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.

SECT. XIX.—ON GANGRENE AND SPHACELUS.

When the inflammation is neither resolved nor converted into pus, it often passes into gangrene and sphacelus, of which we shall now treat. Wherefore, we give the name of gangrene to mortifications arising from the violence of the inflammation, when they are not yet formed but forming; and if such a state is not speedily cured, the affected part readily dies, and the disease seizing upon the surrounding parts, kills the person. But when the parts thus affected become totally insensible, the affection is no longer called gangrene, but sphacelus. This affection happens also to the bones when the flesh that surrounds them engendering noxious humours impregnates the bones therewith, and causes them to putrefy. When, therefore, the part is completely mortified, it must be speedily cut away, where it joins the sound part. Gangrene is to be cured by evacuating as much as possible of the blood in the affected part; and we may either procure the discharge of the corrupted blood by opening a vein, when the vein of the part is large, or we may divide the whole skin by many and deep incisions, so that the blood may be permitted to escape; and we may apply some of the medicines suitable to mortifications. These are, the flour of tares, or of darnels, or of beans with oxymel. When wishing to apply stronger ones we may add salts, or use the trochisk of Andron, or the like. Old walnuts are good applications for gangrene. The nettle also cleans them, and the juice of spurge, when applied in season and in proper quantity. The decoction of bitter lupines, poured on the part, is also beneficial. Some after the incision, for the sake of security, apply the cautery, in which cases we must use salt with leeks: afterwards, in order to remove the eschar, we may apply a cataplasm of bread, or of barley, or of wheaten flour boiled in water and oil; or the dry cephalic powder with honey, and the tetrapharmacon; and that called the Macedonian may be used. The eschars may be properly removed by bread triturated with parsley, or basil, or by iris, panacea, or birthwort, or by the sweet-flag with honey, or by frankincense. And the medicine of Machærion takes away the eschars in a proper manner, and the iris spread upon pledgets with honey; but in soft bodies the flour of tares, with honey, is sufficient.

From the works of Oribasius, for gangrene. Of scraped verdigris, of vermilion, of stone alum, equal parts; triturate in water and anoint. The flour of darnel, with radish and salts, and sometimes with vinegar, will, when applied as a cataplasm, be proper for the scarified parts; also dried grapes deprived of their stones with the bark, and with salts and oxymel; the inner parts of walnuts, and myrtle leaves boiled in wine and triturated with honey. Radish, with vinegar, breaks the eschars even to the bone.

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COMMENTARY. See the authors referred to in the 17th Section.

Paulus copies freely from Oribasius (Synops. vii, 27.) Upon comparing Oribasius with our author we have ventured to give an interpretation of the last sentence not justified by the text as it now stands, and at variance with the translation of Cornarius. Oribasius does not say that the flour of darnel will scarify the parts (how could he?) but that it will be a proper application after the parts are scarified.

Galen (ad Glauc. and Comment. in Hippocr. App. vii. 50,) is the great ancient authority on mortification, and from him Oribasius, Aëtius, Paulus, and all the subsequent writers on this subject have copied. He lays it down as the great rule of treatment, to evacuate the blood which is impacted in the part and prevents the diastole of the arteries. To accomplish this end he directs free incisions to be made, after which the actual cautery is to be applied, at the line of separation between the sound and diseased parts.

Celsus is a strong advocate for this practice, which has been revived lately and is much used in France. (See Encyclopédie Méthiodique, art. Gangrène, and Cross’s Sketches of the Medical Schools in Paris.) He states, however, that when the disease goes on spreading, amputation of the mortified limb is the “auxilium unicum.” At the commencement he approves of venesection, if the strength permit, and of a restricted diet; and, afterwards, astringent food and drink are to be given. He also recommends, for gangrene, applications containing arsenic, quicklime, chalcitis, and the like (v, 22.)

The practice of the Arabians is little or nothing different from that of the Greeks. Avicenna at the commencement approves of Armenian bole and terra sigillata with vinegar; but if these have not the effect he directs us to empty the part by scarifications, leeches, or opening the veins which lead to it. He then recommends us to apply the flour of beans and the other remedies mentioned by the Greeks. When the disease proceeds, free incisions and the actual cautery must be had recourse to. Alsaharavius recommends us to bleed at first, if the strength permit; then to use powerful caustics and escharotics such as arsenic, quicklime, and sublimed quicksilver; or if these do not succeed, the actual cautery. He approves of early incisions, and of amputation, if the mortification spread. He describes a species of gangrene which seizes the hand and spreads upwards; and relates a case of it in which he refused to amputate for fear of hemorrhage. The same case is related by Albucasis, which certainly amounts to a strong presumptive proof that Alsaharavius was the same person as Albucasis. Rhases inculcates in the strongest terms that when an inflammation threatens to terminate in mortification, it is to be treated by scarifications, stimulant applications, and the cautery.

The earlier modern surgeons followed the ancient practice of applying the cautery in cases of gangrene.

SECT. XX.—ON HERPES.

When yellow bile, unmixed with any other humour is fixed in a part, the affection is called herpes: but if it is thicker and rather acrid it ulcerates the whole skin as far as the subjacent flesh, and is called herpes exedens; but if it is thin, less acrid and hot, it raises small blisters on the surface of the skin like millet-seeds, and hence has been called herpes miliaris. According to Oribasius, a mixture of phlegm, with yellow bile, produces the herpes miliaris. Wherefore we may evacuate the whole body with cholagogue medicines, and apply cooling and desiccant things to the affected part. At the commencement, therefore, we may apply cataplasms from vine shoots, bramble, and plantain; but afterwards we may add lentil to them, sometimes with honey and polenta. And the cataplasm recommended for phlegmons from defluxion may be applied without the house-leek. But ulcerated parts are to be rubbed with trochisks dissolved in must, or in a thin and austere wine, not very old, or in a watery oxycrate. Administer also horned poppy, and similar things in water; and when these do not prove effectual, vinegar may be added. But wine diluted with the juice of plantain or strychnos is of great service, or linseed bruised and boiled in wine and oil may be applied; or Cimolian earth, mixed with the juice of strychnos may be applied by anointing: and take of litharge, oz. iv; of the juice of leeks, vij cyathi, and of the juice of beet an equal quantity, triturate and anoint. But when these ulcers have become chronic, the trochisk of Musa and that of Andron will be convenient applications.—Another: For herpes phlyctænodes: having triturated the dross of lead in austere wine and anointed with it, apply above it beet leaves boiled in wine, or of wax, oz. iv; of myrtle oil, oz. xvj; of the dross of lead, oz. iv; anoint with one half of wine. When it has stopped from spreading, use the cerate from the dross; or apply boiled lentil with honey. For herpes, under the skin, mix the dross of lead with the juice of levigated rue, or myrtle cerate, instead of the rue.—Another: Of old unwashed wool wrapped round a dead pine and burnt, dr. xij ss; of wax, dr. xxv; of the dross of lead half an acetabulum; of goat’s tallow cured and washed in water, dr. xxxj; of myrtle oil, oz. v.—Another: To those which spread rapidly: of the rind of the sweet pomegranate, dr. vj; of litharge, dr. vj; of unwashed wool about a dead pine and burnt, dr. iij; of wax, dr. xij; of ceruse, dr. viij; of fissile alum, dr. j; add to wine and myrtle oil.

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COMMENTARY. The writers on phlegmon treat immediately afterwards of herpes and erysipelas. Fabricius ab Aquapendente, Dr. Bateman, and most of our modern authorities on this subject, are of opinion that the ignis sacer of Celsus and the other Latin authors was herpes. Scribonius Largus, however, distinguishes the ignis sacer from zona, which, he says, was called herpes by the Greeks. The ignis sacer of Octavius Horatianus likewise appears to be erysipelas. And Isidorus states decidedly that the ignis sacer was erysipelas:—“Erysipelas est quam Latini sacrum ignem appellant, id est, execrandum, per antiphrasin. Siquidem in superficie rubore flammeo cutes rubescunt. Tunc mutuo rubore quasi ab igne vicina invaduntur loca ita est etiam febris excitatur.” (See a learned dissertation on the ignus sacer in Burman’s edition of Serenus Samonicus, ‘Poet. Latini Minores.’ ii, 335.) Having thus stated the doubts which prevail respecting the ignis sacer of the ancients, we shall return to Celsus’s account of it, which certainly, as already mentioned, seems to apply to herpes. He describes two varieties of it. The first is reddish, or a mixture of redness and paleness, and in it the skin is covered with a great number of small pustules. The disease spreads, the part first affected either healing, or becoming ulcerated from the rupture of the pustules and discharging a humour intermediate between sanies and pus. The breast and sides are mentioned as being frequently the seat of this complaint, and hence Bateman concludes that it is the herpes zoster. The second variety is described as consisting of a superficial ulceration of the skin, broad, somewhat livid, but unequal; the middle part healing as the extremities spread, and the part about to become affected becoming swelled, hard, and of a colour compounded of black and red. It affects principally old and cachectic persons, especially their legs. We cannot understand what could have led Dr. Bateman to think that this is the same as the herpes circinatus of his arrangement. Rayer rather supposes it to be the dartre squameuse centrifuge Alibert. His general treatment consists of abstinence, opening the belly, food intermediate between the glutinous and saltish, and if there is no fever, exercise, austere wine, and the like. The ulcers (vesicles?) are to be washed with hot water, or, if they spread, with hot wine; they are then to be opened with a needle, and dressed with applications for eating away putrid flesh. When the sore is cleaned, gentle applications are to be used.

For the zona or herpes, Scribonius Largus recommends applications containing alum, galls, chalcitis, misy, quicklime, &c.

Pollux defines herpes to be inflammatory and pungent pustules, which spread most commonly about the neck, but sometimes affect also the hands and feet.

Galen gives a very full account of the nature and treatment of herpes. According to him the complaint arises from yellow bile separated from the blood and fixed in a part. When it is thickish it ulcerates the skin down to the bone, and forms the disease called by Hippocrates herpes exedens. But if thinner, it only burns as it were the surface, when it is called by the generic term of herpes. Of the other two varieties, the one, as has been said, is called exedens, and the other miliaris, because it is attended with many small bullæ (phlyctænæ) like millet-seeds. As our author’s treatment is entirely derived from him we shall not enter into any detailed exposition of his practice. We may mention, however, that he decidedly recommends purgatives for proper herpes. When the ulceration is of a malignant nature and attended with putridity it requires the most acrid medicines, and such as in power resemble fire, namely, misy, chalcitis, arsenic, quicklime, and sandarach. For, he adds, these medicines burn like fire, and often when they fail, we must have recourse to fire itself.

Aëtius gives an accurate account of herpes, but it is professedly borrowed from Galen. Like him he divides the disease into three varieties, the herpes proprius, the herpes exedens, and the herpes miliaris, the last being characterized by an eruption of vesicles (phlyctænæ). We shall here notice what Dr. Bateman says respecting this division of herpes:—“The ancient division of herpes into three varieties, miliary (κεγχρίας), vesicular (φλυκταινώδης), and eroding (ἐσθιόμενος), may be properly discarded, for there appears to be no essential difference between the first two, which differ only in respect to the size of the vesicles.” This is evidently an incorrect account of the ancient division, in which no distinction was made between the herpes miliaris and the herpes phlyctænodes.

Palladius makes mention of only two varieties of the disease, namely, the proper, and the eroding herpes. (De Febribus 2.)

Leo briefly refers to Galen’s account of the disease (vii, 3.)

Actuarius mentions only the proper herpes, and the herpes miliaris. This is, perhaps the best division of any, as the herpes exedens is evidently a disease of a very different nature from the other varieties.

The Pseudo-Dioscorides recommends strong stimulant applications containing sori, misy, sulphur, onions, &c.

Avicenna seems to confound herpes with myrmecia, which detracts from the value of his account of it. (iv, 3, 1, 7.)

Rhases describes separately the formica miliaris or herpes miliaris, and the herpes esthiomenos or exedens. For the former he recommends astringent applications, for the latter strong caustics. In his ‘Continens’ he directs the herpes miliaris to be treated with cholagogues and astringent applications.

Serapion in like manner describes two varieties of the disease, but his account of it contains nothing particularly interesting.

Haly Abbas adopts the division laid down by Galen (Theor. viii, 10.) His treatment also is quite similar (Pract. iii, 29.)

In the translation of Alsaharavius the three varieties are described by the names of formica or erysipelas muscina, formica corrosiva (herpes exedens?), and formica miliaris. He describes the formica corrosiva as being a dangerous complaint, spreading deeper and deeper. His treatment, although amply detailed, contains nothing remarkable (Pract. xxix, 9.)

The earlier modern writers on medicine being the servile copyists of the Arabians, describe herpes by the name of formica, as a disease nearly allied to erysipelas, and like it arising from corrupted bile. See Guy of Cauliac (ii, 1), and Theoderic (iii, 16). For the herpes esthiomenos or lupus they recommend the application of arsenic or the actual cautery.

SECT. XXI.—FOR ERYSIPELAS.

Galen, giving the name of erysipelas, more especially to the swelling formed of a hot and thin blood, to that which is formed of both blood and bile, he applies an appellation from the prevailing humour, calling it erysipelatous inflammation when blood prevails, and inflammatory erysipelas when yellow bile prevails. But in general the swelling formed of hot blood and bile is called by him erysipelas. Whatever division we adopt, it will make no great difference as to the treatment. But it is proper to know that erysipelas is a most dangerous disease, more particularly about the head; so that if active treatment be not resorted to, it will sometimes prove fatal to the patients by suffocation. At its first appearance then we must open a vein at the elbow, especially the humeral, or, if it cannot be seen, any one that appears. But if any thing prohibit venesection we must have recourse to purging by cholagogue medicines. The same treatment may be applied to erysipelas of other parts, or we may administer strong clysters. And we are to rub the parts affected by erysipelas with cooling things, in order to repel the defluxion, and with moderately heating and moistening things so as to dissipate that which is collected, before the parts become livid or black; but the parts which are anointed are to be kept constantly in a wet state, by frequently changing the applications, which may be done by cleansing them with soaked sponges: for the heat of the part by converting them into vapour soon renders it dry. As I have said, erysipelas at the beginning requires such things as are cooling and moistening, without astringency; such as house-leek, purslain, and fleawort; the marsh lentil, endive, and gourd; the nightshade, henbane, lettuce, and horned poppy. And parsley, and the leaves of rhamnus by themselves, and made into a cataplasm with bread, are proper applications; also cerates used with very cold water; but we may mix with them some opium, the juice of poppy, cicuta, and mandragora, and thus form them into compound applications. And a cerate may be made of white wax mixed with four parts of rose-oil, prepared from the oil of unripe olives without salts, the ingredients being pounded in a mortar, and as much cold water poured in as it can receive. But if you add a little thin and transparent vinegar, you will render the medicine still better: but polenta, with some of the aforementioned cooling herbs, cool very properly, and fat dates with any of them. And the part may be anointed with ceruse, Cimolian, or potter’s earth, with the juice of strychnos, or litharge with rose-oil, or chalcitis with oil and must; or ceruse, with vinegar and buckthorn; or acacia, with vinegar. When the effervescence subsides we may use these simple applications, native sulphur and mint, with vinegar and rose-oil; or rue with worm-wood; vinegar and oil, or litharge with the juice of leeks and beet; or compound ones, as this trochisk, more especially to the head: of litharge, of ceruse, of saffron, of native sulphur, of opium with must; and in common, for all parts, of Sinopic vermilion, of chalcitis, of roasted misy, of verdigris, of copperas, of fissile alum equal parts, use with vinegar.—Another: Of native sulphur, of ceruse, of opium, of acacia equal parts; use with vinegar. A cataplasm for erysipelas, herpes, abscess, parotis, and burning: of the tender leaves of fresh marsh-mallows, lb. j; having boiled in water and oil, triturate properly, and adding of rose-oil, oz. iv; of litharge, of ceruse, of each, oz. iiss; triturate again with the juice of coriander, or of house-leek, or of strychnos, then adding crumbs of bread so as to form a plaster, apply it. And use this plaster: of oleum cicinum, i. e. castor-oil, lb. j; of oil of myrrh, lb. j; of wax, oz. v; of litharge, oz. iv; of scraped verdigris, oz. ij; the verdigris and litharge are to be triturated with vinegar. A cerate for erysipelas and burns: of white wax, oz. iv; of rose-oil, oz. iij; six eggs, of pellitory of the wall, oz. iv. When the inflammation ceases or becomes chronic, before the part becomes livid, apply a cataplasm of raw barley-meal; but if it has already become livid, incisions must be made in the part, and cataplasms moreover applied, and hot sweet water poured on it, and sometimes sea-water or brine; and sometimes these ingredients are to be mixed with the cataplasm, and then we must use the aforesaid compound medicines with caution: for should these symptoms continue, a transition to suppuration or mortification takes place.

