Part 75

On encanthis and rhyas. Scarpa removes the encanthis by a surgical operation; but, from our own experience of the effect of septic medicines, such as arsenic, in similar complaints, we cannot doubt the propriety of the ancient practice in certain cases. Galen’s applications contain copperas, misy, sal ammoniac, and the like. Those of Aëtius are nearly the same. He remarks that seamen are particularly liable to the complaint. Haly Abbas recommends general evacuation and escharotic applications.

On ulcers. In the description of the ulcers of the eye our author follows Aëtius. He, however, evidently was much indebted to Galen (sec. loc. iv.) The Arabians copy from Galen, describing like him seven varieties of ulcer, which they treat upon general principles. See, in particular, Haly Abbas (Pract. v, 41.) Opium is one of his medicinal articles. Ceruse, starch, gum arabic, albumen, &c. also occur. See also Jesu Haly (ii, 50,) and Rhases (Cont. ii.) Celsus recommends various compound applications for ulcers of the eye, which he treats of very minutely.

The collyria mentioned in this section will be found described in the Seventh Book of this work.

On procidentia. Galen correctly describes procidentia as arising from ulceration of the cornea and protrusion of the iris. (De Diff. Morb. 13.) Aëtius has treated of it with his usual accuracy. He recommends various escharotic applications containing chalcitis, misy, and the like, which, when properly managed, may probably have answered the purpose equally well with the antimonium muriatum and argentum nitratum used by Scarpa and other modern oculists. Avicenna treats of the complaint like the Greeks. Some of his compositions contain antimony with ceruse, burnt lead, and the like. Haly Abbas describes the disease minutely in nearly the same terms, and recommends nearly the same remedies as our author, namely, such as are of a repressing nature. He properly remarks that it is one of the consequences of ulceration of the cornea. Alsaharavius gives a similar account, and recommends general depletion.

On hypopyon. Aëtius gives much more judicious directions for the treatment of this complaint than our author. He properly recommends general bloodletting at the commencement, and afterwards local, by means of leeches and cupping instruments; and then emollient, paregoric, and discutient applications to the eye. Galen (Meth. Med.) makes mention of an oculist in his time who effected wonderful cures in this complaint by shaking the patient’s head. When this does not succeed, Galen directs us to perforate the coats of the eye, and let out the matter. (See Book Sixth.) Scarpa does not approve of this practice, unless the collection of matter be considerable. However, Plempius and most of the earlier modern authorities in surgery decidedly recommend it. Haly Abbas recommends a discutient cataplasm containing opopanax, ammoniac, and fenugreek. Alsaharavius properly directs bleeding and masticatories at the commencement.

On leucoma. Aëtius directs his attention principally to the general treatment, and properly cautions against the use of strongly stimulant applications, as they only increase the evil. He allows afterwards moderately detergent ones, containing verdigris, burnt copper, squama æris, flos æris, sal ammoniac, and the like. His compositions are taken for the most part from Galen’s works (de Med. sec. loc. iv.) Aëtius disapproves of applications for changing the colour of the leucoma. Alexander recommends the detergent applications mentioned by our author. Nonnus copies from him. Haly Abbas describes it by the name of albedo oculi, and recommends nearly the same remedies as our author. He particularly praises green glass finely pulverized, which is still a popular remedy in Scotland. Alsaharavius makes mention of the juice of the lesser centaury as an useful application. Scarpa speaks favorably of this remedy, and further recommends the Sapphirian collyrium, the ingredients of which are similar to those which entered into the ancient applications. It consists of a solution of scr. ij of sal ammoniac and gr. iv of ærugo in oz. viij of aqua calcis, allowed to stand for twenty-four hours, and then filtered. Rhases recommends an ointment containing arsenic.

On pterygium. Aëtius correctly remarks that pterygium generally begins from the inner canthus, rarely from the outer, and scarce ever from above or below. He gives prescriptions for a variety of applications, which, like our author’s, contain burnt copperas, magnesian stone, sal ammoniac, and the like. Galen briefly commends the same. Nonnus, Serapion, and the others approve of this practice. Modern oculists, however, trust to nothing but the operation, which will be described in the Sixth Book. Haly Abbas describes the disease very accurately by the name of ungula; and recommends general bleeding, purging, restricted diet, and a variety of collyria. Alsaharavius gives the same account of the ungula, and when it becomes callous (nervosus), recommends an operation. Jesu Haly recommends, before attempting a surgical operation, to make trial of escharotic applications. Rhases also approves of this plan of treatment. The most active ingredients in his prescriptions are sal ammoniac, copperas, and arsenic. Some of his compositions are merely detergent.

