, that when the bleeding cannot be stopped, the artery or vein is to be secured with a thread.
Avicenna treats of all the modes of stopping hemorrhage with singular accuracy, but at so great length that we can only afford room for a few remarks. He recommends stupefying things, cold water, exposure to cold, escharotics, and the actual cautery. He also directs in extreme cases the vessel to be cut across, or a ligature to be applied, namely, a flaxen thread. His description of the process of taking up and tying an artery has quite a modern complexion. He also recommends the application of a compress with tight bandaging when the ligature cannot be applied.
Rhases makes mention of the cautery, of the application of snow, of the ligature, of styptics, and of cutting the vessel across. He mentions that Galen in certain cases approved of two ligatures, as it sometimes happens that the inferior portion will pour forth blood. He further speaks of his having occasionally used two or three ligatures for the sake of greater security. He also mentions torsion of the artery.
Haly Abbas gives an interesting account of hemorrhage, and makes mention of bandages and the ligature. He and Serapion agree in recommending strongly as a styptic a mixture of one part of frankincense, with a half part of aloes, applied upon the down of a hare. This is the application called the plaster of Galen, and is much recommended by Zacutus Lusitanus (Pract. Admin. i, 85), by Scultet (Arsinal de Chirurg. Tab. 33), by Brunus (Chirurg. Maj. i, 12), and Lanfrancus (Chir. parva. 5.)
The early modern writers on surgery make mention of all the ancient methods of stopping hemorrhage. Guy of Cauliac recommends the ligature upon the authority of Galen and Avicenna (iii, 1, 3.) It is also recommended by Brunus (i, 12), Theodoricus (i, 13), Rolandus (ii, 1), and Lanfrancus (iii, 1, 9.) It appears, therefore, that the use of the ligature for stopping hemorrhages was well understood by the ancients, and had never been lost sight of even in the darkest ages.
SECT. LIV.—ON WOUNDS OF THE NERVES.
When the nerves are wounded or pricked, they experience great inflammation and pain owing to their great sensibility; and therefore fever and convulsions supervene upon them, and in some cases delirium, owing to the continuity of the nerves with the brain. And sometimes phlegmons and abscesses form in the other parts adjacent to the wound, arising from the wounded nerve, owing to their continuity with it. Wherefore we must preserve the wound of the skin from adhering, that the ichor may escape by it. And in punctures, if they appear blind, the part must be divided by two incisions intersecting one another. With regard to the treatment, if the body is plethoric, and the inflammation strong, it will be proper to begin with venesection; and when the body appears to be in a state of cacochymy, purging must also be had recourse to. We must apply to the wound medicines for allaying pain, and for increasing the discharge, more especially if the cross incisions have not been practised. It is necessary to know that warm water, which is most applicable to other inflammations, is inimical in these cases, and it is better to bathe the part with a thin oil which has no astringency and is warm to the feeling; for nothing either very cold or very hot can be applied without detriment. Of medicines turpentine-rosin is beneficial by itself in the case of children, women, and persons of tender flesh, but softened with euphorbium for those of a firmer fibre; and if it become too hard it is to be mixed with some of the thinner oils. To nerves in a state of inflammation and mortifications, we may use cataplasms consisting of the flour of barley or of beans, or by boiling that of tares in trained lye with oxymel. But without boiling we may use the following cerate for punctures: of wax, oz. iij; of euphorbium, oz. j; or of pigeon’s dung; for harder parts, of oil, oz. ij; and sometimes of turpentine, oz. j. When you wish to give the medicine the form of a plaster, you may add to the preparation from euphorbium, of wax, of boiled rosin, of oil, and of fat pitch, of each, oz. vj; but you will make it better by substituting the fattest bee-glue instead of the rosin. The following is a good remedy for punctured nerves, applying also to persons bitten by mad animals: Of vinegar one sextarius, of fat pitch, lb. j; of opoponax, oz. iij; having dissolved the opoponax in the vinegar triturate it more, and having melted the pitch, boil. This medicine is applicable to punctures of the nerves not allowing the mouth of the puncture to close up, as in the case of persons bitten by rabid animals it does not permit the wound to cicatrize. But it answers only with hard bodies, and when you wish to apply it to the punctures of children, or of persons of soft skin, you must melt it in some discutient article such as the oil of marjoram, of opobalsam, or old oil.—Another suitable application is basilicon with the addition of natron, or quicklime, or euphorbium, or sulphur vivum, or wild pigeon’s dung, or opoponax, or sagapene, or Cyrenaic juice, or castor, adding to a pound of the ointment an ounce of one of these medicines. It answers well for wounds of nerves, and more especially punctures. And in the country when one is not supplied with any other medicines, one may apply fresh and fat bee-glue to the wound, or leaven more especially if old, by itself or mixed with bee-glue, or with the juice of tithymal. But cataplasms may be applied made of oxymel, or of strained lye, with the flour of beans, or of tares, or of chick-peas, or of bitter lupines, or of barley, or of the flour of polenta, not only when in a state of inflammation, but they may be used from the commencement. But relaxing cataplasms are to be entirely rejected for wounds of nerves. If the nerve is not cut, but laid bare by a wound, the surrounding skin being divided so that the nerve appears naked, and is wounded longitudingly and not transversely, we must use none of the afore-mentioned from euphorbium, nor any thus acrid, for the nerve being bare will not bear their power which is strong, but one may use lime that has been washed often in the warm season mixed with much honey. The preparation from pompholyx, and that from honey melted with much rose-oil, are also excellent ones. But these things must not touch the wound, for the nerve is sensitive, of a cold temperament, and continuous with the most important part. And neither is it proper to bathe such