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COMMENTARY. Hippocrates in his ‘Prognostics’ has stated the danger of an erysipelas being translated to an internal part. He also states that gangrene supervening upon erysipelas is dangerous. He has not, however, given any very particular account of the disease. In one of his aphorisms he states that cold is useful in erysipelas when not ulcerated, but prejudicial when it is ulcerated. His commentators, Theophilus and Damascius, confirm this statement. (Scholia in Hip. et Galen, ii, 456).

Celsus recommends bleeding if the strength permit, and then repellent and refrigerant applications, especially ceruse with the juice of solanum (nightshade), or Cimolian earth with river water, and the like. When refrigerants fail to produce the effect, sulphur, ceruse, and saffron are to be pounded with wine and applied. If the part become putrid he directs us to use corrosive applications or the actual cautery. Afterwards the sore is to be cleansed with honey and rosin, and treated upon general principles.

We have stated in the preceding Section that the ignis sacer of Scribonius Largus is not herpes. That it was erysipelas seems probable from the similarity between his applications for it and those which Celsus and the other authorities recommend for erysipelas. Thus for ignis sacer he recommends Cimolian chalk, diluted with the juice of solanum, or the solanum by itself, or with bread; or a mixture of sulphur vivum, ceruse, and litharge.

We may remark further in this place that the ignis sacer, or St. Anthony’s fire of the middle ages, would appear to have been some variety of erysipelas.

Galen’s account of erysipelas is particularly deserving of attention. In the 14th Book of his ‘Meth. Med.,’ he is at pains to state the nature of the disease, and the difference between it and phlegmon. The common symptoms of both are heat and swelling. But they differ, first and principally in colour, which is red in phlegmon, but pale or yellow, or a compound of both, in erysipelas. Throbbing is also a characteristic symptom of a great phlegmon, for it is deep-seated, whereas erysipelas is rather in the skin. Erysipelas, he pointedly inculcates, is occasioned by a bilious humour. This humour being thin, readily passes the fleshy and rare parts, and flows to the skin, where, unless it be particularly watery, it is unable to pass the pores, and, consequently, is retained. When things, indeed, are in their natural state, this bitter bile passes through the pores of the skin by the insensible perspiration, but when it is either too abundant or thicker than usual, it is retained by the skin, which it inflames and causes to swell: hence the reason why erysipelas chiefly affects the skin or the prolongation of it which lines the internal cavities. He states that the great indication of cure is refrigeration or cooling, but that there is danger of carrying this plan too far, lest the humour should be driven to some vital part: wherefore cooling applications are to be used until the part change its colour, but are not to be continued until it become black or livid. It is necessary, therefore, as soon as a change of colour in the affected part is remarked, to exchange them for those of a contrary nature. His cooling applications consist of strychnos (solanum?) and the other articles mentioned by our author. When the part becomes livid, he directs us to make incisions, and afterwards to apply cataplasms and fomentations with hot water, to which salt or vinegar may sometimes be added. It is only at this time that quicklime may safely be added to the applications; for it would prove highly prejudicial at first. With respect to the general treatment, he approves strongly of cholagogues, but does not think bleeding necessary in ordinary cases. When erysipelas arises from ulcers or any obvious causes, he recommends scarifications and cataplasms of barley flour. He recommends much the same plan of treatment in his ‘Therapeut. ad Glauc.’ ii. He speaks highly of early incisions.

Aëtius, as he professes, merely copies from Galen.

Oribasius recommends, at first, such things as are cooling without astringency; namely, henbane, nightshade, &c. When the inflammation subsides, he directs us, before the part becomes livid, to apply a cataplasm of barley flour; but when it does become livid, he recommends free incisions, and afterwards cataplasms and fomentations with fresh water, or water with salt and brine.

Actuarius states the danger of carrying refrigerant and repellent applications too far, and recommends something discutient to be added to them.

Octavius Horatianus approves of bleeding (unless contra-indicated by the want of strength), and of cholagogues, with free incisions and fomentations.

Avicenna states that bleeding in general does no good, unless the humour be seated between the two skins. He approves most of cholagogues and of applications strongly refrigerant; only he cautions us not to carry this plan too far, lest the disease be determined to an internal part, or terminate in gangrene.

Serapion treats of the disease very accurately by the name of al massire, but in nearly the same terms as Galen. He approves decidedly of cooling and repellent applications at the commencement. Serapion and Avicenna notice the eruption of bullæ in erysipelas.

Haly Abbas directs us, when erysipelas is not attended with swelling, to use cooling and repellent applications to the part, and to administer gentle cholagogues, such as myrobalans, tamarinds, and prunes. But if swelling be present, and if there is nothing to contra-indicate venesection, he recommends us to bleed and apply cataplasms.

Alsaharavius describes three varieties of erysipelas; namely, the erysipelas properly so called, the ignis Persicus, and the erysipelas inflativa. The first variety, he says, is attended solely with redness of the cuticle. It is to be treated by bleeding, purging, and local applications of a cooling and humid nature. In the ignis Persicus, the heat and redness are strong, and black blisters rise on the part. It is to be treated by bleeding at the commencement, and scarifications. The erysipelas inflativa arises with a sudden swelling, and blisters, like those produced by fire. It is to be treated by bleeding and cooling applications, containing ceruse, litharge, &c. The ignis Persicus would appear to have been some variety of anthrax, or the malignant pustule.

None of the ancient authorities express themselves so decidedly favorable to bleeding as Rhases. Like the others, he attributes it to heated bile. He, and most of the authors quoted by him in his ‘Continens,’ approve of cooling applications, but he cautions against carrying this practice too far. He remarks that vesicles like those from burning often arise on the part.

Fabricius ab Aquapendente is a strong advocate for the ancient theory, of which he gives a full explanation. The system, he says, being loaded with vitiated bile, the more important organs cast it off: it is, therefore, sent outwardly, and is detained by the cuticle when its pores are obstructed. He attempts to reconcile the contrary opinions of the ancients with regard to venesection. He himself approves decidedly of bleeding when the disease is seated in the head or neck.

None of the ancient authorities seem to have entertained the same apprehensions as most of the moderns do against liquid applications in cases of erysipelas. When this prejudice became general we do not exactly know. Heister mentions that, in his days, some surgeons disapproved of liquid applications, but, as he thought, without any good reason. He himself recommends camphorated spirit of wine. The earlier modern surgeons, as, for example, Brunus and Theodoricus, decidedly recommend cold applications at the commencement. When the disease is not thereby resolved, they direct us to have recourse to leeches and scarifications. They approve much of cholagogue purgatives, but do not recommend bleeding unless inflammatory symptoms run high.

SECT. XXII.—ON PHYMA, BUBO, AND PHYGETHLON.

According to Galen, phyma, bubo, and phygethlon, are affections of the glands: bubo being an inflammation of a gland; phygethlon, an inflammatory erysipelas, or an erysipelatous inflammation of a gland; and phyma, an inflammation of a gland passing rapidly into suppuration. But, according to others, all tumours of the nature of apostemes, which arise in any part of the body, are called phymata. For Hippocrates says, “Those in whose urethra phymata form are relieved when they suppurate and burst.” Wherefore those buboes which are occasioned by accidents, either ulcers or pains, are not dangerous; but those which occur in fevers, more especially in the pestilential, are of a very bad description, whether they are formed in the groins, the armpits, or neck. But those of the first kind, as is the case in every other inflammation, we must endeavour to put back with cooling and astringent applications, either applying a sponge out of oxycrate, or wool out of wine and raw oil, or oil of roses, or oil of apples, or oil of lentisk, or oil of myrtles; and then we are to apply diaphoretics. But if the whole body is plethoric, it is to be evacuated. If free from superfluities, we must manage the ulcer arising from it in the manner to be described when treating of ulcers. When the gland is in a state of inflammation, it is to be mitigated by wool soaked in some of the emollient oils, and the whole limb is to be wrapped therewith. When the tumour has suppurated, we must not be in haste to open it, but endeavour to dissipate it by the medicines in the form of cerates, such as that prepared from apyranon, and that from herbs called botanica. When resolution is not thereby accomplished, we must forward the rupture as in the other abscesses, and cure it in like manner as them. In those buboes which arise in fevers or from a collection of humours, we must abstain from all repellents, lest the matter should be repelled and regurgitate to the deep-seated parts; but we must begin at once with discutients. When nothing prohibits, such as the age or strength of the patient, venesection from the arm is to be had recourse to, and fomentations applied to the part, either from the decoction of camomile, or of dill, or of some such; but the materials of the other applications may be transferred from our account, in the Third Book, concerning parotis, and from what has been lately delivered, more especially respecting phlegmons. And in like manner the cure of phygethlon may be learned from what has been stated respecting them and erysipelas. But the herb aster atticus, which, on this account, they call bubonium, not only in the form of a cataplasm, but also when bound round the part as an amulet, is believed to be of use for buboes. Phymata may be discussed by the following applications in particular: maiden-hair; orache; pellitory of the wall; the root of marsh-mallows, boiled in wine; ammoniac, softened with honey, and applied; birdlime, with the rosin cerate. But bee-glue, bitter lupins applied with vinegar, the root of the wild cucumber added to turpentine, and in like manner root of capers, and nitre with leaven, or figs, promote the rupture of these tumours.

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COMMENTARY. The account here given of these glandular inflammations is taken from Galen (ad Glauc. ii.) See also ‘de Tumoribus’ and ‘Comment. in Hippocrat. Epid.’ vi.

Celsus describes phyma as resembling furunculus, but as being larger, and turning to pus. According to Rayer, his description of phyma applies better to the boil than his account of anthrax. (Malad. de la Peau, p. 229.) The phygethlon, he says, is a tumour not high, but broad, and containing something resembling a pustule. It occurs mostly in the armpits, neck, or groins. He proposes applications of a repellent and refrigerant nature; but if the swelling is hard, digestives must be had recourse to, such as dried figs bruised, &c. He also recommends a composition of sal ammoniac, galbanum, bee-glue, and mistletoe, with a small proportion of myrrh. His treatment is considerably different from our author’s. When matter is formed, he directs us to let it out by medicines or the lancet, but he decidedly forbids the use of cerates. In another place, however, he recommends an application containing lime, spuma nitri, round pepper, galbanum, and salt mixed with rose cerate.

Scribonius Largus recommends a malagma containing pitch, aphronitum, pine-rosin, wax, bay-berries, axunge, ammoniac, Illyrian iris, galbanum, and white pepper, for discussing phygethlon.

Oribasius and Actuarius mark the distinction between these affections in the same terms as Galen, and direct us to treat them with emollient, concoctive, and discutient applications. For concocting phymata, the Pseudo-Dioscorides recommends southernwood, boiled with raw barley flour; figs, boiled with yeast, &c.; and for breaking them, the juice of thapsia, with sulphur; cantharides, mixed with turpentine, &c. (Euporist, i, 156.)

Nonnus’ account is mostly abridged from our author’s. Thus, he recommends at first venesection, and sponges squeezed out of oxycrate and the like; then digestives are to be applied; and afterwards cataplasms and such things as will favour the rupture of the abscess, namely, compositions containing bee-glue, bitter lupins, vinegar, nitre, yeast, or figs and pitch.

Avicenna describes these affections by the name of althaum. It is remarked by his translator that the Arabian recommends the same medicines as Paulus, but neglects the distinction which the latter properly makes between the bubo when attended with pestilential fever and when without it.

The phyma seems to have been merely an acute inflammation of a gland, terminating in suppuration. The phygethlon was an erysipelatous inflammation of a gland. These complaints are well defined and described by Fabricius ab Aquapendente (1, i, 23.) Dr. Willan uses the term phyma in a different sense from that of our author. The term occurs in Marcus Antoninus (ii, 16), where see the note of Gataker.

SECT. XXIII.—ON FURUNCULUS.

Furunculus is an apostematous swelling, formed of thick humours in the fleshy parts of the body most especially; being mild when it is formed in the skin only, but of a malignant character when it rises up from a deep-seated part. Furunculus may be discussed and concocted by wheat, chewed and applied; by Egyptian mastic; by raisins, deprived of their stones, and triturated with salts, and applied—(this either discusses or breaks the swelling); or apply dried figs boiled in hydromel; or rosin may be mixed with the figs and applied; or the figs themselves, when they are fat, may be split open and applied; or leaven with nitre; or linseed with honey; or the leaves of henbane, triturated with butter: of compound applications, that which is prepared from leaven and fine flour, and that which is particularly named Dothienicon, are very applicable. Foment with soft sponges frequently dipped in hot water, and then apply the medicines.

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COMMENTARY. In this and the two following Sections, see the authorities on phlegmon.

The furunculus, according to Galen, is an inflammatory affection which is of a malignant nature when deep-seated, and differs from phyma only in hardness. (De Tumoribus.)

Furunculus, says Celsus, is an acute tubercle, attended with inflammation and pain, more especially when converted into pus. After it has been opened, and the pus discharged, there appears part of the flesh below converted into pus and part corrupted, of a whitish or reddish colour, which they call the ventricle or belly of the furunculus. He says that the disease is not attended with danger, and that medicines are necessary solely for removing it the more expeditiously. For this purpose he particularly commends galbanum. If repellent applications do not succeed, suppurative ones may be used; and, failing these, rosin or leaven. When pus is formed, no further treatment is required. According to Rayer, Celsus’ description of furunculus applies to the malignant pustule and not to the boil. (Malad. de la Peau, 233.)

The simple remedies recommended by our author are borrowed from Oribasius.

