We shall briefly notice in this place the singular disease of the face which prevailed in the Roman empire during the reign of Tiberius, called mentagra by Pliny, in his curious description of it, but which he says was named lichenes by some. He represents it as a contagious disease, which was readily propagated by kissing. It attacked principally the higher class, the lower and middle ranks and women having generally escaped it. The seat of it was commonly the chin, but it sometimes spread over the whole face, and affected even the neck, breast, and hands. The only means of cure was burning with caustics down to the bone. (H. N. xxxvii; see also Marcellus, 19.) We are inclined to think that it must have been some variety of elephantiasis. Modern authorities have ranked it under sycosis, but it would appear to have been a much more intractable disease. The sycosis is distinctly described by Celsus, among the diseases of the hairy parts. He recommends for it elaterium, linseed, or figs boiled in water, &c. (vi, 3.)
The prurigo occurring in old age is not to be thoroughly cured, but may be alleviated by the remedies mentioned below: but that which arises from a cacochymy in other ages, is to be cured by evacuation, being formed by a bilious or pituitous humour that has become putrid, or by a saltish one. It is known by attending to the age, temperament, diet, season of the year, situation, and the like. If, therefore, it appear to prevail in the blood contained in the veins, we must begin with venesection; but if it offend rather by its quality, we must evacuate it by corresponding medicines, and turn our attention to external applications. Wherefore we must use the bath at all times before a meal; and sometimes, after eating a little, it may be used a second time, for the affection is of difficult humectation. They are to be rubbed with the decoction of fenugreek, or of beet, or of barley-meal, or of wild or of garden mallows, or of ptisan; and along with these may be joined the flour of beans, or of lupines, or of myrobalan (ben), or of the detergent ointment called peponaton. If it is protracted, we may use the bath in like manner, and foment with the decoction of sage, of tamarisk, of the herb mercury, of marjoram, of pennyroyal, of bay berries, of the root of the wild cucumber, of capers, of strained ley, of vinegar and brine; and then the parts are to be sprinkled with dried natron, or with the lees of vinegar, or with the composition containing of spuma nitri one sextarius, of rosemary, of sulphur vivum, of each, lb. j, of cimolian earth, lb. ss; or this: of aphronitrum, of sulphur vivum, of burnt alcyonium, equal parts; to be used dry, or with some of the decoctions already mentioned; and, if you please, sprinkle some dried hellebore, without grease. But rub in with vinegar and oil, stavesacre pulverized, or sulphur, or red arsenic, or all together; or mustard, with the refuse of expressed myrobalan, and vinegar and oil; or with snails burnt and triturated with honey or the roots of dock, or the detergent ointments prepared from them, as described under the head of Elephantiasis; or with some of the applications for scabies. If the parts become ulcerated, use the plaster called parygron, or that prepared from pompholyx; or melt oz. j of wax in a cyathus of oil of privet, and sprinkle upon it of sulphur vivum oz. j. Another application for prurigo: Of large nuts in a rancid state, oz. j; of sulphur, oz. j; triturate with the juice of parsley, and use in the bath with much friction. This alone has proved sufficient for the cure of many cases of scabies and prurigo; and green parsley by itself, when pounded and rubbed in while the patient is in the bath, has been of great service: and in like manner, pellitory of the wall and maple rosin dissolved with rose oil, and rubbed in.—Another: Bruise three ounces of pure and very white rice, and, having strained, triturate with strong vinegar until it become of the thickness of the sordes of the oil in baths; and adding separately of sulphur vivum pulverized, oz. j; and mixing properly, use in the bath with much friction. When there is a greater redundance of humours, it will be better to mix the ingredients in equal proportions.
Commentary. See Hippocrates (Aphor. iii, 31); Galen (Comment. et alibi); Oribasius (Morb. Curat. iii, 22); Aëtius (xiv, 20); Actuarius (Meth. Med. ii, 11); Nonnus (237); Alexander Aphrodisiensis (Probl. i, 24); Myrepsus (pluries); Pliny (xxviii, 5); Octavius Horatianus (i, 31); Marcellus (de Med. 4); Isidorus (Orig. iv, 8); Serapion (v, 6); Avicenna (iv, 7, 3, 6); Haly Abbas (Theor. viii, 17, and Pract. iv, 6); Alsaharavius (Pract. xxxi, 5); Rhases (Divis. 121); Avenzoar (ii, 7, 2.)
The prurigo of Dr. Willan is here distinctly described, and a suitable method of treatment recommended.
Hippocrates remarks that prurigo is common in old age. The reason which Galen assigns for this is, that the superfluities of the system are then not properly discharged by the skin. He says in another place, that pruritus may either be produced by external substances, such as nettles, squills, &c., or it may arise from indigestion and the neglect of cleanliness.
Oribasius gives an account of the disease not very different from our author’s. Among other applications, he recommends one consisting of opium mixed with liquid cerate.
Aëtius speaks highly of the sulphureous bath for the cure of this disease.
Actuarius characterizes the disease very well, when he says that it is allied to lichen, and that when rubbed either nothing runs from the place, or some slight humidity of various colour and consistence. He assigns, as a reason for its frequency in old age, that the pores of the skin then get constricted.
Alexander Aphrodisiensis assigns, as the reason why the warm bath proves useful in cases of pruritus, that it dispels the phlegm, which is the cause of the complaint.
Celsus gives a particular account of scabies, but says nothing of prurigo.
Octavius Horatianus recommends us, when the patient is young, to bleed, purge, and use baths medicated with frankincense, natron and sulphur. He also says that the cold bath, and friction with the oil of roses, myrtles, &c., will do much good.
Isidorus uses the term prurigo: “Prurigo vocatur perurendo et ardendo.” Marcellus also uses this term, and recommends much the same substances as the others.
This affection is clearly described by the Arabians, and is rendered pruritus by most of their translators. Serapion recommends us, if there is a sanguineous plethora, to bleed, and then to purge with myrobalans, colocynth, and black hellebore, and along with these the warm bath is to be used, and the liniments for removing the pruritus, containing vinegar, roses, nitre, &c. The prurigo senilis he pronounces to be incurable. Rhases and Avicenna recommend similar remedies. They treat of prurigo and scabies together, and there is no doubt of their alliance. Hence Bateman says that prurigo, when neglected, terminates in scabies. Haly Abbas says that scabies and prurigo arise from a saltish phlegm. Scabies, he says, consists of reddish pustules, which appear most frequently between the fingers and upon the arms. Prurigo, he adds, is apt to run into scabies. He recommends, as a lotion, vinegar with rose-oil, the use of the warm-bath, and other remedies like those of our author. Alsaharavius says that the disease arises from debility of the expulsive faculty of the body or constriction of the pores. He praises highly the hot bath. Avenzoar states that pruritus arises from bile or a sharpness of the blood.
Our author has omitted to treat of phthiriasis, for an account of which see in particular Cælius Aurelianus (de Tard. Pass. iv, 2); also, Aristot. (Hist. An. v, 32); Galen (de Comp. Med. sec. loc. i, 8); Pliny (Hist. Nat. xxvi, 86); Haly Abbas (Pract. iv, 7); Plutarchus (in Vitâ Syllæ.) The authorities quoted by Rhases recommend compositions consisting of stavesacre, white hellebore, arsenic, nitre, sulphur, sublimed mercury, and the like. (Contin. xxxvi.) Antiochus, Herod of Judæa, Philip II of Spain, and many other celebrated personages, are said to have died of phthiriasis. Virey accounts for the disease in the following manner: “Il est, en effet, tel tempérament muqueux, telle dégénération des humeurs lymphatiques, dans le phthiriasis ou la maladie pédiculaire, que ces insectes y trouvent une pâture inépuisable, qu’ils se propagent avec une extrême exubérance sous le peau, pénétrent dans le tissu cellulaire, et établissent d’énormes colonies parmi les ulcères qu’ils y forment.” (Hist. des Mœurs des Anim. ii, 207.) Aldrovandi gives a very full history of phthiriasis. (De Insectis, v.)
