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THE
SYDENHAM SOCIETY

INSTITUTED
MDCCCXLIII

SYDENHAM

LONDON
MDCCCXLVI.

THE
SEVEN BOOKS
OF
PAULUS ÆGINETA.

TRANSLATED FROM THE GREEK.

WITH
A COMMENTARY
EMBRACING A COMPLETE VIEW OF THE KNOWLEDGE
POSSESSED BY THE
GREEKS, ROMANS, AND ARABIANS
ON
ALL SUBJECTS CONNECTED WITH MEDICINE AND SURGERY.

BY FRANCIS ADAMS.

IN THREE VOLUMES.
VOL. II.

LONDON
PRINTED FOR THE SYDENHAM SOCIETY
MDCCCXLVI.

“MULTUM EGERUNT QUI ANTE NOS FUERUNT, SED NON PEREGERUNT. SUSPICIENDI TAMEN SUNT, ET RITU DEORUM COLENDI.”

(SENECA, EPIST. LXIV.)

PRINTED BY C. AND J. ADLARD,
BARTHOLOMEW CLOSE.

CONTENTS
OF
THE SECOND VOLUME.

PAULUS ÆGINETA.

BOOK FOURTH.

SECT. I.—ON ELEPHANTIASIS.

Well, in my opinion, did Aretæus the Cappadocian say, that the power of remedies ought to be greater than those of diseases; and that for this reason elephantiasis is incurable, because it is impossible to find a medicine more powerful than it. For if cancer, which is, as it were, an elephantiasis in a particular part, is ranked among the incurable diseases by Hippocrates himself, how much more is not elephantiasis incurable, which is, as it were, a cancer of the whole body? But the black bile from which this affection is formed, having a double origin, (for it arises either from the melancholic and feculent part, and, as it were, dregs of the blood, or from yellow bile, both being overheated); the first variety of the black bile produces the reddish elephantiasis, which is the more mild, or to speak more truly, less malignant variety; the others which are more malignant, being accompanied with ulceration of the whole body and falling off of the extremities, are produced by the latter variety, or that from yellow bile overheated. Wherefore, those who are already overpowered by the disease, must be abandoned; but when the affection is in its commencement, so as that none of the extremities has fallen off, nor the surface of the body become ulcerated, nor the hard swellings appeared, and the face merely appears foul, but not altogether unseemly, we must attempt the cure. For not a few, by merely burning the head, have prevented many who were beginning to be affected from being overpowered by this disease. Wherefore, at the commencement of the disorder, we must have recourse to venesection repeatedly, more especially if in spring, when the complaint is most apt to occur, and has its exacerbations. After an interval of a few days, say nine or ten, we may purge them with the pottage of colocynth, not once only but frequently, proportioning the dose of the medicine to its strength. Purging with hiera also suits well with them. After the interval of about ten days again, we must give them the vinegar of divided milk, not in less quantity than three heminæ, nor in greater than five, and on the following days they are to be supported with milk that is not divided into parts, or new-drawn milk; by which means, if the affection yield, the same food may be continued; but if it remains in the same state, after eating acrid things, they must be made to vomit with radishes and frumentaceous articles of food. After these things, purging with white hellebore is proper, twice if possible when in spring, but once only if in autumn. Those, however, who are thoroughly overpowered by the complaint, must be neither bled nor put on a course of hellebore. For neither can a translation of the disease from the superficies to the inner parts, nor a diminution of the offending matter, be any longer accomplished by these means; but the matter is to be determined to the stomach and bowels, and alteratives (metasyncritica), used to dry and constrict the skin. Dry-cupping is also to be applied over the mouth of the stomach and to the hypochondria, and dropaces used to the same places; but after a short interval, the same process is to be repeated, beginning by purging with hiera, and omitting the venesection, which would prove rather deleterious than beneficial. This process is to be repeated three or four times in a year, more especially in the seasons of spring and autumn. The draughts before meals, most suitable for them, are a cyathus of vinegar, with a cyathus of cedria, and two cyathi of the juice of unripe cabbage—they are given mixed together, morning and evening; or, the dried leaves of the herb ironwort, to the amount of a drachm in one cyathus of wine; or, a drachm of hartshorn and a cyathus of the vinegar of squills, is given after the morning walk every day; and other things are to be administered at the same season, such as drs. v of washed squills in honied water, or in honey, as a linctus; or Cyrenaic juice, to the amount of a bitter vetch, mixed with honey and butter; or, dr. ss of the shavings of hartshorn, with two cyathi of wine; or, drs. iij of Æthiopian cumin, with honey, as a linctus. But a more suitable remedy is a drachm of the theriac trochisk, triturated in a cyathus of fine wine, and drunk; and a drachm of the trochisk of squills may in like manner be taken in a draught. And they praise the juice of calamint as a most effectual remedy when drunk, and say that the dose to commence with is three cyathi, which may be increased to six. But of all others the theriac of vipers is the most effectual remedy, both in a draught and when rubbed in externally. But where plenty of these animals can be procured, nothing answers so well as eating the flesh of the vipers boiled in white broth, with much water, salts, leeks, and dill, to the separation of their back-bones, their head and tail being first cut off to the extent of four fingers’ breadth, and their entrails and skin taken away. And theriac salts are in the same celebrity when taken with other food. By using them thus, it happens that the scales, or, as it were, the bark, falls off from the skin.

The regimen is to be as follows: After sleep, having been first rubbed, and the bowels evacuated, let the patient have recourse to gestation and vociferation, then to friction and gymnastic exercises of all kinds, partly by leaping, but more especially by using the halcteres and leather bag. Having wiped off the sweat, let him be rubbed with the grease of a boar, of a wolf, of a goat, or of some winged animal, or with fresh butter; and after a short interval let him bathe, having his body anointed with the juice of fenugreek, of ptisan, or with a little ammoniac dissolved in vinegar. After the bath, having got his body wiped, let him anoint with the oil of lentisk, of wild vine, or of myrtles; and with a little wine, containing alum and ammoniac, so as to be of the thickness of the sordes of baths. Having had his body rubbed again with soft rags, let him rest for half an hour, after which, having drunk water, let him make himself vomit by putting his fingers or a feather down his throat. Having vomited, let him drink the wine of wormwood or of marjoram. The food should be barley bread, or a cake of dried barley flour, and of potherbs, the beet, the lettuce, the radish, leeks, and cabbage sweetened in two waters, and capers. Of sea animals, he may take oysters, pelorides, urchin, all shell fishes, limpets boiled with beets, and old pickle in place of medicine. But let him abstain from wine during the whole continuance of the complaint, and from venery; only he may take a little thin watery wine at the time of his recovery from the purging, at which season all acrid substances must be abstained from, except condiments. Give him ptisan, eggs and chondrus, milk and honey, with bread, mallows, dock, skirret, and fishes with tender flesh; and of fowls, those which contain wholesome juices; and of fruits, the fig, grape, and raisins: but of sweetmeats, those which are prepared from pine kernels, toasted almonds, or bastard saffron. He may take food twice a day, as it is injurious to subsist upon one meal. After taking care of the internal parts, let him use detergent ointments (smegmata) in the bath, from the decoction of beet, or of fenugreek with aphronitrum, soap, or myrobolan, and sometimes apply depilatories. Purslain triturated with vinegar is detergent and also the slender houseleek, and the roots of dock boiled in vinegar, and alum with salts, and red arsenic in equal proportions with wine and oil of lentisk. Also the composition for alphos, consisting of alcyonium, nitre, myrtle, sulphur, and the dried leaves of the wild fig, being rubbed in dry with vinegar; and that from the burnt shell of the cuttle-fish, and pumice, nitre, and burnt Cimolian earth, gum, unripe galls in equal quantity, sprinkled dry, or rubbed in with vinegar. And this one is admirable: Of the roots of dock a bunch to the amount of a handful, of natron, dr. xl; of frankincense, dr. xxv; of sulphur, dr. xxv; it is rubbed in with Egyptian vinegar. And this one is efficacious: Of arsenic, dr. x; of sulphur vivum, dr. viii; of costus, dr. xii; of quicklime, dr. iv; of wax, dr. iv; of dried bay berries, dr. xii; these things are mixed with the juice of white poplar leaves, or with a thick decoction, and they are rubbed in, having the consistence of honey.—Another: Two fasciculi of the roots of dock are to be boiled in vinegar, pounded in a mortar and triturated, then of alcyonium, lb. j; of aphronitrum, oz. viij; of sulphur vivum, lb. j; of the burnt shells of cockles, oz. iv; of chamæleon with its roots, oz. iv; these things are pounded together until they are of the consistence of the sordes of the baths, and are then rubbed in often in the sun, if summer, but if winter, in the bath, until it occasions sweating. And the dry smegma of Æsculapius would agree excellently with these cases, and all the smegmata about to be described, even unto those for alphos, and also those now mentioned, are applicable for those complaints. And the tumid excrescences, whether inflammatory or ulcerous, are to be rubbed with Indian buckthorn: or horned poppy, or aloe, or the Andronian trochisk, or that of Polyides; and let cataplasms be applied of chondrus with the juice of knot-grass or plantain; or of pellitory of the wall, triturated; and the leaves of the green Melisian herb, when pounded with axunge and applied, are wonderfully efficacious, for they redden the parts, but the redness is easily repressed by the application of bread; or of the cerate made from almond oil. By this means their natural colour is restored. When the parts are ulcerated, plasters are suitable: that from diphryges, and the apple one with wine, that called coracium, that made from oxymel, the Andronian trochisk, pompholyx and calamine. It is a symptom that the whole disease is becoming more moderate when the first ulcers are cicatrized. For the dyspnœa of persons labouring under elephantiasis give a draught of five or six slaters in three cyathi of honied water. And some of the general remedies described for dyspnœa will be applicable for them. Of the natural baths we must select, as being most particularly useful, the aluminous and chalybeate, and if possible, such as are cold. It is also particularly serviceable to drink them. And the use of the sand of the sea-shore has the same effect, and so have all the sudorifics. But since this affection is one of those which are easily communicable, no less so than the plague, they are to be removed as far as possible from cities, and lodged in inland and cold situations, where there are few inhabitants, if this can be accomplished; for so they may descend from thence to surrounding places. This is proper partly on their own account and also on account of those whom they might come in contact with. For they themselves will thus enjoy the use of a more commodious air, and they will not communicate the evil to others.

Commentary. Consult Lucretius (vi, 1112); Celsus (iii, 25); Pliny (Hist. Nat. xxvi, 5); Scribonius Largus (102); Cælius Aurelianus (Pass. Tard. iv, 1); Marcellus (De Med. xix); Serenus Samonicus (11); Octavius Horatianus (i, 32); Isidorus (Orig. iv, 8); Vegetius (Mulom. i, 9); Aretæus (Curat. Morb. Chron. ii, 13); Plutarch (Symp. viii, Quest. 9); Galen (ad Glauc. ii, 10; de Causis Morb. 7); Oribasius (Morb. Curat. iii, 62; Synops. vii, 5); Pseudo Dioscorides (Euporist. i, 105); Aëtius (xiii, 120); Actuarius (Meth. Med. ii, 11, and iv, 15); Nonnus (Epit. 233); Psellus (op. medicum); Leo (vii); Myrepsus (De Med. comp.); Avicenna (iv, 3, 3, 1); Serapion (v, 14); Avenzoar (ii, 7, 12, 26); Albucasis (Chirurg. i, 49); Haly Abbas (Theor. viii, 15, Pract. iv, 3, ix, 69); Alsaharavius (Pract. xxxi, 2); Rhases (ad Mansor, v, 35, ix, 93, Contin. xxxv, 26.)

We owe the earliest notice which we have of this disease to the poet Lucretius, who briefly mentions it in the following lines:

“Est elephas morbus qui propter flumina Nili

Gignitur Ægypto in mediâ neque præterea usquam.”

Celsus says that elephantiasis is a chronic disease, almost unknown in Italy, but very common in certain countries. He calls it an affection of the whole body, even of the bones. The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. Baths are to be rarely used; fatty, glutinous, and flatulent articles of food are to be avoided, but wine is to be allowed, except at the beginning. The body is to be rubbed with pounded plantain.

According to Pliny, elephantiasis was never known in Italy until the days of Pompey the Great, when it was imported from Egypt, and raged for a time, but soon became extinct. He describes it as affecting the face in particular with hard, rough, black maculæ, which sometimes spread to the bones, the toes and fingers being swelled.

Serenus Samonicus, who is said to have flourished about the beginning of the third century, thus describes the disease:

“Est elephas morbus tristi quoque nomine dirus,

Non solum turpans infandis ora papillis,

Sed cito præcipitans funesto fata venino.”

His remedies are the juice of the bark of the juniper, the ashes and blood of the weasel, mint, and various external applications, consisting of ceruse, Egyptian paper, roses, &c.

Scribonius Largus recommends sulphur with common oil for lepra, “et quam elephantiam dicunt,” but he gives no description of the latter.

It is greatly to be lamented that Cælius Aurelianus’ account of elephantiasis has come down to us in an imperfect state. His description is entirely lost, and his detail of the treatment is in a mutilated state. It appears, however, that his views were similar to those of Celsus, and that he considered it to be a malignant disease, affecting principally the skin. He approves of rubbing stimulant ointments into the skin, and of using medicinal baths, especially the aluminous and chalybeate. When the applications produce ulceration of the skin, he directs us to treat it upon general principles. He makes mention of vomiting by radishes, and latterly by means of the white hellebore. He approves of a sea voyage and change of scene. He says the first author who described elephantiasis was Themison, the same person that is damned to everlasting fame in one of the lines of Juvenal: “Quot Themison agros autumno occiderit uno.” (Sat. x, 221.) If this statement be correct, it is clear that Celsus cannot be of so early a date as is generally believed, that is to say, the Augustan age, for Themison flourished towards the end of the first century, P. C. He was the founder of the Methodical sect. Cælius also blames Themison for recommending bleeding and vomiting unseasonably, and disapproves of his directions respecting the applications to the skin. It appears that he also disapproved of the theriac of vipers, and of giving to drink water in which red-hot iron had been extinguished. There can be no doubt, from the circumstances which he mentions, that the disease was thought contagious in his time.