It is to be remarked that Galen, Celsus, Pliny (Nat. Hist. xxiii, 7), Octavius Horatianus, and Avicenna concur in recommending figs for furunculus or the boil. It was with a lump of figs that the prophet Isaiah cured Hezekiah’s boil.

Avicenna and Rhases treat furunculus judiciously by bleeding and purging, which prevent the formation of a large abscess. When there is throbbing in the tumour, they direct us to use maturative applications. When it is ripe, and does not break readily, they recommend us to open it. Haly Abbas says, that boils arise from gross and depraved humours. (Theor. viii, 11.) Alsaharavius also ascribes them to a full and unwholesome diet. He mentions that he often succeeded in stopping the formation of the furunculus by cauterizing it with a piece of myrtle or any other wood. When the pain is violent, he recommends an application of the leaves of henbane and poppies with the yelk of an egg. When the boil is indolent, he approves of a stimulant plaster. (Pract. xxix, 4.)

SECT. XXIV.—ON TERMINTHUS.

Oribasius says, that terminthus is a species of phyma, but that a dark bulla lies over it, which having burst, the part below appears as if excoriated, and when it is divided, the pus is found. But Dioscorides of Alexandria says, “Terminthi are eminences formed in the skin, round, of a dark green colour, like the fruit of turpentine.” These, therefore, are to be cured like other phymatous swellings, by applying the remedies there described.

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COMMENTARY. Aëtius gives the same account of terminthus, which is a species of phyma. See Hippocrat. (Epidem. ii, 11; de Humor. xi, 1); Galen (Comment. in Epidem.); Oribasius (Synops. vii, 136.) Avicenna describes these affections by the name of albothin (iv, 7, 3, 1.) He says that they are ulcers produced by black bile; that they appear upon the leg, and are of the same nature as varices.

The terminthus would appear to have been the cutaneous disease to which Willan applied the name of ecthyma.

SECT. XXV.—ON CARBUNCLE OR ANTHRAX.

When the blood having become more melancholic than natural, ferments and fixes in a part, the diseases called carbuncles are formed, which are sloughy ulcers, for the most part beginning with bullæ, like burnt parts, but sometimes without them; and the patients at first rub the part for its itchiness, whether one bulla is formed or several small ones, like millets, which, having burst, a sloughy ulcer takes place, resembling those occasioned by cauteries, the eschar being sometimes of a cineritious colour and sometimes black, along with its being fixed to the base, and in a certain manner nailed to it, and it spreads at the same time, the surrounding flesh is in a fiery state, black in the colour, and shining like bitumen and pitch. Such is the true black bile. But carbuncles that form in the flesh are speedily circumscribed; whereas those which take place in membranes or nerves remain long, and affect sympathetically the parts below, so as to give origin to erysipelatous inflammations. Not a few terminate in suppuration, and most cases are attended with fever.

Carbuncles also sometimes arise from epidemic causes. We must treat them, unless they are very small, by venesection, carrying evacuation as far as to occasion deliquium animi; and after venesection it will not be improper to make deep scarifications in the part, on account of the thickness of the humour. To the affected part we may apply such things as are moderately repellent and discutient, as the cataplasm of plantain and boiled lentil, receiving the tender part of bread baked in an earthen pan, neither very fine nor foul; and above the ulcer we must put some of the strong applications, such as those of Andron, of Polyides, and of Pasion, mixing them with must, until they are of the consistence of the sordes of oil in baths. And so also the dry Massaleotic powder, which may be diluted in like manner. And the root of dracunculus, or of birthwort, or the juice of laserwort, or the Cyrenaic juice may be properly rubbed in, each of these with vinegar. Cases of an erysipelatous nature may be anointed with the applications for erysipelas; but those parts which are suspected of being sympathetically affected are to be wrapped in unwashed wool, out of wine and oil. When the inflammation abates, we must apply to the carbuncles the cephalic cerates spread upon pledgets. That from herbs is an excellent one, and that from natron, and the dry application for spreading ulcers, separately and with rose-oil. When the hardness remains, we must use the one from apples ascribed to Serapion. But we must hasten the suppuration of the carbuncles as much as possible, by changing the cataplasms and medicines twice during the day, and once during the night. In order to root out the carbuncles, and free them from their attachments to the surrounding parts, having divided sour pomegranates, boil in vinegar, and when softened, triturate, put into a linen rag, and apply. When dried, let them be moistened with vinegar. The carbuncle is made to suppurate and burst, by the inner part of old walnuts, or even of that which is not old, and by the leaves and shoots of cypress, or by its young and tender balls (pilulæ), with barley-flour; by raisins deprived of their stones; by dried figs boiled in wine; by the flowers of horned poppy; by the juice of laserwort, with rue and some honey; by liquid pitch with raisins and axunge.

An excellent application for carbuncles. Of litharge, lb. j; of old oil, lb. j; of arsenic, oz. j; boil the oil and litharge until they do not stain, and taking them off the fire, add the arsenic, and then boil it until it become black, and having levigated it in a mortar, use upon pledgets.

For gangrene, old ulcers, those called chironia, strumous ulcers, and the gout: it is a most admirable application for carbuncle, particularly in the eyelids. Of opium, of acacia, of toasted misy, of flakes of copper, of each, dr. ij; of copperas, dr. j; of the seed of henbane, dr. j; triturate in water, and use. They say also that the ointment called tetrapharmacon, having a fifth part of frankincense, is an excellent application. But for carbuncles in the pudenda, take of chalcitis, of copperas, of each, dr. viij; of aphronitrum, dr. ij; triturate with water, and use. Sheep’s dung roasted with honey is also a good remedy. In Alexandria they use the green serapias, which is also called orchis and triorchis, with crumbs of bread, as a cataplasm for carbuncles and all sloughy ulcers; and when the eschar falls off, they cure them as a common ulcer.

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COMMENTARY. The carbuncle is briefly treated of by Hippocrates (Epidem. ii, 1), and is frequently mentioned by him as a symptom of the pestilential fever. (Epidem. iii.)

Celsus gives a very minute description of carbuncle. With regard to the treatment, nothing, he says, answers so well as immediate burning, which produces no pain, as the flesh is dead. The sore is to be treated like other burnt parts. Under the use of eroding applications a crust is formed, which, being removed from the living flesh, carries all the corrupted parts along with it, and leaves a clean cavity, which is to be filled up by incarnants. When the disease is superficial, corrosive or caustic substances may be substituted, of such a degree of strength as to produce a separation between the dead and sound flesh. But if these applications fail, recourse must be had to burning. He recommends abstinence from food and wine at the commencement, and directs water to be given freely, especially if fever be present.

Pliny gives an indistinct account of an epidemical anthrax, which, he says, prevailed in the province of Narbonne. (Nat. Hist. xxvi, 4.)

Galen ascribes the carbuncle to a defluxion of hot, black, and thick blood, which gives rise to blisters, ulcers, and eschars. He directs us to apply to the eschars those medicines the properties of which resemble fire, such as misy, chalcitis, arsenic, quicklime, and sandarach. His particular remedies are quite similar to our author’s. (Meth. Med. xiv), and (ad Glauc. ii.) He mentions the carbuncle as a very unfavorable symptom of the plague. (Epidem. iii, and de Diff. Febr. i, 6.)

The account of the carbuncle given by Aëtius is full and accurate, but is entirely derived from Galen. Oribasius, Actuarius, and Nonnus also repeat his doctrines. Actuarius says that the disease is occasioned by melancholic blood overheated. This is much the same as Galen’s theory.

Octavius Horatianus recommends bleeding at the commencement, and external applications of an acrid and caustic nature, or the actual cautery itself. When danger is apprehended from a hot cautery, he directs us to use a cold one.

In the Latin translation of Avicenna the carbuncle is described by the names of pruna and ignis Persicus. It was called pruna from a black slough which is formed in it, resembling a burnt coal. His account of the disease is ample, but mostly copied from Galen and his successors. Rhases approves of venesection at the beginning, and of the actual cautery. He also recommends an application containing mustard and figs. Alsaharavius describes the varieties of anthrax by the names of alcubam and alcoasat. (Pract. xxix, 12.) At the commencement, he approves of general bleeding and leeches, and afterwards of refrigerant and analeptic medicines, to obviate the tendency to sinking. When these things do not succeed, he directs us to use powerful caustics or the actual cautery. Serapion, like Avicenna, describes it under the name of the ignis Persicus.

Procopius mentions the anthrax as one of the symptoms of the great plague which he describes. (Persica, ii.)

For the carbunculus or anthrax, Brunus and the other writers of that age recommend, at first, bleeding and restricted diet, with maturative applications, such as figs and mustard, or the yeast cataplasm, with oil and salt. When the part becomes black, Theodoricus directs us to have recourse to the actual cautery. (iii, 12.) Municks rather disapproves both of purging and bleeding, but strongly commends the actual cautery, which he greatly prefers to the potential. (Chirurg. i.) Vigierius, however, prefers a paste made from quicklime and soap. V. Manget. (Bibl. Chirurg. i, 374.) The learned Schelhammer speaks favorably both of the potential and the actual cautery. (De Humoribus.)

SECT. XXVI.—ON CANCERS.

Cancer occurs in every part of the body; for it takes place in the eyes and uterus (as we have stated when treating of those parts), and in most other parts of the body; but it is more particularly frequent in the breasts of women, because owing to their laxity, they readily admit the thick humours which occasion it. For cancers are formed by black bile overheated; and if particularly acrid, it is attended with ulceration. On this account, they are darker than phlegmons, without being attended with the same degree of heat. The veins are filled and stretched around like the feet of the animal called cancer (crab), and hence the disease has got its appellation. But some say that it is so called because it adheres to any part which it seizes upon in an obstinate manner like the crab. Owing to the thickness of the humour which occasions it, cancer is an incurable disease, for it can neither be repelled nor discussed; not yielding to purging of the whole body, resisting the milder applications, and being exasperated by the stronger ones. It may be possible, however, to prevent incipient cancers from increasing, by evacuating the melancholic humour before it becomes fixed in the part. We may evacuate, first, if nothing prohibit, by venesection, and afterwards by purging at the commencement, with the simpler purgatives, such as giving dodder of thyme to the amount of oz. ivss; in whey or honied water, and afterwards hiera, containing the black hellebore.

The juice of strychnos may be applied to the ulcerated parts without exciting pain, a linen rag being folded and wetted in it, and laid on; but externally to this, we must apply soft wool, which also has been soaked in the juice, and care must be taken that they do not become dry, by frequently pouring on some of the juice. In all carcinomatous ulcers of a chronic nature, one may use the preparation from pompholyx; and those remedies which were mentioned in the Third Book for cancers in the womb may be applied with advantage.

For carcinomatous and malignant ulcers, for rugose ulcers on the fundament, and for inflammations on the pudenda, testicles, and breasts. In a leaden mortar, and with a leaden pestle, having triturated the Lemnian earth with oxycrate and honied water or milk, so that it become black, or having triturated rose-oil, or the oil of unripe olives, or the juice of house-leek, or that of wall-pennywort, or of lettuce, or of fleawort, or of unripe grapes in like manner, anoint with them. The patient’s diet should consist principally of the juice of ptisan and the whey of milk, and from among pot herbs, of mallows, orache, blite, and gourd, of the fishes which live among rocks, and of all kinds of fowls, except those that live in marshes.

From Archigenes, for carcinomatous and malignant ulcers. Levigate equal parts of burnt river crabs and calamine, and sprinkle or apply the ashes of crabs with cerate; or apply the seed of hedge mustard triturated with honey.

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COMMENTARY. See Hippocrates (Epidem. v); Galen (de Tumoribus; Meth. Med. xiv; Therap. ad Glauc. ii); Celsus (v, 28); Scribonius Largus; Aëtius (xvi, 43); Oribasius (Morb. Curat. iii, 28); Actuarius (Meth. Med. iv, 16); Avicenna (iv, 3, 2, 15); Serapion (v, 24); Alsaharavius (Pract. xxix, 1, 16); Avenzoar (ii, 7, 27); Haly Abbas (Pract. iii, 32); Rhases (ad Mansor. vii, 9; Contin. xxvii.)

Hippocrates relates a fatal case of cancer in the breast, attended with a sanious discharge, but he does not explain the nature of the treatment.

Our author’s description of cancer is abridged from Galen (de Tumor. l. c.) The treatment is derived from the 14th Book of the ‘Meth. Med.’ He recommends melanogogues to remove the material cause of the disease. In external applications he places little confidence, but prefers those prepared from metallic substances which have been burnt and washed. The only chance of a radical cure consists, he says, in making a complete excision of the part; but in doing this he forbids us to secure the arteries with ligatures, as they will occasion a recurrence of the disease. The part, he says, is loaded with a thick, black, or recrementitious blood. When the cancer is ulcerated, he disapproves of cutting and burning.

Celsus describes carcinoma as an immovable and unequal tumour, attended with swelling of the veins, which are pale or livid. His account of the treatment is so important that it deserves to be given in his own words: “Quidam usi sunt medicamentis adurentibus; quidam ferro adusserunt; quidam scalpello exciderunt: neque ulla unquam medicina profuit; sed adusta, protinus concitata sunt, et increverunt donec occiderent; excisa, etiam post inductam cicatricem, tamen reverterunt, et causam mortis attulerunt: cum interim plerique nullam vim adhibendo, qua tollere id malum tentent, sed imponendo tantum lenia medicamenta quæ quasi blandiantur, quo minus ad ultimam senectutem perveniant, non prohibeantur.” In another place, however, he recommends compositions containing arsenic, copperas, cantharides, galls, &c. (v, 22.) He makes a distinction between the cacoethes, or malignant tumour, and the true carcinoma, but says that the difference between them is to be recognized only “tempore et experimento.” He marks the gradations of malignant disease with singular precision: first, there is cacoethes; then carcinoma without ulceration; and last, there is the fungated ulcer. (The reading in the edition of Milligan is a great improvement.) In doubtful cases he directs us, first to apply caustics or heating medicines, and, if the disease is alleviated, to proceed to the scalpel or burning, according to circumstances; but if it is exacerbated, we are to conclude that it is of a carcinomatous nature, and must abstain from all acrid and vehement applications.

Scribonius Largus recommends for all malignant ulcers, even such as are cancerous, an application consisting of arsenic, p. vj; of squama æris, p. iij; of elaterium, p. j; of burnt paper, p. iij.

Aëtius gives from Archigenes and Leonidas an interesting account of the disease, which he divides into ulcerated cancer, and cancer without ulceration. He describes the disease in the female breast as consisting of a large tumour which is unequal and resisting, extending its roots far, and being attended with varicose veins: its colour is either cineritious, verging to redness or livid; it appears soft, but is in reality very hard; is accompanied with a pungent pain, and gives rise to malignant phlegmons in the armpits. The pains shoot to the clavicle and scapula. An ulcerated cancer, he says, goes on corroding and spreading deeper, nor can it be stopped; it discharges a sanies of an abominable smell, and is aggravated by medicines and handling. The disease he considers as generally incurable. His surgical treatment will be stated in the Sixth Book. He recommends purging with hiera and the theric, Mithridatic antidote, &c. Apparently, in order to mitigate the violence of the pains, he directs us to make an application containing equal portions of plantain, poppy heads, the seed of the wort, and other things of the like kind. For ulcerated cancer he recommends emollient epithemes, such as the one containing litharge, axunge, white wax, oil, and the yelks of eggs.