an ulcer with oil, for it will make it become foul, and we must only wipe away the ichor with soft wool wrapped about a probe. When all things succeed agreeably to our wish, there will be no danger in fomenting with must. For stronger persons the trochisk of Polyides with sodden must may be used upon a warm pledget. After the exposed nerve has been covered over, we must apply externally pledgets, with some of those things which are fitting for narrow wounds, such as that from euphorbium, or that from pigeon’s dung, taking in also much of the sound parts. When the wound is transverse there is greater danger of convulsions, but everything relating to the cure is in this case the same, except that while the wound is recent some have used sutures and certain of the agglutinative applications; but the sutures must not be applied very superficially lest the part below remain ununited, but more deeply, taking care however that the nerve be not punctured by the needle. It is to be known once for all, that in wounds of the nerves the medicine which cures punctures being of a bitter nature, it is not possible to cure with it the division of the nerve, as the parts cannot endure pungency and inflammation. And neither does the medicine which cures incisions answer with punctures. For its strength does not reach the bottom of it, the incision of the skin being narrow. A spare diet is to be allowed, and a soft couch; and warm oil is to be applied to the armpits, head, and neck; but when the wound is in the leg, the medicine is to be applied to the groins, pubes, and the parts there. Baths, until the inflammation is on the decline, are to be abstained from, water not agreeing with these wounds, as we have said. But since some from habit cannot bear to want the bath, if the wounded part be the hand it must not, if possible, be wet in hot water, and still less in cold; but when the wound is in the foot, since it is impossible to preserve it from being wet, when about to go into the bath apply to the wounded part some of the plasters, and externally a compress consisting of many folds and moistened with oil; and again external to that a linen bandage; and after having done these things when the person affected is about to take his seat in the bath pour oil once more upon the bandage. When he comes out of the bath take away all those applications, and have recourse to the treatment described above. When there is only contusion of the nerve, if along with it there be contusion of the skin and ulceration, the cataplasm of the flour of beans and of oxymel will be a fit one, but you may add sometimes the flour of tares, and some iris; and when the contusion is attended with pain, you may mix a little liquid pitch with it. If there be no contusion of the skin, it will be more discutient to bathe frequently with an oil of a heating nature, I mean that of dill, of rue, of iris, or of marjoram. When the whole nerve is cut asunder no danger will result from it, but the part will be mutilated; and the treatment is to be conducted as in the case of other ulcers. The treatment of the wounds of nerves by simples is sufficient for accomplishing the whole cure, but some are in the practice of using compound applications in such cases, as the plaster from metals, those called barbarous, and the cissinum, that from groundsel, the melanchlorum, the indicum, harmonica, and athena, the composition of which, and the manner of using them you will find described in the Seventh Book. And since some very wealthy people are fond of using expensive applications to wounds of the nerves, Galen has described the following for punctures of the nerves: Of cinnamon, oz. j; of dittany, oz. j; of marum, oz. j; of amaracus, dr. ij; of wax, oz. viij; of opobalsam, oz. x; of turpentine, oz. x.—Another: of cyrenaic juice, oz. j; of wax, oz. iij; of opobalsam, oz. xij. This is an application for exposed nerves: Of wax used for ointments, oz. iij; of the ointment called spicatum, or foliatum, or that of nard, oz. xij; of washed pompholyx, oz. j; of spikenard, oz. j; of amomum, oz. j; of the leaf (malabathrum), oz. j. And these, Galen says, are superlatively excellent.
Commentary. Galen has devoted a whole book of his work ‘De Med. sec. genera’ to the consideration of wounds of tendons, membranes, ligaments, and nerves properly called, and he also treats of them more generally in the sixth book of his work ‘Meth. Med.’ He professes to have had ample experience in the treatment of these cases while attending wounded gladiators. As our author has given a very comprehensive abstract of Galen’s principles of cure, it will be unnecessary for us to enter into any minute detail of them. He states very decidedly that cold applications, especially cold water, are highly dangerous, and inculcates that calefacient oils are the most proper applications. He particularly praises oils medicated with spurge, or sagapene, or turpentine-rosin. They are to be applied upon soft wool. In certain cases, he says, I have mixed the powerfully desiccant substances, such as quicklime, misy, chalcitis, pompholyx, arsenic, and sandarach, with the oils or cerates. When tendons are cut across he directs us to unite the ends together by sutures. Wounds of membranes and ligaments are said to be less dangerous than those of tendons. In general he further recommends either bloodletting or purging.
Oribasius, Aëtius, and, in short, all the subsequent authorities, like our author, copy everything from Galen. As a specimen we shall give an abstract of the method of treatment recommended by Octavius Horatianus, who, it is probable, belonged to the Methodical sect. He commences with stating that wounds of nervous parts are in general very dangerous, and recommends applications of a digestive nature to avert the violent symptoms and pains. In such cases he directs us to bleed and purge, forbids all fomentations of warm water, but approves of those made with tepid oil, after which dressings composed of turpentine-rosin, either by itself or with some sponge, are to be applied. But for women and children of a delicate frame he recommends turpentine alone; for others, however, he recommends turpentine with spurge and oil, to which occasionally may be added bee-glue, sagapene, assafœtida, and opoponax. He also from personal experience speaks favorably of an application prepared from lime washed in water, spurge, sulphur, turpentine, wax, and pitch. He mentions other preparations from rosin, spurge, with oil and sea water.