Leuce is a change of the skin to a white colour, occasioned by a viscid and glutinous phlegm. Since all the kinds of leuce are not curable, you may form a diagnosis of it in this manner. Pierce the leuce superficially, not deeper than the skin, with a needle, and if blood flow, the complaint may be cured; but if a milky moisture be discharged, it is incurable. Or, rub it with a rough woollen rag, and if the part become red, the complaint may be cured; but if it remain of the same colour, it cannot be cured. And those kinds which attack a great part of the body are to be supposed more difficult to cure than those which are confined to a small space, and old cases than recent. Some, therefore, in leuce, have approved of burning by iron, consisting simply of the application of heat. Others, dreading the pain of burning, and the scar arising from it, as being no less unseemly than leuce itself, have had recourse to escharotic medicines, such as they say will produce a scar of the natural colour. Others rejecting all these things on account of the difficulty of their application, have used dyes (paying more consideration to the deception than the utility which they produce,) which are, of all others, the most to be rejected, owing to the speedy renewal of the affection. We must use, then, the under-mentioned remedial powers: Of adarce, of rosemary seed, of sulphur vivum, of each, equal parts; bruise and strain singly, and then, having triturated together for a sufficient number of days, anoint in the sun, but not in great quantity, lest the skin be ulcerated; and, after some time, a little hellebore and galls may be added in like manner.—Another: Macerate the tops of the black fig in vinegar, and having triturated, mix equal parts of aphronitrum, sulphur vivum, and the fruit of tamarisk, and having rubbed natron into the part, anoint and expose to the sun, taking care lest an ulcer be produced. But Archigenes having mixed a sufficiency of quicklime with fig-leaves, used them in like manner: or, he says, having rubbed the leuce with white hellebore until the part perspire and become of the same colour as the rest of the body, anoint with sinopis or melian earth; or, having perforated them with needles until they bleed, anoint with sinopis in vinegar; or, having first rubbed them as formerly said, anoint with the fresh juice of figs, or rub in so much with the leaves of it.
Commentary. In the second Section we have stated so fully the nature of the leuce, and the difference between it and its cognate affections, that it will be unnecessary for us now to resume the subject. It is there mentioned that leuce is Celsus’ third species of vitiligo, and the baras of all the Arabian translators, with the exception of Stephanus Antiochensis, the translator of Haly Abbas, who applies the term lepra to it. It was therefore the white species of leprosy. All the medical authorities represent it as an intractable disease, not only the cuticle being altered in structure, but also the flesh below, and even the hairs, having undergone a change of colour. All direct us to prick the skin with a needle, and, if it bleed, the cure is to be attempted; but if a slight colourless fluid issue from it, the case is to be abandoned as hopeless. They consider it as arising from debility of the assimilative faculty of the part which can no longer convert the nutritive juices into their proper consistence. All recommend nearly the same treatment. The diet is to be regulated with a strict abstinence from gross food; if there be plethora, venesection is to be premised; then drastic purgatives and emetics are to be given, and the parts affected are to be rubbed with stimulant and caustic applications, containing hellebore, nitre, sulphur, misy, red arsenic, &c., or even the actual cautery may be applied. In short, all treat the disease in nearly the same manner as our author. (See in particular Serapion and Avicenna.)
Aristotle, we believe, is the first Greek writer who makes mention of leuce. He calls it a disease in which all the hairs of the body turn white. (Hist. Nat. iii, 11.)
“The snow-white leprosy” of the ancient Jews was the leuce of the Greeks. Moses describes very correctly the method of distinguishing it from the alphos and melas; (Leviticus, c. xiii.) The symptoms of leuce are given in the 3d verse; of the alphos in the 4th; of the melas in the 6th. He calls it contagious, which might lead us to suspect that elephantiasis was mixed up with the leprosy of the Jews. This opinion is further confirmed from what is mentioned by Josephus of its being said that his countrymen were driven out of Egypt because they were affected with leprosy. (See also Justin. xxxvi, 20, and Tacit. Hist. v, 3.) Now we know that elephantiasis was endemial in that country. (See chap. i.) The English translation of this chapter is very inaccurate, the translators having evidently failed to recognize the nice distinction between cognate diseases, laid down by the Jewish legislator.
Leuce is still common in tropical climates. Negroes affected with it are called Albinos. It is merely an aggravated variety of the Lepra vulgaris.
The formation of alphos is similar to that of leuce, but the latter produces a deep change of the skin, so that the hairs grow of a similar colour, whilst the alphi affect the skin superficially, except that when continued, they extend more deeply, so that the hairs grow white, owing to the humour which causes it. From the pituitous humour then they are produced white, but black from the melancholic. Wherefore, a common application for both is washed lime dissolved in water, or, the root of dracunculus applied with vinegar; in like manner, either species of hellebore, the decoction of bitter lupines poured on the part, and their flour when applied as a cataplasm with vinegar or oxymel, the bark of the root of capers with vinegar, the root of lily with honey, onions with vinegar rubbed into the part in the sun, the dung of the land crocodile, and in like manner, that of starlings, when they are fed solely upon rice, and the burnt shells of the cuttle-fish. The following is a compound application: of alcyonium, of natron, of each, oz. ij; of white hellebore, of sulphur vivum, of each, oz. j; and some also add the burnt lees of wine.—Another: Of sulphur vivum, of the spuma nitri, of each, dr. iv; rosemary seeds, vij; triturate with vinegar. But rub only the part affected with alphos, not touching the unaffected parts, and when dry, wash with cold water.—Another: Of the flour of lupines, of buccina, and natron, of each, a chænix; of white hellebore, dr. viij; rub with it in a dry state.—Another: Of the flour of bitter vetches, lb. ij; of the seeds of rocket, of bitter almonds, of the root of the wild cucumber, of each, lb. j; triturate with wine and honey and anoint, and after an interval of an hour wipe it away with a sponge. It applies also for freckles, warts, and other spots on the skin.
A tried remedy for white alphos: of sulphur vivum, ii sextarii, of quicklime whitened, oz. iv; five whites of eggs, of nard-oil and vinegar, a small quantity. The sulphur is first pounded, then we add to it the oil of nard, and again triturate; then the vinegar is poured in, and the mixture is again triturated. But the quicklime is to be washed separately, once, twice, and thrice, and then we add it to the sulphur with the white of the eggs and triturate; and we pour out the collected fluid; but leaving a small quantity so that the ointment may admit of anointing, we use it thus.—Another tried remedy: Take sulphur vivum, dried fig leaves, aphronitrum, alcyonium, Cimolian earth, and myrtle, use with vinegar.—Another of Archigenes: Rub in equal parts of fig leaves dried in the shade, of sulphur, and of alum with vinegar, or of fig leaves, dr. iv; of nitre, dr. ij; of burnt alcyonium, dr. ij; anoint with vinegar in the bath. But red arsenic with one half of sulphur is excellent for removing the black alphos; thus having cleansed the part with natron, anoint with it in the sun. For white alphos: of copperas, of verdigris equal parts, of natron the double, rub without fat: or, of rosemary seeds, of sulphur vivum, of adarce, equal parts; triturate with vinegar, rub, and anoint; but when it is dry, bathe by rubbing. This applies also to the white species.
Commentary. We have again to refer the reader to the second chapter for an account of these complaints, and an exposition of the differences between them and the affections to which they are allied. It will be seen that they are varieties of the genus vitiligo of Celsus, and that they bear a near resemblance to leuce, from which they are chiefly distinguished as being mere superficial affections of the skin. The Arabians treat of them under the names of morphea alba and nigra. Dr. Willan makes them to be varieties of lepra, in which opinion we fully coincide with him.