Oribasius and Actuarius supply nothing of importance that is not to be found in our author. Nonnus, according to Sprengel, is the only ancient author who attributes cancerous ulcerations to acrimony of the bile. But Nonnus merely copies the words of our author.

The Arabians agree with the Greeks in representing the disease as being produced by black bile. They were, no doubt, led to form this opinion from remarking that the blood in the part is thick and black, which they considered owing to its not being properly purged of its recrementitious sediment. The moderns deride this theory, but they have substituted nothing satisfactory in its stead. Van Swieten thinks more favorably of the ancient doctrines. (Comment. § 485.) Avicenna speaks highly of a milk diet. Serapion likewise approves of milk deprived of its butter, and of a vegetable diet. He speaks of no other treatment as being likely to prove remediable, with the exception of excision and the cautery. Haly Abbas rather approves of excision when the disease is seated in a part which admits of this operation. However, like Galen, he disapproves of tying the arteries. The characteristic symptoms of the disease, he says, are a stony hardness and distension. The account given by Alsaharavius is nothing different. Rhases has little confidence in excision. After ulceration has taken place he approves of using a cooling application, containing ceruse, tutty, rose-oil, the juice of nightshade, and some other such things of a cold nature. He mentions a case of cancer of the breast, in which the whole mamma was extirpated, but the disease returned on the other side. One of his authorities, Antyllus, describes the cancerous sore as having a tendency to spread inwards, its edges being thick, large, and everted, and the discharge thin and acrid. When the disease cannot be got completely extirpated, he forbids us to meddle with it.

Theodoricus and all the earlier modern writers on medicine, call the cancer by the name of apostema melancholicum, and recommend the same treatment for it as the Greeks and Arabians.

SECT. XXVII.—ON ŒDEMA.

Having treated of swellings formed by hot humours, we shall now treat of those from the opposite, beginning with the œdema. For as erysipelas is formed by a bilious humour, so is œdema by a pituitous, being a loose swelling devoid of pain. We are aware also, that œdematous swellings occur in the feet, in dropsical affections, in phthisis, and in cachexia, but in them the œdema is a symptom of the complaint under which the person is labouring, and requires no very particular treatment; for it will be sufficient in general to rub the limbs sometimes with vinegar and rose-oil, and sometimes with oil and salts, or the salts may be added to the vinegar and rose-oil. When the œdema is occasioned by a pituitous humour being determined to the part, a sponge soaked in oxycrate may be properly applied with a bandage loosely put on, beginning below and terminating above. The sponge ought to be new, but if such a one is not at hand, that which is may be cleaned with natron, or more especially with what is called strained lye. If the swelling do not thereby subside, we may mix some alum. And a very convenient application is a tender wick of a lamp, soaked in such a fluid, and applied. A good remedy also is horned poppy. When the œdema has become chronic, having first anointed the part with oil, and then applied a sponge out of lye, bind it firmly, and you will effect a cure. Every kind of earth discusses and represses œdematous swellings, more especially the Ægyptian, and also the matured woad.

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COMMENTARY. See Galen (ad Glauc. ii; de Tumoribus); Aëtius (xv, 1); Oribasius (Morb. Curat. iii, 51); Leo. (vii, 5); Actuarius (Meth. Med. iv, 16); Nonnus (251); Serapion (v, 23); Avicenna (iv, 3, 2); Haly Abbas (Theor. viii, 11; Pract. iii, 30); Alsaharavius (xxix, 13); Rhases (ad Mansor. vii, 12.)

Our author’s account of this disease is taken from Galen, Oribasius, Aëtius, and, in fact, all the Greek, Latin, and Arabian authorities adopt his views, without any material alteration. They all concur in recommending cooling and astringent applications, with suitable bandages; and, in certain cases, friction. Rhases recommends that the limb should be buried in heated sand. He also approves of various cooling and astringent applications with bandages. In the translation of Alsaharavius, the œdema is described by the name of apostema flegmaticum; in those of Avicenna, Haly Abbas, and Serapion, by that of undemia. The celebrated Paracelsus used the term undemia for œdema. In some late works we have seen it stated that the undemia was a species of erysipelas, but this is evidently a mistake.

SECT. XXVIII.—ON EMPHYSEMA.

Emphysema is formed by a flatulent spirit, collected sometimes under the skin, sometimes under the periosteum, or the membranes which surround the muscles. And it is also sometimes collected in the stomach and intestines, or between them and the peritoneum, in those kinds of dropsy which are called tympanitic; and it differs from œdema in this, that the parts do not pit upon pressure like it, and that it sounds like a drum. The density of the body co-operates in preventing the flatus from being dissipated, at the same time that the flatus also is of a thick nature. Wherefore, the indication of cure is to rarefy the body, and attenuate the thick air; which is to be accomplished by means of attenuant and heating remedies. When the complaint is seated in the stomach and intestines, this is to be brought about by a fine oil, having rue, cumin, or parsley seed boiled in it. And sometimes a large cupping instrument without scarificators, applied two or three times to the navel, will discuss it. When the muscles from contusion are inflated, so as to sound like an emphysema, the parts will not bear very heating and acrid applications. Wherefore, at the commencement, we must use paregorics liberally, and, when the disease is on the decline, discutients. Thus we may use sodden must with a small quantity of oil, applying them warm upon unwashed wool, or mixing the cerate of unwashed wool. And we must take care that the heat be preserved, for it is not expedient that the part be cooled. When the patient has been soothed, we are to mix vinegar and nitre or aphronitrum, and afterwards some lye; and lastly, we may use discutient plasters, for the removal of the complaint such as the following: having boiled the sordes of the oil used in baths, strain it first, so that it may become pure, and again throw it into the pot, and having triturated slaked lime like flour, sprinkle until it become of the consistence of clay, and use. A still more effectual application is the compound medicine from sycomores.

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COMMENTARY. See Galen (Meth. Med. xiv); (Therap. ad Glauc. ii); Aëtius (xv, 2); Oribasius (Synop. vii); Actuarius (Meth. Med. ii, 12); Nonnus (252); Scribonius Largus (§ 119); Avicenna (iv, 3, 2, 20); Serapion (v, 23); Alsaharavius (Pract. xxix, § 1, 14); Rhases (Divis. 127, Cont. xxvii.)

Our author has copied closely from Galen. The great indications of cure, as laid down by him and acknowledged by all subsequent authorities, are to rarefy the containing parts and attenuate the spirit. By spirit, as we stated in another place, the ancients meant a thick air or gas. The indications which we have mentioned are best fulfilled by friction with oils, in which calefacient medicines, such as cumin, parsley, anise, and the like, have been boiled. When, however, any inflammation is suspected, he properly forbids us to use acrid or heating medicines. When the pain of the bowels is violent in cases of tympanites, he allows medicines containing opium, which are to be given by the mouth if the small intestines be affected, but are to be administered in a clyster if the large intestines be the seat of the disease. When the disease is in a muscular part, he directs us to use a combination of attenuants and emollients. In certain cases he recommends dry-cupping. Oribasius, Aëtius, Actuarius, and Nonnus, adopt the views of Galen, without any alteration.

For tympanites, Scribonius recommends cumin internally.

Avicenna, like our author, in ordinary cases recommends combinations of attenuants and calefacients, dry-cupping and the like, for dispelling the spirit; but when the disease arises from contusion of the muscles, he directs us to use resolvents and paregorics. Serapion approves of similar treatment. Alsaharavius recommends attenuant and calefacient remedies externally and internally. In the translation of his works, the disease is called inflatio. Rhases recommends friction with calefacient oils; he remarks that the disease occurs most commonly in the stomach and intestines. He calls it by the name of apostema inflatum.

SECT. XXIX.—FOR SPRAINS AND CONTUSIONS.

Sprains of the joints and contusions are remedied by unwashed wool, or a sponge soaked in vinegar and oil, and applied; by the tender parts of boiled bulbous roots with honey, by the leaves of the chaste tree, salts, and roasted nitre, triturated with cerate. The affusion of sweet water, or of hot sea water, may be used. But after the inflammation and pains have subsided, apply rubbing to the sprained parts.

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COMMENTARY. See Aëtius (xiv, 71); Oribasius (Synops. vii, 14); Actuarius (Meth. Med. ii, 35); Scribonius Largus (§ 209); Rhases (Divis. i, 140.)

Aëtius makes mention of all the remedies recommended by our author, with the exception of the affusion of water; which, however, is a method of treatment deserving of attention. Oribasius mentions particularly the affusion of hot sea water. Scribonius Largus recommends a plaster containing litharge, alum, ærugo, ammoniac, &c. Rhases directs us to use attenuant ointments, sedative plasters, and loose bandages, with rest.

SECT. XXX.—ON CONTUSIONS OF THE FLESH AND ECCHYMOSIS.

The flesh being bruised by some weight falling upon it, and the small veins in it being ruptured, blood is poured out from them by exhalation, and collecting under the skin, is called ecchymoma. When the skin is not divided, a soft yielding tumour is the consequence; it is pale, and for the most part unattended with pain. Our object, therefore, is to discuss the contained blood, and that quickly, before it become black; and at first, astringents are to be mixed with the discutients, because the bruised coats of the veins stand in need of condensation. After these things, we must use those applications which are merely discutient without astringency. And by scarifying the ecchymomata at the commencement, we may thus apply the subsequent treatment. For chronic cases of ecchymoma, radish in the form of a cataplasm is a suitable remedy, but it must be taken away when it becomes pungent; or a cataplasm of the juice of radish with crumbs of bread, may be applied. The diseases called hypopion and hyposphagma, are species of ecchymosis, and also the effusion of blood below the nail from a blow; of these, the first two are treated of in their proper places in the Third Book; and the affection of the nail will be handled in the Surgical part of the work.

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COMMENTARY. This is taken almost word for word from Oribasius (Synops. vii, 14); Aëtius directs us to scarify the part affected with ecchymosis, and then to apply to it the inside of citrons (xiv, 68.)

Avicenna approves of scarifications, provided the extravasated blood cannot be got otherwise removed. (iv, 4, 2, 3.)

SECT. XXXI.—ON RUPTURE AND TEARING OF THE FLESH.

Rupture is altogether attended with ecchymosis. It is cured by medicines which are moderately heating, as the acopon from black poplars, and such as resemble it. But when the rupture is deep-seated, we must have recourse to such remedies as are more acrid and cutting. The use of the cupping instrument is likewise beneficial to them. Should therefore the whole ecchymosis be discussed, the separated flesh readily unites; but if it continue a long time, and sordes form under it, the ruptured flesh can no longer unite; and we must only apply the lips together, so that a small occasion may readily separate them, and that the intermediate space may be filled with some moisture, and in a certain manner an ecchymosis may be formed as at the commencement, except that it is sooner discussed, as containing a thin humour, whereas that at the commencement was formed of blood. Vulsion takes place when certain fibres are torn asunder, and it only requires soothing applications until the pain is removed; for they cannot be made to coalesce. Wherefore, the round birthwort, if any, is a convenient application to ruptured and torn parts; and in like manner, the root of the large centaury, and the juice of it, rhubarb, costus, and bdellium, drunk with oxymel.

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COMMENTARY. These remarks are taken from Aëtius (xiv, 69, 70); or Oribasius (Synops. vii, 14); and they are copied by Nonnus (Epit. 254); and Actuarius (Meth. Med. iv, 16.)

The Arabians treat these accidents upon exactly the same principles. See in particular Avicenna, as quoted in the preceding section.

SECT. XXXII.—ON SCIRRHUS.

Genuine scirrhus is a preternatural swelling, hard and devoid of sensibility; but that which is not genuine is only attended with diminished sensibility. That which is wholly insensible, then, is utterly incurable; but that which is attended only with diminished sensibility is not incurable, and yet it is not easily cured, for it is occasioned by a viscid and thick humour, which is fixed in the hardened parts, so as to be difficult to get discharged. Sometimes, then, the scirrhus is the original complaint, and goes on to increase; but for the most part, it is occasioned by the physicians applying too cooling and astringent remedies to erysipelas and phlegmon.

If one, therefore, apply strongly discutient medicines to indurations of the body, one will indeed produce a visible diminution of the scirrhus in a short time, but will leave the remainder of the complaint in an incurable state; for the thin moisture being dissipated, what remains is rendered dry and hard as a stone. The discutient application, then, ought to be in a certain degree emollient, without possessing manifestly heating and desiccant qualities. Such are all kinds of marrow, more especially that of a stag or of a calf, and the grease of a lion, of a panther, or of bears, or of a bull, and among birds, that of geese, of domestic fowls, or of pheasants: but that of bucks and he-goats is drier. And to these may be added, ammoniac perfume, bdellium, more especially the Scythian, the humid and fatty storax, and the Egyptian mastich. To all other parts of the body, when in a scirrhous state, these things may be applied singly, and in composition; but for tendons and ligaments, we are to dissolve in the strongest vinegar some stone that has been heated in the fire. If possible, the one to be used should be pyrites, or if not it, the lapis molaris or millstone. In this, therefore, the affected part is to be moved, so that it may receive the vapour which arises from it; and afterwards, an emollient medicine is to be applied. A thin oil then, and not water, is to be poured on the part, by all means once a day, and sometimes one may boil in the oil the root of marshmallows, or of wild cucumber. The patients ought to abstain from the use of the bath, at least from the frequent use of it. But when the scirrhus is moderately softened, the softest ammoniac is to be dissolved in very strong vinegar, and the part rubbed with it for several days in succession; after which, we must again have recourse to an emollient application, having the fattest galbanum and opoponax added to it. Such are that from bacon, that ascribed to Amythaon, and those which we are about to describe for scrofula.

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COMMENTARY. See Galen (De Tumoribus; Meth. Med. xiv; Therap. ad Glauc. ii); Oribasius (Synops. vii, 34); Aëtius (xv, 3, 4); Leo (vii, 4); Actuarius (Meth. Med. iv, 16); Serapion (v, 23); Avicenna (iv, 3, 2, 12); Haly Abbas (Pract. iii, 31); Alsaharavius (xxix, 1, 15); Rhases (Antid. i, Cont. xxvii, Antidot. i.)

This section is entirely taken from Galen (Ther. ad Glauc. l. c.) Galen’s account, however, is somewhat fuller than our author’s, and contains a case treated upon the principles which he lays down. It was a case of hard swelling in the thigh, arising from an erysipelas which had been improperly treated by astringent and cooling applications. Galen informs us that he began by pouring upon the limb an attenuant oil, namely, the Sabine; after which he caused it to be rubbed with marrows and fats medicated with bdellium, mastich, ammoniac perfume, and the like. After this he bathed the whole limb with a solution of ammoniac in very acrid vinegar. When the swelling had been lessened, but not completely removed by these means, he afterwards applied one of the pitch medicines, and at length effected a cure. In another place he states that scirrhus is sometimes allied to cancer.

Oribasius likewise recommends a combination of emollients with discutients; and Actuarius approves of the same practice.

Aëtius has a valuable chapter upon this subject. Besides the articles mentioned by our author, he recommends various rosins, turpentine, frankincense, and the like. He forbids the use of aluminous, sulphureous, and chalybeate baths. For indurations of tendons he recommends things possessed of attenuant and cutting properties combined with emollients, such as ammoniac dissolved in vinegar with melons.