The Arabians copy from Galen very closely. Thus Avicenna condemns cold applications, and recommends calefacient ones. He approves of sutures when the tendons are cut asunder. Haly Abbas cautions against cold water, and particularly commends wool dipped in hot oil of violets. When spasm (tetanus) supervenes owing to the wound of a nerve, he directs us to divide it asunder lest the affection of it spread to the brain and prove fatal. Rhases also forbids all relaxing applications. He commends hot stimulant oils, and basilicon mixed with spurge, natron, lime, assafœtida, castor, &c.
Gulielmus de Saliceto, Guido de Cauliaco, Severinus, and Lanfrancus in laying down the treatment of wounded nerves and tendons, follow closely the principles delivered by their Arabian masters. They approved of sutures when the tendon is cut across.
SECT. LV.—ON ANCYLOSIS.
Contractions of joints arising from impacted humours, or some nervous tension, we are accustomed to call ancylæ and ancylosis, which cases require emollient and relaxing applications. Wherefore, in general, those things recommended for scirrhous parts, but still more particularly the applications to paralysed members will be proper, and more especially pouring upon the part water and oil, in which linseed, fenugreek, marshmallows, bay, the root of the wild cucumber, and the Sicyonian oil itself, have been boiled. After bathing we may apply first the more simple acopa, such as that from poplar, that from fir, the one called bromium, that ascribed to Basilius, and the pyxis; and after these the Aristophanian, and that ascribed to Azanites. But the strongest are those called lysoponium and varium. Of plasters, that ascribed to Amathaon, and the anicetum. This is a most excellent one: Of bdellium, of calves’ fat, of ammoniac perfume, of Illyrian iris, of each, dr. xvj; of opoponax, of galbanum, of the seeds of rosemary, of storax, of frankincense, of each, dr. viij; of pepper, clx grains; of wax, lb. ss.; of turpentine-rosin, lb. ss.; of the lees of the oil of iris, q. s.; of wine, q. s.; the medicine is pounded. It forms a good acopum when diluted with oil of iris, of privet, or of bay. Intermediate between the acopa and plasters is the preparation from bacon called polymigmaton. The acopa are to be used with soft and continued friction, along with gentle attempts to bend and stretch the affected joint.
Commentary. The principles of treatment here laid down are the same as those inculcated by all the other authorities. For a complete account of the formation of malagmata, we refer the reader to Galen (Med. sec. gen. vii), and to Aëtius (xii, 42.)
Actuarius recommends an acopum composed of old oil, the oils of bay, iris, and storax, with turpentine, spurge, castor, ammoniac, pepper, opoponax, galbanum, and stag’s marrow. He remarks that emollient and relaxing medicines are indicated. (iv, 16.)
Celsus recommends, “ad recenti vulnere contractos articulos, quas ἀγκυλας Græci nominant,” a malagma consisting of frankincense, rosin, galbanum, ammoniac, and bdellium, with wax. (v, 18.) Avicenna makes mention of a similar one. Scribonius Largus gives a prescription for ancylosis consisting of bdellium, opoponax, ammoniac, galbanum, calves’ fat, &c. (civ.)
SECT. LVI.—ON RELAXATION OF THE JOINTS.
The joints often become relaxed from protracted febrile complaints, and from colic, and paralytic affections, especially when a hot and humid intemperament seizes them; and hence the motion of the joint is impeded. In these cases the juice of acacia mixed with water may be poured upon the part; or a decoction of bramble, of myrtle, of lentisk, or of the bark of elm roots will answer well; or the rind of pomegranate may be formed into a cataplasm, or myrtle leaves with myrtle ointment may be applied. For the ligaments require to be strengthened by astringent and desiccative powers; and such applications are therefore to be made to the joints, as that from willows, that called oxyrum, and the phœnicinum, with the addition of an astringent wine or vinegar. Some imagining that the weakness of the joints proceeds from cold, and having had recourse to more heating remedies, have only increased the mischief.
Commentary. Our author has correctly stated that relaxation of the joints is to be cured by astringent desiccant applications. Aëtius makes mention of the simple articles enumerated here (xiv, 72), and Oribasius recommends a few of the same. (Synops. vii, 23.) Our author is much fuller than Oribasius on this head. (Ibid.)
SECT. LVII.—ON WORMS.
There are three different sorts of worms, the round, the broad, and thirdly, those called ascarides. They are all the offspring of crude and thick pituitous matters with a suitable putrefaction, such matters collect in children, and others who take too much food. But they do not grow from hot, acrid, or melancholic humours; for these being too strong for nutrition, are inapt for the generation of worms; and, on the contrary, bilious superfluities are particularly destructive of them. Or if at any time yellow bile be discharged along with worms, either downwards or by vomiting, you may be sure that they have been formed in the intestines, whereas the bilious humour had been collected at the mouth of the stomach, or in some other part. We shall now describe the form, generation, situation, diagnosis, and cure of each variety, beginning with the round.