The description of the two diseases by Actuarius is so precise that we shall give it in lieu of all the others. The alphi, he says, are superficial, but sometimes extend in depth, so that the hairs appear of the same colour. The white species is tried as to the depth it has spread, by being pricked moderately with a needle; when blood flows though the needle has only penetrated the skin, the disease is curable, but if the discharge be milky it is incurable, inasmuch as the flesh is converted into the disease. Others, he adds, rub the part with rough towels, and if it become red they have good hopes, but if it remain of the same colour they abandon all hopes of recovery. They are of a more aggravated nature when they affect different parts of the body and are inveterate. The alphi, he says, are generally milder than leuce, and can be cured by gentler means, but when they become inveterate they require similar treatment. The difference between the white and the black alphos is produced by the colour of the prevailing humour.
There is scarcely any difference of opinion among the authorities respecting the general plan of treatment. Haly Abbas has correctly remarked, that the alphi are to be cured by the same sort of remedies as lepra (leuce?) only that they do not require so strong applications. The Arabians greatly commend their myrobalans with ginger, mastich, parsley, &c. Their internal applications are powerful detergents and escharotics, such as hellebore, natron, sulphur, vinegar, arsenic, copperas, &c. Celsus says nothing of internal remedies, but recommends external applications of a stimulant nature, containing sulphur, alum, nitre, frankincense, alcyonium, &c. In the ‘Isagoge’ it is said that all these complaints are to be cured by phlegmagogues, and by abstergent applications externally.
Guy of Cauliac, and the other medical authorities of that age, describe these diseases by the names of Morphea alba and M. nigra. They recommend applications containing sulphur, alum, natron, arsenic, and the like. As usual they are the mere copyists of the Arabians.
You may remove stigmata by rubbing in that which sticks to a chamber-pot, along with the most acrid vinegar, or rub of quicklime, p. j; of red natron toasted, p. ss; with water, in the sun: but when it ulcerates let it be healed like an ulcer. But Crito says, for stigmata, having first scrubbed the part with nitre (soda), cover it with an application of turpentine; then having bound it, let it remain for six days, and on the seventh perforate the stigma with a needle, and having wiped away the blood with a sponge, after a little time rub with some powdered salt. Then, having applied the medicine, allow it to remain for five days. It is this: of frankincense, of natron, of the lye of quicklime, of wax, of each, dr. iv; of honey, dr. viij; having loosed it, you will find the blackness upon the application.—Another ointment: Of pepper, dr. ij; of rue, dr. iv; of realgar, dr. iv; of orpiment, dr. j; of honey, q. s. Anoint with it, have previously scrubbed the part with natron, and done otherwise in like manner as for the former. Taking it away after three days, and cleaning away the blackness, anoint with it again; for, he says, it removes the complaint in twenty days, without ulceration or cicatrix.—Another called Criticum: Of frankincense, dr. iv; of nitre, dr. ij; of copperas, dr. iv; of wax, dr. vj; of pepper, dr. iij; of lime, dr. iij; of thapsia, dr. iij; of orpiment, dr. iss; of realgar, dr. iij; of honey, q. s; use as the former. Oribasius says, that crowfoot (ranunculus) if applied, or the leaves of capers, take away the marks. But if they be deep seated upon only a small extent of skin, form an eschar by a cold cautery, and thus remove them.
Commentary. Consult Aëtius (viii, 12); Actuarius (Meth. Med. vi, 8); Scribonius Largus (§ 231); Avicenna (iv, 7, 2, 7); Pseudo-Dioscor. (Eupor. i, 116.)
Aëtius explains that by stigmata are meant the marks of injuries on the face or any part of the body. To eradicate them he recommends compositions containing quicklime, natron, arsenic, &c.
The Pseudo-Dioscorides recommends the ranunculus, the juice of the leaves of capers, or that of mandragora, &c.
Actuarius copies from our author.
Scribonius Largus mentions a composition containing garlic, cantharides, sulphur, chalcitis, &c.
Avicenna recommends friction with natron and the other substances mentioned by our author.
Dr. Willan defines the stigma, “a small speck on the skin, occasioning no elevation of the cuticle.” The ancient authorities, it will be perceived, apply the term in a wider sense.
Exanthemata are formed by thick humours impacted in the skin, and more especially if the cuticle be thick. In these cases, then, even if the humours are deep-seated, they must be first purged away; for unless you do this in the first place, before attempting to dispel them, you will only impact them the more firmly, instead of evacuating them by the skin. But if the deep-seated parts be free from crudities, you may evacuate the humours by the skin, and not produce revulsion of them to a distance, which is the case, if you attempt to evacuate them by the belly or emetics. But the cure of humours fixed in the skin, is to be accomplished by fomentations and calefacients, more especially when the exanthemata happen to be broad, for these are formed by a cold and thick humour. Wherefore, take of the tender leaves of bay, of manna, and of rue equal parts, triturate together, and dissolving frankincense in honey, anoint with it; or, having boiled and pounded tender beet, apply as a cataplasm; or, take of wax, dr. viij; of sulphur the same quantity; of salt, dr. vj; triturate them dry, and having poured on them half a cyathus of oil, boil all together, and use the plaster that is formed. But one must attentively sit by while the boiling is going on. It is a very excellent medicine.
Commentary. See Hippocrates (Epidem. et alibi); Galen (Meth. Med. v); Alexander (i, 5); Oribasius (Synops. vii, 7); Morb. Curat. (iii, 21); Aëtius (v, 129); Actuarius (Meth. Med. ii, 11; i, 23); Celsus (v, 28); Pseudo-Dioscor. (Euporist. i, 106); Haly Abbas (Theor. viii, 17; Pract. iv, 8).
As stated in another place, the Greeks used the term exanthema in a much laxer signification than it is applied in Dr. Willan’s ‘System of Cutaneous Diseases.’ Hippocrates in particular may be mentioned as applying it to various classes of these affections. Alexander describes the exanthemata of the head as superficial ulcerations, which are red and rough. Does he allude to porrigo? He recommends for the cure of them a composition of litharge, ceruse, alum, the green leaves of rue, vinegar, and myrtle oil.
Galen says that exanthemata is a term applied by some to all ulcerative and rough affections of the skin, which, according to Archigenes, stand in need of desiccative applications. In another place he mentions the exanthemata as a common symptom of the plague. Aëtius in like manner gives from Herodotus an interesting account of fevers which are accompanied with exanthemata. Both have been supposed to allude to the smallpox, but we agree with Dr. Willan, that this interpretation of their descriptions is altogether fanciful.
Our author follows Oribasius closely.
According to Actuarius exanthemata, properly speaking, are produced by thick humours either formed in the skin or in the whole body, and being detained by the density of the epidermis.
Celsus describes the exanthemata under the generic term pustulæ. His words are: “Earum plura genera sunt. Nam modo circa totum corpus partemve asperitudo quædam fit, similis iis pustulis, quæ ex urticâ, vel ex sudore nascuntur: ἐξανθήματα Græci vocant. Eæque modo rubent, modo colorem cutis non excedunt.” For pustules of all kinds he recommends exercise, restricted diet, and abstinence from all things of an acrid and attenuant nature, which regimen is likewise to be enforced upon the nurse, if the child be at the breast. If the patient be strong, he is also to be put into the hot bath, and rubbed with natron and a mixture of wine and oil. If this treatment does not succeed lentils are to be applied, especially if the pustules be large; and after the outer skin has been removed they are to be treated with gentle applications. Such is the plan of cure recommended by the great Roman authority. His directions respecting the diet are particularly important, and appear to be quite in accordance with the practice of the modern physicians, who recommend the half-starving system in all such complaints.
For red exanthemata the Pseudo-Dioscorides recommends ceruse with oil of bays and sulphur, pure bark with wax, &c.