Octavius Horatianus, who lived under the emperor Valentinian, gives a pretty full detail of the treatment, but his description of the symptoms is defective. He makes mention, however, of maculæ, which affect principally the face; he contends that the whole system is attacked with the disease, and that the flesh is corrupted. His remedies are much the same as those recommended by the other authorities, namely, bleeding, purging, vomiting, the theriac of vipers, and rubbing with the usual applications for scabies. He also speaks favorably of the natural and the sea-water baths.

Marcellus the Emperic, who is supposed to have flourished in the reign of Theodosius, recommends, like Serenus, mint, juniper, and mezereon, for elephantiasis. He describes it as being attended with hard excrescences of the extremities, eruptions on the face, and disease of the bones. He speaks of its being endemic in Ægypt.

The disease, elephantiasis, according to Isidorus, is so called from its resemblance to the elephant. The skin in it is hard and rough, from which it gets its appellation, because the surface of the patient’s body resembles that of an elephant; or because it is a mighty affection, as the elephant is one of the largest of animals.

Vegetius, the great ancient authority on veterinary surgery, describes elephantiasis as it affects cattle. The symptoms are hardness and roughness of the skin, squamæ, eruptions on the feet and head, and a fetid discharge from the nose. He approves of bleeding, and the other means recommended by the regular surgeons.

We shall next give the descriptions of the Greek authorities.

Aretæus gives a most elaborate but surely somewhat overstrained description of elephas, which he paints in colours the most hideous and disgusting. We shall endeavour to convey to the reader an idea of his sketch, stripping his picture of its flowery ornaments, and contracting its bulk. The disease is called elephas, he says, from its magnitude, leontium or morbus leoninus, from the supposed resemblance of the eyebrows to those of the lion; and satyriasis, from the venereal desires with which it is attended. The disease is described as escaping notice at first, being deep-seated and preying upon the vitals, but afterwards it is determined to the superficies, commencing sometimes with the face, and at other times with the extremities. The belly is dry, because, as he ingeniously remarks, the distribution of the food is performed regularly, and the vitiated parts strongly attract the chyle to them as a pabulum to the disease. There are large callous eminences on the skin, and the veins appear enlarged, owing to a thickening of the vessels and not to a plethora of blood. The hairs of the head, pubes, and other parts of the body, drop off. The face in particular is affected with callous tubercles or warts, and it is not uncommon for the tongue, and most parts of the body, to be also covered with them. The eyebrows are thickened, stripped of their hair, and hang down like those of the lion. The general appearance of the skin, covered as it is with hard tubercles, and intersected with deep fissures, is said to bear some resemblance to that of the elephant. Sometimes particular members, such as the nose, feet, fingers, the whole hand, or the pudenda, will die and drop off; and it is not uncommon for incurable ulcers to break forth on different parts of the body. Dyspnœa, and a sense of suffocation, are occasionally present. He says, it is dangerous to have any intercourse with persons labouring under the disease, no less so than in the case of the plague, as both are readily communicated by respiration. He directs us, at the commencement, to abstract blood freely, because blood is the pabulum morbi. He recommends us to purge with hiera, and to procure vomiting by radishes, but more particularly by the white hellebore, upon which he bestows a glowing and eloquent eulogy. Like our author, he approves of the theriac of vipers. He makes mention of many external applications of a detergent nature, and in particular praises a soap used by the Celts for cleaning their clothes. He also commends natron, alcyonium, sulphur, alum, ammoniac with vinegar, and the like, for the same purpose. When the flesh is livid, he directs us previously to make deep incisions in it. The diet is to be plain and digestible; sulphureous baths are to be used: the patient is to swim frequently in sea-water, to take a sea voyage, and otherwise not neglect suitable exercise.

Plutarch informs us that it was disputed in his time whether or not elephantiasis was a new complaint.

Galen, as far as we can recollect, has nowhere treated very particularly of elephantiasis, but in his work ‘De Causis Morborum’ he has briefly mentioned that in this disease the nose becomes flattened, the lips thick, and the ears extenuated, the whole appearance resembling that of a satyr: and in his work entitled ‘De Curatione ad Glauconem’ he ranks elephantiasis with cancerous swellings, and says that the disease is common about Alexandria, owing to the heat of the place and the food of the inhabitants, which consists principally of lentils, snails, pickles, the flesh of asses, and the like, all which things have a tendency to engender the melancholic humour. The temperature of the place likewise, he shrewdly remarks, determines the superfluities of the system to the skin. He recommends the treatment which we have already had occasion to mention, namely, bleeding, purging, and the theriac of vipers. In the ‘Isagoge,’ the black and white hellebores are particularly commended. Galen elsewhere calls it contagious. (Lib. ii, Simpl. de carne viperæ.)

Oribasius gives no description of the disease, but briefly recommends the theriac of vipers, and in certain cases purging and bleeding for the cure of it.

The account given by Aëtius is principally taken from Archigenes, and is very circumstantial. The disease, he remarks, has been called by the several names of elephantiasis, leontiasis, and satyriasis. Suspicions, he says, have been entertained of its being contagious, and he is of opinion that it is unsafe to hold intercourse with those who are ill of the disease, as the air becomes contaminated by the effluvia from their sores, and by their respiration. The disease, he says, is insidious, for it begins in a concealed manner internally, and does not make its appearance on the skin until it is confirmed. Men are more subject to it than women, and intemperate climates predispose to it. The first symptoms of the disease are torpor, slow respiration, constipated bowels, urine like that of cattle, continued eructations, and strong venereal appetites; and when it is determined to the skin, the cheeks and chin become thickened and of a livid colour, the veins below the tongue are varicose, and eminences are formed all over the body, but especially on the forehead and chin. The body becomes increased in bulk, and is borne down by an intolerable sense of heaviness. Those affected with it become pusillanimous, and shun the haunts of men. Though the disease, when confirmed, is of the most hopeless description, he forbids us to abandon the sick at the commencement. His treatment is almost the same as our author’s: venesection at the beginning, purging with colocynth or hiera, and vomiting with radishes or white hellebore. Some, he says, having remarked that eunuchs escaped taking this complaint, have castrated themselves as a preventive. He makes mention of all the medicinal substances recommended by our author, namely, iron-wort, Cyrenaic juice, the theriac of vipers, &c. For the cutaneous affections he recommends a great many external applications, containing white hellebore, sulphur, rue, natron, aloes, and even arsenic. He also speaks of cataplasms, depilatories, and detergent ointments. He is very particular in directing that the diet be light and wholesome.

Actuarius calls elephantiasis a cancer of the whole body, which preys upon all the flesh, and derives its origin from black bile corroding everything like fire. The first symptoms of it are a falling off of the hairs of the eyebrows and chin, tumours on the face, an alteration of the appearance of the eyes, a change of the voice, turgidity of the sublingual veins, and afterwards cutaneous eruptions of an intractable nature. He then states that elephantiasis, lepra, psora, and impetigo are diseases of different gradations of malignity. In another place he has given the treatment, which is exactly the same as that recommended by Aretæus, namely, bleeding, purging with hellebore, detergent and desiccative applications to the skin, &c.

Some applications, seemingly of little efficacy, are recommended for elephantiasis in the ‘Euporista’ of the Pseudo-Dioscorides.

Nonnus, as usual, abridges our author’s detail of the treatment, and omits the description. He says it arises from a melancholic humour, which corrodes the extremities. According to Psellus, the disease is produced by melancholy adust and the lees of putrid blood.

The account of elephantiasis given by Leo is brief and imperfect. The disease, he says, is produced by a melancholic humour, which has become putrid, and corrodes the extremities. It is, he adds, almost incurable, but may be benefited by purging with the dodder of thyme, by the theriac, and burning the head at the bregma. The affection, he says, is also called satyriasmus.

Myrepsus merely mentions some of the common remedies for elephantiasis, such as arsenic, turpentine, litharge, &c. He gives no description of the disease.

We now proceed to the Arabians.

Avicenna gives a very circumstantial account of elephantiasis, under the name of juzam or judam, which his translator renders by lepra. He calls it a cancer of the whole body, which arises from black bile, and is sometimes attended with ulceration, and is sometimes without it. The disease, he says, is contagious: it is produced by living upon the flesh of asses, lentils, &c., and is endemic in Alexandria. It is sometimes called leonina, because the face assumes the stern appearance of the lion’s. He states that, although it begins internally, its first symptoms are manifested on the extremities. He then describes minutely the symptoms, namely, redness of the face, inclining to lividity; falling off of the hairs, enlargement of the veins, affection of the breathing, thickening, and discoloration of the lips; and afterwards ulceration of different parts of the body, corrosion of the cartilages of the nose, then falling off of the nose and extremities, loss of voice, &c. The treatment he gives with great minuteness, but as it is little different from that of the Greeks, we need scarcely enter upon it. Suffice it to say that he mentions early bleeding, purging with hellebore, colocynth, scammony, &c.; the theriac of vipers, the application of the cautery to the head, and so forth. Enough has been said to show that this description applies to the elephantiasis of the Greeks. Considerable confusion, however, has arisen in consequence of his translator applying the term elephantia to a very different disease, namely, to an enlargement of the leg with varicose veins, now generally known by the name of the Barbadoes leg. This complaint he directs to be treated at first with local bleeding and astringents; but when ulceration takes place, it is to be remedied only by amputation.

Serapion, in like manner, describes the elephantiasis of the Greeks by the name of lepra. The face, he says, is swelled, livid, and covered with hard pustules, the hairs of the eyebrows fall off, the whole aspect becomes hideous, the voice is changed, the perspiration becomes vitiated, and ulceration seizes different parts of the body. The disease, he says, takes its origin from the liver, in which the office of sanguification is improperly performed. His remedies are bleeding, hellebore, the theriac, &c.

Avenzoar describes the lepra as a cancer arising from contact with other lepers, or from unwholesome food. He recommends to purge away the melancholic humour with scammony, colocynth, black hellebore, &c. The elephantia he describes as a disease in which the leg is swelled like the leg of an elephant. He considers it almost incurable.

Albucasis gives an account of the operation of burning the head for lepra, i.e. the elephantiasis of the Greeks.

The translator of Haly Abbas, namely, Stephanus Antiochensis, who says he wrote about the year 1127, describes the disease which we have been treating of by the name of elephantia. Like the others, Haly represents it to be a general cancer arising from black bile. He says it proves contagious by respiration. Among the symptoms, he mentions falling off of the ciliary and superciliary hairs, dryness of the nose, which sometimes falls in; in short, he enumerates the same symptoms as the preceding authorities. For the cure he directs us to bleed from the arteries behind the ears, those of the temples, or from a vein in the arm; to give emetics, such as hellebore; to avoid cold; to apply cupping-instruments to the scrobiculus cordis; to administer the theriac, &c. He recommends externally decoctions of beans and vetches at first; and afterwards stimulant lotions, containing arsenic, sulphur, quicklime, and so forth. He also applies the term elephantia, and sometimes elephas, to the swelled leg, which he considers to be a species of varix.

Alsaharavius describes four varieties of lepra, namely, the leonina, elephantia, serpentina, and vulpina. The disease, he says, may be contracted, 1st, by an hereditary taint; 2d, by the use of corrupted food, such as the flesh of buck-goats, cows, &c.; 3d, by contagion, through the medium of the respiration. He describes all the gradations of the disease with greater minuteness than any other ancient author. In its last stage, he says, the nose falls in, the hairs drop off, the voice is lost, ulcers break out on the skin, the extremities mortify and fall away, and the breath is fetid. His treatment varies according to the circumstances of the case, but, upon the whole, it is scarcely at all different from that of the others. By the name of elephantia he also describes the swelled leg, which he pronounces to be a very intractable disease. He directs us, however, to have recourse to bleeding, melanogogues, abstinence from gross food, emetics, and various external applications of a stimulant nature, among which he mentions burying the leg in hot sand.

The translator of Rhases also applies the term lepra to the elephantiasis of the Greeks. The colour of the eye, he says, is changed, the voice becomes rough, the face is swelled, like a bladder, and red with nodes, the hairs fall off, and the extremities at last become swelled and ulcerated. There is nothing peculiar in his treatment. He describes, likewise, the swelled leg by the name of elephantia or elephas. He says that, when tubercles arise on it, it is utterly incurable; but that when simply enlarged, it may be remedied by bleeding in the arm, cupping, emetics, attenuant food, and the like. In his ‘Continens,’ he calls the lepra (elephantiasis) hereditary and contagious. He says, it is a general cancer, arising from black bile. For the swelled leg he recommends, as in his other work, bloodletting and emetics, with stimulant applications, containing pearlashes, sulphur, &c., and also tight bandages.

Such is the history of elephantiasis given by ancient authors.

The earlier of our modern writers on medicine, describe elephantiasis as a species of lepra, of which they enumerate four varieties, namely, elephantia, leonina, alopecia, and tyria. This arrangement is evidently taken from Alsaharavius. Such is the account which Platiarius gives of these diseases. In like manner, the Pseudo-Macer ranks elephantiasis with lepra:

“Est lepræ species elephantiasisque vocatur,” &c. Upon this passage Cornarius makes the following annotation: “Vulgus medicorum Arabas in hoc secuti lepram cum elephantiasi confundunt. Immo lepram pro elephantiasi accipiunt.”

Guido de Cauliaco’s account of the disease is also nearly the same as that of Alsaharavius. He states decidedly that the disease is contagious, and recommends bleeding, purging, the actual cautery, the theriac of vipers. (vi, 1.) Rogerius remarks that the disease is contracted per coitum. (i, 15.) And here, by the way, we may be permitted to state that we have long been convinced that the syphilis of modern times is a modified form of the ancient elephantiasis. This opinion is maintained by several of the writers of the Aphrodisiacus, and also by the learned Sprengel, who gives a very interesting disquisition on Syphilis in his ‘History of Medicine.’