On carbuncle and cancer. we are not aware that the parts about the eye are particularly liable to anthrax, nor do we recollect to have ever met with such a case; and yet, as Alexander and our author remark, the disease may occur there as well as in other parts of the body. Rowley describes carbuncle both of the eye and eyelids. Aëtius has given a very circumstantial account of the symptoms and treatment of anthrax. He forbids the early application of cataplasms, and seems to depend most upon constitutional treatment, by clysters, purging, and bleeding. Afterwards cooling and styptic fomentations are to be applied by means of a sponge, along with other treatment similar to our author’s. Alexander’s plan of treatment is nearly the same, and is laid down with excellent judgment. That of Oribasius is similar.

To relieve the pains of cancer, Aëtius recommends soothing applications and an anti-stimulant diet, consisting principally of milk. Avicenna, Alsaharavius, and most of the ancient authorities join in praising milk as the principal article of food in cancer of the eye. Avicenna’s applications contain ceruse, opium, and the like. Haly Abbas recommends general bleeding, if the patient’s strength permit, with emollient lotions, and collyria: the diet to consist of birds, kids, and lambs. According to Rhases, cancer of the eye is attended with excruciating pains, redness, and distension of the veins, loss of appetite, and inability to bear all applications.

On mydriasis. Aëtius treats mydriasis, or preternatural dilatation of the pupil, like our author, by general and local bleeding, clysters, an attenuant diet, and friction of the extremities. They no doubt considered that the disease arises from congestion in the brain. Avicenna refers the disease to cephalæa and injuries of the head. Scarpa quotes with approbation the account given by Celsus of mydriasis, by which he thinks was meant not only cases of dilated pupil but also of incipient amaurosis occurring suddenly. Celsus approves of opening the bowels freely. Haly Abbas describes the disease, but thinks it almost incurable. It sometimes occurs, he says, from a blow, and sometimes from abscess within the uva. Alsaharavius attributes the disease to congestion, and directs bleeding, purging, and cooling applications. He calls it dilatatio. According to Jesu Haly, it is produced by dryness of the uva, or abscess within that tunic, or pressure on the brain. The first species is to be relieved by diluents and relaxants, such as the warm bath. For the second he recommends suitable cataplasms and purgative pills. The third is to be treated by general and local bleeding, cupping, and fomentations with water, vinegar, and salt. Constriction of the pupil he directs us to treat upon the same principles as our author. His account of it is mostly taken from Aëtius. Leo describes, under the name of symptosis, constriction of the pupil; under that of paremptosis, an affection of the optic nerves; under that of platycoria, a preternatural dilatation of the pupil, for which he recommends astringents; and under that of myocephalos, procidentia of the lens, for which he recommends astringents, and even copperas.

On nyctalopia. Aëtius recommends, according to the circumstances of the case, general and local bleeding, drastic purgatives, errhines, and the like. He, Celsus, Alexander, Rhases, Avicenna, Mesue, Jesu Haly, Haly Abbas, and Alsaharavius, like our author, speak favorably of the application from the roasted liver of a goat. Instead of it Hippocrates recommends the liver of an ox. His treatment otherwise consists of bleeding, purging with elaterium, and, in desperate cases, of trepanning the head at the bregma and evacuating the water. (De Visu.) The general treatment of the Arabians is like that of the Greeks. Thus Alsaharavius recommends bleeding, purging with hiera, gargles, sternutatories, and the like. This is also the practice of Jesu Haly.

The term nyctalopia is not used by all the ancient authorities in the same sense. Thus Hippocrates applies it to that morbid state of vision in which the patient is blind during the day but sees better in the evening. Aëtius, Alexander, Paulus, and Actuarius, on the contrary, apply it to that state in which the patient sees clearly during the day but becomes blind in the evening.