The exanthemata are described by the name of pustulæ parvæ in most of the translations of the Arabians. The exanthemata is, we think, the first species of Serie described by Haly Abbas.
For the opinions of Alsaharavius and Haly Abbas about the exanthemata of infancy, see Book i, 6.
Dr. Willan thinks that the nettle-rash was comprehended under the term exanthemata. He is also of opinion that the benat noctis of Avicenna is the nettle-rash. It would appear, however, that the benat noctis was the same as the sera or epinyctis. See Rhases (Cont. xxxvi, 2). The symptoms of it are said to be itching, roughness of the skin, and small eruptions attacking the patient during the night.
Thucydides, Hippocrates, and Galen mention exanthemata as a common symptom of the plague.
We may take the present occasion to mention that none of the Greek or Latin authorities has given any distinct account of purpura. Avicenna has briefly described it in its chronic form. (iv, 3, 1, 8).
Epinyctides are small ulcers breaking out spontaneously on the skin, in the form of bullæ, reddish, and when broken, discharging a bloody ichor. These are not very troublesome during the day, but at night, they are more painful than the smallness of the ulcer would bespeak. Wherefore, having dissolved the juice of laserwort in water, apply it; for it is desiccative without being pungent; or, having levigated hemlock, apply it; or crude cabbage with water, or triturate parsley with polenta, and apply; or, triturate the leaves of henbane with honey, and apply; or, strychnos by itself, and with the green coriander; or, use the leaves of olives boiled with water; or, having triturated raisins deprived of their stones, and spread them upon a splenium or oblong pledget, apply; or triturate maiden-hair with honey. They must avoid all acrid, acid, and saltish things, also fomentations, baths, and insolation.
Commentary. Celsus (v, 28); Aëtius (xiv, 61); Oribasius (Morb. Curat. iii, 54); Actuarius (Meth. Med. ii, 11; vi, 8); Pollux (Onomasticon iv, 24); Avicenna (iv, 3, 1, 13); Serapion (v, 8); Haly Abbas (Theor. viii, 17); Pract. (iv, 8); Rhases (Divis. i, 122.)
Celsus describes the epinyctis as a bad species of pustule, somewhat livid or red, about the size of a bean, very painful and inflamed, and coming on principally at night, whence it derives its name. Persons of all ages, even infants at the breast, are subject to it, and in treating them he directs the regimen of the nurse to be properly attended to. In laying down the rules of treatment he puts particular stress upon the hot bath.
Aëtius, Oribasius, and Actuarius treat of it as our author. Pollux defines it to be a vesicle of a palish colour, somewhat humid and bloody, and forming about the legs and feet in the night.
The Arabians give a similar account of epinyctis, under the names of Sare, Serie, and Essere. Thus Serapion recommends bleeding if required by the general symptoms, purging with myrobalans and prunes; and external applications, containing sumach, savin, &c. Haly Abbas, who describes it as one of his serie, approves of much the same treatment. Avicenna and Rhases in like manner recommend bleeding, gentle purgatives, cooling lotions, and the tepid bath. Rhases, in his ‘Continens,’ applies the directions given in this chapter by Paulus to the treatment of the cutaneous disease, which he calls sera. This establishes their identity (xxxvi, 6.) As stated in the preceding chapter, the epinyctis is also the “benat noctis,” i. e. “filia noctis” of the Arabians. Marcus Aurelius Severinus, therefore, is mistaken in distinguishing between the epinyctis and the benat noctis. Ingrassius admits their identity.
Fracastorius gives the following account of this affection: “Si inflammata et accensa sit cholera, pustulam illam facit, quæ ἐπινυκτις vocatur, quod sæpissime noctu nascatur, Arabes Essere appellant.” (De Morb. Cont. ii, 15.) Both Lorry and Rayer confess themselves unable to determine what the epinyctis of the ancients was. It would appear to have been some peculiar species of eczema, now extinct. It must have been a more formidable disease than the nettle-rash, which certain modern authorities have taken for the epinyctis of the ancients.
As Bullæ when they burst spontaneously are attended with acute pain, it is proper to perforate at their under part with a sharp needle, and then to squeeze out the humour gently, suffering the skin which covers it to remain. And if the wound should close up and the bullæ fill up, it is to be evacuated again in like manner, and pressed out; and the incumbent skin is to be kept pressed down until the ulcer below be healed. Before the bullæ break, apply boiled lentils triturated with water; or, the shoots of pomegranate, having been warmed upon hot coals, are to be applied, so as to burn the parts. But if they burst and form an ulcer, having melted axunge, and mixed levigated litharge, put into a linen cloth, and apply; or, having boiled the root of lily in water, triturate it with cerate, and apply.
For epinyctis and phlyctæna. Having triturated equal portions of litharge and sulphur vivum with vinegar and myrtle-oil, until it become of the thickness of the sordes of baths, rub with oil and wine. For hot eruptions, warm papulæ, achores, incipient furunculus, and burns, the composition of plumbago, and that from eggs is applicable.
Commentary. See Aëtius (xiv, 63); Oribasius (Morb. Curat. iii, 23); Actuarius (Meth. Med. vi, 8); Avicenna (iii, 3, 1, 11.)
This appears to be the pompholyx of Drs. Willan and Bateman. Aëtius remarks, that the disease principally attacks women whose menses are obstructed. (Bateman says, “it seems to affect only women.”) He recommends emmenagogues, laxatives, and diuretics, and forbids all acrid things.
Our author copies the whole from Oribasius. Actuarius recommends nearly the same applications.
Celsus describes the phlyctænæ as a variety of the pustulæ. There is nothing particular in the treatment recommended by Avicenna.
Thucydides mentions small phlyctænæ and ulcers among the symptoms of the plague of Athens. (De Bello Pelopon. ii.) Hippocrates gives the name of pemphyx to the cutaneous eruption, by which the plague of Athens was distinguished. (Epidem. vi.) See Galen’s Comment. (v, 453, ed. Basil.) Procopius also takes notice of black phlyctænæ among the symptoms of the great plague which raged in the reign of Justinian (Pers. ii.) See also Diodorus Siculus (Biblioth. xiv.) Some suppose, however, that by phlyctænæ were meant petechie. See Prælect. Marc. p. 301.
Burnt parts require applications which are moderately detergent, without being decidedly heating or cooling. Wherefore, Chian, Cimolian, Cretan, and every light earth, when rubbed in with vinegar not very acrid, or mixed with water, are excellent applications, and prevent blisters from forming; also a whole raw egg immediately applied upon soft wool, for it cools moderately, and dries without being stimulant. And anoint the part with black ink, or with frankincense dissolved in water, or use a cataplasm of boiled lentils, or of tares. For burning with hot water, before blisters arise, pour frequently on the part the brine of pickled olives, or apply olives themselves triturated with polenta; or, triturate stone-alum with vinegar, and rub it in; or, anoint with bull’s gall dissolved with much water; or, pour on the part strained ley with sauce of pickles, or brine; or, triturate the bulbous roots of lilies, hyacinths, or narcissi with rose-oil, and having made it of the consistence of the sordes of oil in baths, anoint with it. But Marcellus gives the following composition: having smeared a rag with honey, and wrapped it around barley, burn it, and mix of the ashes, dr. viij; of ceruse, dr. iv; of butter, dr. viij; of wax, dr. xvj; of goat’s fat, dr. xvj; of rose-oil, dr. xvj. For burnt parts already blistered, having triturated sumach and polenta with vinegar, apply it; or, mix quicklime with cerate, put it on a rag, and apply. And the medicine called Sphæria is applicable in such cases. The parts which are ulcerated, may be covered with pounded leeks; or, triturate purslain with polenta, and apply; or, put pigeon’s dung into a rag of linen, burn it, and mix the ashes with oil, and use; (this is an excellent application:) also the bark of pine and of spruce fir, or dried maiden-hair levigated, or the burnt leaves of myrtle, are to be triturated and sprinkled upon the part. Each of these things answers well, when applied with cerate. But a good application is formed by triturating together of the dried roots of the red alkanet, oz. iv; of white wax, oz. ix; of rose-oil, oz. xviij; and also that made of ceruse, with a small quantity of stag’s marrow.