The Arabians treat of scirrhus in much the same terms as the Greeks. Avicenna properly directs us to bleed when there is congestion of black blood in the part, and afterwards to use applications of a solvent and emollient nature. He and Serapion mention the same identical remedies as those of Paulus. For dissolving hard tumours he recommends an oil containing fenugreek, cyperus, and aromatic reed. Haly Abbas ascribes the formation of scirrhus to the same causes as our author, and recommends relaxant and emollient applications. Alsaharavius directs us to procure evacuations of black bile, and gives prescriptions for various emollient and discutient applications. When the usual remedies do not succeed, he advises recourse to be had to the operation. Rhases divides scirrhus into two varieties, that accompanied with sensibility, and that which is insensible. He mentions that Antyllus approved of extirpation and the actual cautery when the disease is of a corroding and cancerous nature.

SECT. XXXIII.—ON STRUMA OR SCROFULA.

Strumæ are indurated glands forming principally in the neck, armpits, and groins. Their general treatment therefore is the same as that for scirrhus, but in particular the flour of bitter lupines is to be boiled in oxymel and applied (this also answers with phyma;) or apply cows’ dung boiled in vinegar. This discusses all indurated swellings. But strumæ may be properly discussed by means of quicklime mixed with honey, the sordes of baths, oil, or axunge; or, equal parts of quicklime and natron, and four times the quantity of cardamom and fenugreek may be boiled with honey for an emollient ointment and applied. This one discusses hard strumæ, and produces the rupture of suppurated swellings; the flour of darnel boiled with pigeon’s dung, or linseed and wine: or, green olives, either wild or cultivated; or, the white cardamus triturated with liquid pitch and made into an emollient ointment may be applied; or, the ashes of the dried root of the wild cucumber, and the burnt dried leaves of the bay, may be mixed with turpentine and applied; or, equal parts of stavesacre and of natron, with double the quantity of rocket may be applied, with rosin; or, goats’ or cows’ dung boiled in vinegar; or, the flour of bitter vetches soaked in the urine of a young person not come to manhood, and added to melted pitch, wax and oil; or, a dead snake may be thrown into a pot, and being covered over with gypsum, it is to be put into a furnace, the ashes of it mixed with equal parts of fenugreek, and then added to honey and used. And the composition from asps is an admirable one, also that from fullers’ herb, that from the wild cucumber and that from cedar rosin. The following one produces suppuration, or resolution of strumæ: Of myrrh, dr. x; of ammoniac perfume, dr. ij; of the mistletoe of oaks, dr. viij; of galbanum, dr. iv; of bee-glue, dr. j; pound in a mortar.

For strumæ and hardness of the breasts. Of wrought birdlime, of dry rosin, of wax, of each lb. j; of galbanum, oz. iij.

For strumæ ulcerated and not ulcerated. Of wax, of pine rosin, of axunge not salted, of horehound, of scraped birdlime, of each oz. vj.

An application for strumæ. Of old oil, lb. ij; of wax, lb. j; of colophonian rosin, oz. iv; of natron, oz. iv; the heads of garlic xij. Take away the cloves (nuclei) of the garlic, macerate in oil for three days, then having boiled until they are softened, throw them away, and melt in the oil those ingredients which are soluble, and after they are taken off the fire sprinkle on it levigated natron. It also breaks apostemes.—Another: Of the ashes of figs, oz. ij; of fissile alum, oz. j; of aphronitrum, oz. j; of liquid pitch, oz. vij.

A septic application for scrofula. Of fissile alum, of realgar, of each, dr. iv; of the flakes of copper, dr. j; of orpiment, dr. j; sprinkle the strumæ with it in a dry state; but if they are of a cancerous nature, mix with rose oil and use twice a day.

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COMMENTARY. See Hippocrates (De Glandulis); Galen (Meth. Med. xiv, 11); Oribasius (Synops. vii, 29); Aëtius (xv, 5); Actuarius (Meth. Med. iv, 16); Nonnus (Epit. 124); Celsus (v, 18); Scribonius Largus (153); Myrepsus (56); Marcellus (36); Serapion (v, 25); Avicenna (iv, 3, 2, 10); Albucasis (Chirurg. ii, 42); Alsaharavius (Pract. xxix, 1, 23); Haly Abbas (Pract. iii, 33); Rhases (ad Mansor. vii. 8; Cont. xxvii); Avenzoar (i, 10, 10.)

Hippocrates mentions struma as being one of the worst diseases of the neck, originating in inflammation, and being produced by a pituitous and indolent defluxion.

Galen directs us when scrofulous glands are not situated near large vessels to extract them with the knife, or consume them with septic applications. In another place he relates a case in which an imprudent surgeon, while removing a scrofulous gland of the neck, cut the recurrent nerves, and thereby occasioned loss of speech. (De Loc. Aff. i, 6.) For an account of the operation see the Sixth Book.

Part only of our author’s applications are derived from Oribasius.

A very minute account of these complaints is given by Aëtius. He divides strumæ into the mild and the malignant. The mild are without inflammation or pain, and are attended with a moderate degree of hardness; the malignant are accompanied with inflammation, and a throbbing pain, feel unequal, have enlarged veins, and are exacerbated by handling or medicines. The latter are said to be incurable. He mentions, upon the authority of Leonidas, the accident related by Galen. He approves, however, of the operation in general. Incipient strumæ, he states, may be discussed like scirrhi, by a combination of emollients with discutients. He gives a long list of prescriptions for removing scrofulous tumours. One of them contains arsenic mixed with the fat of a goat or ox. With regard to the general treatment, he recommends laxatives, restricted diet, emetics, and the theriac.

Actuarius and Nonnus, as usual, borrow from our author.

Celsus remarks that strumæ occur most frequently in the neck, armpits, groins, sides, and the female breasts. He represents them as indolent affections of the glands, which come slowly to maturity and prove very troublesome to the physician. Some, he says, give white hellebore in these cases, and use applications for bringing them forward or for discussing them. Others have recourse to caustics, and when the eschar is removed, they heal the ulcer upon general principles. When the sore becomes clean he recommends exercise and a nourishing diet.

Scribonius Largus, Marcellus, and Myrepsus give nearly the same prescriptions as our author. Arsenic is an ingredient in the septic applications of Myrepsus.

Avicenna recommends emetics, phlegmagogues, bleeding in the arm, attenuant food, and avoiding all gross things and repletion. As a discutient he and Serapion commend the diachylon plaster. Haly Abbas likewise mentions this application, and also directs the swellings to be burnt with caustics. Alsaharavius briefly recommends excision or burning. Serapion evidently copies from our author. Avenzoar gives a very full account of scrofulous swellings, which, he says, are formed in general of a gross and viscid phlegm. Except in very particular cases he disapproves of bleeding. He approves in general of discutient applications; but when the swelling tends to suppuration, he directs us to promote it; and when pus is fairly formed he recommends us to let it out, but cautions the surgeon not to attempt this operation unless he has a practical acquaintance with anatomy, lest he wound any of the veins, arteries, or nerves.

Rhases forbids the knife when the scrofula is in the neck or deep seated. In certain cases he approves of destroying the tunic with septic applications.

Brunus, and the other surgical writers of that age, in imitation of the Arabian authorities, direct scrofulous tumours to be treated with discutients, excision, or septics. A discutient ointment recommended by Brunus consists of litharge, common oil, and the juice of melons and fenugreek. His septic medicine is a mixture of arsenic and quicklime, which is to be applied with honey. (Chirurg. Minor. 19.)

SECT. XXXIV.—ON STEATOMA, ATHEROMA, AND MELICERIS.

These things belong to the class of apostemes, as we said when treating of them, and each receives its peculiar appellation from the substance contained in the tumour. Thus one of them is like fat, another like honey, and the third like pap. The indication of cure in them all is to discuss the contents, produce the putrefaction of them, or to cut them out. Some tumours fall under all these three indications of cure, namely, those which contain a thin fluid, as the meliceris; others come under two of them only, as the atheroma, for it can only be cured by excision or putrefaction. But the steotoma admits of no cure except by a surgical operation, for it can neither be discussed nor made to putrefy. The diagnosis of each of these may be found in the Surgical part of the work, while the materials of which the discutients are formed are mentioned under the head of scrofula. This application is peculiarly adapted for discussing meliceris: Twenty raisins without their stones; of squama æris, dr. iij; having first fomented, apply.—Another: Of Cretan cistus, of bdellium, of galbanum, of ammoniæ perfume, of bee-glue, of turpentine, equal parts; to be pounded together in a mortar. It applies to scrofula, parotis, furunculus, and phyma. But Archigenes applies to meliceris aphronitrum, and double the quantity of hellebore, with hard cerate. But septics cannot be applied while the skin remains entire; we must therefore in the first place lay bare the meliceris, atheroma, or strumæ, with caustic medicines, of which the most simple is that consisting of quicklime (calx viva,) soap, and strained lye. The following one is more complex, and admits of being kept: Of calx viva, dr. iv; of red natron toasted, of burnt lees of wine, of each, dr. ij; of vermilion, dr. j; triturate in lye; and having made it of the consistence of liquid honey, boil three times, until it is of the proper thickness, and lay it up in a leaden vessel, pouring in some lye, so that it may not quickly become dry. It applies to acrochordon, myrmecia, pterygium, clavus, callus, and excrescences of the gums. The lees of wine should not be older than two months. Anoint the skin with this, and when it begins to dry clean it away with a sponge, and anoint again; and when the skin becomes black, wash away again, and use escharotics. When the eschars fall off, apply the septic medicines. A septic application which is not irritating: Of squama æris, dr. iv; of realgar, dr. ij; of black hellebore, dr. ij; use with rose oil.—Another: Of squama æris, of realgar, of nettle seeds toasted, equal parts; use with rose oil.—Another: Of burnt sea-urchins, of the shell of the cuttle fish, of arsenic, equal parts; use with rose oil, but rub all the parts around with cerate and oil. This also is a good application: Of quicklime, p. ij; of chalcitis, p. j; of arsenic, p. j.

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COMMENTARY. See most of the authorities referred to in the preceding section.

Our author’s definitions seem to be taken from Galen. (De Tumoribus and Meth. Med. xiv.) Galen states that the steatoma is to be cured solely by a surgical operation; that the meliceris may be treated by discutients, septics, or excision with the knife; and that the atheroma admits only of excision, or the application of septics.

Aëtius may be referred to as an interesting authority upon this subject. The steatoma, he says, is a preternatural tumour, free from discoloration, and soft to the touch. He recommends excision for it. The contents of the atheroma consist of a pultaceous substance surrounded by a membranous tunic, within which are also sometimes found hairs; nay, Philoxenus affirms that he had found animals like gnats and flies. The meliceris also has a membranous coat, and its contents resemble honey. He approves also of the surgical operation for the meliceris and atheroma, but permits to attempt their reduction by means of discutients consisting of such ingredients as ammoniac, ceruse, turpentine, galbanum, vinegar, &c. He makes no mention of septics; indeed arsenic does not enter into any of his compositions.

Oribasius and Actuarius lay down the same rules of treatment as our author. Nonnus as usual epitomises him with some slight alterations. The active ingredients in one of his septic applications are sandarach and hellebore. Leo is brief and indistinct.

Celsus marks the differences of these tumours with his characteristic terseness and precision: “Atheromati subest quasi tenuis pulticula: meliceridi liquidior humor; ideoque pressus fluit: steatomati pingue quiddam.” He recommends excision. (vii, 6.)

Avicenna’s plan of treatment is so like our author’s, that we need not give it in detail. The steatoma is to be removed solely by an operation. For the two others he permits the use of septic applications, such as arsenic, quicklime, hellebore, the lees of wine, &c. Haly’s definitions are similar to those of our author, and he recommends either excision or the use of septics, such as vitriol. The treatment laid down by Alsaharavius is quite the same. In the barbarous translation of his works they are called by the names of alsahamia, asalia, and accida. (Pract. xxix, 1, 22.)

Vegetius, the veterinary surgeon, describes these tumours as they appear in cattle. He directs them to be treated by excision. (Mulom. ii, 30.)

It will be remarked from the text, that the ancients were well acquainted with the caustic powers of the calx cum kali. In fact, our author in this section has given a prescription for the paste now commonly used for forming issues.

It appears from the works of Fabricius of Aquapendente, that the practice of treating atheroma and meliceris by septic applications was sufficiently common in his time. Andreas Laurentius approves of removing scrofulous tumours in this way when they are deep-seated and have a broad base. He thus enumerates the septics used in his age: “Secundo extrahi potest struma caustico, nunc affixo in ejus medio candente ferro, nunc admotis erodentibus et putrefacientibus ut sandaraca, arsenico, argento liquido usto, oleo quod ex atramento sutorio igne elicitur, calce non extincta cum sapone, axungia porcina cum argenti sublimati portiuncula, pulvere mercurii, erinaceorum cumbustorum, testæ sæpiæ, auripigmenti.” He also recommends us to tie the base of the tumour with a thread wet in a solution of arsenic (De strum. nat.) The treatment of atheroma by caustics is well described in the ‘Bibliotheca Chirurgica’ of Manget.

SECT. XXXV.—OF FAVI.

The favus is a swelling on the skin, having perforations through which a honey-like fluid is discharged. Wherefore dried grapes with rue are to be applied to it; or, the tender leaves of the fig tree with honey; or, cresses with linseed in honey; or, the root of the garden cucumber with honey; or, sulphur vivum with cerate or turpentine. You may vary the treatment of favi by transferring hither what is said in the Third Book regarding achores.

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COMMENTARY. Alexander states that the favus resembles the achores, differing from them solely in magnitude: for the openings of the pores by which the fluid escapes resemble the combs of bees, whence it takes it appellation; but in achores we cannot see the pores by which the fluid issues.

Aëtius gives a similar description of the complaint, which, he says, mostly attacks muscular parts, as the limbs, soles of the feet, over the sixth vertebra of the neck, and the sides. When it attacks the head, he says, it sometimes spreads to the skull. In this case he directs us to treat it with acrid applications, and even the actual cautery. For incipient favus he recommends an application consisting of sulphur, barley flour and meal.

Nonnus recommends the following application: of litharge, dr. ij; of alum, dr. iij; of the leaves of rue, dr. ij; of wine and rose-oil, q. s.

Celsus’s description is so important, that we shall give a considerable part of it in his own language. He mentions two species of the favus, or κήριον. “Alterum est subalbidum, furunculo simile; sed majus, et cum dolore majore: quod ubi maturescit, habet foramina, per quæ fertur humor glutinosus et purulentus; nec tamen ad justam maturitatem pervenit. Si divisum est, multo plus intus corrupti, quam in furunculo, apparet, altiusque descendit. Raro fit nisi in capillis. Alterum est minus, super corpus eminens, durum, latum, subviride, subpallidum, magis exulceratum; siquidem ad singulorum pilorum radices foramina sunt, per quæ fertur humor glutinosus, subpallidus, crassitudinem mellis, aut visci referens, interdum olei: si inciditur, viridis intra caro apparet. Dolor autem, et inflammatio ingens est, adeo ut acutam quoque febrem movere consuerint.” For the second species he recommends as external applications a dried fig, linseed boiled in mulse, and emollient plasters. To the other he also directs us to make applications containing figs, turpentine, rosin, &c. But when these have not the effect, he recommends us to cut the fungous excrescences down to the sound flesh, and then to dress the sore upon general principles. (v. 28.) The above account of an affection of the scalp, which we have often met with in practice, is the most accurate to be found in any author ancient or modern. We are even in doubt whether the complaint be at all noticed in modern works on surgery. It is not to be confounded with the Porrigo favosa, or Porrigo scutulata, of Dr. Bateman.