It appears that the disease in its ancient form is still prevalent in certain parts of the world; as, for example, in the Sardinian States, where it is still looked upon as being both contagious and hereditary. It is also endemic in Norway: nay, it is reported to have broken forth with all its ancient character in the province of New Brunswick. In the East, elephantiasis and leontiasis are still considered as aggravated forms of leprosy. (See Heber’s Travels, ii, 50; and Niebuhr’s Travels, xxvii, 11.) We may be allowed to add, in conclusion, that a great mass of misapprehension has prevailed in modern times regarding the elephantiasis of the Greeks and Arabians. We trust the above sketch will remove the difficulties which formerly beset this subject.

SECT. II.—ON LEPROSY AND PSORA.

Both these affections consist of an asperity of the skin, with pruritus or wasting of the body, having their origin from a melancholic humour. But leprosy spreads over the skin more deeply in a circular form, throwing out scales which resemble those of fishes. But psora is more superficial and variously figured, and throws out furfuraceous bodies. In these cases we must premise venesection when the body appears more than usually plethoric; but, if not, we must by all means purge with those things which evacuate black bile. Externally we may use in common either of the hellebores; and have washed lime dried, and, when going to use it, we may dilute it in water until it attain the thickness of the wrestler’s sordes, and anoint.—Another: Of sage, of the tears of Æthiopian olive, of each, dr. viij; of the bark of capper’s root, of gum, of each, dr. xiij; anoint with vinegar, in the sun. Anemone, when applied, and the root of the white vine particularly, remove psora. But the following are compound remedies: Of the flour of darnel, one chœnix; of the white cardamom, dr. iv; of the scum of natron, dr. j; of copperas, dr. viij; of the middle roots of asphodel, dr. iv; having triturated them in vinegar, and made of the thickness of a cerate, anoint, having first applied nitre to the part; and having removed it, (which do about the third day,) and washed with cold water, again anoint.—Another: Of the juice of kings’ spears’ roots, oz. vj; of sulphur vivum, of manna, of each, dr. x; of natron, dr. viij; anoint, mixing with vinegar. The following simple remedies are particularly applicable for psora: Stavesacre, bitter lupins, cardamom with vinegar, the root of lily with honey, turpentine rosin, sulphur, chick peas, goat’s dung; and these compound ones—mix equal parts of chalcitis and misy with wine, and anoint the more humid kinds of psora.—Another: Boil the tender leaves of rose-bay in a sextarius of oil until they are dried, and, throwing away the leaves, add to the oil oz. iij of white wax, and, after it is dissolved, cool and sprinkle upon it oz. j of sulphur vivum, and anoint in the sun or in the bath. Some boil also squills with the rose-bay.—Another: Of diachylon, oz. ij; of wax, oz. ij; of oil of roses, oz. j; of litharge, oz. iij; of ceruse, oz. iij; of liquid pitch, oz. vj; of the dross of silver, oz. ij; of siricum, oz. ij; of vinegar, what will be sufficient for the trituration of the dry things.—Another: Of ceruse, oz. ss; of starch, oz. ss; of lead, oz. j; of red lotuses, or of alkanet, oz. ij; of wax, oz. vj; of oil of roses, oz. ix; boil the alkanet properly with the oil of roses, and then add the other things.—Another: Take ten eggs, or as many as are required, and having macerated in the most acrid vinegar until their shell become tender; boil in the vinegar the yelks of them; having triturated with rose-oil and what remains of the vinegar a moderate quantity of litharge, anoint, when of the consistence of the sordes of oil in baths.—Another: Three yelks of eggs out of vinegar; of rose-oil, oz. vj; of sulphur vivum, oz. iij; having triturated the yelks of the eggs and the sulphur with the vinegar, add the cerate. And litharge triturated with vinegar and rose oil, until it be of the consistence of a plaster, cleanses the most acrid kinds of psora; and the detergent ointments from dock, and the most of those for elephantiasis, answer well in general with leprosy and psora.

Commentary. See Hippocrates (de Usu Humidorum, Epidem. ii); Galen. (Meth. Med. xiv; de Causis Sympt. iii, 6; et alibi); Oribasius (Morb. Curat, iii, 58); Aëtius (xiii, 134); Actuarius (Meth. Med. ii, 11); Nonnus (Epit. 234); Pseudo-Dioscor. (Euporist. i, 128); Leo (vii, 15, 18); Pollux (Onomasticon, iv, 9); Æschylus (Choeph. 274); Alexander Aphrodisiensis (Prob. i, 146, and ii, 42); Celsus (v, 28); Scribonius Largus; Octavius Horatianus (i, 31); Serenus Samonicus; Marcellus (de Med. xix); Isidorus (Orig. iv, 8); Psellus (op. Medicum); Vegetius (Mulom. iii, 71); Geopon. (xviii, 15); Serapion (v, 2); Avicenna (iv, 7, 2, 9); Avenzoar (ii, 7, 4); Haly Abbas (Theor. viii, 16; Pract. iv, 4); Alsaharavius (xxxi, 1, 2, 3, 4); Rhases (ad Mansor. v, 31 et seq.; Divis. 117, et seq.); Contin. (xxxvi.)

As in the preceding chapter, we shall here give a separate account of the views of the Greeks, Latins, and Arabians, beginning, in this instance, with the Greeks.

Hippocrates makes only casual mention of these diseases, and has nowhere marked their distinguishing characters. In one place he calls leprosy a blemish rather than a disease; and in another he remarks that some varieties of it itch before rain. He speaks of vinegar, and of lime and water as remedies for it. It is proper to apprize the reader that the two works quoted above from the Hippocratic Collection are, most probably, not genuine.

Galen also is very deficient on the subject of lepra, having nowhere given a complete description of it, although he notices it incidentally in many parts of his works. In one place he calls elephas, leuce, and alphos cognate affections. Alphos, he says, is much more superficial than leuce. In another, he attributes these complaints to the melancholic humour which becomes fixed in the skin. In the ‘Isagogue,’ which, however, seems not to be a genuine work of his, it is said that lepra is an affection of the skin, which becomes whiter and rougher than natural, the roughness resembling that from prominent psydracia. Psora is said to partake more of the nature of ulceration. Both are represented as arising from a saltish phlegm, and as being cured by phlegmagogues, and ointments rubbed into the skin. It is also stated that leuce is distinguished from lepra by there being no roughness of the skin in the former disease. In another place he mentions psora as a disease most inveterate to cure. (Facult. Natur. i, 13.)

Oribasius thus distinguishes leuce, alphos, melas, lepra, and psora from one another. Leuce is occasioned by a pituitous and viscid blood, which, in process of time, renders the colour white. Alphos arises in like manner, but the superficial skin only is affected, and not the whole flesh. When a pituitous humour is the cause of the complaint, it puts on the appearance of alphos, and when the melancholic, of melas. Lepra affects mostly the deep-seated parts, and psora the superficial. For all these complaints he recommends a mixture of lime and water and some other such things.

In the ‘Euporista,’ generally ascribed to Dioscorides, there is given a long list of medicinal articles for lepra, such as the flour of darnel with sulphur, hellebore with vinegar, verdigris, cantharides, &c.

Aëtius, copying from Archigenes, thus marks the difference between lepra and its cognate diseases. Lepra differs from leuce and alphos, inasmuch as lepra is distinguished by roughness and a sense of itching, and yet the skin only is affected, and when it is removed, the flesh below is discovered to be sound; but in leuce, the flesh below assumes an unnatural degree of whiteness, while the surface of the part is very smooth, and when rubbed it soon becomes red, especially in those who are readily cured; and alphos is altogether superficial, having the appearance of a scale fastened to the skin. Lepra differs from psora, inasmuch as in psora the substances which appear on the skin are of a furfuraceous nature, while in lepra they resemble the scales of a large fish. He omits the constitutional treatment so judiciously stated by our author, but his local applications are little different. They contain hellebore, sulphur, misy, verdigris, liquid pitch, cantharides, natron, copperas, myrrh, galls, vinegar, &c., mixed in various proportions.

Actuarius states that lepra is next to elephantia in malignity, and that it is distinguished from psora by spreading deeper and having scales of a circular shape like those of fishes; whereas, psora is more superficial, and its scales are furfuraceous and of no determinate shape. Both are attended with asperity of the skin, and itching. Leuce holds the same place to alphos that lepra does to psora, that is to say, leuce is more deep-seated, and affects the colour of the hair, while alphos is more superficial, and the hair is in general unchanged. For all these affections he recommends an application containing copperas, black hellebore, arsenic, and cantharides, mixed with oil, cedar resin, or rose oil.

Psellus states correctly that the scales in leprosy assume a circular shape.

Nonnus marks the distinction between these diseases very accurately. Lepra arises from a corroding humour, and hence scales fall from the surface of the skin, and it is attended with pruritus. But lepra is more deep-seated, and affects the skin circularly; whereas psora is more superficial and variously figured. Leuce and alphos albus and niger, he says, are allied; but leuce is deeper seated, so as to change the colour of the hairs, whereas the alphi are more superficial affections.

Pollux, like most of the others, states that in leuce, when the skin is pricked, it does not bleed, and that the disease is difficult to cure. Alphos and melas, he says, are easily cured.

Although Myrepsus has not described these diseases, he gives prescriptions for various compositions to remove them. The most active ingredients in them are hellebore, natron, sulphur, quicksilver, sal ammoniac, quicklime, bay-berries, &c.

Alexander Aphrodisiensis mentions psora among the contagious diseases, but says that lepra and leuce are not contagious.

Chrysostom alludes to the common opinion that psora is a contagious disease. The poet Æschylus gives a short description of leprosy in his ‘Chöepheræ’ by the name of lichenes. (l. 277.)

Celsus nowhere uses the terms lepra and psora, and therefore there is considerable difficulty in comparing his account of these cutaneous affections with the descriptions of the Greeks. Alphos, melas, and leuce, he describes very intelligibly, connecting them together by the generic term of vitiligo. We shall give his own characteristic description of these diseases:—“Ἄλφος vocatur ubi color albus est, fere subasper, et non continuus, et quædam quasi guttæ dispersæ esse videantur: interdum etiam latius, et cum quibusdum intermissionibus serpit. Μέλας colore ab hoc differt quia niger est et umbræ similis: cætera eadem sunt. Leuce habet quiddam simile alpho, sed magis albida est et altius descendit; in eâque albi pili sunt, et lanugini similes. Priora curationem non deficillimam recipiunt: ultimum vix unquam sanescit.” Another class of cutaneous affections he connects by the generic term of impetigo, and it is to be remarked that they are all squamous diseases, and not pustular, like the complaints to which Drs. Willan and Bateman have applied the term. His second species of impetigo (as Bateman remarks) appears to be the psora of the Greeks:—“Alterum genus pejus est, simile papulæ feræ, sed asperius rubicandiusque, figuras varias habens: squamulæ ex summâ cute discedunt, rosio major est, celerius et latius procedit, certioribusque etiam quam prior temporibus et fit et desinit. Rubra cognominatur.” His third species bears some resemblance to the lepra nigricans of Willan and Bateman:—“Tertia etiamnum deterior est: nam et crassior est et durior, et magis tumet, in summâ cute finditur, et vehementius rodit, ipsa quoque squamosa sed nigra, &c. Nigræ cognomen est.” His account of the fourth species seems to refer to the lepra vulgaris:—“Quartum genus est quod curationem omnino non recipit distans colore: nam sub-albidum est et recenti cicatrici simile: squamulas habet pallidas, quasdam subalbidas, quasdam lenticulæ similes: quibus demptis nonunquam profluit sanguis.” For all these diseases he recommends a composition containing sulphur, natron, and rosin.

Scribonius Largus describes several compositions, “ad lepram, quæ quasi impetigo est cum prurigine cutis,” and for scabies. They contain sulphur, Æthiopian cumin, vinegar, frankincense.

Serenus Samonicus makes mention of a few popular remedies for scabies, prurigo, and papulæ, but he gives no description of these complaints.

Octavius Horatianus recommends for scabies (meaning, we suppose, the psora of the Greeks,) bleeding, purging, frequent baths, and external applications containing natron, frankincense, and sulphur. He does not mention lepra by name, nor does he seem to allude to it at all.

Marcellus recommends for lepra a composition containing equal parts of natron, frankincense, litharge, and sulphur pounded with vinegar.

Vegetius says that the scabies of cattle “contagiosa est et transit in plures.” Probably Virgil alludes to the scab of sheep in this line: “Nec mala vicini pecoris contagia lædant.” (Ecl. i.) He mentions, as remedies for it, sulphur, litharge, pitch, hellebore, &c. (Georg. iii, 449.) See also Geopon. (xvi, 18, xviii, 15); Columella (viii, 5); and Gratius (Cyneget. 412).

Isidorus gives the following definitions of the complaints we have been treating of: “Lepra vero cutis asperitas squammosa lepidi similis unde nomen accepit: cujus color nunc in nigridinem vertitur, nunc in alborem, nunc in ruborem. Scabies tenuis asperitas et squammata est. Impetigo est sicca scabies; prominens a corpore cum asperitate et rotunditate formæ. Hanc vulgus sarnam appellat.”

Justin applies the terms vitiligo and scabies to the diseases treated of in this chapter. See Hist. (xxxvi, 2.) We now turn to the Arabians.

In the Latin translation of Serapion, lepra and psora are described under the generic term of “impetigines in quibus excoriatur et scinditur cutis;” but they are further distinguished from one another by the specific titles of albaras nigra and pruritus. The former is characterized as arising from the melancholic humour, and as casting off round scales. The latter is said to consist of pustules, which appear on different parts of the body, are variously figured, and cast off furfuraceous scales. The leuce is described by the name of baras, as arising from viscid, pituitous blood, and being produced by a defect of the assimilative faculty. In it the flesh itself is said to be changed to a white colour. If, when pricked with the head of a needle it bleeds, there is a probability of cure; but if it does not bleed, it is incurable. The two alphi are described by the names of morphea alba and nigra. The morphea alba resembles the white albaras (leuce) only that in the latter the affection of the skin is more deep-seated, and the hairs in it are turned to a white colour; but in morphea the only change is in the external appearance of the skin. The morphea nigra (melas?) is said to resemble the albaras nigra (lepra nigricans?) only that it is more superficial.