Of the round worms. The form of the round worms must be known to everybody, because they are more common than any of the others. They are generated principally in the small intestines, and are very prevalent in the stomach; wherefore they are often discharged by the mouth, and sometimes by the nose. They are most common in children, more especially in fever. For they are formed about the commencement of fevers from a corruption of the matters; at their acme from the malignant nature of the disease; and during the decline from a change of the whole system to a better state. Wherefore Hippocrates says, “it is a good symptom when round worms are evacuated at the crisis of the disease, and these speedily die.” Those who have round worms experience pain of the intestines and stomach, small dry tickling cough, and in some cases hiccough, sleep with palpitations and irregular startings; and some start from their sleep with a scream, and again fall over asleep. The pulse is unequal, and the fever has irregular exacerbations, making its attacks with coldness of the joints, and coming on three and sometimes four times in the day or night without any stated form. Children have mastication and projection of the tongue without cause, and grinding of the teeth; they shut their eyes and wish to remain silent, and are offended when disturbed. Their eyes appear bloody, their cheeks red, and again change to pale. But these things occur at intervals in a short time. Sometimes the worms crawling up to the stomach occasion nausea, gnawing pain, and anorexia to the patients. When forced to take food they can scarcely swallow for nausea, or they vomit what they have taken, or their bowels are loose with corruption of the food, or are inflated like a bladder; but the rest of the body is wasted in an unaccountable manner, there being neither famine nor any extraordinary evacuation. But one must not expect to find all these symptoms in all cases, but certain ones, according to prevailing circumstances, and occasionally the most of them. These symptoms occur from the animals turning themselves about in the intestines and biting them, and the febrile heat raising noxious vapours to the brain from putrid humours collected in the belly, in which case we must sometimes pay attention alike both to the fever and the worms, and sometimes we must bestow little attention to the fever, and direct our efforts to remove the worms from the body. Many having neglected them have been eaten through by them, and have died convulsed. And others say that they have seen them come out from the groins of the patient. You may remove them from the body by killing them, and you may kill them principally by using bitter remedies. When both the treatment of the fever and of the worms is common, the simple remedies will be proper. Wherefore the patients must first drink a decoction of camomile, and of the fruit of the sebesten plum, or these medicines themselves may be given boiled. We may also give the juice of endive, or coriander seed, triturated with hot water or with oxycrate; or a decoction of the herb mouse-ear, or the shavings of hart’s horn, or sinopic vermilion finely levigated. And they may swallow by degrees two spoonfuls of the oil of bitter unripe olives, for by its bitterness it kills them, and by its lubricity it drags them along and evacuates them with the fæces. When inflammation and distension of the intestines are present, we must have recourse to a cataplasm of linseed and of the flower of lupines, and of wormwood, and of the roots of bryony in hydromel, or pour upon the hypochondria the oil of camomile, wine, and the infusions of the fruit of wormwood and aloes. When the fevers are not very troublesome we may mix with the sebesten plums some mint, and give them: and when there is no fever we may administer the more drastic medicines, such as the decoction of seriphum, or of calamint, or of fern, or the seed of cardamon, or a decoction of the root of acid pomegranate reduced to one third, or of toasted cumin, and of tawny-coloured natron, of each, scr. iij; or wormseed, or southernwood, or both made into pills with honey, or scr. iij of bitter lupines, or the levigated seed of cabbage or of rocket, or wormwood which is often sufficient alone. We may give of washed aloes to the amount of scr. iij; which is one of our most celebrated remedies; but to stronger persons we may give them unwashed. And since children will not take the aloes from a cup, they are to be secured upon their back, and their mouth being forced open by a spoon, we are to inject in spite of them the aloes by means of a syringe having a strong pipe, throwing it in as far as possible. This is an admirable method with children who can hardly be prevailed upon to take medicines, and in this way we may often inject soup in cases of anorexia. And cyphi and masuaphium may be properly administered, and burnt hart’s horn with pepper in honey or oxymel; and we may also endeavour to give the other medicines in oxymel. But the vinegar of squills will be still better, especially when given to adults. Or mustard with oil and vinegar may be given to the amount of a spoonful. Those whose bowels are troubled with a flux owing to worms may take a potion of the juice of plantain, or the plaintain itself may be given in a dry state, for it is of use both for the flux and the worms. We may apply to them cataplasms of crude barley flour, of fern, of wormwood, of the flower of lupines, of wormseed, and of southernwood, and likewise pomegranate rind, acacia, galls, and the flowers of the wild pomegranate are to be mixed with them. And since many people often loathe bitter draughts, we may give of those we have mentioned, such as are not decidedly bitter, and in addition, ground pine and horehound, elecampane, bay berries, cassia, thyme, pennyroyal, carpesium, cyperus, polypody, iris, bastard-saffron, madder, Egyptian thorn, with an equal quantity of pepper, to the amount of scr. vj, to a decoction of mint, the juice of the root of mulberry, or the decoction of stone parsley, or of other aromatic seeds. Externally we may use aloes with the oil of apples and wine. This also whets the appetite, which is a thing to be much attended to. With the aloes we may often mix wormwood; or the navel may be filled with bull’s gall along with some of the bitters formerly mentioned; or the oil of rose-bay may be constantly rubbed in, or cedar-pitch may be applied alone and along with cerate to the whole belly; or dried pitch may be levigated and sprinkled on it; or it may be anointed with mint and gith in rose-oil; or we may mix with them the decoction of seriphum; or we may triturate peach leaves and apply. We may use stag’s marrow in the form of an ointment to the navel, pubes, and loins; and, if necessary, we may apply the cerate of aloes, of wormwood, of the flour of lupines, of seriphum, of gith, of each, scr. vj; of wax, oz. jss; of oil of camomile q. s.; triturate the powders with bull’s gall. We may give them frequent injections of honied water, that the worms may be attracted downwards by the sweetness of the honey. But if they putrefy in the deep-seated parts, and are not discharged, but on the contrary raise effluvia, we must evacuate them by giving aloes, or the medicine called picra, prepared from it. In certain cases a moderate evacuation, by means of a suppository, is not unuseful to them.