On glaucoma and suffusion. Aëtius and Oribasius give nearly the same account of these complaints as Paulus, and yet that of Aëtius seems slightly different. He says that there are two kinds of glaucoma: that the first, to which the name is properly applied, arises from a dryness and concretion of the crystalline humour, which is changed to a sea-green (glaucum) colour; but that the other arises from a suffusion, the humour near the pupil having become congealed and dry. According to Leo, the affection of glaucoma arises when the crystalline humour is congealed, as it were, and having become white, obstructs vision: this occurs in old age and is incurable. Haly Abbas was aware that the disease is sometimes seated in the crystalline lens, but did not know that it always is so. Hippocrates recommends masticatories and the actual cautery. Haly Abbas and Alsaharavius approve of making trial of remedies similar to those mentioned by our author, before attempting the operation. Rhases forbids bleeding when the disease arises from the state of the eye itself. Canamusali, who flourished about the year 1258, recommends a seton in the nape of the neck for the cure of suffusion. (De Oculis, vi.) Rhases considers the case incurable when the pupil has become insensible to the stimulus of light.

On amaurosis and dimness of vision. Galen and Aëtius give a very circumstantial account of the causes and treatment of amaurosis. They state that the disease either comes on suddenly, in which case they refer its origin to obstruction and paralysis of the optic nerve, or gradually, when they believe it occasioned by a thickening of the coats of the optic nerve, or a change of the spirits, or of the humours of the eye. They enumerate various causes of it, such as injuries of the head, heat or cold, indigestion, or the like. When the disease occurs suddenly, they approve of general or local bleeding, such as cupping the back part of the head, and active purging. In the other case general depletion is not required, but the treatment is otherwise nearly the same, attention being particularly paid to the state of the bowels. They forbid emetics after food, but approve of errhines. They recommend in certain cases sinapisms to the head.

The Arabians treat the disease upon the same principles. Haly Abbas describes amaurosis among the affections of the optic nerves, and recommends for it general bleeding, purging, and the saffron collyrium. Alsaharavius remarks that it often arises from the state of the stomach, which, in that case, will require the principal attention. Avenzoar blames Galen for giving up as desperate cases of amaurosis which occur suddenly. He recommends general and local bleeding, with repellent applications to the head.

On strabismus. See Galen (de Causis Morborum); Oribasius (Synops. viii, 49.)

Avicenna properly remarks that squinting is occasioned by debility or spasm of some of the muscles of the eye. He and Rhases recommend the same treatment as our author. Avicenna also makes mention of a mask. Haly Abbas, who appears to have been intimately acquainted with anatomy, of which his work contains a valuable compendium, explains minutely the cause of the disease, which he attributes to an unequal contraction of the muscles of the eye. See also Alsaharavius and Jesu Haly. Jesu, like our author, directs us to fasten a piece of black or red cloth on the angle of the eye at the temples, when the eye inclines towards the nose. He correctly explains that the complaint arises from spasms or paralysis of some of the muscles of the eye.

On ecpiesmus, or protrusion of the eyes. This section is taken from Oribasius. (Syn. viii, 50.)

Aëtius, Avicenna, and Rhases recommend the same treatment for this complaint, which can only arise from suffocation, violent straining, or swelling of the eye.

On synchysis, or confusion of sight. Aëtius and Oribasius treat of this affection in nearly the same words.

Rowley defines synchysis to be “a solution of the vitreous humour into a fine attenuated aqueous fluid.” It does not appear to us that the ancients understood it in this sense, or that they meant anything more by it than a confusion or disorder of the eye occasioned by a blow.

On myopia. This section also is taken from Oribasius or Aëtius.

Alsaharavius treats of it by the name of alhayn. He says it sometimes arises from external causes, such as exposure to snow and cold, in which case he directs us to apply stimulant fumes to the eye and refrigerants to the head. Although the ancients were aware of the magnifying powers of specula (as appears from Seneca, ‘Quæst. Natur.’), it is doubtful if they ever thought of applying this knowledge to any useful purpose; and hence none of the Greek, Latin, or Arabian medical authors make any mention of spectacles or magnifying glasses as a remedy for this complaint, or for weakness of sight. Dutens, however, maintains that they were not unacquainted with telescopes. (p. ii, 10.) From a passage in Iamblichus it has been supposed that they also used microscopes. (Vit. Pyth. 26.)

One of the causes of myopia mentioned by Jesu Haly is enlargement of the crystalline lens, which he recommends us to endeavour to lessen by means of dissolvents. (De Oculis, iii, 6.)