In the Latin translation of Avicenna by Bullonensis, alphos albus and niger are distinguished by the names of morphea alba (or alguada), and morphea nigra; leuce by that of albaras; and lepra by those of albaras nigra and impetigo excorticativa. The specific differences between them are stated with great precision. The morpheæ are superficial affections of the skin, but the albaras affects also the flesh, penetrating sometimes down to the bone. All these diseases are said to arise from a weakness of the assimilative faculty. In the albaras nigra, or leprosy, the skin is said to be covered with scales, like those of a fish. Like the authorities formerly quoted, Avicenna states that in alguada (alphos albus) the hairs do not change their colour, but that they do so in albaras. The puncture of a needle likewise extracts blood from the guada, but not from the baras.

Avenzoar makes mention of the morphea alba and nigra, but has not described them particularly. These authors seem to have treated lepra and psora like the Greeks, by bleeding, melanogogues, and abstergent applications to the skin, such as the two hellebores, lime, lupines, &c.

In the translation of Haly Abbas, leuce is correctly described by the name of lepra. It is represented as a whiteness sometimes affecting the whole body, and it is said to be occasioned by debility of the assimilative faculty. When the hairs are white, and the skin does not bleed when pricked with a lancet or needle, the disease is incurable. Alphos albus is described by the name of morphea alba, and is distinguished from the former by the whiteness being more superficial, and the colour of the hairs remaining unchanged. In the morphea nigra, that is to say the alphos niger, the colour is said to be black, owing to the prevalence of black bile, and if rubbed a furfuraceous scale falls off, and it becomes red. The lepra nigricans is described by the names of impetigo and sarpedo, as an asperity of the skin, inclining to blackness or redness, and terminating in round scales, like those of fishes. For the cure of lepra, he directs us to abstain from all articles of food which engender phlegm, to take hiera of colocynth, with pepper, &c., and also the theriac of vipers, and various other internal medicines. He recommends various external applications, containing sulphur, arsenic, hellebore, spurge, &c.

Alsaharavius describes three varieties of morphea. 1st. The morphea terrestris, which is attended with furfuraceous scales on the skin, and tingling. This is evidently the psora of the Greeks. 2d. The morphea alba, which consists of a more superficial whiteness of the skin than the albaras (leuce): this is the alphos albus. 3d. The morphea nigra, is like the former, only that the colour is black. This must be the alphos niger. All these affections he treats upon much the same principles as the Greeks, namely, by evacuants, and stimulant applications to the skin, such as sulphur, hellebore, &c. Albaras he describes as a deep-seated whiteness of the skin, and directs us to prick the skin with a needle, and if it does not bleed the disease is to be set down as incurable. This, of course, is the leuce of the Greeks. He treats it upon much the same principles as the morpheæ. He appears not to make any distinction between the leuce and the lepra.

Rhases describes the lepra of the Greeks by the term impetigo; alphos albus by that of morphea alba; alphos niger by that of morphea nigra; and leuce by that of albaras. There is nothing very particular in his treatment of leprosy. It may be worth while to mention, however, that he strongly recommends leeches to the affected part, at the commencement. Scabies, he says, is formed by a salt diet, old wine, and neglect of the bath. For the cure of it, he recommends bleeding, purging, and various external applications, some of which contain quicksilver, nitre, vinegar, and the like. In his ‘Continens’ he gives a full account of these diseases, upon the authority of preceding writers. He gives the names of baras to lepra, and morphea alba to alphos. He recommends stimulant applications containing cantharides, nitre, with vinegar, &c. He says that he had found a mixture of sal ammoniac and oil of eggs an excellent application.

It will be remarked that the leuce of the Greeks, the leuce and fourth species of impetigo of Celsus, and the albaras of most of the Arabians, are the same as the lepra vulgaris of Drs. Willan and Bateman; that the alphos of most of the Greek authorities and of Celsus, and the morphea alba of most of the Arabians, correspond to the lepra alphoides of our English nosologists; that the melas, alphos niger, and common lepra of the Greeks, Celsus’ third species of impetigo and his melas, and the morphea nigra and impetigo of most of the Arabian translators, apply to the lepra nigricans of our modern arrangement; and that the psora of the Greeks, Celsus’ second species of impetigo, and the scabies of Octavius Horatianus, and of most of the Arabian translators, comprehend both the psoriasis and scabies of Willan and Bateman.

Since many of the ancient authorities speak of scabies as being infectious, they must have applied the term to the true itch, with which it is not likely, as Rayer maintains, that they were wholly unacquainted.

The earlier modern writers, such as those of the Schola Salernitana, Platearius, Guy of Cauliac, and Lanfrancus, jumble together the Latin and Arabian names, so as to produce no ordinary degree of confusion. Guy of Cauliac, indeed, maintains that there is little necessity for distinguishing lepra, alphos, melas, impetigo, gutta rosacea, and such like cutaneous complaints from one another, as they are all varieties of the same disease. Lanfrancus, however, is of a different opinion. (i, 3, 6.)

SECT. III.—ON LICHEN.

Lichen is formed by the mixture of a thin and acrid ichor with other gross humours, and passes readily into leprosy and psora; wherefore it requires to be treated by the most desiccative applications. After general depletion, if necessary, the following simple medicines will be proper: chick-peas, hellebore, the urchin which dwells among rocks, pitch mixed with cerate and rosin, the dung of the land crocodile, that of starlings fed solely upon rice. And many have cured the complaint when occurring on the chin, or other parts of the body, by this application alone: take several grains of wheat and place upon a stithy red-hot, and taking the fluid which flows from them while yet warm, anoint the part affected with lichen. The lichen of children is to be rubbed frequently with human saliva. The gum of the plum tree, when rubbed in, is beneficial in these cases. When the complaint is protracted, the leaves of the chaste tree, triturated with vinegar, are to be applied, or the leaves of capers in like manner. The following are compound applications: Dissolve sulphur with rosemary in vinegar, or with ammoniac, and anoint. A trochisk for lichen: Of artificers’ glue, dr. iv; of frankincense, dr. iij; of vinegar half a cyathus; dissolve in vinegar, and anoint.—Another: Of chalcitis, of gum, of each, dr. viij; of sulphur vivum, of misy, of each, dr. vj; of the flakes of copper, of acacia, of each, dr. ij; anoint with vinegar.—Another: Of sulphur vivum, of spuma nitri, of each, dr. iv; of the seeds of rosemary, lx; triturate with vinegar, and anoint only the part which is affected, not touching the sound skin. When dry, wash it away with cold water.—Another: Of white hellebore, dr. viij; of the flour of lupines, of burnt shell-fishes called buccina, of natron, of each, one chœnix; rub with it dry. They call that variety of lichen agrius which is nowise remedied by moderately desiccative applications, and is exacerbated by more acrid ones. These cases are therefore to be treated by applications which are sufficiently strong, without being pungent, such as this: of horned poppy, of frankincense, of alcyonium, of bitumen, of sulphur, of gum, of each, oz. j; anoint with vinegar. Boil African pitch with vinegar, and, when dissolved, anoint.—Another, for lichen and prurigo: Of copperas, of sulphur vivum, of natron, of frankincense, equal parts; use for lichen with vinegar, and for prurigo with wine.—Another, for lichen: Of ammoniac perfume, of the flour of bitter vetch, of the flour of lupines, equal parts; add to vinegar.

Commentary. See Hippocrates (de Humor., de Affect.); Galen. (Isagoge, de Med. sec. loc. v); Oribasius (Morb. Curat. iii, 59); Aëtius (viii, 16); Actuarius (Meth. Med. ii, 11); Marcellus (19); Nonnus (236); Celsus (v, 28); Pliny (H. N. xxvi, 2); Serapion (v, 2); Avicenna (iv, 7, 3, 3); Alsaharavius (Pract. xxxi, 7); Rhases (Divis. 117); Haly Abbas (Pract. iv, 10.)

Dr. Bateman states, that the exact acceptation of the term lichen cannot well be ascertained from the writings of Hippocrates; but Dr. Willan affirms that he restricted it to a papular eruption on the skin.

In the ‘Isagoge,’ usually ascribed to Galen, two varieties are described, the lichen mitis, and the lichen agrius, in both of which scales are formed upon the skin, which appear almost ulcerated when they are removed. They are to be cured by cholagogues internally, and liniments externally.

Galen remarks the tendency of the disease to pass into lepra and scabies. To prevent this, he directs desiccative and detergent applications, for the preparation of which he gives various prescriptions. One of these, which bears the name of Pamphilus, is a powerful escharotic, composed of orpiment, realgar, burnt copper, and cantharides. (Med. sec. loc. v.) He says it affects principally the chin, but is apt to spread over the face.

Oribasius, Aëtius, Actuarius, and Nonnus, treat of the complaint in nearly the same terms as our author. Their translators improperly render it by impetigo. Leo ascribes the origin of the disease to hot and corrupted blood.

Celsus describes the lichen of the Greeks by the name of papula, of which he mentions two varieties. In the first, he says, the skin is merely roughened by small pustules, is reddened and slightly corroded; the middle is somewhat smoother, and it spreads slowly, generally in a round shape. This description would seem to apply to the lichen circumscriptus of Drs. Bateman and Willan, although the latter author thinks that it possessed a wider signification. The second variety, he says, is called ἀγρία by the Greeks, and in it the skin is more rough, red, and corroded. The more it departs from the circular form the less tractable is it, and, unless removed, it is said to pass into impetigo. From this account it is clear that the lichen of the Greeks, in its original form, was different from impetigo. Celsus recommends friction with the saliva of a fasting person, and also mentions a composition containing natron, frankincense, sulphur, &c.

The translator of Serapion improperly renders the name of this affection by the term impetigo. His remedies are nearly the same as our author’s, namely, the saliva of a person fasting, compositions containing hellebore, natron, the ashes of starlings, &c.

In the translation of Avicenna it is likewise described by the name of impetigo. It is called a species of dry achor, by which is no doubt meant papula. It is stated that it has a tendency to pass into lepra or psora. The remedies which are recommended are human saliva, the chaste tree, capers, leeches (which are not mentioned by the Greeks), likewise gum arabic dissolved in vinegar, mustard and vinegar, salt water, the roots of king’s spear, &c. Haly Abbas recommends stimulant liniments of a similar kind.

Rhases briefly recommends lotions of vinegar and ammoniac, and, when it becomes inveterate, leeches, strong friction, &c. His translator also misapplies the term impetigo to it.

The lichen appears to be the cutaneous complaint which Alsaharavius describes by the name of alcoab. He represents it as a superficial ulceration, and mentions four species of it.

Dr. Willan confirms the statement of the ancient authorities, that the disease has a tendency to pass into lepra and psora. The species called lichen tropicus by Dr. Willan, seems to be the hidroa of Hippocrates (Aph. iii, 21); the sudamen of Pliny (xxiii, 45); one of the essere of Haly Abbas (Theor. viii, 17); one of the alsara of Alsaharavius (Pract. xxx, 8); and the hasef of Avicenna (iv, 7, 3, 8). See also Galen’s ‘Commentary’ (v, 261); ed. Basil. Galen says it is attended with pruritus, asperity, and ulceration. Avicenna and Rhases particularly commend bleeding, cleansing the skin, and the cold bath. Most of Rhases’ authorities in his ‘Continens,’ recommend for the asaf, or sudamen, cooling and astringent applications, containing roses, myrtles, galls, sandals, camphor, and the like. They attribute the complaint to profuse perspiration. In certain cases, Rhases directs us to allay the pruritus or tingling, with hot water and the flesh of melons. He also approves of purging with tamarinds and myrobalans. (Cont. xxxvi.) See also ad Mansor. (v, 30). Mercurialis is of opinion that Virgil alludes to the sudamina in the following lines:

“Verum etiam invisos si quis tentarat amictus,

Ardentes papulæ atque immundus olentia sudor

Membra sequebatur.”

(Georg. iii, 565.)

We shall briefly notice in this place the singular disease of the face which prevailed in the Roman empire during the reign of Tiberius, called mentagra by Pliny, in his curious description of it, but which he says was named lichenes by some. He represents it as a contagious disease, which was readily propagated by kissing. It attacked principally the higher class, the lower and middle ranks and women having generally escaped it. The seat of it was commonly the chin, but it sometimes spread over the whole face, and affected even the neck, breast, and hands. The only means of cure was burning with caustics down to the bone. (H. N. xxxvii; see also Marcellus, 19.) We are inclined to think that it must have been some variety of elephantiasis. Modern authorities have ranked it under sycosis, but it would appear to have been a much more intractable disease. The sycosis is distinctly described by Celsus, among the diseases of the hairy parts. He recommends for it elaterium, linseed, or figs boiled in water, &c. (vi, 3.)

SECT. IV.—ON PRURITUS, OR PRURIGO.

The prurigo occurring in old age is not to be thoroughly cured, but may be alleviated by the remedies mentioned below: but that which arises from a cacochymy in other ages, is to be cured by evacuation, being formed by a bilious or pituitous humour that has become putrid, or by a saltish one. It is known by attending to the age, temperament, diet, season of the year, situation, and the like. If, therefore, it appear to prevail in the blood contained in the veins, we must begin with venesection; but if it offend rather by its quality, we must evacuate it by corresponding medicines, and turn our attention to external applications. Wherefore we must use the bath at all times before a meal; and sometimes, after eating a little, it may be used a second time, for the affection is of difficult humectation. They are to be rubbed with the decoction of fenugreek, or of beet, or of barley-meal, or of wild or of garden mallows, or of ptisan; and along with these may be joined the flour of beans, or of lupines, or of myrobalan (ben), or of the detergent ointment called peponaton. If it is protracted, we may use the bath in like manner, and foment with the decoction of sage, of tamarisk, of the herb mercury, of marjoram, of pennyroyal, of bay berries, of the root of the wild cucumber, of capers, of strained ley, of vinegar and brine; and then the parts are to be sprinkled with dried natron, or with the lees of vinegar, or with the composition containing of spuma nitri one sextarius, of rosemary, of sulphur vivum, of each, lb. j, of cimolian earth, lb. ss; or this: of aphronitrum, of sulphur vivum, of burnt alcyonium, equal parts; to be used dry, or with some of the decoctions already mentioned; and, if you please, sprinkle some dried hellebore, without grease. But rub in with vinegar and oil, stavesacre pulverized, or sulphur, or red arsenic, or all together; or mustard, with the refuse of expressed myrobalan, and vinegar and oil; or with snails burnt and triturated with honey or the roots of dock, or the detergent ointments prepared from them, as described under the head of Elephantiasis; or with some of the applications for scabies. If the parts become ulcerated, use the plaster called parygron, or that prepared from pompholyx; or melt oz. j of wax in a cyathus of oil of privet, and sprinkle upon it of sulphur vivum oz. j. Another application for prurigo: Of large nuts in a rancid state, oz. j; of sulphur, oz. j; triturate with the juice of parsley, and use in the bath with much friction. This alone has proved sufficient for the cure of many cases of scabies and prurigo; and green parsley by itself, when pounded and rubbed in while the patient is in the bath, has been of great service: and in like manner, pellitory of the wall and maple rosin dissolved with rose oil, and rubbed in.—Another: Bruise three ounces of pure and very white rice, and, having strained, triturate with strong vinegar until it become of the thickness of the sordes of the oil in baths; and adding separately of sulphur vivum pulverized, oz. j; and mixing properly, use in the bath with much friction. When there is a greater redundance of humours, it will be better to mix the ingredients in equal proportions.