Of the broad worm (tænia). The broad worm is (if I may say so) a conversion of the membrane which lines the inside of the intestine into a living body, which is often either discharged whole, when its size appears incredible to be seen; or it is evacuated in parts; but when loosed from its attachment it does not form again. It occurs most frequently without fever, but sometimes in fever after a protracted disease, when it brings on constant gnawing pains of the stomach, and an insatiable desire of food; for the animal which is formed in the intestines seize the food lying there, so that another supply is straightway required, and, if not furnished with it, the worm will bite the bowels. It is accompanied with emaciation of the body and loss of strength, with anomalous symptoms: but the most unerring symptom is when certain substances, like the seed of gourd, are discharged with the fæces. The cure resembles that of the former kind; taking the bitter draughts, eating garlic, drinking or injecting a decoction of fern, or of centaury, or of calamint, of dittany, or of pennyroyal. And we may also inject brine. The patient may also drink this potion, which is not unserviceable to those who are troubled with other worms, if they happen to have fever: Of red natron, of pepper, of cardamom, equal parts: the dose is gr. iij, with wine or hot water.—Another, a linctus: Of pepper, of pure bay berries, of Ethiopian cumin, of mastich, equal parts; of honey, q. s.; the dose is a spoonful taken in the morning and at bedtime. But if you wish to make it stronger, add an equal part of red natron.—Another: Of elecampane, of ammoniac perfume, of pepper, (in another formula, of fern,) of each, dr. v, with hot oxymel; and after an interval give adults one or two drachms of euphorbium in a draught.—Another: Of fern, an acetabulum; of natron, dr. ij; give it in a hemina of water, but it will be better if a little scammony be added to it.—Another: Of the bark of the roots of sour pomegranate stripped of its rind above, dr. iv; of pepper, dr. iv; of cardamom, dr. vj; of horehound, dr. ij; give it in honey to the patient after he has previously eaten of garlic, until the affection is completely removed. Give also of theriac, when not prevented by strong fever.
SECT. LVIII.—ON ASCARIDES.
Ascarides, as we formerly mentioned, are a kind of intestinal worms resembling earth-worms, being formed about the extremity of the rectum and the beginning of the sphincter ani, and occasioning a great itching of the parts. This species is formed by bad diet, cold, and indigestion of the food. Wherefore they are to be discharged, in children, by suppositories of honey with a moderate quantity of salts or natron; but in adults by acrid brine, or a decoction of centaury with natron and honey, or of colocynth, or of wormwood, or of chamæleon, or of alkanet, or of bastard saffron, or of hyssop, or of pennyroyal, or of calamint, or of lupines. After the injections we may anoint the rectum with these simples: Acacia, or hypocistis with natron, or Syriac sumach with liquid alum; and in those which are bound, with Lemnian earth in wine, and with these compound medicines, the trochisk of Andron and the like. And we may give them an injection of cedar-rosin with a syringe having many perforations, such as those used for the uterus; or salted flesh is to be adapted to the part and secured with a bandage, as long as it can be allowed to remain, and changed often. In general all those infested with worms derive benefit from fumigations with the hairs of ichneumon. The food should contain wholesome juices, and such as are easily distributed over the system, neither increasing the cause which engenders the worms, nor allowing the strength to sink; and on that account we may give some diluted wine. And we must give food frequently on that account, and in order that the worms may not bite the intestines for want of their food. The best time for taking food is when the worms are full. If there be a defluxion of the belly you may be sure that the worms are on the increase, the food not being properly distributed, and we are to give soups with a mixture of astringents, such as pears, apples, and pomegranates, more especially such as are acid; and we may apply to the belly, externally, astringent remedies as mentioned above.
Commentary. On this curious subject consult Hippocrates (Aphor. iii, 26; De Morbis, iv, 27); Aristotle (H. A. v, 9); Celsus (iv, 17); Cælius Aurelianus (Pass. Tard. iv, 8); Scribonius Largus (36); Serenus Samonicus; Marcellus (31); Octavius Horatianus (ii, 30); Dioscorides (pluries); Galen (Meth. Med. xiv; Isagoge;) Aëtius (ix, 39); Oribasius (Morb. Curat. iv, 90); Actuarius (Meth. Med. i, 21); Nonnus (172); Myrepsus (8); Avicenna (iii, 16, 5); Serapion (iii, 30); Averrhoes (Collig. vii, 37); Avenzoar (ii, 7, 22); Haly Abbas (Theor. viii, 28; Pract. vii, 29); Alsaharavius (Pract. xvii, 2, 9); Rhases (Divis. 169; Contin. xxvi); Alexandri Tralliani Epistola ap. Alb. Fabricii Bibl. Græc. xii, 602, and ed. Ideler, 1842.
Hippocrates states that the round and broad lumbrici are often passed with the first discharges from the bowels of children. This is a fact very difficult to account for. When, and how did the seed of the worm get access to the belly of the child? He rejects the opinion that the rings of the broad lumbricus (tænia) which are passed from the bowels are its offspring. He says it does not occasion death, but continues to live as long as the man lives.