Commentary. See Hippocrates (de Ulceribus.) Celsus (v, 27); Galen (de Simpl. Med. et alibi.) Aëtius (xiv, 64); Pseudo-Dioscor. (Euporist. i, 178); Actuarius (Meth. Med. vi, 6, 8); Nonnus (240); Serapion (v, 11); Avicenna (iv, 4, 2, 12); Haly Abbas (Pract. 4, 25); Alsaharavius (xxix, 2, 8); Rhases (Antid. i, 27); (ad Mansor. vii, 18); (Div. i, 136.) The author of the Hippocratic treatise referred to above, recommends various applications to burns, such as old axunge rubbed into the part, and the root of squills applied above; or a mixture of old axunge, rosin, and bitumen, spread upon a rag and heated at the fire; or the roots of the ilex boiled in white wine at a gentle fire until it be of the consistence of a liniment.
Dioscorides, Avicenna, and Galen, agree in praising Cimolian earth as an application to recent burns. Galen says that copperas, especially when dissolved in vinegar, forms an excellent application for the ulcers occasioned by burning.
Aëtius treats burns upon nearly the same principles as our author. When blisters rise he forbids an early opening to be made in them. As an application to them he recommends alum with water and the white of an egg. Some of his applications can only be supposed proper for the foul ulcers left by burning. Such is that consisting of verdigris and litharge, pounded with wine and oil. For healing ulcers he recommends a composition containing ceruse, litharge, toasted barley pounded, wax, and rose or myrtle oil.
In the ‘Euporista’ Cimolian earth, litharge and oil, and many other applications are recommended.
Actuarius recommends a composition of litharge, ceruse, wax, turpentine, and some other articles of less importance. We need scarcely mention how much the oil of turpentine has been used of late in such cases. He praises such things as are moderately astringent, such as alum dissolved in vinegar, &c.
Celsus recommends at first such things as are, “mediocriter exedentia reprimentiaque,” and afterwards articles of a soothing nature. To the former class belong the farina of lentils and honey; myrrh with urine, or the Cimolian chalk, with the bark of frankincense; and to the latter belong all fatty applications, and such things as contain the dross of lead and the yelks of eggs. He also mentions turpentine rosin, as an application to foul ulcers from burning.
Serapion, like our author, recommends applications which are moderately detergent, and neither very calefacient nor refrigerant. He gives the following directions for making a preparation from lime. Take of lime, seven times washed in sweet water and dried, oz. viij; of wax, oz. ij; of oil of roses, oz. vj: let the wax be melted along with the oil, and well mixed with lime. This is to be rubbed into the part. He also gives a prescription for preparing a mixture of lime-water and oil, exactly similar to that which is now used in cases of burns. (vii, 28.) Avicenna, with his usual accuracy, lays down very particular rules for the treatment of burns. To prevent blisters from rising he recommends cooling things; when the burning is occasioned by hot water, he directs us to apply sandals, rose-water, and camphor: or a cloth dipped in congealed water is to be kept constantly applied, and it will prevent blisters from rising. Most of the applications recommended by our author are also mentioned by him. Haly Abbas directs us to apply a cloth cooled in rose-water. He also speaks of the ointment of lime and rose-oil, mentioned above. When the burning is not severe, Alsaharavius directs us in the first place to wash the part with vinegar and salt, and then to sprinkle upon it the flour of barley or of oats. Then if blisters do not rise, but there is a sensation of burning in the part, he recommends us to apply cloths dipped in cold water, rose-water, or snow-water, which are to be changed frequently. Afterwards some emollient applications, such as the white of an egg, with gum arabic is to be used. When the burning is more severe, he recommends us to bleed and use a cooling application, such as the brain of a sheep, the white of an egg mixed with rose-oil, or an ointment made of white wax and rose-oil. He also makes mention of the application from lime. Rhases recommends an ointment containing ceruse, camphor, opium, &c. Like Avicenna, he directs us to apply at first a cloth wetted in cold water, or in rose-water, which has been cooled with snow. If the burning be extensive he recommends venesection, with a cooling and attenuant diet. When the pain is great he directs us to apply the yelks of eggs mixed with rose-oil. When a large ulcer is formed, he directs us to dress it with the ointment of lime, described above. He also approves of a white ointment, consisting of ceruse, oil of roses, and wax. In his ‘Continens,’ he relates a case of severe burning, which he treated with liniments composed of sandals, camphor, and roses; a cloth wetted in snow-water being applied externally to it. He approves of opening the blisters. To prevent them from forming, he recommends strongly an astringent collyrium of galls. Like many of the other authorities, he recommends Cimolian earth very much. The applications recommended by Haly Abbas are of a refrigerant and cooling nature, such as Armenian earth in vinegar, the white of an egg, ceruse, &c.
The earlier modern authors treat burns upon the plan laid down by the ancients, more especially the Arabians. Thus Guy, of Cauliac, recommends us in cases of extensive burning to have recourse to venesection, along with a cooling and attenuant regimen. As a local application, he recommends a cloth wetted in rose-oil congealed in snow, and afterwards cooling ointments containing ceruse, litharge, and the like. He approves of opening the blisters, of afterwards dressing the part with desiccative remedies, such as the ointment of lime, seven times slaked. (Tr. vi, Doct. C. 6.)
Take of ceruse and litharge equal parts, of wax four parts, use as a plaster with the oleum susinum, or rose-oil; but on the first day use the susinum separately; or, of saffron, dr. j; of tragacanth, dr. j; unite with them a whole egg, without the shell, and use. For those who have been scourged, the skin of a sheep newly taken off, when applied while yet warm, of all remedies cures the soonest, effecting this purpose in a day and a night.
Commentary. See Aëtius (xiv, 62); Avicenna (iv, 4, 2, 7); Haly Abbas (Pract. iv, 26); Alsaharavius (Pract. xxxi, 2, 1); Rhases (Contin. xxviii.)
Aëtius gives similar directions. The following is said to be an excellent application for the stripes of a whip: mix washed lime with raw eggs, and add some rose cerate. Aëtius, Galen, Nonnus, Avicenna, Rhases, Haly Abbas, and Alsaharavius join our author in recommending the fresh skin of a newly-killed sheep as an application in such cases. Alsaharavius recommends an ointment containing white wax, rose-oil, and ceruse, when the wounds are deep; when there is any apprehension of heat and inflammation, and more especially if the patient be plethoric, he approves of venesection. When on the other hand the patient is weak, and is in danger of falling into a state of syncope, he recommends musk and wine to be administered. When there is much appearance of ecchymosis he speaks of scarifying the part after the heat is gone. Rhases recommends a composition of ceruse, litharge, wax, and rose-oil, as a general application.
Most of the applications recommended by Bertapalia contain litharge, ceruse, tutty, wax, and oil. (De Ulceribus, 16.) The other earlier medical authors of modern times likewise follow the ancients in this case.
Hairs grow on a burnt part if you apply fig leaves boiled in a pot with cerate, in the form of a plaster; or, of dried fig, dr. viij; of marjoram, dr. j; triturate with oil to the thickness of a cerate, and use; or, of gypsum, dr. c; of squama æris, dr. j; form trochisks with water, and keep. When going to use, mix one part with eight parts of cerate.
Commentary. The Arabians mention various things which were supposed to be possessed of the property of making hairs grow; such as turpentine, spikenard, thapsia, &c.