Commentary. See Hippocrates (Aphor. iii, 31); Galen (Comment. et alibi); Oribasius (Morb. Curat. iii, 22); Aëtius (xiv, 20); Actuarius (Meth. Med. ii, 11); Nonnus (237); Alexander Aphrodisiensis (Probl. i, 24); Myrepsus (pluries); Pliny (xxviii, 5); Octavius Horatianus (i, 31); Marcellus (de Med. 4); Isidorus (Orig. iv, 8); Serapion (v, 6); Avicenna (iv, 7, 3, 6); Haly Abbas (Theor. viii, 17, and Pract. iv, 6); Alsaharavius (Pract. xxxi, 5); Rhases (Divis. 121); Avenzoar (ii, 7, 2.)

The prurigo of Dr. Willan is here distinctly described, and a suitable method of treatment recommended.

Hippocrates remarks that prurigo is common in old age. The reason which Galen assigns for this is, that the superfluities of the system are then not properly discharged by the skin. He says in another place, that pruritus may either be produced by external substances, such as nettles, squills, &c., or it may arise from indigestion and the neglect of cleanliness.

Oribasius gives an account of the disease not very different from our author’s. Among other applications, he recommends one consisting of opium mixed with liquid cerate.

Aëtius speaks highly of the sulphureous bath for the cure of this disease.

Actuarius characterizes the disease very well, when he says that it is allied to lichen, and that when rubbed either nothing runs from the place, or some slight humidity of various colour and consistence. He assigns, as a reason for its frequency in old age, that the pores of the skin then get constricted.

Alexander Aphrodisiensis assigns, as the reason why the warm bath proves useful in cases of pruritus, that it dispels the phlegm, which is the cause of the complaint.

Celsus gives a particular account of scabies, but says nothing of prurigo.

Octavius Horatianus recommends us, when the patient is young, to bleed, purge, and use baths medicated with frankincense, natron and sulphur. He also says that the cold bath, and friction with the oil of roses, myrtles, &c., will do much good.

Isidorus uses the term prurigo: “Prurigo vocatur perurendo et ardendo.” Marcellus also uses this term, and recommends much the same substances as the others.

This affection is clearly described by the Arabians, and is rendered pruritus by most of their translators. Serapion recommends us, if there is a sanguineous plethora, to bleed, and then to purge with myrobalans, colocynth, and black hellebore, and along with these the warm bath is to be used, and the liniments for removing the pruritus, containing vinegar, roses, nitre, &c. The prurigo senilis he pronounces to be incurable. Rhases and Avicenna recommend similar remedies. They treat of prurigo and scabies together, and there is no doubt of their alliance. Hence Bateman says that prurigo, when neglected, terminates in scabies. Haly Abbas says that scabies and prurigo arise from a saltish phlegm. Scabies, he says, consists of reddish pustules, which appear most frequently between the fingers and upon the arms. Prurigo, he adds, is apt to run into scabies. He recommends, as a lotion, vinegar with rose-oil, the use of the warm-bath, and other remedies like those of our author. Alsaharavius says that the disease arises from debility of the expulsive faculty of the body or constriction of the pores. He praises highly the hot bath. Avenzoar states that pruritus arises from bile or a sharpness of the blood.

Our author has omitted to treat of phthiriasis, for an account of which see in particular Cælius Aurelianus (de Tard. Pass. iv, 2); also, Aristot. (Hist. An. v, 32); Galen (de Comp. Med. sec. loc. i, 8); Pliny (Hist. Nat. xxvi, 86); Haly Abbas (Pract. iv, 7); Plutarchus (in Vitâ Syllæ.) The authorities quoted by Rhases recommend compositions consisting of stavesacre, white hellebore, arsenic, nitre, sulphur, sublimed mercury, and the like. (Contin. xxxvi.) Antiochus, Herod of Judæa, Philip II of Spain, and many other celebrated personages, are said to have died of phthiriasis. Virey accounts for the disease in the following manner: “Il est, en effet, tel tempérament muqueux, telle dégénération des humeurs lymphatiques, dans le phthiriasis ou la maladie pédiculaire, que ces insectes y trouvent une pâture inépuisable, qu’ils se propagent avec une extrême exubérance sous le peau, pénétrent dans le tissu cellulaire, et établissent d’énormes colonies parmi les ulcères qu’ils y forment.” (Hist. des Mœurs des Anim. ii, 207.) Aldrovandi gives a very full history of phthiriasis. (De Insectis, v.)

SECT. V.—ON LEUCE.

Leuce is a change of the skin to a white colour, occasioned by a viscid and glutinous phlegm. Since all the kinds of leuce are not curable, you may form a diagnosis of it in this manner. Pierce the leuce superficially, not deeper than the skin, with a needle, and if blood flow, the complaint may be cured; but if a milky moisture be discharged, it is incurable. Or, rub it with a rough woollen rag, and if the part become red, the complaint may be cured; but if it remain of the same colour, it cannot be cured. And those kinds which attack a great part of the body are to be supposed more difficult to cure than those which are confined to a small space, and old cases than recent. Some, therefore, in leuce, have approved of burning by iron, consisting simply of the application of heat. Others, dreading the pain of burning, and the scar arising from it, as being no less unseemly than leuce itself, have had recourse to escharotic medicines, such as they say will produce a scar of the natural colour. Others rejecting all these things on account of the difficulty of their application, have used dyes (paying more consideration to the deception than the utility which they produce,) which are, of all others, the most to be rejected, owing to the speedy renewal of the affection. We must use, then, the under-mentioned remedial powers: Of adarce, of rosemary seed, of sulphur vivum, of each, equal parts; bruise and strain singly, and then, having triturated together for a sufficient number of days, anoint in the sun, but not in great quantity, lest the skin be ulcerated; and, after some time, a little hellebore and galls may be added in like manner.—Another: Macerate the tops of the black fig in vinegar, and having triturated, mix equal parts of aphronitrum, sulphur vivum, and the fruit of tamarisk, and having rubbed natron into the part, anoint and expose to the sun, taking care lest an ulcer be produced. But Archigenes having mixed a sufficiency of quicklime with fig-leaves, used them in like manner: or, he says, having rubbed the leuce with white hellebore until the part perspire and become of the same colour as the rest of the body, anoint with sinopis or melian earth; or, having perforated them with needles until they bleed, anoint with sinopis in vinegar; or, having first rubbed them as formerly said, anoint with the fresh juice of figs, or rub in so much with the leaves of it.

Commentary. In [the second Section] we have stated so fully the nature of the leuce, and the difference between it and its cognate affections, that it will be unnecessary for us now to resume the subject. It is there mentioned that leuce is Celsus’ third species of vitiligo, and the baras of all the Arabian translators, with the exception of Stephanus Antiochensis, the translator of Haly Abbas, who applies the term lepra to it. It was therefore the white species of leprosy. All the medical authorities represent it as an intractable disease, not only the cuticle being altered in structure, but also the flesh below, and even the hairs, having undergone a change of colour. All direct us to prick the skin with a needle, and, if it bleed, the cure is to be attempted; but if a slight colourless fluid issue from it, the case is to be abandoned as hopeless. They consider it as arising from debility of the assimilative faculty of the part which can no longer convert the nutritive juices into their proper consistence. All recommend nearly the same treatment. The diet is to be regulated with a strict abstinence from gross food; if there be plethora, venesection is to be premised; then drastic purgatives and emetics are to be given, and the parts affected are to be rubbed with stimulant and caustic applications, containing hellebore, nitre, sulphur, misy, red arsenic, &c., or even the actual cautery may be applied. In short, all treat the disease in nearly the same manner as our author. (See in particular Serapion and Avicenna.)

Aristotle, we believe, is the first Greek writer who makes mention of leuce. He calls it a disease in which all the hairs of the body turn white. (Hist. Nat. iii, 11.)

“The snow-white leprosy” of the ancient Jews was the leuce of the Greeks. Moses describes very correctly the method of distinguishing it from the alphos and melas; (Leviticus, c. xiii.) The symptoms of leuce are given in the 3d verse; of the alphos in the 4th; of the melas in the 6th. He calls it contagious, which might lead us to suspect that elephantiasis was mixed up with the leprosy of the Jews. This opinion is further confirmed from what is mentioned by Josephus of its being said that his countrymen were driven out of Egypt because they were affected with leprosy. (See also Justin. xxxvi, 20, and Tacit. Hist. v, 3.) Now we know that elephantiasis was endemial in that country. (See chap. i.) The English translation of this chapter is very inaccurate, the translators having evidently failed to recognize the nice distinction between cognate diseases, laid down by the Jewish legislator.

Leuce is still common in tropical climates. Negroes affected with it are called Albinos. It is merely an aggravated variety of the Lepra vulgaris.

SECT. VI.—ON WHITE AND BLACK ALPHI.

The formation of alphos is similar to that of leuce, but the latter produces a deep change of the skin, so that the hairs grow of a similar colour, whilst the alphi affect the skin superficially, except that when continued, they extend more deeply, so that the hairs grow white, owing to the humour which causes it. From the pituitous humour then they are produced white, but black from the melancholic. Wherefore, a common application for both is washed lime dissolved in water, or, the root of dracunculus applied with vinegar; in like manner, either species of hellebore, the decoction of bitter lupines poured on the part, and their flour when applied as a cataplasm with vinegar or oxymel, the bark of the root of capers with vinegar, the root of lily with honey, onions with vinegar rubbed into the part in the sun, the dung of the land crocodile, and in like manner, that of starlings, when they are fed solely upon rice, and the burnt shells of the cuttle-fish. The following is a compound application: of alcyonium, of natron, of each, oz. ij; of white hellebore, of sulphur vivum, of each, oz. j; and some also add the burnt lees of wine.—Another: Of sulphur vivum, of the spuma nitri, of each, dr. iv; rosemary seeds, vij; triturate with vinegar. But rub only the part affected with alphos, not touching the unaffected parts, and when dry, wash with cold water.—Another: Of the flour of lupines, of buccina, and natron, of each, a chænix; of white hellebore, dr. viij; rub with it in a dry state.—Another: Of the flour of bitter vetches, lb. ij; of the seeds of rocket, of bitter almonds, of the root of the wild cucumber, of each, lb. j; triturate with wine and honey and anoint, and after an interval of an hour wipe it away with a sponge. It applies also for freckles, warts, and other spots on the skin.

A tried remedy for white alphos: of sulphur vivum, ii sextarii, of quicklime whitened, oz. iv; five whites of eggs, of nard-oil and vinegar, a small quantity. The sulphur is first pounded, then we add to it the oil of nard, and again triturate; then the vinegar is poured in, and the mixture is again triturated. But the quicklime is to be washed separately, once, twice, and thrice, and then we add it to the sulphur with the white of the eggs and triturate; and we pour out the collected fluid; but leaving a small quantity so that the ointment may admit of anointing, we use it thus.—Another tried remedy: Take sulphur vivum, dried fig leaves, aphronitrum, alcyonium, Cimolian earth, and myrtle, use with vinegar.—Another of Archigenes: Rub in equal parts of fig leaves dried in the shade, of sulphur, and of alum with vinegar, or of fig leaves, dr. iv; of nitre, dr. ij; of burnt alcyonium, dr. ij; anoint with vinegar in the bath. But red arsenic with one half of sulphur is excellent for removing the black alphos; thus having cleansed the part with natron, anoint with it in the sun. For white alphos: of copperas, of verdigris equal parts, of natron the double, rub without fat: or, of rosemary seeds, of sulphur vivum, of adarce, equal parts; triturate with vinegar, rub, and anoint; but when it is dry, bathe by rubbing. This applies also to the white species.

Commentary. We have again to refer the reader to the second chapter for an account of these complaints, and an exposition of the differences between them and the affections to which they are allied. It will be seen that they are varieties of the genus vitiligo of Celsus, and that they bear a near resemblance to leuce, from which they are chiefly distinguished as being mere superficial affections of the skin. The Arabians treat of them under the names of morphea alba and nigra. Dr. Willan makes them to be varieties of lepra, in which opinion we fully coincide with him.

The description of the two diseases by Actuarius is so precise that we shall give it in lieu of all the others. The alphi, he says, are superficial, but sometimes extend in depth, so that the hairs appear of the same colour. The white species is tried as to the depth it has spread, by being pricked moderately with a needle; when blood flows though the needle has only penetrated the skin, the disease is curable, but if the discharge be milky it is incurable, inasmuch as the flesh is converted into the disease. Others, he adds, rub the part with rough towels, and if it become red they have good hopes, but if it remain of the same colour they abandon all hopes of recovery. They are of a more aggravated nature when they affect different parts of the body and are inveterate. The alphi, he says, are generally milder than leuce, and can be cured by gentler means, but when they become inveterate they require similar treatment. The difference between the white and the black alphos is produced by the colour of the prevailing humour.