Aristotle divides intestinal worms into the lumbrici teretes, the l. lati, and ascarides. He remarks that the broad produce something resembling the seeds of the gourd. He believed in spontaneous generation.
The pomegranate seems to have been a popular remedy for intestinal worms. Cato the Censor gives directions for medicating wine by the addition of pomegranate and fennel, of which, he says, “Id vinum tinias perpurgat et lumbricos, si sic concinnes.” (De re rust. 127.)
Celsus treats of the lumbrici lati and teretes. For the cure of the former he recommends a draught containing lupine and the bark of mulberry, with the addition of hyssop, pepper, or scammony. He also recommends emetics with garlic, or pomegranate rind with some nitre. For the teretes he recommends the same, and also the seed of nettle, or of cabbage, or mint, or wormwood, or hyssop with mead, or the seed of cresses with vinegar. He advises, likewise, to eat garlic, and use clysters of oil.
Scribonius Largus directs first garlic and old soft cheese to be eaten, and then Macedonian fern to be taken with honey. After four hours a mixture of aloes and scammony with honied water is to be given, and a clyster of warm water administered. He also recommends wormseed and the shavings of hart’s horn. Marcellus mentions the same remedies.
Serenus Samonicus recommends hartshorn, calamint, garlic, southernwood, coriander, pennyroyal, horehound, &c.
The beginning of the chapter of Cælius Aurelianus on lumbici unfortunately is lost. He mentions the usual symptoms which accompany them, namely, occasional deliquium, agitation, grinding of the teeth, change of colour, convulsions, &c. Worms are discharged by the mouth or anus, sometimes single, and at other times in great numbers rolled up in a ball; sometimes dead, and at other times alive; and they are of various colours. For ascarides he recommends when there is inflammation of the rectum an injection of oil, to which may sometimes be joined a decoction of wormwood and centaury. But if bloody scrapings of the bowels are discharged, he directs us to give a decoction of pomegranate-rind, and, if the complaint continue, equal parts of burnt paper and of arsenic, to the amount of six drs., with the infusion of plantain. Surely there must be some mistake as to the amount of the dose, for so great a quantity could not be injected with safety. When there is putrefaction he recommends an injection of salt water, with other suitable remedies. When complicated with any other disorder he properly directs us to pay attention to it; after which the animals may readily be discharged by drinking oil, or a decoction of sebesten plums (myxæ), or of liquorice: these things, he says, will obviate constriction and swelling, while by lubricating the bowels they will promote the discharge of the worms. When complicated with relaxation he recommends astringents externally and internally, such as vinegar with honey, lupine, the shavings of hart’s horn, &c. Sometimes, he says, in order to expel them we must have recourse to acrid substances, such as onions, garlic, mustard, cresses, cardamus, assafœtida dissolved in vinegar, wormwood, &c. In stating the detail of the treatment he mentions various other anthelmintics, such as the hiera of aloes, gentian, mulberries, squills, spurge, alkanet, colocynth, and scammony. All these things may be given by the mouth or in injections, with a considerable admixture of oil. For the lumbricus latus he directs, first, an emetic of oil, and next day a clyster with nitre or salt. Saltish things are also to be given in drink, with liquorice, or scammony, or polypody, &c. When the animals are discharged, to prevent a renewal of the complaint, he recommends friction, vomiting, acrid food, calefacient plasters, sinapisms, paroptesis, and the like.
Pliny recommends the ashes of hart’s horn for tænia. (H. N. xxviii, 59.)
Dioscorides ascribes anthelminthic properties to various acrid and bitter substances, such as garlic, cresses, fern, gith, mulberry, pomegranate rind, lupine, cabbage, nettle, hyssop, mint, calamint, wormwood, wormseed, rue, coriander, thyme, &c. Similar remedies are recommended in the ‘Euporista,’ which is falsely ascribed to him.
Galen mentions that bitters in general are destructive of intestinal worms. The teres, he adds, is killed by the absinthium; but the latus and ascaris require stronger medicines, such as the filix. The author of the ‘Isagoge,’ a work generally ascribed to Galen, divides intestinal worms into the broad, the round, and the ascarides. The round are about the length of a span or somewhat more, especially such as are formed about the stomach. The ascarides are short, and form in the rectum. The broad, called also fasciæ or tæniæ, from their resemblance to tape, are said to be sometimes the length of the intestines. The round are most common in children, the ascarides before manhood; and these are difficult to remove except by bitters, elecampane, and acrid food.
Oribasius treats briefly of lumbrici, recommending for the l. rotundus, southernwood, wormwood, calamint, gith, &c., taken internally or applied outwardly; for ascarides, the juice of calamint, and cedar rosin, in like manner; and for the tænia the bark of the root of mulberry, and the roots of fern in honied water, and also the root of the white chamæleon and costus.
Aëtius gives a full and accurate detail of the symptoms and treatment of lumbrici, but as his remedies are much the same as our author’s, it will be unnecessary to deliver any account of them. He remarks, that anthelminthics either kill worms by their acrimony, or remove them by their bitterness, or irritate them so as to expel them, or by lubricating the parts facilitate the expulsion of them.
Actuarius gives a sensible account of the formation of worms, which he ascribes to putrefaction or indigestion. White worms, he says, are the product of indigestion, but the red, and those of any other colour, arise from putrefaction.