Avicenna’s description of the achor and favus is far from distinct. (iv, 7, 3, 1.) The favi appear to be the pustulæ capitis quæ dicuntur alsahafa of Alsaharavius. (Pract. i, 11.) His description, however, is by no means distinct. He approves of general evacuants, and local applications of a stimulant nature, such as sulphur, mercury, birthwort, &c. Serapion has not described the favus very accurately, but he has given a full account of the treatment. He properly forbids strong applications at first. (i, 3.) Rhases recommends much the same applications as Serapion. (Ad Mansor. v, 16.)

SECT. XXXVI.—ON THE SIMPLE ULCER.

Since a simple ulcer is merely a division, if one will bring together the parts which are separated, and apply a circular bandage around, the divided parts will adhere together without more ado. It is necessary, however, when at one of its lips the ulcer is everted obliquely, to begin the bandaging there, and turn it to the opposite side. When it is deranged both ways, it will be proper to use a double-headed bandage, and thus to bring the lips together; for when nothing has fallen between the lips, such as a hair, or a sand, or oil, or filth, or the like, the ulcer will adhere completely. When the ulcer is large, so that the separated parts cannot be completely brought together by the aforesaid bandaging, they are to be first united with sutures, and then bandages are to be thus applied, and those remedies used which are called agglutinants, which have the power of drying and consuming the collected moisture, and prevent more from flowing to the part.

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COMMENTARY. On ulcers the following ancient authors may be consulted: Hippocrates (De Ulceribus); Galen (Meth. Med. iii, & iv); Oribasius (Synops. vii); Aëtius (xiv); Actuarius (Meth. Med. iv, 16); Nonnus (Epit. 259); Pliny (H. N. xxxii, 44); Celsus (v); Octavius Horatianus (i, 19, 20); Scribonius Largus (94); Avicenna (iv, 4, 1, 2, 3); Serapion (vii, 28); Averrhoes (Collig. vii, 32); Haly Abbas (Pract. iv, 18); Alsaharavius (Tract. xxix, 2, 2); Rhases (Ad Mansor. vii, 3; Divis. i, 138; Contin. xxviii.)

The author of the Hippocratic treatise quoted above particularly praises wine as a lotion for ulcers; and we may mention that Dr. Hosack, an intelligent American writer, states it as his opinion, that the surgeons of the present day might learn from him an important lesson upon its utility in such cases. He condemns the use of oils and fat.

Of all authors, ancient or modern, Galen has laid down the principles upon which ulcers ought to be treated with the greatest precision. He defines an ulcer to be, “a solution of continuity,” a definition evidently very comprehensive, and including wounds as well as cases of spontaneous ulceration. His directions for the treatment of a simple ulcer or fresh wound are similar to those of our author; that is to say, he directs us to bring the lips of it together, and secure them with a bandage, or, if that is not sufficient, by sutures or clasps. Wine he pronounces to be the best of all applications to ulcers, in as far as they are ulcers.

Our author copies very closely from Oribasius.

In applying the bandage, Aëtius directs us to begin above the sore if only one simple bandage is to be used, but if two are necessary, as in fractures, he recommends us to begin at the ulcer and proceed upwards, and in like manner to begin again at the ulcer and roll downwards. He forbids us to loose the bandages oftener than every alternate day; and directs us not to apply water to the ulcer, but to remove the sanies with a soft, dry linen cloth.

Celsus describes very accurately the treatment of a recent wound or simple ulcer. He approves, according to circumstances, of bandages, clasps, or sutures, and his directions respecting the application of them are highly important, but too long for our limits. After the sore is dressed he directs us to apply over it a sponge soaked in vinegar, or, if that cannot be borne, in wine or cold water. This practice is deserving of imitation. He says afterwards: “Optimum etiam medicamentum quies est: moveri et ambulare nisi sanis alienum.”

Octavius Horatianus directs us to avoid the bath, the fire, the sun, cold air, loud cries, intoxication, venery, and passion, lest these should occasion a rupture of the parts which had adhered.

Avicenna with his usual good sense gives judicious directions for the treatment of simple ulcers, but his principles are nearly the same as those laid down by Galen. He defines an ulcer to be “a solution of continuity, attended with a discharge of sanies or pus.” This seems to be an unexceptionable definition. He forbids all oily and watery applications, and recommends us to observe that no body intervene between the lips of the wound when the bandage is applied. Rhases gives similar directions. He condemns the practice of those who put oil into a wound, and who allow the patient to take wine and heating food. Averrhoes lays down similar rules with considerable precision. Haly Abbas and Alsaharavius follow the practice of Galen without the slightest alteration.

Considerable difference of opinion has prevailed respecting the nature of the clasps (Fibulæ ἄγκτηρες) recommended by Celsus and other ancient authorities. Rhodius and Le Clerc maintain that no more was meant than a simple interrupted suture, but to this opinion we cannot subscribe. (See Le Clerc, Hist. de la Méd. iv, 2, 5, and Fabricius of Aquapendente Œuvres Chirurg. ii, 108.) They would appear to have been metallic clasps of a peculiar construction.

SECT. XXXVII.—ON AGGLUTINANTS.

Oak leaves applied, and those of the willow and cabbage; the fruit, leaves, and bark of the mezereon, and the juice of the more austere plantain, papyrus soaked in oxycrate or wine, and wrapped round in a circular manner. The following are agglutinants of fresh wounds: the leaves of the pine and spruce fir, and their fresh bark wrapped round like a bandage, with water, oxycrate, or wine; and new cheese pounded. But we must apply externally the leaves of dock, or of vine, or of beet, or of lettuce. But cheese made of acid milk cures even the larger sores; and the wild pears repress the discharge. The horse-tail (Hippuris) may be applied with advantage, even if the tendons are divided asunder; and the matured woad may be used to indurated bodies even when they occur in the heads of muscles. The leaves and shoots of cypress, and its recent and soft balls (pilulæ) may be applied to indurated parts, but we must mix with it some of the fine dust taken from a wall near a mill. Myrrh rubbed with water, or frankincense and earth worms, agglutinate even the divisions of tendons; also, cinquefoil leaves with honey, and garlic burnt and applied. Old ulcers again are remedied by barley burnt with cerate, and by ceruse with a quadruple quantity of myrtle cerate. For ulcers on the head sprinkle dried myrrh, and do not moisten it, for it will speedily produce adhesion. Or, having triturated dried aloes or birthwort, and having boiled it with honey in wine until it is of a proper consistence, spread upon a pledget and apply it. Of the compound agglutinants are those called the Barbarous, the Golden, that ascribed to Nicolaus, that from willows and dittany, and others of a similar nature, which can produce the adhesion even of very large sores.

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COMMENTARY. Celsus gives the following list: glutinant vulnus, myrrha, thus, gummi, præcipueque acanthinum, psyllium, tragacantha, cardamomum, bulbi, lini semen, nasturtium, ovi album, gluten, ichthyocolla, vitis alba, contusæ cum testis suis cochleæ, mel coctum, spongia, vel ex aquâ frigidâ, vel ex vino, vel ex aceto expressa, ex iisdem lana succida: si levis plaga est etiam aranea.

Our author’s list is copied from Oribasius. Aëtius has a long chapter on the composition of applications for agglutinating fresh wounds. The ingredients of them are most various: sumach, litharge, wax, galbanum, bee-glue, turpentine, alum, chalcitis, &c. Actuarius merely extracts a few articles from our author’s list.

Avicenna’s list scarcely differs in any one particular from our author’s, and nearly the same may be said of Haly’s. Isaac (ap. Rhasis Contin. xxviii) particularly commends bdellium and myrrh, with honey and wine.

Galen has explained at considerable length the principles upon which these applications should be used. Agglutinants, he remarks, are austere and astringent medicines, being such as occasion a contraction and condensation of the fleshy fibres; and they must not possess detergent properties. They are principally applicable in the case of plane ulcers, that is to say, ulcers without loss of substance. (See Meth. Med. iii.)

SECT. XXXVIII.—ON PAINFUL AND INFLAMMATORY SORES.

To painful and inflamed wounds desiccant and anti-inflammatory remedies must be applied. Of liquid remedies the best is wine, but oxycrate is also a good remedy. But if the ulcer is foul as well as inflamed, much diluted hydromel may be used. Of dry medicines, those in general will apply which are mentioned for phlegmons, except such as are oily and acrid. This is a particularly excellent one: Having boiled the sweet pomegranate in wine and pounded, apply it. This is an admirable application and much used, for it applies to ulcers of the head, and those of the privy parts, and to very painful sores on all parts of the body, and to inflammations of the eyes. But if the erysipelas or the like attack an ulcer, we must have recourse to the remedies described for them.

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COMMENTARY. Hippocrates gives a long list of applications for inflamed sores. We have mentioned above that wine was one of his favorite remedies. If erysipelas come on, he directs us to purge either upwards or downwards.

Galen explains general principles. Our author copies closely from Oribasius.

Avicenna and Rhases agree with Paulus in approving of cooling or desiccative applications, such as a decoction of sweet pomegranate in Pontic wine. This application is recommended by Haly Abbas, who also mentions a cataplasm containing opium.

SECT. XXXIX.—ON UNCONCOCTED ULCERS, AND SUCH AS HAVE NOT SUPPURATED.

Recent ulcers, and such as being in an inflammatory state have not suppurated, may be digested and made to suppurate by these things: of simple things, tepid water poured on them, wheat flour, or chondrus, or bread, or glue for books, applied with turpentine, wax, saffron, frankincense, pitch, rose oil, axunge, or the fat of calves; but the compound application called tetrapharmacon may be applied upon a pledget mixed with rose oil. Old and callous ulcers are concocted by these simple medicines: the dried grape, storax, galbanum, myrrh, Cretan cistus, pitch, rosin, butter, Egyptian mastich and unwashed wool; and by these compound ones: Galen’s plaster without wax, dissolved in oil of ricinus, and applied upon a pledget with old oil, or oleum ricini; and in like manner those called dichromos and basilicon, and the like.

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COMMENTARY. Celsus’s list is not very different from our author’s: Concoquunt et movent pus, nardum, myrrha, costum, balsamum, galbanum, propolis, styrax, thuris et fuligo et cortex, bitumen, pix, sulphur, resina, sevum, adeps, oleum. These articles furnish the ingredients of most of our modern applications. For further information respecting each article, the reader is referred to Dioscorides, Galen, and Serapion.

SECT. XL.—ON HOLLOW ULCERS.

The hollow ulcer requires the filling up of the deficient flesh, the materiel of which is a moderate quantity of good blood. Wherefore we procure a moderate supply of it by a sufficiency of food, and produce a proper temperament of the sore by food of wholesome juices, and a suitable temperament of the part in which the sore is seated. With regard to the discharge, that which is thin renders the sore more humid, and that which is thicker makes the sordes adhere to it; on that account it requires applications that are moderately desiccant and detergent; such as frankincense, the flour of barley, that of beans and tares, iris, birthwort, calamine, panax, and pompholyx. When one incarnative remedy does not answer another must be tried. But if the sordes of the ulcer appear greater, and the ulcer more humid, it is to be understood that the medicine has not dried properly, and its powers are to be increased by a mixture of honey. If it is clean, but with less moisture than natural, the medicine has dried more than was proper, and we must apply a cerate mixed with more oil. It sometimes happens when the application is too strong, that the flesh is melted down, so that the ulcer appears foul and moist, like those which have been imperfectly dried; but that from the melting of the flesh becomes more hollow, its lips are callous, and it is red and inflamed; and sometimes the patient has very acute pain. But the other, which arises from the applications being less desiccant than proper, is attended with none of these characters. Wherefore the caries of wood, more especially of such as is possessed of a moderate degree of astringent and detergent qualities, as that of the elm, purges and incarnates clean ulcers; or anemone may be applied for the same purpose. Having shaven down the bark of the pine and pounded it with cerate, and rubbed it upon pledgets, apply it to hollow ulcers, more especially to such as are recent, for it will fill them. The compound medicines for ulcers which are clean, are, that from snails, that ascribed to Manetho from the lees of wine, that from aloes, the dry powder called meletera, that containing equal parts of starch, of manna, of halica, and of tares; and in like manner, the composition from frankincense and that called aphroditarium. But when the ulcers are fouler the powders called cephalic are to be applied, and of those applications that are made upon pledgets, that called trophos, the isis and the athena, and that from distaff-thistle (atractylis,) and moreover that called Italicum, and any others of tried efficacy.

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COMMENTARY. The resemblance here pointed out between an ulcer too strongly stimulated and one too little is highly deserving of attention. Our author appears to have borrowed his description from Oribasius, who however abridges it from Galen. Galen and Aëtius give a somewhat fuller account than our author, but their principles of treatment are the same. They remark that frankincense in humid intemperaments engenders flesh, but in dry ones only pus. Pompholyx burnt and washed; calamine and the shells of oysters are said to be incarnant and dissiccant without pungency. Galen inculcates that the greatest difficulty in treating these ulcers, is to find out the nature of the intemperament of the part, and correct it.

Celsus gives the following list of incarnants: Carnem alit et ulcus implet resina pinea, ochra attice, vel asterace, cera, butyrum. He recommends the use of hot water; an application consisting of butter, roses, and a small portion of honey; or the tetrapharmacum with roses. He approves of giving wholesome and nutritious food, such as fowls, venison, pork, and even wine. The list of the Pseudo-Dioscorides contains nearly the same articles as that of Celsus. (Euporist. i, 186.)

Octavius Horatianus recommends a composition of equal parts of honey, turpentine, rosin, and wax, melted in a vessel; or a mixture of powdered rosin, wax, and fat.

Scribonius Largus recommends basilicon, and a composition consisting of calf’s marrow, the fat of geese, butter, stag’s marrow, wax, turpentine, honey, and roses.

Avicenna remarks, that in treating hollow ulcers we must not use very desiccative applications, as they dry up the fluids which are necessary for forming flesh; nor for the same reason, very astringent applications, nor abstergents of any greater strength than to remove the sordes. Rhases recommends a mixture of equal parts of olibanum, aloes, sarcocolla, and dragon’s blood. Camphor is an ingredient in one of his incarnative applications. Alsaharavius makes mention of an application from olibanum, like that of Rhases.

All the ancient authors say that round ulcers are more difficult to heal than those of any other shape; and Cassius Medicus and Alexander Aphrodisiensis assign various reasons for this, the most probable of which seems to be, that in this case the sound parts are further removed than in any other.

Apollonius Dyscolus states that ulcers are prevented from healing by pregnancy, by disease of the spleen, and by varicose veins. (Histor. Mirab. 42.)