For excoriated surfaces and superficial ulcers, at first use astringents, such as wine, or vinegar and brine, and afterwards such plasters as contain fat and promote cicatrization, and the most delicate of the white plasters. This is particularly applicable: of ceruse, p. j; of ammoniac, p. ss; of myrtle-oil, q. s; having triturated the ammoniac in water, mix the ceruse, adding the myrtle-oil, and use in an oily state: or, mix the squama æris with gypsum, and having triturated with myrtle-oil, use: or, having triturated Cimolian earth and litharge with wine, and the oleum ricini, or myrtle-oil, use.
For excoriations, intertrigo, chronic ulcers, and old and tender skin. Of golden-coloured litharge, dr. lx; of wax, dr. xx; of dried pitch rosin, dr. xij; of oil, iss cyathus: having boiled the litharge and the oil, add the other things, and having agitated it with a spatula, or softened it in a mortar, use. Skin which has been torn away, ought not to be cut from the sores, but it ought to be laid on, and the medicine applied; for thus they coalesce, even if it is black. When stripped of the skin, the cicatrization is difficult, the ulcer being irritated and rendered foul. Excoriated parts are preserved from inflammation by the application of red sumach, triturated with honey, or with the hair of sweet flag burnt and applied with honey.
An anodyne for excoriations, sores from stripes, and contusions of the joints. Of litharge, of ceruse, of each, oz. j; of wax, oz. vj; of pure oil or rose-oil, lb. iss; of starch, oz. ij. The composition called pelarium, from the dross of silver, produces the same effects, and that from eggs in like manner.
Commentary. See Oribasius (Morb. Curat. iii, 18); Aëtius (xiv, 66, 67); Scribonius Largus (88); Marcellus (De Med.); Avicenna (iv, 4, 2, 9); Haly Abbas (Pract. iv, 10); Rhases (ad Mansor. vi, 18.)
Our author copies closely from Oribasius.
Aëtius recommends as a good application for intertrigo occasioned by the friction of shoes, the warm liver of a pig or lamb, or unwashed wool. Here he follows Dioscorides (ii, 37.) He also makes mention of several cooling applications, containing ceruse, litharge, the dross of lead, &c.
Scribonius Largus recommends an ointment containing litharge, ceruse, the flour of frankincense, alum, axunge, old austere wine, roses, and sour oil.
Marcellus also recommends litharge for intertrigo.
The Arabians treat these cases similarly. Thus Avicenna agrees with Aëtius in recommending the liver, and the ointment containing ceruse, &c. For bruised parts he recommends astringents; such as galls, acacia, &c.
To relieve the heat and irritation occasioned by riding, or any such cause, Rhases directs us to apply a cloth dipped in rose-water properly cooled, he means, perhaps, with ice. After the heat and pain have been removed, an ointment of ceruse, or litharge is to be applied. Blisters produced by walking are to be opened and then washed with rose-water; and afterwards they are to be dressed with an astringent application, containing Armenian bole, galls, pomegranate flowers, or the like.
Each of these is a small rising of the skin, of a callous nature, and for the most part circular; but the myrmecia have a broad base, and when rubbed, convey a sensation like the bites of ants. But the acrochordon has a narrow base so as to seem to hang, resembling the extremity of a cord. Wherefore, elaterium with salts, when applied, removes these swellings; and frankincense with vinegar, green figs with vinegar, flour and natron, the juice of the fig rubbed in, and in like manner, that of the spurge, the pickled head of picarel burnt, verdigris burnt with sulphur vivum, the leaves of basil with copperas; that which flows from green vine shoots when burning, sheep’s dung with vinegar, a buck-goat’s gall when rubbed in, the fruit of the large sun-flower, when applied with wine, rue with natron and pepper, natron with the urine of a youth not come to puberty, the dung of an ox of the herd in vinegar.
Commentary. See Celsus (v, 28); Galen (Meth. Med. xiv); Aëtius (xiv, 4); Oribasius (Morb. Curat. iii, 55); Actuarius (Meth. Med. vi, 8); Pollux (Onomast. iv); Avicenna (iv, 3, 1, 6); Rhases (Divis i, 131, et seq.; ad Mansor. vii, 15, 16.)
Celsus defines these tumours in the following terms: “Ἀκροχορδόνα Græci vocant, ubi sub cute coit aliquid durius, et interdum paulo asperius, coloris ejusdem: infra tenue, ad cutem latius: idque modicum est quia raro fabæ magnitudinem excedunt. Vix unum tantum eodem tempore nascitur; sed fere plura, maximeque in pueris; eaque nonnunquam subito desinunt; nonnunquam mediocrem inflammationem excitant; sub quâ etiam in pus convertuntur.” He then describes the θύμιον to be about the size of an Ægyptian bean, and of the colour of thyme. He adds: “Μυρμήκια autem vocantur humiliora thymio durioraque: quæ radices altius exigunt, majoremque dolorem movent: infra lata, supra autem tenuia; minus sanguinis mittunt; magnitudine vix unquam lupini modum excedunt. Nascuntur ea quoque aut in palmis aut in inferioribus partibus pedum.” The acrochordon, he says, if cut out, leaves no roots, and does not grow again. This is not the case with the myrmecia. For it he recommends an application consisting of alum and red arsenic.
Galen describes minutely the method of extracting these tumours; but that belongs more properly to the surgical part of this work.
Applications containing arsenic, chalcitis, quicklime, elaterium, sulphur, and alum are mentioned by Oribasius and Aëtius. See in like manner the ‘Euporista’ of the Pseudo-Dioscorides.
The myrmecia is generally rendered formicaria by the Latin translators of the Greek medical authors, and formica miliaris by those of the Arabians. Avicenna seems to confound the myrmecia with the herpes.
Pollux defines the thymus, or thymium, to be an excrescence about the pudenda, anus, fingers, or face, of a red colour, rough, bloody, and not difficult to remove. The acrochordon, he says, is white at the root, and it gets enlarged at the extremity. The myrmecia he defines to be a hard, rough excrescence of a callous nature, but bloody at its extremity.
The acrochordon is thus described by an intelligent modern author: “Est verruca subcutanea durior et asperior, callosa, atque plerumque teres, cute concolor, in basi tenuis, summitatis vero latioris, fabæ magnitudinem raro excedens, juniores maxime infestans.” (Mangeti Bibl. Chirurg. i, 72.) The terms thymus, myrmecia, and acrochordon, have now fallen into disuse.
Ganglion is a round tumour of a nerve (tendon?) arising from a blow or pressure, in many parts of the body, but particularly in those parts which are moved, such as the extremities of the hands and feet. In this case, says Archigenes, apply quick lime with the grease of geese and turpentine. But Poles uses the medicine from agate stone, and Oribasius the following: of ceruse, of pine rosin, of old oil, of each, oz. j; of ammoniac perfume, of galbanum, of each, oz. j; of wax, oz. iv; or, he says, apply a thick plate of lead, like the vertebræ, and larger than the ganglion, and bind it on; for by its weight this dissolves it in process of time. This we have used.
Commentary. See Hippocrates (De Artic. xxvi); Galen (Comment., de Med. Simpl. ix); Celsus (vii, 6); Oribasius (De Virt. simpl. ii, in voce Plumbum); Aëtius (xv, 9); Actuarius (Meth. Med. ii, 11); Avicenna (iv, 3, 2, 6); Albucasis (Chirurg. ii, 50); Rhases (ad Mansor. vii, 15: Contin. xxviii.)
Hippocrates points out the danger of opening these tumours indiscriminately. They consist, as Galen remarks, of a viscid and mucous fluid. Galen and Oribasius agree with our author in directing a piece of lead to be bound upon the ganglion. Nearly the same plan of treatment is recommended by Aëtius, who directs us to bind a piece of lead upon the tumour, and after some days to remove it, when the ganglion will be found much softened; it is then to be squeezed firmly between the thumb and the fingers, by which means it will be speedily dissolved. Albucasis approves of extirpating the tumour, unless it be seated near a joint. Rhases as usual collects the opinions of all preceding authorities. Antyllus, he says, directed the surgeon to break the sack, or to bind a heavy plate over it, or to extract it by the knife. When an operation is attempted, he recommends that the surgeon be sure that he has removed the whole sac. He relates a case in which the swelling was dissolved by an application containing mustard.