Nonnus merely abridges our author’s account of this subject.
The ingredients in the compositions recommended by Myrepsus, are such as aloes, scammony, southernwood, and bitter almonds.
Octavius Horatianus gives a good account of worms, but it contains scarcely anything that is not to be found in our author’s. He says, that from long experience he had great confidence in a purgative draught consisting of scammony, the ashes of burnt peas, euphorbium, and nitre, given in sweet wine. But garlic, and other acrid things, are to be first eaten.
The Epistle of Alexander Trallian on worms, first published by Hieronymus Mercurialis, and afterwards by Albertus Fabricius, and again lately by Ideler, contains an interesting exposition of the ancient views on this subject. He divides intestinal worms into three genera: the ascaris, the strongylus or round, and the latus or broad. He remarks that the small worms (ascarides) are generally found in the large intestines, the round in the small intestines, and hence they are often vomited up; while the broad worms (tænia) are sometimes as long as the intestines, some having been discharged sixteen feet in length. He states that they are engendered by corruption of the food, and putrefaction of crude humours. He lays down at great length the plan of treatment, which he varies according as they are with or without fever. His remedies consist of cathartic, acrid, oily, acid, and bitter substances. Of purgatives he mentions aloes, scammony, and hellebore; of acrid articles, garlic, cresses, and the like; of oily medicines, the oil of roses, castor oil (oleum ricini), and common oil boiled with rue; of acids, salt and nitre (soda); and of bitters, southernwood, wormwood, hyssop, fennel, and the like. For the expulsion of the strongylus he speaks favorably of a decoction of gagate stone (jet). For ascarides and lumbrici he recommends a lavement prepared from juniper. He concludes his treatise by stating that “ten thousand” other things had been recommended as anthelminthics by the ancients.
Avicenna in his account of worms condenses all the information contained in the Greek authors, but we do not find that he supplies anything new. He in particular copies freely from Aëtius and our author. The same may be said of Serapion, who recommends wormwood, bitter lupines, calamint, peach leaves, cabbage, onions, thyme, colocynth, &c. Averrhoes says that the lumbrici in general are removed by bitters, such as wormwood or wormseed, but that the cucurbitini (tæniæ) require strong medicines. Of the pineæ nuces he says, “Occidunt vermes qui sunt in ventre.” (Collig. v, 42.) Probably this hint may have led to the use of turpentines for the cure of tænia. Avenzoar attributes the formation of worms to ill-digested food in the stomach, and recommends much the same remedies as the Greeks. Haly Abbas describes the three species of worms, and details the symptoms of them. He remarks that these animals are to be killed by medicines of a hot and dry nature, such as bitters. He recommends wormwood, fern, and the like, pounded with honey, vinegar, &c. The remedies mentioned by Alsaharavius are oils, bitters, and drastic purgatives. He treats of lumbrici very fully. Rhases recommends in general terms bitters; for the round, wormwood, for the broad, (tæniæ, called by him semina cucurbita) seriphium, bitter lupines, narcissus, &c. And for the ascarides he directs us to apply a suppository of wool dipped in the gall of a bull. He remarks that they occur most frequently in autumn, being engendered by fruit. He states correctly that they often bring on epilepsy, and looseness of the bowels. He much commends the oil of unripe olives.
Vegetius recommends nearly the same medicines for removing the vermes of cattle as those already mentioned, namely, wormwood, cresses, coriander, fenugreek, and the like, boiled in oil, and administered by the mouth and in clysters. (Mulom. i, 44; see also Columella vi, 25.)
According to Michaelis and Sprengel the ancient Brahmins were acquainted with the anthelminthic properties of the dolichos pruriens.
We have stated above that the most celebrated of the ancient savans believed in the spontaneous generation of animals. This doctrine, although generally rejected at the present time, has been advocated by many modern naturalists of great eminence, such as Baron Buffon and Professor Rudolphi. Virey gives a very impartial statement of the arguments for and against this physiological doctrine. (See Hist. des Mœurs et de l’Instinct des Animaux, ii, 121.) Mr. Madden, the traveller, relates that the bark of the pomegranate is still considered in the east as a specific, not only for ascarides, but also for the tape-worm. He says, “I have rarely seen it fail in the cure of tænia. They make a decoction of two oz. of the fresh bark in a pint of water, this they drink daily till the worm is expelled, which it generally is the third day.” (Travels in Egypt, ii, 371.)
SECT. LIX.—ON DRACUNCULUS, OR THE GUINEA-WORM.
In India and the upper parts of Egypt a class of worms called dracunculi, resembling the intestinal, are formed in the muscular parts of the body, such as the anus, thighs, legs, and in the sides of children, under the skin; and they move in a perceptible manner. Then in process of time at the extremity of the dracunculus matter is formed in the part, and the skin being opened the head of the dracunculus comes forth. But if the worm be dragged it occasions pains, and particularly when it breaks. Wherefore some say that it is proper to fix a piece of lead to the worm in order that its discharge may not take place at once, but gradually with the weight of the lead. Some disapproving of this practice, inasmuch as the worm is apt to break with the weight of the lead and occasion violent pains, direct the part to be put into hot water, in order that the dracunculus being warmed may come forward, when it is to be seized with the fingers and dragged forth by degrees. But Soranus is of opinion that the dracunculus is not an animal originally, but a nervous concretion, which has only the appearance of moving. Whether this or the former be the true account of the matter, it appears to Soranus, Leonides, and others, that they are to be treated with the affusion of warm water, and digestive cataplasms made of honied water and the flour of wheat or barley; and they approve of sometimes using a plaster possessed of similar properties. Wherefore that from bay-berries, and the one from honey are proper. For by the use of these the dracunculus or concretion dies and falls out. But when suppuration takes place, if it does not fall out, the skin is to be divided, and the part being laid open, that which is contained in it is to be taken out, when a tent is to be put into the skin, and then the treatment for suppurations is to be applied.