SECT. XLI.—MEDICINES FOR CLEANSING FOUL ULCERS.

Foul ulcers, whether hollow or level with the surface, may be properly cleansed by birthwort in honey, turpentine with an equal portion of rose oil and honey, or instead of rose oil butter may be substituted, with Illyrian iris and honey; and by pickled olives applied. To nervous parts, turpentine melted with butter may be applied. When the sores are very foul and spreading, horehound with honey is a good application, which removes the eschars. The following are compound applications: Of boiled lees of oil, of scummed honey, of the species of alum called phormion, equal parts.—Another: Of the dried serapias, called also triorchis, of Illyrian iris, of dried horehound, of birthwort, of each, dr. viij; of the flour of tares, dr. x; use in a powder and with honey. And for foul ulcers the Egyptian cerate is useful, also those from salts when melted, the Indian, that called athena, the green plasters diluted, the powder of dried pumice stone, those from tares, the trochisk called melanchlorus, and in like manner that called criogenes.

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COMMENTARY. The following are the most important articles in Celsus’s long list of substances for cleansing ulcers: Purgant, ærugo, auripigmentum, quod ἄρσένικον a Græcis nominatur; (huic autem et sandarachæ in omnia eadem vis, sed validior est) squama æris, thus, resina, et pinea, et terebinthina liquida, misy, chalcitis, galla, sulphur, pix, oleum, ruta, ammoniacum, &c. Hippocrates makes mention of many of these, namely, arsenic, verdigris, flowers of copper, frankincense, myrrh, hellebore, &c.

Scribonius Largus recommends honey, Illyrian iris, and a compound application containing arsenic, scales of copper, elaterium, and burnt paper.

One may find in Galen and Aëtius many compound applications, but as they are all formed from much the same ingredients as those of our author, it will be unnecessary to take further notice of them. Aëtius commends a combination of turpentine and honey.

Avicenna and Haly Abbas recommend the same applications as our author. They make no mention of arsenic. Alsaharavius gives very particular directions for treating these ulcers; when the edges are hard, he directs us to rub them until they become red, or to cut them off and apply to the sore the green ointment; and when the ulcer is covered with much sordes, he recommends us to dress it with the Egyptian ointment. Rhases mentions antimony as an excellent application for cleansing foul ulcers. He properly recommends us to consider whether the foulness of the ulcer be the effect of too much or too little stimulation. He relates a case of the former description, in which the sore got worse under the application of the green ointment. (Cont. xxviii.)

SECT. XLII.—FOR WORMS IN ULCERS.

For worms which form in ulcers, the first thing to be done is to stop the humidity and the putrefaction which occasion them. Worms may be killed by all the things in general which are described for those in the ear. But for those which form in ulcers Archigenes says, mix equal parts of ceruse and poley with liquid pitch, and anoint with it.

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COMMENTARY. Aëtius recommends dried plantain, the ashes of the wood of figs, and the juice of calamint. Galen and Avicenna also mention calamint.

Pliny mentions the gall of frogs.

SECT. XLIII.—ON FUNGOUS ULCERS.

The fungous flesh of ulcers is to be removed by medicines which are powerfully desiccant, such as diphryges sprinkled upon it, the squama æris, all the testacea burnt, both the echini (the hedgehog and sea-urchin,) burnt entire. But the following things are moderately cleansing, and repress the fungous flesh: the flower of the Asian stone, and still more powerful than it, the sori and chrysocolla, chalcitis and misy (when burnt they are less caustic,) and the flos æris in like manner; but verdigris is the most powerful of all. Salts, when burnt, consume the foul flesh, and in like manner charpie that has been soaked in strong brine and dried, consumes fungous flesh that is moderately large. But verdigris with the squama æris is powerfully repressing. Of the compound applications the powder called rhodium, and the psarum, and that named yellow, repress fungous growth without being pungent. But the trochisks called phaustiani, when levigated and sprinkled on the sore, and the dry medicine (or powder) called heliocaes, make fungous flesh slough off to the bottom. But the application consisting of equal parts of calx viva, squama æris and manna, answers with fungous flesh; with honey it cleanses such as resemble a mushroom, and with cerate it proves incarnating.

A powder for keeping down fungous flesh: Of litharge, of chalcitis, of verdigris, of plumbago, equal parts.—Another, which represses strongly without being pungent, and applies also to spreading ulcers, and more especially the epulis of the gums, and whitens the teeth: Of quicklime, lb. j; of arsenic, oz. vj; having triturated the dried arsenic with water, add the lime washed like calamine, and, having rubbed them together dry and use. And of the trochisks, that called pantolmios, and those described for polypus, are excellent for repressing fungus in ulcers. But the green plasters, more especially the one from Cappadocian salts, and in like manner the isis, are most effectual in preventing fungous flesh in ulcers.

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COMMENTARY. The powerful applications mentioned by our author will be found amply sufficient to fulfil every intention in conducting the treatment of these ulcers. Many of them are mentioned by Hippocrates.

Galen lays it down as a rule that these fungous excrescences are to be repressed by powerfully desiccative substances, such as misy, chalcitis, or more especially verdigris; when burnt and washed they become mild detergents. (Meth. Med. iii.)

Aëtius gives many useful prescriptions for such preparations, but they are entirely formed of the ingredients which enter into those of our author.

Celsus gives a long list of caustics highly applicable in such cases: Adurunt, auripigmentum, atramentum sutorium, chalcitis, misy, ærugo, calx, charta combusta, sal, squama æris, veratrum et album et nigrum, cantharides, sandaracha, alumen scissile, &c. Pliny speaks of a composition of unwashed wool, with barley flour, and verdigris.

Octavius Horatianus recommends the Phrygian stone pulverized, and a powder consisting of the recrementum plumbi, verdigris, aloe, and quicklime.

Rhases and Avicenna copy from our author. Haly Abbas speaks of removing the superfluous flesh with an instrument.

SECT. XLIV.—ON SPREADING ULCERS, PUTRID ULCERS, AND PHAGEDÆNA.

Spreading and putrid ulcers are to be bathed with vinegar and oxycrate, an astringent wine, cold water, sea-water, or the decoction of lentil, of pomegranate rind, of the flowers of the wild pomegranate, of lentisk, of myrtles, of Egyptian thorn, or some other astringent and desiccant medicine. Cataplasms are to be applied to them of the flower of tares and liquid alum, the inner part of bread made of similago, an old goby fish, or some other old pickle, unwashed flesh, and liquid turpentine; these things are to be all pounded together in equal proportions. Or the parts may be anointed with equal proportions of birthwort, and the juice of the leaves of the Palma Christi, and half the quantity of verdigris, made with water to the thickness of honey; but if the eschar is not removed an equal proportion of elaterium is to be mixed with the verdigris. For putrid ulcers sori levigated and sprinkled on them is an effectual remedy, and above is to be put dried charpie; or the round birthwort and galls in equal quantities may be rubbed in with oil; or the root of the wild cucumber, or of cabbage, or of beet, or the leaves of dock are to be bound in a piece of linen, and put into ashes; when they are softened triturate with salt and apply; they will cleanse powerfully. Or apply green olive leaves boiled in wine with honey; or apply chalcitis, or parsley seed levigated, or apply linseed triturated with copperas, or use an application of thyme, dried grapes and boiled figs, or of fig leaves triturated with honey; or of nitre, cumin, and fine flour with honey; or of the root of the wild cucumber, or of squill boiled with honey; or of sori, dr. xij; of chalcitis, dr. x; of misy, dr. iv; triturate with half an hemina of the strongest vinegar until it is dried, and taking it off use by dipping a specillum in it, and rubbing it over the ulcer, and placing above it a double pledget out of wine and oil. But if it is inflamed apply henbane with polenta, or cabbage with honey.

For putrid and spreading ulcers on all parts of the body.—Of quicklime, of chalcitis, of each dr. ij; of arsenic, dr. j. This may be used for pterygia of the fingers, for phagedæna and carbuncle, with honey if on the genital organs, but dry if on any other part of the body. Above apply an oblong pledget with rosin.

An universally applicable powder for all spreading sores, and those of the mouth, for hemorrhages, and for repressing fungous flesh. Of chalcitis, of misy, of both in a crude state, dr. xx; of squama ferri, dr. vj; of immature galls, dr. viij.

For spreading and putrid sores. Of salts, dr. ij; of any species of alum which has been burnt, dr. j; of squama æris, of burnt pumice stone, equal quantities. Scraped verdigris, with burnt misy mixed with liquid pitch; and the flakes of iron with oil also answer well.

For spreading ulcers of the pudendum. These things will apply to them, and also the composition called meliterium, the powder of the wild myrtle, and that from paper; also the composition from oxymel called coracion, the trochisk of Andron and the like, will answer with all spreading ulcers. The same things also apply with phagedæna; for phagedæna is an ulcer that spreads by eating.

For foul and fetid ulcers. The Lemnium sigillum (Lemnian earth) mixed with vinegar, oxymel, oxycrate, or wine, until it is of the consistence of clay, may be rubbed on them with advantage; or the leaves of cypress, its shoots, and tender balls (pilulæ), or the ashes of dried gourd burnt, or of the burnt bark of the plane tree, or of burnt dill in like manner, or of foul wool burnt, or of plaintain; also woad by itself or with polenta, or the dried root of hog’s fennel.

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COMMENTARY. It will be remarked that the milder applications mentioned in this section are all powerful desiccants and astringents. Most of them are mentioned by Dioscorides as possessing these properties.

Galen recommends the compound applications mentioned by our author, containing verdigris, squama æris, &c.

For these spreading and putrid sores Aëtius, among other prescriptions, gives one which would no doubt be applicable in the worst cases: “Of crude misy, of crude chalcitis, ā dr. viij; of ochre, dr. iij; of sandarach, dr. iv; of quicklime, dr. ij; of the scales of copper, of alum, ā dr. ij; of diphryges dr. iij; m.” These caustic and escharotic medicines enter into the composition of many of his applications. Some of them contain astringents and desiccants, such as sumach, galls, alum, fossil salts, frankincense, calamine, birthwort, pomegranate rind, &c. In short the ingredients in his applications correspond with Celsus’s list of corrosive substances: Rodunt, alumen liquidum, sed magis rotundum, ærugo, chalcitis, misy, squama æris, sed magis rubri, æs combustum, sandaracha, galla, thus, auripigmentum, calx, nitrum et spuma ejus, alcyonium, resina, squama ferri, atrumentum sutorium, veratrum, &c.

The other authorities give only combinations of these substances; for a full account of which preparations we refer the reader to Galen. (Med. sec. gen. iv.)

Octavius Horatianus recommends lentils boiled and mixed with honey; the leaves of cabbage, coriander, or ivy, all mixed with honey.

The Arabians, although they supply nothing new, add their authority in confirmation of the remedial virtues which the Greeks assigned to the substances mentioned above. Avicenna and Rhases recommend arsenic, copperas, misy, sori, chalcitis, flos æris, quicklime, alum, galls, ammoniac, the trochisk of Andron, &c. When a part becomes black and putrid, Haly Abbas directs us to open a vein leading to it, if the age and state of the patient permit, and afterwards to apply odoriferous things, such as camphor, &c.

SECT. XLV.—ON ULCERS REQUIRING CICATRIZATION.

By drying and constringing the flesh of ulcers requiring cicatrization to such a degree as not only to dissipate the preternatural superfluity, but also to touch upon that which is in its natural state, we may render the surface of the sore like skin, and make the ulcer cicatrize. This is promoted by immature galls, the moderately desiccant bark of pomegranate, and whatever else is desiccant without being possessed of pungent astringency. And such things as these promote cicatrization: myrrh, litharge, and oysters if burnt, for they must be sprinkled on the sore dry. And these things often produce cicatrization: pine bark with myrtle cerate, ivy flowers with cerate, the root of the lily with rose-oil, dried pine-rosin, burnt pumice stone, the flakes of copper; they are to be used in equal proportions dry. The following also repress: mix a small quantity of manna and of diphryges with levigated pumice, and use; or of litharge p. j; of diphryges p. ss, apply on a pledget with cerate. Birdlime with frankincense cicatrizes old ulcers, also verdigris with an equal portion of diphryges and with myrtle cerate, or the small centaury applied fresh. To the more humid apply the root of cypress. To those about the anus and pudendum, more particularly if inflamed, use levigated aloes, either in a dry state or with water, or squama æris; or soften chrysocolla in the sun with wax, and apply.

A dry application for producing cicatrization. Of oysters, dr. xij; of manna, dr. vj; of calamine, dr. iv. It applies also to spreading sores.—Another: Of birthwort, dr. vj; of pine bark, dr. vj; of manna, dr. vj; of pumice, dr. iv; of Colophonian rosin, dr. iv; of iris, dr. iv.—Another: Of hart’s horn burnt, dr. iv; of pine-bark, oz. vj: of ceruse, oz. iv; of scraped verdigris, oz. ix; of calamine, dr. xviij.—Another: Of the flowers of pomegranate, of copperas, of each, dr. xvj; of squama æris, of fissile alum, of each dr. viij; of galls, dr. j.—Another: Of ceruse, of litharge, of each, oz. viij; of the dross of lead, of galls, of dried myrrh, of each, dr. iv.

A cicatrizing application. Take of fissile alum, oz. j; and having levigated it, macerate in a sextarius of water: when dissolved in the water soak pledgets in it, and having dried them apply.

A plaster for cicatrizing the more simple ulcers. Of wax, dr. xl; of litharge, dr. xxxv; of diphryges, dr. viij; of myrtle-oil, half a hemina. The plaster called phœnicinum, that from calamine, the myrsinatum, and the like, are also applicable in such cases. For ulcers of difficult cicatrization: Of wax, of myrtle-oil, of each, dr. vj; of calamine, oz. vj; of lead, of frankincense, of each, dr. ij; of fissile alum, of burnt copper, of each, oz. j; of scraped verdigris, dr. ij; dissolve them singly. For chronic ulcers, and such as are of difficult cicatrization: Of calamine, dr. viij; of chrysocolla, dr. viij; of fissile alum, dr. viij; of verdigris, of the flakes of copper, of each, dr. j; of pine-rosin, dr. xl; of wax, dr. c; of myrtle-oil, q. s.—Another: Of wax, of pine-rosin, of each, oz. vj; of calamine, oz. vj; of crude chalcitis, oz. iij; of myrtle-oil, q. s. The calamine and the chalcitis are to be triturated with wine during the season of the dog-star; use it upon a broad compress, and apply above it a pledget and sponge out of wine.—Another: Of burnt copper, oz. ij; of fissile alum, oz. ij; of sal ammoniac, dr. ij; of wax, oz. vj; of Colophonian rosin, oz. vj; of myrtle-oil, oz. ij; the dry things are to be triturated in the vinegar in the sun for twenty days, and when it becomes of the consistence of honey, having melted the wax, mix it and soften. The medicine from pumice-stone, the isis, and the like, are also applicable in such cases.

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COMMENTARY. Celsus gives the following list of the more active articles of this class: Crustas ulceribus tanquam igne adustis inducunt, præcipue, chalcitis, utique si cocta est, flos æris, ærugo, auripigmentum, misy, et id quoque magis coctum.