In general, we call all those swellings phlegmons which are red and painful, and accompanied with heat; some diversity of their nature arising from the cause which occasions them. For when good blood and of moderate consistence rushes abundantly to a part and from its quantity becomes seated in it, the disease is that which is properly called phlegmon; but when yellow bile is seated in a part, it is called herpes; and when blood and yellow bile together are collected in a part, erysipelas is formed; but when in this case the blood is hot and thick, it usually gives rise to carbuncle. Wherefore, we shall begin with what is properly called phlegmon, which occurs in many cases, being a swelling which is red, painful, elastic, and hot, deriving its origin, as I said, from good blood which is sometimes collected from the whole body, and sometimes is formed abundantly in the part itself, so that it cannot be contained in the vessels, but escapes from them in the form of vapour into the surrounding cavities. And this affection supervenes upon wounds, fractures, ulcers, and many other causes. When therefore a part becomes inflamed without any obvious cause preceding it, the whole body sending a defluxion to the part, we must evacuate the general system by venesection, and apply to the part embrocations and cataplasms, not such as are of a heating and moistening nature, but such as are calculated to repel the fluid, which is flowing to the part, and evacuate that which is already contained in it. Apply, therefore, a cataplasm of house-leek, and of the bark of the pomegranate tree boiled in wine, with sumach and polenta: when the pain is not violent, this or such like applications are to be used; but when there is a defluxion to the part with greater pain, then cataplasms of hot water and oil, or of polenta, must not be applied (for all these are inimical to such defluxions); but the vehemence of the pain is to be allayed by that which is composed from musk, rose-oil, and a little wax, with unwashed wool containing much grease: these things are to be prepared and applied cold in summer, but tepid if in winter, so that the parts above the affected places be covered with a sponge soaked in austere wine or cold oxycrate. But we must add to the cataplasms such herbs as are proper for the purpose required. Pellitory of the wall, therefore, is applicable to every phlegmon at the commencement, and while on the increase; and in like manner, horned poppy, orach, mallows, lettuce, and gourd, when applied on hot parts. Both kinds of caltrops (tribuli) are applicable to inflammatory defluxions, and the cabbage to such as are hard. When a change is thereby effected, and no pus falls into the part, you may accomplish the cure by means of the plaster from chalcitis, or some of those plasters of a similar nature, which apply to defluxions; but clean wool soaked in austere wine is to be put externally to the medicine. In this manner you may cure phlegmons from defluxion. But such as are occasioned by any external cause will not be injured by moistening and heating applications, and if necessity require, you may scarify them with advantage. But in phlegmons arising from defluxion, scarification, more especially at the commencement, may become the cause of much mischief to the patient.
Commentary. See Galen (ad Glauc. ii); de Different. Morb. (12); Meth. Med. (xiii, 2); Celsus (iii, 10); Oribasius (Morb. Curat. iii. 41); Aëtius (xiv. 31); Leo (vii, 4); Actuarius (Meth. Med. ii, 12); Avicenna (iv, 3, 1, 2); Serapion (v, 22); Haly Abbas (Theor. viii, 9; Pract. iii, 27); Alsaharavius (Pract. xxix, 2); Rhases (Divis. 126, and Contin. xxvii.)
Galen explains that the term phlegmone is used either to signify inflammations in general, or a red, resisting, and painful tumour in particular. It is here used in the latter acceptation. He says, when a defluxion of blood of good quality and of moderate consistence takes place to a part, and from its quantity becomes fixed in it, the person is seized with a violent pain, unless the part be very insensible; it is also accompanied with a deep-seated throbbing; it seems stretched and broken; there is a sensation of increased heat, so that the part feels as if it were burnt and desires cooling; there is a florid redness as in those who have been in the bath, or have been warmed at the fire, and by other means. This affection, he says, gets the generic appellation of phlegmone, or inflammation. He enumerates many causes of it, such as bruises, fractures, and dislocations; but even without these, he adds, it may arise from the veins being immoderately distended with humours, and the superfluity being cast off upon a part fitted to receive them at the time. Such a part, from some cause or other, happens to be weaker, or more lax, or more calculated to attract, or is more inactive than the other parts of the body. He lays it down as a general principle, that the cure of such affections is to be accomplished by evacuation. Reason and experience, he adds, teach us that the general system is to be evacuated by the suitable means, and the inflamed part by embrocations and cataplasms of a repellent nature, and such as are calculated to give tone and strength to it. Such are his general principles of treatment. His particular remedies we need not mention, as in fact our author’s are entirely borrowed from him. Oribasius, Aëtius, Actuarius, and Nonnus, in like manner, borrow from him everything which they advance upon this subject.
Celsus does not treat of phlegmon in particular, but he has given an excellent account of inflammation in general. His definition of inflammation is singularly appropriate: “Notæ inflammationis sunt quatuor, rubor, et tumor, cum calore et dolore.” Isidorus attempts the same not so successfully: “Phlegmone est fervor cum extensione et dolore; sive est inquietudo cum rubore, et dolore, et extensione, et duritie, et vastitate: quæ quum cæperit fieri, inquietudo et febris insequitur.”
Avicenna gives a clear and comprehensive exposition of the doctrines of the Greeks, but supplies no new information. He is at pains to explain that the term phlegmon applies generally to every inflamed part; and also to a hot aposteme in particular. He joins Galen in recommending a free incision when it is apprehended that the member in which it is seated will become corrupted. Serapion’s treatment is nowise dissimilar. A phlegmon, says Haly Abbas, is a sanguineous collection, arising either from an external cause, such as a bruise, a blow, a wound, or the like, or from an internal cause, namely, a defluxion upon the part. He attributes the collection which takes place in a part to its debility, which makes it unable to cast off the load which is thrown upon it. When seated in a vascular part, phlegmon, he says, is attended with a throbbing pain. He approves of free and bold incisions. Alsaharavius treats of phlegmon at great length, but there is nothing original in his views. Rhases recommends at first bleeding, purging, and applications of a cooling and astringent nature. But when suppuration has commenced he properly forbids depletion, lest it only protract this process. He remarks that phlegmons are often occasioned by disorder of the stomach, and the use of too much food and drink. He recommends in general maturative applications, to which, if necessary, narcotics may be added.
If it appear to you impossible to prevent suppuration, boil bread in water and oil, and apply it as a cataplasm; or apply barley flour prepared in like manner; and bathe the part with an infusion of marshmallows. But when the swelling is difficult, either to convert into pus or to dissipate, you may use a cataplasm of dried figs. But sweet and fat figs are to be dissolved by boiling in water, and made like thin honey, and barley flour added to it. And if the swelling is resolved but imperfectly, you may boil with the figs hyssop or marjoram; or, if you wish to increase its strength, add salts to the decoction. But you must attend that the part be not dried too much, for thus will it be rendered hard. If you perceive any such thing, you must boil with the water the root of wild cucumber, or of marshmallows, or of bryony. But the root of the dracunculus is stronger than these and more discutient; and the medicine formed from the dracunculus itself is very discutient. Sometimes, therefore, you may apply decoctions of these things alone; but at other times you may add dried figs, and mix polenta with fat. And the oil of dill is discutient, and adapted for concocting crude humours, and unconcocted swellings. And pitch, more especially the liquid, concocts all hard and unconcocted swellings, when added to the cataplasms. A compound medicine for procuring the discharge of the concocted matter of abscesses, so that often the pus is found on the pledget; and for thoroughly discussing what is not concocted: of pyrites, of levigated ammoniac, of each, dr. xij; of the flour of beans, dr. vj; add to liquid pitch, and spread upon skin, and apply. But do not take away the pledget until it fall off spontaneously. The medicine must not be prepared long beforehand, as it soon becomes dry. When the tumour is no wise dissipated by these means, and matter falls into it, it is to be opened, and the matter evacuated, taking care not to apply to it water or oil; or, if it be necessary to clean the sore, it must be done with honied water, oxycrate, wine, and wine and honey; and if it become inflamed, the cataplasm of lentils is to be applied; but if it is not inflamed, we may use some of the plasters to such openings, more especially that from chalcitis; but apply to them sponge or wool soaked in austere wine. But to the wound itself, do not apply any of the oily ointments, such as the tetrapharmacon, for it stands much in need of being dried.