There is scarcely any difference of opinion among the authorities respecting the general plan of treatment. Haly Abbas has correctly remarked, that the alphi are to be cured by the same sort of remedies as lepra (leuce?) only that they do not require so strong applications. The Arabians greatly commend their myrobalans with ginger, mastich, parsley, &c. Their internal applications are powerful detergents and escharotics, such as hellebore, natron, sulphur, vinegar, arsenic, copperas, &c. Celsus says nothing of internal remedies, but recommends external applications of a stimulant nature, containing sulphur, alum, nitre, frankincense, alcyonium, &c. In the ‘Isagoge’ it is said that all these complaints are to be cured by phlegmagogues, and by abstergent applications externally.

Guy of Cauliac, and the other medical authorities of that age, describe these diseases by the names of Morphea alba and M. nigra. They recommend applications containing sulphur, alum, natron, arsenic, and the like. As usual they are the mere copyists of the Arabians.

SECT. VII.—ON STIGMATA, FROM THE WORKS OF ARCHIGENES.

You may remove stigmata by rubbing in that which sticks to a chamber-pot, along with the most acrid vinegar, or rub of quicklime, p. j; of red natron toasted, p. ss; with water, in the sun: but when it ulcerates let it be healed like an ulcer. But Crito says, for stigmata, having first scrubbed the part with nitre (soda), cover it with an application of turpentine; then having bound it, let it remain for six days, and on the seventh perforate the stigma with a needle, and having wiped away the blood with a sponge, after a little time rub with some powdered salt. Then, having applied the medicine, allow it to remain for five days. It is this: of frankincense, of natron, of the lye of quicklime, of wax, of each, dr. iv; of honey, dr. viij; having loosed it, you will find the blackness upon the application.—Another ointment: Of pepper, dr. ij; of rue, dr. iv; of realgar, dr. iv; of orpiment, dr. j; of honey, q. s. Anoint with it, have previously scrubbed the part with natron, and done otherwise in like manner as for the former. Taking it away after three days, and cleaning away the blackness, anoint with it again; for, he says, it removes the complaint in twenty days, without ulceration or cicatrix.—Another called Criticum: Of frankincense, dr. iv; of nitre, dr. ij; of copperas, dr. iv; of wax, dr. vj; of pepper, dr. iij; of lime, dr. iij; of thapsia, dr. iij; of orpiment, dr. iss; of realgar, dr. iij; of honey, q. s; use as the former. Oribasius says, that crowfoot (ranunculus) if applied, or the leaves of capers, take away the marks. But if they be deep seated upon only a small extent of skin, form an eschar by a cold cautery, and thus remove them.

Commentary. Consult Aëtius (viii, 12); Actuarius (Meth. Med. vi, 8); Scribonius Largus (§ 231); Avicenna (iv, 7, 2, 7); Pseudo-Dioscor. (Eupor. i, 116.)

Aëtius explains that by stigmata are meant the marks of injuries on the face or any part of the body. To eradicate them he recommends compositions containing quicklime, natron, arsenic, &c.

The Pseudo-Dioscorides recommends the ranunculus, the juice of the leaves of capers, or that of mandragora, &c.

Actuarius copies from our author.

Scribonius Largus mentions a composition containing garlic, cantharides, sulphur, chalcitis, &c.

Avicenna recommends friction with natron and the other substances mentioned by our author.

Dr. Willan defines the stigma, “a small speck on the skin, occasioning no elevation of the cuticle.” The ancient authorities, it will be perceived, apply the term in a wider sense.

SECT. VIII.—ON EXANTHEMATA.

Exanthemata are formed by thick humours impacted in the skin, and more especially if the cuticle be thick. In these cases, then, even if the humours are deep-seated, they must be first purged away; for unless you do this in the first place, before attempting to dispel them, you will only impact them the more firmly, instead of evacuating them by the skin. But if the deep-seated parts be free from crudities, you may evacuate the humours by the skin, and not produce revulsion of them to a distance, which is the case, if you attempt to evacuate them by the belly or emetics. But the cure of humours fixed in the skin, is to be accomplished by fomentations and calefacients, more especially when the exanthemata happen to be broad, for these are formed by a cold and thick humour. Wherefore, take of the tender leaves of bay, of manna, and of rue equal parts, triturate together, and dissolving frankincense in honey, anoint with it; or, having boiled and pounded tender beet, apply as a cataplasm; or, take of wax, dr. viij; of sulphur the same quantity; of salt, dr. vj; triturate them dry, and having poured on them half a cyathus of oil, boil all together, and use the plaster that is formed. But one must attentively sit by while the boiling is going on. It is a very excellent medicine.

Commentary. See Hippocrates (Epidem. et alibi); Galen (Meth. Med. v); Alexander (i, 5); Oribasius (Synops. vii, 7); Morb. Curat. (iii, 21); Aëtius (v, 129); Actuarius (Meth. Med. ii, 11; i, 23); Celsus (v, 28); Pseudo-Dioscor. (Euporist. i, 106); Haly Abbas (Theor. viii, 17; Pract. iv, 8).

As stated in another place, the Greeks used the term exanthema in a much laxer signification than it is applied in Dr. Willan’s ‘System of Cutaneous Diseases.’ Hippocrates in particular may be mentioned as applying it to various classes of these affections. Alexander describes the exanthemata of the head as superficial ulcerations, which are red and rough. Does he allude to porrigo? He recommends for the cure of them a composition of litharge, ceruse, alum, the green leaves of rue, vinegar, and myrtle oil.

Galen says that exanthemata is a term applied by some to all ulcerative and rough affections of the skin, which, according to Archigenes, stand in need of desiccative applications. In another place he mentions the exanthemata as a common symptom of the plague. Aëtius in like manner gives from Herodotus an interesting account of fevers which are accompanied with exanthemata. Both have been supposed to allude to the smallpox, but we agree with Dr. Willan, that this interpretation of their descriptions is altogether fanciful.

Our author follows Oribasius closely.

According to Actuarius exanthemata, properly speaking, are produced by thick humours either formed in the skin or in the whole body, and being detained by the density of the epidermis.

Celsus describes the exanthemata under the generic term pustulæ. His words are: “Earum plura genera sunt. Nam modo circa totum corpus partemve asperitudo quædam fit, similis iis pustulis, quæ ex urticâ, vel ex sudore nascuntur: ἐξανθήματα Græci vocant. Eæque modo rubent, modo colorem cutis non excedunt.” For pustules of all kinds he recommends exercise, restricted diet, and abstinence from all things of an acrid and attenuant nature, which regimen is likewise to be enforced upon the nurse, if the child be at the breast. If the patient be strong, he is also to be put into the hot bath, and rubbed with natron and a mixture of wine and oil. If this treatment does not succeed lentils are to be applied, especially if the pustules be large; and after the outer skin has been removed they are to be treated with gentle applications. Such is the plan of cure recommended by the great Roman authority. His directions respecting the diet are particularly important, and appear to be quite in accordance with the practice of the modern physicians, who recommend the half-starving system in all such complaints.

For red exanthemata the Pseudo-Dioscorides recommends ceruse with oil of bays and sulphur, pure bark with wax, &c.

The exanthemata are described by the name of pustulæ parvæ in most of the translations of the Arabians. The exanthemata is, we think, the first species of Serie described by Haly Abbas.

For the opinions of Alsaharavius and Haly Abbas about the exanthemata of infancy, see [Book i, 6].

Dr. Willan thinks that the nettle-rash was comprehended under the term exanthemata. He is also of opinion that the benat noctis of Avicenna is the nettle-rash. It would appear, however, that the benat noctis was the same as the sera or epinyctis. See Rhases (Cont. xxxvi, 2). The symptoms of it are said to be itching, roughness of the skin, and small eruptions attacking the patient during the night.

Thucydides, Hippocrates, and Galen mention exanthemata as a common symptom of the plague.

We may take the present occasion to mention that none of the Greek or Latin authorities has given any distinct account of purpura. Avicenna has briefly described it in its chronic form. (iv, 3, 1, 8).

SECT. IX.—ON EPINYCTIDES.

Epinyctides are small ulcers breaking out spontaneously on the skin, in the form of bullæ, reddish, and when broken, discharging a bloody ichor. These are not very troublesome during the day, but at night, they are more painful than the smallness of the ulcer would bespeak. Wherefore, having dissolved the juice of laserwort in water, apply it; for it is desiccative without being pungent; or, having levigated hemlock, apply it; or crude cabbage with water, or triturate parsley with polenta, and apply; or, triturate the leaves of henbane with honey, and apply; or, strychnos by itself, and with the green coriander; or, use the leaves of olives boiled with water; or, having triturated raisins deprived of their stones, and spread them upon a splenium or oblong pledget, apply; or triturate maiden-hair with honey. They must avoid all acrid, acid, and saltish things, also fomentations, baths, and insolation.

Commentary. Celsus (v, 28); Aëtius (xiv, 61); Oribasius (Morb. Curat. iii, 54); Actuarius (Meth. Med. ii, 11; vi, 8); Pollux (Onomasticon iv, 24); Avicenna (iv, 3, 1, 13); Serapion (v, 8); Haly Abbas (Theor. viii, 17); Pract. (iv, 8); Rhases (Divis. i, 122.)

Celsus describes the epinyctis as a bad species of pustule, somewhat livid or red, about the size of a bean, very painful and inflamed, and coming on principally at night, whence it derives its name. Persons of all ages, even infants at the breast, are subject to it, and in treating them he directs the regimen of the nurse to be properly attended to. In laying down the rules of treatment he puts particular stress upon the hot bath.

Aëtius, Oribasius, and Actuarius treat of it as our author. Pollux defines it to be a vesicle of a palish colour, somewhat humid and bloody, and forming about the legs and feet in the night.

The Arabians give a similar account of epinyctis, under the names of Sare, Serie, and Essere. Thus Serapion recommends bleeding if required by the general symptoms, purging with myrobalans and prunes; and external applications, containing sumach, savin, &c. Haly Abbas, who describes it as one of his serie, approves of much the same treatment. Avicenna and Rhases in like manner recommend bleeding, gentle purgatives, cooling lotions, and the tepid bath. Rhases, in his ‘Continens,’ applies the directions given in this chapter by Paulus to the treatment of the cutaneous disease, which he calls sera. This establishes their identity (xxxvi, 6.) As stated in the preceding chapter, the epinyctis is also the “benat noctis,” i. e. “filia noctis” of the Arabians. Marcus Aurelius Severinus, therefore, is mistaken in distinguishing between the epinyctis and the benat noctis. Ingrassius admits their identity.

Fracastorius gives the following account of this affection: “Si inflammata et accensa sit cholera, pustulam illam facit, quæ ἐπινυκτις vocatur, quod sæpissime noctu nascatur, Arabes Essere appellant.” (De Morb. Cont. ii, 15.) Both Lorry and Rayer confess themselves unable to determine what the epinyctis of the ancients was. It would appear to have been some peculiar species of eczema, now extinct. It must have been a more formidable disease than the nettle-rash, which certain modern authorities have taken for the epinyctis of the ancients.

SECT. X.—ON PHLYCTÆNÆ OR BULLÆ.

As Bullæ when they burst spontaneously are attended with acute pain, it is proper to perforate at their under part with a sharp needle, and then to squeeze out the humour gently, suffering the skin which covers it to remain. And if the wound should close up and the bullæ fill up, it is to be evacuated again in like manner, and pressed out; and the incumbent skin is to be kept pressed down until the ulcer below be healed. Before the bullæ break, apply boiled lentils triturated with water; or, the shoots of pomegranate, having been warmed upon hot coals, are to be applied, so as to burn the parts. But if they burst and form an ulcer, having melted axunge, and mixed levigated litharge, put into a linen cloth, and apply; or, having boiled the root of lily in water, triturate it with cerate, and apply.

For epinyctis and phlyctæna. Having triturated equal portions of litharge and sulphur vivum with vinegar and myrtle-oil, until it become of the thickness of the sordes of baths, rub with oil and wine. For hot eruptions, warm papulæ, achores, incipient furunculus, and burns, the composition of plumbago, and that from eggs is applicable.

Commentary. See Aëtius (xiv, 63); Oribasius (Morb. Curat. iii, 23); Actuarius (Meth. Med. vi, 8); Avicenna (iii, 3, 1, 11.)

This appears to be the pompholyx of Drs. Willan and Bateman. Aëtius remarks, that the disease principally attacks women whose menses are obstructed. (Bateman says, “it seems to affect only women.”) He recommends emmenagogues, laxatives, and diuretics, and forbids all acrid things.

Our author copies the whole from Oribasius. Actuarius recommends nearly the same applications.

Celsus describes the phlyctænæ as a variety of the pustulæ. There is nothing particular in the treatment recommended by Avicenna.

Thucydides mentions small phlyctænæ and ulcers among the symptoms of the plague of Athens. (De Bello Pelopon. ii.) Hippocrates gives the name of pemphyx to the cutaneous eruption, by which the plague of Athens was distinguished. (Epidem. vi.) See Galen’s Comment. (v, 453, ed. Basil.) Procopius also takes notice of black phlyctænæ among the symptoms of the great plague which raged in the reign of Justinian (Pers. ii.) See also Diodorus Siculus (Biblioth. xiv.) Some suppose, however, that by phlyctænæ were meant petechie. See Prælect. Marc. p. 301.

SECT. XI.—ON BURNS.