For a variety of applications suitable to this class of ulcers, we refer the reader to Galen’s 4th book of ‘De Med. sec. gen.’ The ingredients of them are powerfully desiccative, astringent, and escharotic. Many of our author’s prescriptions will be recognized in it. For an account of the isis, and the other compound medicines mentioned towards the end of this section, we refer the reader to Galen (l. c.) and to the Seventh Book of this work. Galen, in another place, and after him Aëtius, give the following important directions for the use of these applications. The ulcers to which this mode of treatment is applicable, being very foul and filled with a vitiated discharge, are first to be wiped clean with a soft linen cloth, and then the cavity of them is to be filled with the medicine, and a splenium (oblong compress) applied externally. Then having put a piece of linen above the splenium and bound it on, we are to place over it a sponge squeezed out of cold water or wine, endeavouring to keep the sponge cold during the whole time of the treatment, which may easily be done by pouring cold water upon it without loosing the bandages. They are not be removed until the third day. Galen states that the articles which answer best in such applications are galls, pomegranate-rind, alum, chalcitis, misy, and the like.

A similar mode of treatment, without any material alteration, is described by the Arabians. Haly Abbas remarks, that cicatrizing medicines are powerfully desiccative with some astringency, such as galls, alum, and the like.

SECT. XLVI.—ON THE MALIGNANT ULCERS CALLED CHIRONIAN AND TELEPHIAN.

Old ulcers which are difficult to get cicatrized are called chironian, as if requiring Chiron himself to cure them; and telephian, from Telephus having long laboured under such a sore. We must attend then whether the whole body being in a state of cacochymy, sends such defluxions to the ulcer, and the prevailing humour is to be evacuated by appropriate remedies. Or if it is a varix which sends these humours to the legs, the ulcer being in it, it is to be cured as will be described in the Surgical part of this work; or the humours are to be evacuated by venesection, taking away blood frequently, and then using topical applications which have the property of extirpating the disease without being pungent. These therefore are simple applications; those from pumice and diphryges, and flakes of copper, verdigris, and lime moderately washed; sprinkle fissile alum levigated, or of unwashed wool, dr. iv; of dried grapes, dr. iv; of natron, dr. ij; having previously anointed with honey, sprinkle of flakes of copper, dr. x; of alum, dr. ij; and having softened in the sun with dr. x of wax, apply.

These are compound medicines. A plaster for chironia. Of ceruse, oz. viij; of fissile alum, oz. ij; of the flakes of copper, dr. ij; of sal ammoniac, of frankincense, of scraped verdigris, of pomegranate rind, of each, oz. ij; of quicklime, oz. j; of wax, lb. j; of myrtle-oil, lb. j. ss; triturate the dry things with wine. At first it removes callus; and it is laid by and kept, and at last when used, being softened with myrtle-oil, it cicatrizes.—Another: Of litharge, lb. j; of oil, lb. ij; of black chamæleon, of the roots of birthwort, of immature galls, of each, oz. j; of galbanum, of ammoniac perfume, of frankincense, of each, oz. ij; prepare, stirring with the roots of green reeds.

From Archigenes, for chironia, and malignant ulcers in the legs and breast, for struma, and parotis. Of the fat of an ox lb. iij; of turpentine, oz. v; of manna, oz. vij: of the earth called sarda which painters use, oz. v: having put the soluble and dry articles together and melted, use.—Another, of Archigenes: Of wax, oz. iv; of oil of unripe olives, of manna of frankincense, of diphryges, of the flakes of copper, of each, dr. iv; having triturated the powder with vinegar, and made of the thickness of honey, mix with the cerate, and use upon a pledget.—Another, for the malignant ulcers of women, and of other persons having a soft skin: Of Tuscan wax, dr. viij; of bulls’ fat, of turpentine, of burnt lead, and of pepper, of each, dr. j; use on a pledget with rose-oil or myrtle-oil.

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COMMENTARY. Celsus describes the chironian ulcer as being large, and having hard, callous, and swelled edges, with a copious discharge of thin sanies. It is attended with no inflammation, the pain is moderate, it does not spread, and therefore it is not dangerous, although not readily cured. Sometimes, he says, it becomes covered with a thin cicatrix, and then again the ulcer breaks out. It occurs mostly in the feet and legs. From this description it is evident that by the chironian ulcer Celsus meant merely an ill-conditioned ulcer, and that he distinguished between it and the cacoethes, or malignant ulcer, which last he held to be nearly allied to the carcinoma. However, most of the Greek authors apply the term malignant to the chironian ulcer. For the cure of it Celsus recommends an application consisting of squama æris, lead burnt and washed, calamine, wax, and a small quantity of roses.

Galen furnishes us with an account of the manner in which Thessalus the Methodist proposed to cure all chironian and malignant ulcers. Thessalus lays it down as a rule for the treatment of all sores which are difficult to cure, or which break out again when healed, to remove the exciting cause, whether local or constitutional, by means of proper alteratives. He adds: “In cases of chronic ulcers which cannot be got healed, we must remove the parts which prevent adhesion, and convert the sore into the state of a recent ulcer; and then having allayed the inflammation proceed accordingly. Those sores which heal up and break out again during their exacerbations, and when ulcerated, are to be cured like recent inflammations by soothing applications until the irritation subside, after which cicatrizing applications are to be used, and then the surrounding parts are to be covered with a malagma of mustard, or some other rubefacient and alterative, to remove the indolence. If this is not sufficient, we must attend to the general health, attempting to effect a change of the system by repeated exercise, gestation, a diet increased or diminished according to circumstances, and at the commencement by administering an emetic of radishes, or even the white hellebore.” (Galen, Meth. Med. iv.) Although Galen, who all along displays a strong hostility to the Thessalian asses, (so he calls the Methodists,) has animadverted in severe terms upon the rules here laid down, they would appear to be highly proper and ingenious. Galen in another place (Med. sec. gen. iv) gives from Asclepiades, Andromachus, and others, a great collection of applications for chironian, malignant, and indolent ulcers. One by Asclepiades consists of the scales of copper, scraped verdigris, wax, and larch rosin. Others by Andromachus contain sori, misy, chalcitis, verdigris, alum, turpentine-rosin, and the like, mixed with wax. Hippocrates directs us to treat a callous ulcer by applying to it septic medicines to make the hard parts slough off, after which the edges are to be brought together. (De locis in homine.)

The directions of Aëtius, more especially respecting the constitutional treatment, are highly important. In cases where there is a redundance of blood he recommends venesection, in others both purging and bleeding; and in certain cases he directs us to pay attention to the state of the liver and spleen. He relates a case of an ulcer on the hand, which he cured by opening a vein leading to it. He also directs us to scarify or cut off the callous edges of the ulcer. He gives various prescriptions for sores of this description, containing verdigris, sori, chalcitis, burnt copper, alum, &c.

Octavius Horatianus recommends a plaster consisting of equal parts of chalcitis, wax, and alum. For phagedænæ Pliny mentions an old shad-fish triturated with sandarach. (H. N. xxxii, 44.)

The Arabians treat of these ulcers very fully. Avicenna in particular gives very proper directions for the constitutional treatment. When the state of the ulcer is occasioned by an intemperament, it is to be corrected, and if the blood is deficient in quantity or quality, this is to be remedied by a proper diet; and when on the contrary it is connected with plethora, venesection is to be had recourse to, and if the veins leading to it are varicose, it may be proper to open them. When the sore is kept from healing by a spiculum of bone, we are to cut down and remove it. His applications consist of the same ingredients as those used by the Greeks, namely, the flower of copper, copperas, alum, ceruse, lime, arsenic, &c., mixed with wax and oil. The directions given by Rhases are less circumstantial, but to the same purpose. He particularly directs us to remove the callous edges by friction, scarifications, and septics. He speaks of turpentine as an excellent addition to other ointment. (Contin. xxviii.) He mentions that in case of malignant ulcer on the leg connected with varix, Galen opened the enlarged vein.

The cacoethes of Celsus was evidently the disease called noli me tangere by Theodoricus; a very absurd appellation, which however has been retained to the present day. Celsus has pointed out its resemblance to carcinoma, and recommended the only mode of treatment which ever does any good in these cases, namely, the application of septics, such as arsenic, quicklime, &c., or the actual cautery. As our limits will not permit us to enlarge further on this subject at present, we must be content with referring to No. 108 of the ‘Edinburgh Medical and Surgical Journal,’ where we have given a full exposition of the ancient principles of treatment. (See also the Commentary on s. xxvi of this Book.)

SECT. XLVII.—FOR BLACK CICATRICES.

Let the root of the white and black bryony be boiled in oil until they are reduced to the state of juice, and the oil applied will take away black scars; and so in like manner calamint boiled in wine, and litharge washed with white rose-oil. But the scars from lichen, and all other kinds are made like the other skin by anointing them with the fat of asses; or the seed of rocket triturated with the gall of a goat, of an ox, and of a sheep may be rubbed in with litharge; or a lamb’s foot burnt may be triturated with austere wine for the same purpose; or, ammoniac perfume may be rubbed in with swines’ gall. These are compound applications: Of litharge, of mint, of frankincense, equal parts with honey.—Another: of natron, of ammoniac perfume, of sulphur vivum, of myrrh, equal parts; having triturated with vinegar, white wine, or water, rub in but a very little, so as not to produce an ulcer.—Another: Of Cimolian earth, of pigeons’ dung, of soap, of frankincense, equal parts with vinegar. A detergent ointment for black scars: Of Cimolian earth, dr. xiij; of aphronitrum, dr. v; of white hellebore, dr. v; of the greasy dregs of nut-ben, dr. iv; scrub with it while in the bath.

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COMMENTARY. Avicenna condenses all the information contained in the authors who preceded him. He sets out with stating that the class of medicines which are applicable in such cases are the abstergents; of which he enumerates verdigris, stavesacre, the scales of copper, and even arsenic. Among the less active ingredients he mentions, like our author, the fat of asses. We need not give extracts from the other authorities, as no one has treated of this case so fully as Avicenna.

SECT. XLVIII.—ON SINUOUS ULCERS.

When the skin adjacent to an ulcer is not united with the parts below, we call such a complaint a sinus. When, therefore, the sinus extends upwards, the ichor readily flows out from the sore, and adhesion easily takes place; but when it extends downwards the ichor by remaining within corrodes the continuous parts, and unless you first make an incision for its discharge, you will be able to effect nothing; for the sores can neither be incarnated nor the parts made to unite. But if the sinus is in any of the limbs, as the arms or legs, one may produce adhesion without a counter-division by putting the limb in a declining position. Thus when the sinus is in the arm, and the mouth of the sore is near the elbow, by placing the hand in an elevated position, you will render the discharge from the ulcer below easy. And when the sinus is in the thigh, and has its outlet near the knee, you must make the position declining by putting a soft pillow below the back part of the knee, so that the groin may be in a lower position than the knee; and if the sinus does not require incarnation, forthwith by means of a straight and hollow pipe having a bladder attached to it, syringe it with honey so diluted with water that one could drink it, in order to clear away the ichor from the sinus. For promoting adhesion when about to take place, do it with wine, or wine and honey, and then proceed to the agglutinating medicine. But if the sinus being hollow requires incarnation, first inject a little of the composition from dried paper with much rose-oil, then plug up the mouth of it with charpie, and afterwards the plaster of iris, or of Machærion, or of some such, may be melted with liquid rose-cerate, and injected in like manner. If the sinus is moderately incarnated you may apply some of the agglutinating medicines, as if you were curing a case of recent bloody wound. Such are those called the barbarous, dichromos, and gilvus; and more especially that prepared from the oil of palma Christi and the metals without wax which is called the dun plaster of Galen, is applicable. After the application of the medicine, a recent sponge out of wine and honey, or wine alone, is to be put on particularly in a soft manner, and the bandaging is to commence at the bottom of the sinus and end at its orifice. The folds of the bandage should bind the bottom of the sinus firmly, yet so as not to occasion pain, but ought to be gradually relaxed towards its orifice; and the plaster which is put on should be so cut as to leave an opening at the orifice for the escape of the matter, but another small plaster of the same materials should be applied to it in a loose state, so as to favour the discharge. This is to be left on till the bandages are loosed, which is to be done on the third day, when they are to be taken off and changed, but the application along the sinus is to be left. You may judge whether the bottom of the sinus has adhered, from observing if the matter be small and well concocted, or if there be no discharge at all; and moreover if there be no sensible pain along the sinus nor swelling, but the whole part is contracted, dry, and free from pain. But if you see a little well concocted pus at the orifice, you may still more confidently entertain good hopes. If on the second or third day a thin ichor be discharged from the sinus, you need not despair that adhesion has taken place, for often the strength of the medicine squeezes out from the parts below a thin fluid, which being discharged the parts become dry and adhere. But if on the third or fourth day from the commencement the matter appear unconcocted as it runs from the opening, you may be sure that the sinus has not adhered, and you must persevere with the same application. When owing to the moisture of the part it falls off, as is not unlikely, it will not be improper to make some change in the medicine itself.

On sinuous ulcers with a thin covering of skin. When the abscess is too long opened, owing either to the unskilfulness of the surgeon, or the timidity of the patient, the skin which lies over it becomes thin and ragged, and it cannot be removed, then after the syringing which has been described, we must have recourse to an agglutinating application of a humid consistence, but of desiccative properties, such as that from chalcitis called phœnicinum, diluted with old oil, so as neither to be very hard nor of such a consistence as not to stain the finger; and afterwards it is to be mixed with moderately old wine, and applied in a circular form with corresponding bandaging. To skin in this ragged state honey, as was said, is not one of the least proper applications when boiled to the consistence of a plaster and applied. It will be better, however, if after spreading it on the rag you sprinkle over it from a sieve some myrrh finely pulverized, or aloes, or frankincense, or all of these together. I have also found the lesser centaury a wonderful application for the same purpose; next to it is comfrey, after which is the root of the Illyrian iris, and after these is the flour of tares. Sometimes during the process of boiling we sprinkle these upon the honey when the vessel is about to be taken off from the fire. It is better, however, to do so after it is taken off, and then it is to be stirred about, and when it becomes tepid applied to the sinus, and bandaged as aforesaid.

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COMMENTARY. Similar directions are given by Galen and Aëtius, but upon the whole those of our author are superior; and as those of the other two supply no additional information, it will be unnecessary to multiply extracts from them. (See Galen, Therap. ad Glauc. ii.)

Actuarius, in like manner, briefly directs that unless the sinus open downwards, it shall be cut open and dressed with an agglutinative application. You may think well of the case, he adds, when the part is dry and free from pain, or when only a little well-concocted pus is discharged from it.

In the translations of the Arabians, the sinus is described by the names of absconsio and caverna. Avicenna states that the sinus differs from the fistula in having a larger cavity, and its edges not being indurated. He lays down very correct rules of treatment, but they are all copied from Galen. Thus he directs, when the orifice of the sore is above the cavity of the sinus, that it should be cut open; or, if this cannot be conveniently accomplished, he recommends us to introduce a tent smeared with some incarnant or detergent application. Upon the authority of Dioscorides he recommends the lesser centaury in such cases. His directions for the application of the bandages are similar to those of our author.

Celsus, and other of the ancient authorities, do not treat of the sinus separately from the fistula.

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.