Those things which open abscesses. Since some persons will not endure to have abscesses opened with iron, we must endeavour to have recourse to epispastic medicines. Having triturated the root of narcissus in honied water, boil it with oil of iris, and apply; or, having triturated the tender root of calamus, and if it be hard, boil it in honied water, and apply; or, use a cataplasm of birthwort and honey. But equal parts of dry pitch and Cretan bee-glue, produce the rupture of abscesses and promote cicatrization.
The Dionysian plaster, a wonderful epispastic application for abscesses, to the breasts and to buboes, dissipating by the insensible pores. Of old oil, of water, of each, lb. j; having boiled the oil and water for a little time, add of aphronitrum, oz. vj; of misy, oz. j or ij; and boil until it does not stain the finger; then add of the manna of frankincense, of wax, of turpentine, of each, oz. vj.
For abscesses of the nervous parts. Of wax, of colophonian rosin, of butter, of each, lb. j; of dry pitch, of honey, of each, lb. ij, oz. vj; of verdigris, oz. iij; of bird lime, q. s.—Another, an epispastic: Of ammoniac perfume, oz. vj; of wax, of turpentine, of each, oz. iv; of sulphur vivum, oz. iij; of natron, oz. iij; and the application called smilium, and that from garlic are strongly calculated to promote the breaking of abscesses already formed. But that which consists of the juice of linseed dissipates, changes, and bursts abscesses most aptly. For the milder sorts of abscesses, those also which were mentioned for parotis will apply. These observations apply to an abscess following phlegmon. But, Galen says, that an abscess will sometimes take place without being preceded by inflammation, in which case, it has its origin from good blood. For at the commencement, he says, owing to some humour, excoriation takes place, and in process of time, the containing parts are separated from those below. And, therefore, when opened, they appear to contain within them all kinds of fluid and solid bodies. For, bodies resembling dung, urine, thrombus, a honey or mucus-like humour, bones, nails, and hairs, have been found in abscesses. And even animals have been found very like to those which derive their origin from putrefaction. Nay, they affirm that, more particularly in chronic abscesses from metastasis, bodies have been formed resembling stones, sand, shells, wood, coals, clay, the sordes of the oil of baths, the lees of oil, and the lees of wine. Wherefore, we shall now give a succinct account of abscesses, more especially such as are seated in the external parts of the body, and those which do not admit of resolution by medicines. An abscess, then, is a corruption and change of the flesh or fleshy parts, such as muscles, veins, and arteries. Of them, some are contained in a cyst, as atheroma, steatoma, and meliceris, and others are formed without a cyst, and are properly called by the generic name, and of them we have now to treat. The formation of an abscess then is most commonly preceded by inflammation, as we have stated, but sometimes it arises at once originally, as we have just now mentioned. An abscess, then, is attended with strong heat of the place, the swelling becomes greater and more red than formerly, and is hard, with a pungent pain, throbbing, and weight, so that it seems as if something were suspended from the part. And if the part be a vital one, fever supervenes with irregular rigors, and the pain and fever are greatest at night. Sometimes too a bubo is formed in the neighbouring glands. When the abscess is fairly formed, the most of these symptoms are diminished, the pungent pain becomes itchy and somewhat dull, the swelling is more sharpened into an acute point, is soft and yielding to the touch, and the skin at the top is separated; I speak with regard to those that burst externally. If therefore, it has burst spontaneously, or from medicines, it is to be cured by means of pledgets spread with ointment, the pus being evacuated by degrees; but if not, it is to be opened in the manner to be described in the surgical part of the work.
Commentary. All the writers referred to in the last Chapter may be consulted on the treatment of abscesses. See especially Aëtius. He recommends when suppuration is not taking place properly to apply barley meal, or bread boiled in the decoction of figs, to which if necessary may be added nitre, turpentine, or the like. When suppuration takes place, the abscess is to be opened where the skin is thinnest. (See Book 6.) The incision is to be made long and narrow, and if any putrid substance appear it is to be cut out. The opening is to be sprinkled with frankincense and suitable pledgets applied. When the neighbouring parts are inflamed a cataplasm will be the most proper application. When the ulcer is foul, turpentine and honey will serve for cleaning it; or applications containing verdigris may be used for the same purpose. After the ulcer is cleaned, first incarnants and afterwards incrassants are to be applied. For producing rupture of the abscess, he recommends various applications, such as ammoniac, and nitre triturated with vinegar, and the like. This account, however, is mostly taken from Galen.
The treatment recommended by Celsus is nearly the same in principle. At first if the part be soft he recommends applications of a repellent and cooling nature: but if it is hard he directs us to use applications which digest and produce resolution, such as dried figs pounded. To such applications may be added equal proportions of ammoniac, galbanum, bees-glue, and birdlime, with somewhat less than one half of myrrh. The plasters and malagmata for this purpose are likewise to be applied. When these applications do not produce resolution, we must conclude, he says, that the abscess will ripen. The symptoms of an unripe abscess are strong motion of the arteries, weight, distension, pain, redness, and hardness; to which are to be added horror and fever if the abscess be large. When there is a remission of these symptoms, and the part becomes itchy, and somewhat livid or white, the suppuration is ripe, and the matter is to be let out by medicines or iron. Unless the opening be large he properly forbids tents or pledgets to be put into it. When these are used, however, lentils and honey, or pomegranate rind boiled in wine are to be applied over them. Whatever is applied must not be tightly bound.
The Arabians mention a variety of applications for producing the rupture of abscesses. (See in particular Avicenna and Rhases.) Thus, they recommend a plaster consisting of cantharides and old oil. Some of their applications contain nitre, quicklime, and arsenic. Such a composition, by producing a slough, would no doubt effect the purpose for which it was intended. Haly Abbas recommends a poultice made of leaven, boiled figs, and the seeds of rosemary. He speaks of onions as an application to indolent abscesses. Alsaharavius treats of abscesses at great length.
By abscesses of the nervous parts it will be readily understood that our author does not mean that they are seated in what are now properly called nerves, but in tendinous and membranous parts, for all these were comprehended under the name of nerves by the older writers, namely, Hippocrates, Plato, and Aristotle. Galen pointed out clearly the distinction between these parts, but the term is often used in its old and popular acceptation by the writers subsequent to him.
The account which our author gives of deep-seated abscesses is highly interesting, but is mostly borrowed from Galen (ad Glauc. ii.) Rhases, in his ‘Continens’ (xxvii), gives an interesting outline of the opinions of all preceding authorities, with some ingenious observations of his own. When there is any hope of producing resolution he approves of scarifications. When the pain is violent he recommends hot and humid applications with the addition of narcotics. After the abscess has been opened with the knife, he says that desiccative applications are indicated, and not ointments containing wax or oil. He describes the leaven cataplasm, and others of a similar nature. He gives Antyllus’ directions for opening abscesses. Abscesses in the limbs are to be opened by a straight incision, but those about the ancles by a circular, as they are apt to terminate in fistulæ. He recommends it to be made at the lower part of the abscess, but mentions that Galen prefers the thinnest part.