Burnt parts require applications which are moderately detergent, without being decidedly heating or cooling. Wherefore, Chian, Cimolian, Cretan, and every light earth, when rubbed in with vinegar not very acrid, or mixed with water, are excellent applications, and prevent blisters from forming; also a whole raw egg immediately applied upon soft wool, for it cools moderately, and dries without being stimulant. And anoint the part with black ink, or with frankincense dissolved in water, or use a cataplasm of boiled lentils, or of tares. For burning with hot water, before blisters arise, pour frequently on the part the brine of pickled olives, or apply olives themselves triturated with polenta; or, triturate stone-alum with vinegar, and rub it in; or, anoint with bull’s gall dissolved with much water; or, pour on the part strained ley with sauce of pickles, or brine; or, triturate the bulbous roots of lilies, hyacinths, or narcissi with rose-oil, and having made it of the consistence of the sordes of oil in baths, anoint with it. But Marcellus gives the following composition: having smeared a rag with honey, and wrapped it around barley, burn it, and mix of the ashes, dr. viij; of ceruse, dr. iv; of butter, dr. viij; of wax, dr. xvj; of goat’s fat, dr. xvj; of rose-oil, dr. xvj. For burnt parts already blistered, having triturated sumach and polenta with vinegar, apply it; or, mix quicklime with cerate, put it on a rag, and apply. And the medicine called Sphæria is applicable in such cases. The parts which are ulcerated, may be covered with pounded leeks; or, triturate purslain with polenta, and apply; or, put pigeon’s dung into a rag of linen, burn it, and mix the ashes with oil, and use; (this is an excellent application:) also the bark of pine and of spruce fir, or dried maiden-hair levigated, or the burnt leaves of myrtle, are to be triturated and sprinkled upon the part. Each of these things answers well, when applied with cerate. But a good application is formed by triturating together of the dried roots of the red alkanet, oz. iv; of white wax, oz. ix; of rose-oil, oz. xviij; and also that made of ceruse, with a small quantity of stag’s marrow.

Commentary. See Hippocrates (de Ulceribus.) Celsus (v, 27); Galen (de Simpl. Med. et alibi.) Aëtius (xiv, 64); Pseudo-Dioscor. (Euporist. i, 178); Actuarius (Meth. Med. vi, 6, 8); Nonnus (240); Serapion (v, 11); Avicenna (iv, 4, 2, 12); Haly Abbas (Pract. 4, 25); Alsaharavius (xxix, 2, 8); Rhases (Antid. i, 27); (ad Mansor. vii, 18); (Div. i, 136.) The author of the Hippocratic treatise referred to above, recommends various applications to burns, such as old axunge rubbed into the part, and the root of squills applied above; or a mixture of old axunge, rosin, and bitumen, spread upon a rag and heated at the fire; or the roots of the ilex boiled in white wine at a gentle fire until it be of the consistence of a liniment.

Dioscorides, Avicenna, and Galen, agree in praising Cimolian earth as an application to recent burns. Galen says that copperas, especially when dissolved in vinegar, forms an excellent application for the ulcers occasioned by burning.

Aëtius treats burns upon nearly the same principles as our author. When blisters rise he forbids an early opening to be made in them. As an application to them he recommends alum with water and the white of an egg. Some of his applications can only be supposed proper for the foul ulcers left by burning. Such is that consisting of verdigris and litharge, pounded with wine and oil. For healing ulcers he recommends a composition containing ceruse, litharge, toasted barley pounded, wax, and rose or myrtle oil.

In the ‘Euporista’ Cimolian earth, litharge and oil, and many other applications are recommended.

Actuarius recommends a composition of litharge, ceruse, wax, turpentine, and some other articles of less importance. We need scarcely mention how much the oil of turpentine has been used of late in such cases. He praises such things as are moderately astringent, such as alum dissolved in vinegar, &c.

Celsus recommends at first such things as are, “mediocriter exedentia reprimentiaque,” and afterwards articles of a soothing nature. To the former class belong the farina of lentils and honey; myrrh with urine, or the Cimolian chalk, with the bark of frankincense; and to the latter belong all fatty applications, and such things as contain the dross of lead and the yelks of eggs. He also mentions turpentine rosin, as an application to foul ulcers from burning.

Serapion, like our author, recommends applications which are moderately detergent, and neither very calefacient nor refrigerant. He gives the following directions for making a preparation from lime. Take of lime, seven times washed in sweet water and dried, oz. viij; of wax, oz. ij; of oil of roses, oz. vj: let the wax be melted along with the oil, and well mixed with lime. This is to be rubbed into the part. He also gives a prescription for preparing a mixture of lime-water and oil, exactly similar to that which is now used in cases of burns. (vii, 28.) Avicenna, with his usual accuracy, lays down very particular rules for the treatment of burns. To prevent blisters from rising he recommends cooling things; when the burning is occasioned by hot water, he directs us to apply sandals, rose-water, and camphor: or a cloth dipped in congealed water is to be kept constantly applied, and it will prevent blisters from rising. Most of the applications recommended by our author are also mentioned by him. Haly Abbas directs us to apply a cloth cooled in rose-water. He also speaks of the ointment of lime and rose-oil, mentioned above. When the burning is not severe, Alsaharavius directs us in the first place to wash the part with vinegar and salt, and then to sprinkle upon it the flour of barley or of oats. Then if blisters do not rise, but there is a sensation of burning in the part, he recommends us to apply cloths dipped in cold water, rose-water, or snow-water, which are to be changed frequently. Afterwards some emollient applications, such as the white of an egg, with gum arabic is to be used. When the burning is more severe, he recommends us to bleed and use a cooling application, such as the brain of a sheep, the white of an egg mixed with rose-oil, or an ointment made of white wax and rose-oil. He also makes mention of the application from lime. Rhases recommends an ointment containing ceruse, camphor, opium, &c. Like Avicenna, he directs us to apply at first a cloth wetted in cold water, or in rose-water, which has been cooled with snow. If the burning be extensive he recommends venesection, with a cooling and attenuant diet. When the pain is great he directs us to apply the yelks of eggs mixed with rose-oil. When a large ulcer is formed, he directs us to dress it with the ointment of lime, described above. He also approves of a white ointment, consisting of ceruse, oil of roses, and wax. In his ‘Continens,’ he relates a case of severe burning, which he treated with liniments composed of sandals, camphor, and roses; a cloth wetted in snow-water being applied externally to it. He approves of opening the blisters. To prevent them from forming, he recommends strongly an astringent collyrium of galls. Like many of the other authorities, he recommends Cimolian earth very much. The applications recommended by Haly Abbas are of a refrigerant and cooling nature, such as Armenian earth in vinegar, the white of an egg, ceruse, &c.

The earlier modern authors treat burns upon the plan laid down by the ancients, more especially the Arabians. Thus Guy, of Cauliac, recommends us in cases of extensive burning to have recourse to venesection, along with a cooling and attenuant regimen. As a local application, he recommends a cloth wetted in rose-oil congealed in snow, and afterwards cooling ointments containing ceruse, litharge, and the like. He approves of opening the blisters, of afterwards dressing the part with desiccative remedies, such as the ointment of lime, seven times slaked. (Tr. vi, Doct. C. 6.)

SECT. XII.—FOR THOSE BEATEN WITH SCOURGES.

Take of ceruse and litharge equal parts, of wax four parts, use as a plaster with the oleum susinum, or rose-oil; but on the first day use the susinum separately; or, of saffron, dr. j; of tragacanth, dr. j; unite with them a whole egg, without the shell, and use. For those who have been scourged, the skin of a sheep newly taken off, when applied while yet warm, of all remedies cures the soonest, effecting this purpose in a day and a night.

Commentary. See Aëtius (xiv, 62); Avicenna (iv, 4, 2, 7); Haly Abbas (Pract. iv, 26); Alsaharavius (Pract. xxxi, 2, 1); Rhases (Contin. xxviii.)

Aëtius gives similar directions. The following is said to be an excellent application for the stripes of a whip: mix washed lime with raw eggs, and add some rose cerate. Aëtius, Galen, Nonnus, Avicenna, Rhases, Haly Abbas, and Alsaharavius join our author in recommending the fresh skin of a newly-killed sheep as an application in such cases. Alsaharavius recommends an ointment containing white wax, rose-oil, and ceruse, when the wounds are deep; when there is any apprehension of heat and inflammation, and more especially if the patient be plethoric, he approves of venesection. When on the other hand the patient is weak, and is in danger of falling into a state of syncope, he recommends musk and wine to be administered. When there is much appearance of ecchymosis he speaks of scarifying the part after the heat is gone. Rhases recommends a composition of ceruse, litharge, wax, and rose-oil, as a general application.

Most of the applications recommended by Bertapalia contain litharge, ceruse, tutty, wax, and oil. (De Ulceribus, 16.) The other earlier medical authors of modern times likewise follow the ancients in this case.

SECT. XIII.—TO MAKE HAIRS GROW ON A PART THAT HAS BEEN BURNT.

Hairs grow on a burnt part if you apply fig leaves boiled in a pot with cerate, in the form of a plaster; or, of dried fig, dr. viij; of marjoram, dr. j; triturate with oil to the thickness of a cerate, and use; or, of gypsum, dr. c; of squama æris, dr. j; form trochisks with water, and keep. When going to use, mix one part with eight parts of cerate.

Commentary. The Arabians mention various things which were supposed to be possessed of the property of making hairs grow; such as turpentine, spikenard, thapsia, &c.

SECT. XIV.—FOR EXCORIATIONS.

For excoriated surfaces and superficial ulcers, at first use astringents, such as wine, or vinegar and brine, and afterwards such plasters as contain fat and promote cicatrization, and the most delicate of the white plasters. This is particularly applicable: of ceruse, p. j; of ammoniac, p. ss; of myrtle-oil, q. s; having triturated the ammoniac in water, mix the ceruse, adding the myrtle-oil, and use in an oily state: or, mix the squama æris with gypsum, and having triturated with myrtle-oil, use: or, having triturated Cimolian earth and litharge with wine, and the oleum ricini, or myrtle-oil, use.

For excoriations, intertrigo, chronic ulcers, and old and tender skin. Of golden-coloured litharge, dr. lx; of wax, dr. xx; of dried pitch rosin, dr. xij; of oil, iss cyathus: having boiled the litharge and the oil, add the other things, and having agitated it with a spatula, or softened it in a mortar, use. Skin which has been torn away, ought not to be cut from the sores, but it ought to be laid on, and the medicine applied; for thus they coalesce, even if it is black. When stripped of the skin, the cicatrization is difficult, the ulcer being irritated and rendered foul. Excoriated parts are preserved from inflammation by the application of red sumach, triturated with honey, or with the hair of sweet flag burnt and applied with honey.

An anodyne for excoriations, sores from stripes, and contusions of the joints. Of litharge, of ceruse, of each, oz. j; of wax, oz. vj; of pure oil or rose-oil, lb. iss; of starch, oz. ij. The composition called pelarium, from the dross of silver, produces the same effects, and that from eggs in like manner.

Commentary. See Oribasius (Morb. Curat. iii, 18); Aëtius (xiv, 66, 67); Scribonius Largus (88); Marcellus (De Med.); Avicenna (iv, 4, 2, 9); Haly Abbas (Pract. iv, 10); Rhases (ad Mansor. vi, 18.)

Our author copies closely from Oribasius.

Aëtius recommends as a good application for intertrigo occasioned by the friction of shoes, the warm liver of a pig or lamb, or unwashed wool. Here he follows Dioscorides (ii, 37.) He also makes mention of several cooling applications, containing ceruse, litharge, the dross of lead, &c.

Scribonius Largus recommends an ointment containing litharge, ceruse, the flour of frankincense, alum, axunge, old austere wine, roses, and sour oil.

Marcellus also recommends litharge for intertrigo.

The Arabians treat these cases similarly. Thus Avicenna agrees with Aëtius in recommending the liver, and the ointment containing ceruse, &c. For bruised parts he recommends astringents; such as galls, acacia, &c.

To relieve the heat and irritation occasioned by riding, or any such cause, Rhases directs us to apply a cloth dipped in rose-water properly cooled, he means, perhaps, with ice. After the heat and pain have been removed, an ointment of ceruse, or litharge is to be applied. Blisters produced by walking are to be opened and then washed with rose-water; and afterwards they are to be dressed with an astringent application, containing Armenian bole, galls, pomegranate flowers, or the like.

SECT. XV.—FOR MYRMECIA AND ACROCHORDON.

Each of these is a small rising of the skin, of a callous nature, and for the most part circular; but the myrmecia have a broad base, and when rubbed, convey a sensation like the bites of ants. But the acrochordon has a narrow base so as to seem to hang, resembling the extremity of a cord. Wherefore, elaterium with salts, when applied, removes these swellings; and frankincense with vinegar, green figs with vinegar, flour and natron, the juice of the fig rubbed in, and in like manner, that of the spurge, the pickled head of picarel burnt, verdigris burnt with sulphur vivum, the leaves of basil with copperas; that which flows from green vine shoots when burning, sheep’s dung with vinegar, a buck-goat’s gall when rubbed in, the fruit of the large sun-flower, when applied with wine, rue with natron and pepper, natron with the urine of a youth not come to puberty, the dung of an ox of the herd in vinegar.

Commentary. See Celsus (v, 28); Galen (Meth. Med. xiv); Aëtius (xiv, 4); Oribasius (Morb. Curat. iii, 55); Actuarius (Meth. Med. vi, 8); Pollux (Onomast. iv); Avicenna (iv, 3, 1, 6); Rhases (Divis i, 131, et seq.; ad Mansor. vii, 15, 16.)

Celsus defines these tumours in the following terms: “Ἀκροχορδόνα Græci vocant, ubi sub cute coit aliquid durius, et interdum paulo asperius, coloris ejusdem: infra tenue, ad cutem latius: idque modicum est quia raro fabæ magnitudinem excedunt. Vix unum tantum eodem tempore nascitur; sed fere plura, maximeque in pueris; eaque nonnunquam subito desinunt; nonnunquam mediocrem inflammationem excitant; sub quâ etiam in pus convertuntur.” He then describes the θύμιον to be about the size of an Ægyptian bean, and of the colour of thyme. He adds: “Μυρμήκια autem vocantur humiliora thymio durioraque: quæ radices altius exigunt, majoremque dolorem movent: infra lata, supra autem tenuia; minus sanguinis mittunt; magnitudine vix unquam lupini modum excedunt. Nascuntur ea quoque aut in palmis aut in inferioribus partibus pedum.” The acrochordon, he says, if cut out, leaves no roots, and does not grow again. This is not the case with the myrmecia. For it he recommends an application consisting of alum and red arsenic.

Galen describes minutely the method of extracting these tumours; but that belongs more properly to the surgical part of this work.

Applications containing arsenic, chalcitis, quicklime, elaterium, sulphur, and alum are mentioned by Oribasius and Aëtius. See in like manner the ‘Euporista’ of the Pseudo-Dioscorides.

The myrmecia is generally rendered formicaria by the Latin translators of the Greek medical authors, and formica miliaris by those of the Arabians. Avicenna seems to confound the myrmecia with the herpes.