Commentary. The following authors treat of the vena medinensis, or dracunculus, now generally called the Guinea worm: Galen (De Loc. Affect. vi, 3; Isagoge;) Aëtius (xiv, 85); Pollux (Onomast. iv); Plutarch (Symp. viii, 9); Theophrastus (H. P. ix); Actuarius (Meth. Med. vi, 8; iv, 16); Avicenna (iv, 3, 2, 21); Avenzoar (ii, 3, 20); Haly Abbas (Theor. viii, 18); Alsaharavius (Pr. xxviii, 12); Rhases (ad Mansor. vii, 24; Cont. xxvi.)
Galen admits that he had never seen the dracunculus, and that therefore he could not be positive respecting its origin and nature. He had known many persons, however, who had seen it, and was inclined to believe that it is of a nervous nature, and resembles lumbrici only in colour and thickness. The author of the Isagoge states that dracunculi resemble varices, and that when they project or move about they occasion great pain, and are to be removed by making an incision of the skin as for varices.
Plutarch briefly mentions the dracunculus as being a disease which had newly attacked the inhabitants of the country adjoining the Red Sea.
Aëtius professes to derive his account of the dracunculus from Leonides. He says, like our author, that it is formed most commonly in the legs and muscular parts of the arms in India and Ethiopia, and that the generation of it is not dissimilar to that of intestinal worms. He adds, that in process of time suppuration takes place at the end of the worm, when an opening is made in the flesh, and the head of the dracunculus protrudes. If dragged out considerable disturbance is produced, especially if the worm should be broken, for what remains occasions the most excruciating pains. He directs us, therefore, to put a ligature round the arm, and to tighten it every day so that the dracunculus may come forth by degrees without breaking. The part is to be washed with honied water, with oil in which wormwood or southernwood has been boiled, or with some such anthelminthic decoction; but all acrid things are to be avoided for fear of inflammation. He recommends us to forward suppuration by means of maturative cataplasms, and the other means mentioned by our author.
Pollux calls the dracunculus a piece of corrupted nerve which sometimes comes from the sores of Ethiopians, but seldom troubles other people.
Actuarius, like our author, mentions that the dracunculi occur most commonly in the region above Egypt, being generally formed in the muscular parts, and that in process of time the part becomes livid and suppurates. They are killed, he adds, by bitter and acrid things.
Avicenna comprehends in his account whatever information could be gleaned from preceding writers. He says the dracunculus is called vena medine, from Medine, the name of the country where it is most prevalent. It occasions a blister in the part which bursts, when a red and somewhat blackish substance protrudes and gradually increases in length. He directs us to correct the habit which gives rise to it by baths, humid food, and the like. His treatment is similar to that of Aëtius and our author, namely, binding a ligature round the arm, fastening a piece of lead to the worm, using fomentations of warm water, and the like.
Haly Abbas mentions the vena as being a worm which forms principally in the legs of the inhabitants of warm countries, such as India, Egypt, Ethiopia, and Lybia.
Avenzoar says that the complaint most commonly attacks negroes, being formed by gross humours, for dispelling which he recommends internally various sharp and acrid medicines, such as squills, nettles, colocynth, &c. He further directs a piece of lead to be bound firmly over the worm so that it may be made to crawl out gradually, which, however, he says, will not be accomplished in less time than a year.
Alsaharavius states the danger of breaking the worm (vena). He recommends the same treatment as Avicenna. The conclusion of his chapter on the dracunculus decides him to be the same person as Albucasis.
Albucasis recommends us to fasten to the end of the animal a piece of lead from one to two drs. in weight, and thereby to extract it gradually. He says that in some cases the animal is as long as fifteen palms, nay, that he had seen one twenty palms long.
Rhases says that the dracunculus takes place in hot and squalid bodies, and is formed by the use of potherbs and fruits. He recommends gradually increased doses of aloes, and when the animal protrudes it is to be wrapped round a leaden reed one dr. in weight, so that it may be dragged out gradually. He cautions us not to leave any part of it in the body. He also approves of incision as described by our author. In his ‘Continens’ he collects the opinions of Galen, Paulus, and others. He says that it forms most commonly in the bodies of persons who bathe frequently, and drink much wine. He says that he had seen it extracted by making free incisions.
See an interesting account of the guinea-worm in No. 66 of the ‘Edinburgh Medical and Surgical Journal,’ by Mr. Scott, surgeon, Madras.
Bertapalia, Guy of Cauliac, and all the early modern writers on medicine, repeat the ancient accounts of the vena civilis vel medine. They direct us to extract it by attaching a small piece of lead to its extremity. Ambrose Paré adopted Galen’s notion, that it is corrupted animal matter; but Andry held that it is a real animal. It appears, however, from some statements which we have seen in the periodicals of the day, that some of our English surgeons in the East Indies still advocate the doctrine of Galen; but we are inclined to think that the other opinion is the more correct one.