SECT. XXIII.—OF DISEASES OF THE EAR; AND, FIRST, CONCERNING PAIN OF IT.

Earach may be known to be occasioned by cold from the season of the year, the preceding regimen, or from the patient’s own account, if it proceed from any external exciting cause. If the pain be deep-seated without heaviness, distension, or heat, such cases are to be cured by calefacient remedies, as hot oil of rue, or of nard, or hot oil of bays, or that of marjoram, that called foliatum, or that called spicatum, or common oil with euphorbium, or pepper, or castor, or the ointment called commagenum, or opobalsam poured into the auditory foramen; and oil in which garlic or onion has been boiled is of service when injected. Pain from a hot intemperament is judged of by a certain sensation of heat without heaviness or tension. You may cure it by the opposite remedies; by injecting the white of an egg triturated, as in affections of the eye; and woman’s milk, along with some of the anodyne collyria, or the juice of perdicias (pellitory of the wall?), with a small quantity of rose-oil, and rose-oil itself, or rose-oil and vinegar, or the juice of the nightshade, or of coriander, or of kingspear, or oil in which earthworms or millepedes have been boiled; or almond-oil, either by itself, or having three living buccinæ boiled in it, is of great natural efficacy. Pain from viscid and thick humours you may judge of from the heaviness of head, or of the ear itself, and from the previous regimen. When it is without heaviness, this state alone of hearing indicates a windy spirit that cannot get vent. In both these cases we must use remedies of a deobstruent and incisive nature, such as the aphronitrum with vinegar and honey, and sheep’s gall with common oil, or the oil of almonds, and the tepid juice of leeks and onions with honey; or triturate common marjoram with honey and a woman’s milk, and inject it. For stronger coldness inject goat’s gall with the juice of leeks; and when the pain is great and of long duration, and when difficulty of hearing is present, we must use these remedies, namely, the juice of dragon-herb, of wake-robin, and of bryony, and the like. When the pain is occasioned by a windy spirit, it may be greatly remedied by applying a cupping-instrument previously heated in hot water, and affixed near the ear. But if there be heaviness, distension, and heat, with a pulsatory pain or fever, you may be sure that the ear is inflamed; and you must, in the first place, have recourse to phlebotomy, then foment frequently with hot sweet oil by means of the ear specillum wrapped in wool. We must also inject into the ear the fat of a goose or of a fox, or the ointment basilicon, with the oil of roses, of privet, or of iris, and apply externally cataplasms of a paregoric and digestive nature; but when the pain compels us we may use those things which are moderately narcotic, for there is no little danger, owing to the nearness of the brain to the inflamed auditory nerve. The following is an excellent paregoric: Of opium, p. j; of castor, p. ij. Inject it warm with a woman’s milk, or the white of an egg, or tepid sweet wine. And the trochisk of saffron, that called aster, and the antidote of Philo is often of service to them. You must foment frequently, either with common oil or some of the hot fomentations, and apply to the ear wool steeped in it, taking care not to touch the inflamed part. When the pain continues and an abscess is about to form, use the remedy from the juice of linseed, injecting it softened with oil of roses or of chamomile. When the pain is occasioned by poisonous water which has got into the foramen of the ear, and if it be in considerable quantity it will be necessary to suck it out either with the mouth or by a reed; but if in small quantity, it may be wiped away with the ear specillum wrapped in wool; and then some of the attenuant oils may be injected, or else rose-oil, or the white of an egg, or a woman’s milk. Everything applied to the ear should be moderately warm.

For ulcers with inflammation. Triturate equal parts of lycium (catechu?) and meconium with honey, and inject.

For severe pain, pus, and difficulty of hearing. Of whitened almonds, xx in number; of aphronitrum, dr. iij; of opium, dr. iij; of frankincense, dr. iij; of saffron, dr. iv; of galbanum, dr. ij; of myrrh, dr. j; triturate with vinegar, and inject. When there is pain, dissolve it in oil of roses, and when there is a discharge of pus, in mulse or oxymel, and when there is deafness, in vinegar. Recent ulcers are cured by horned poppy dissolved in vinegar, by the collyria from it, and by those formed from roses, saffron, and myrrh, in like manner as running ulcers without pain are cured by the recrement of iron triturated with vinegar during the heat of the dog-star.