Pollux defines the thymus, or thymium, to be an excrescence about the pudenda, anus, fingers, or face, of a red colour, rough, bloody, and not difficult to remove. The acrochordon, he says, is white at the root, and it gets enlarged at the extremity. The myrmecia he defines to be a hard, rough excrescence of a callous nature, but bloody at its extremity.

The acrochordon is thus described by an intelligent modern author: “Est verruca subcutanea durior et asperior, callosa, atque plerumque teres, cute concolor, in basi tenuis, summitatis vero latioris, fabæ magnitudinem raro excedens, juniores maxime infestans.” (Mangeti Bibl. Chirurg. i, 72.) The terms thymus, myrmecia, and acrochordon, have now fallen into disuse.

SECT. XVI.—ON GANGLION.

Ganglion is a round tumour of a nerve (tendon?) arising from a blow or pressure, in many parts of the body, but particularly in those parts which are moved, such as the extremities of the hands and feet. In this case, says Archigenes, apply quick lime with the grease of geese and turpentine. But Poles uses the medicine from agate stone, and Oribasius the following: of ceruse, of pine rosin, of old oil, of each, oz. j; of ammoniac perfume, of galbanum, of each, oz. j; of wax, oz. iv; or, he says, apply a thick plate of lead, like the vertebræ, and larger than the ganglion, and bind it on; for by its weight this dissolves it in process of time. This we have used.

Commentary. See Hippocrates (De Artic. xxvi); Galen (Comment., de Med. Simpl. ix); Celsus (vii, 6); Oribasius (De Virt. simpl. ii, in voce Plumbum); Aëtius (xv, 9); Actuarius (Meth. Med. ii, 11); Avicenna (iv, 3, 2, 6); Albucasis (Chirurg. ii, 50); Rhases (ad Mansor. vii, 15: Contin. xxviii.)

Hippocrates points out the danger of opening these tumours indiscriminately. They consist, as Galen remarks, of a viscid and mucous fluid. Galen and Oribasius agree with our author in directing a piece of lead to be bound upon the ganglion. Nearly the same plan of treatment is recommended by Aëtius, who directs us to bind a piece of lead upon the tumour, and after some days to remove it, when the ganglion will be found much softened; it is then to be squeezed firmly between the thumb and the fingers, by which means it will be speedily dissolved. Albucasis approves of extirpating the tumour, unless it be seated near a joint. Rhases as usual collects the opinions of all preceding authorities. Antyllus, he says, directed the surgeon to break the sack, or to bind a heavy plate over it, or to extract it by the knife. When an operation is attempted, he recommends that the surgeon be sure that he has removed the whole sac. He relates a case in which the swelling was dissolved by an application containing mustard.

SECT. XVII.—ON PHLEGMON.

In general, we call all those swellings phlegmons which are red and painful, and accompanied with heat; some diversity of their nature arising from the cause which occasions them. For when good blood and of moderate consistence rushes abundantly to a part and from its quantity becomes seated in it, the disease is that which is properly called phlegmon; but when yellow bile is seated in a part, it is called herpes; and when blood and yellow bile together are collected in a part, erysipelas is formed; but when in this case the blood is hot and thick, it usually gives rise to carbuncle. Wherefore, we shall begin with what is properly called phlegmon, which occurs in many cases, being a swelling which is red, painful, elastic, and hot, deriving its origin, as I said, from good blood which is sometimes collected from the whole body, and sometimes is formed abundantly in the part itself, so that it cannot be contained in the vessels, but escapes from them in the form of vapour into the surrounding cavities. And this affection supervenes upon wounds, fractures, ulcers, and many other causes. When therefore a part becomes inflamed without any obvious cause preceding it, the whole body sending a defluxion to the part, we must evacuate the general system by venesection, and apply to the part embrocations and cataplasms, not such as are of a heating and moistening nature, but such as are calculated to repel the fluid, which is flowing to the part, and evacuate that which is already contained in it. Apply, therefore, a cataplasm of house-leek, and of the bark of the pomegranate tree boiled in wine, with sumach and polenta: when the pain is not violent, this or such like applications are to be used; but when there is a defluxion to the part with greater pain, then cataplasms of hot water and oil, or of polenta, must not be applied (for all these are inimical to such defluxions); but the vehemence of the pain is to be allayed by that which is composed from musk, rose-oil, and a little wax, with unwashed wool containing much grease: these things are to be prepared and applied cold in summer, but tepid if in winter, so that the parts above the affected places be covered with a sponge soaked in austere wine or cold oxycrate. But we must add to the cataplasms such herbs as are proper for the purpose required. Pellitory of the wall, therefore, is applicable to every phlegmon at the commencement, and while on the increase; and in like manner, horned poppy, orach, mallows, lettuce, and gourd, when applied on hot parts. Both kinds of caltrops (tribuli) are applicable to inflammatory defluxions, and the cabbage to such as are hard. When a change is thereby effected, and no pus falls into the part, you may accomplish the cure by means of the plaster from chalcitis, or some of those plasters of a similar nature, which apply to defluxions; but clean wool soaked in austere wine is to be put externally to the medicine. In this manner you may cure phlegmons from defluxion. But such as are occasioned by any external cause will not be injured by moistening and heating applications, and if necessity require, you may scarify them with advantage. But in phlegmons arising from defluxion, scarification, more especially at the commencement, may become the cause of much mischief to the patient.

Commentary. See Galen (ad Glauc. ii); de Different. Morb. (12); Meth. Med. (xiii, 2); Celsus (iii, 10); Oribasius (Morb. Curat. iii. 41); Aëtius (xiv. 31); Leo (vii, 4); Actuarius (Meth. Med. ii, 12); Avicenna (iv, 3, 1, 2); Serapion (v, 22); Haly Abbas (Theor. viii, 9; Pract. iii, 27); Alsaharavius (Pract. xxix, 2); Rhases (Divis. 126, and Contin. xxvii.)

Galen explains that the term phlegmone is used either to signify inflammations in general, or a red, resisting, and painful tumour in particular. It is here used in the latter acceptation. He says, when a defluxion of blood of good quality and of moderate consistence takes place to a part, and from its quantity becomes fixed in it, the person is seized with a violent pain, unless the part be very insensible; it is also accompanied with a deep-seated throbbing; it seems stretched and broken; there is a sensation of increased heat, so that the part feels as if it were burnt and desires cooling; there is a florid redness as in those who have been in the bath, or have been warmed at the fire, and by other means. This affection, he says, gets the generic appellation of phlegmone, or inflammation. He enumerates many causes of it, such as bruises, fractures, and dislocations; but even without these, he adds, it may arise from the veins being immoderately distended with humours, and the superfluity being cast off upon a part fitted to receive them at the time. Such a part, from some cause or other, happens to be weaker, or more lax, or more calculated to attract, or is more inactive than the other parts of the body. He lays it down as a general principle, that the cure of such affections is to be accomplished by evacuation. Reason and experience, he adds, teach us that the general system is to be evacuated by the suitable means, and the inflamed part by embrocations and cataplasms of a repellent nature, and such as are calculated to give tone and strength to it. Such are his general principles of treatment. His particular remedies we need not mention, as in fact our author’s are entirely borrowed from him. Oribasius, Aëtius, Actuarius, and Nonnus, in like manner, borrow from him everything which they advance upon this subject.

Celsus does not treat of phlegmon in particular, but he has given an excellent account of inflammation in general. His definition of inflammation is singularly appropriate: “Notæ inflammationis sunt quatuor, rubor, et tumor, cum calore et dolore.” Isidorus attempts the same not so successfully: “Phlegmone est fervor cum extensione et dolore; sive est inquietudo cum rubore, et dolore, et extensione, et duritie, et vastitate: quæ quum cæperit fieri, inquietudo et febris insequitur.”

Avicenna gives a clear and comprehensive exposition of the doctrines of the Greeks, but supplies no new information. He is at pains to explain that the term phlegmon applies generally to every inflamed part; and also to a hot aposteme in particular. He joins Galen in recommending a free incision when it is apprehended that the member in which it is seated will become corrupted. Serapion’s treatment is nowise dissimilar. A phlegmon, says Haly Abbas, is a sanguineous collection, arising either from an external cause, such as a bruise, a blow, a wound, or the like, or from an internal cause, namely, a defluxion upon the part. He attributes the collection which takes place in a part to its debility, which makes it unable to cast off the load which is thrown upon it. When seated in a vascular part, phlegmon, he says, is attended with a throbbing pain. He approves of free and bold incisions. Alsaharavius treats of phlegmon at great length, but there is nothing original in his views. Rhases recommends at first bleeding, purging, and applications of a cooling and astringent nature. But when suppuration has commenced he properly forbids depletion, lest it only protract this process. He remarks that phlegmons are often occasioned by disorder of the stomach, and the use of too much food and drink. He recommends in general maturative applications, to which, if necessary, narcotics may be added.

SECT. XVIII.—ON EXTERNAL ABSCESSES.

If it appear to you impossible to prevent suppuration, boil bread in water and oil, and apply it as a cataplasm; or apply barley flour prepared in like manner; and bathe the part with an infusion of marshmallows. But when the swelling is difficult, either to convert into pus or to dissipate, you may use a cataplasm of dried figs. But sweet and fat figs are to be dissolved by boiling in water, and made like thin honey, and barley flour added to it. And if the swelling is resolved but imperfectly, you may boil with the figs hyssop or marjoram; or, if you wish to increase its strength, add salts to the decoction. But you must attend that the part be not dried too much, for thus will it be rendered hard. If you perceive any such thing, you must boil with the water the root of wild cucumber, or of marshmallows, or of bryony. But the root of the dracunculus is stronger than these and more discutient; and the medicine formed from the dracunculus itself is very discutient. Sometimes, therefore, you may apply decoctions of these things alone; but at other times you may add dried figs, and mix polenta with fat. And the oil of dill is discutient, and adapted for concocting crude humours, and unconcocted swellings. And pitch, more especially the liquid, concocts all hard and unconcocted swellings, when added to the cataplasms. A compound medicine for procuring the discharge of the concocted matter of abscesses, so that often the pus is found on the pledget; and for thoroughly discussing what is not concocted: of pyrites, of levigated ammoniac, of each, dr. xij; of the flour of beans, dr. vj; add to liquid pitch, and spread upon skin, and apply. But do not take away the pledget until it fall off spontaneously. The medicine must not be prepared long beforehand, as it soon becomes dry. When the tumour is no wise dissipated by these means, and matter falls into it, it is to be opened, and the matter evacuated, taking care not to apply to it water or oil; or, if it be necessary to clean the sore, it must be done with honied water, oxycrate, wine, and wine and honey; and if it become inflamed, the cataplasm of lentils is to be applied; but if it is not inflamed, we may use some of the plasters to such openings, more especially that from chalcitis; but apply to them sponge or wool soaked in austere wine. But to the wound itself, do not apply any of the oily ointments, such as the tetrapharmacon, for it stands much in need of being dried.

Those things which open abscesses. Since some persons will not endure to have abscesses opened with iron, we must endeavour to have recourse to epispastic medicines. Having triturated the root of narcissus in honied water, boil it with oil of iris, and apply; or, having triturated the tender root of calamus, and if it be hard, boil it in honied water, and apply; or, use a cataplasm of birthwort and honey. But equal parts of dry pitch and Cretan bee-glue, produce the rupture of abscesses and promote cicatrization.

The Dionysian plaster, a wonderful epispastic application for abscesses, to the breasts and to buboes, dissipating by the insensible pores. Of old oil, of water, of each, lb. j; having boiled the oil and water for a little time, add of aphronitrum, oz. vj; of misy, oz. j or ij; and boil until it does not stain the finger; then add of the manna of frankincense, of wax, of turpentine, of each, oz. vj.

For abscesses of the nervous parts. Of wax, of colophonian rosin, of butter, of each, lb. j; of dry pitch, of honey, of each, lb. ij, oz. vj; of verdigris, oz. iij; of bird lime, q. s.—Another, an epispastic: Of ammoniac perfume, oz. vj; of wax, of turpentine, of each, oz. iv; of sulphur vivum, oz. iij; of natron, oz. iij; and the application called smilium, and that from garlic are strongly calculated to promote the breaking of abscesses already formed. But that which consists of the juice of linseed dissipates, changes, and bursts abscesses most aptly. For the milder sorts of abscesses, those also which were mentioned for parotis will apply. These observations apply to an abscess following phlegmon. But, Galen says, that an abscess will sometimes take place without being preceded by inflammation, in which case, it has its origin from good blood. For at the commencement, he says, owing to some humour, excoriation takes place, and in process of time, the containing parts are separated from those below. And, therefore, when opened, they appear to contain within them all kinds of fluid and solid bodies. For, bodies resembling dung, urine, thrombus, a honey or mucus-like humour, bones, nails, and hairs, have been found in abscesses. And even animals have been found very like to those which derive their origin from putrefaction. Nay, they affirm that, more particularly in chronic abscesses from metastasis, bodies have been formed resembling stones, sand, shells, wood, coals, clay, the sordes of the oil of baths, the lees of oil, and the lees of wine. Wherefore, we shall now give a succinct account of abscesses, more especially such as are seated in the external parts of the body, and those which do not admit of resolution by medicines. An abscess, then, is a corruption and change of the flesh or fleshy parts, such as muscles, veins, and arteries. Of them, some are contained in a cyst, as atheroma, steatoma, and meliceris, and others are formed without a cyst, and are properly called by the generic name, and of them we have now to treat. The formation of an abscess then is most commonly preceded by inflammation, as we have stated, but sometimes it arises at once originally, as we have just now mentioned. An abscess, then, is attended with strong heat of the place, the swelling becomes greater and more red than formerly, and is hard, with a pungent pain, throbbing, and weight, so that it seems as if something were suspended from the part. And if the part be a vital one, fever supervenes with irregular rigors, and the pain and fever are greatest at night. Sometimes too a bubo is formed in the neighbouring glands. When the abscess is fairly formed, the most of these symptoms are diminished, the pungent pain becomes itchy and somewhat dull, the swelling is more sharpened into an acute point, is soft and yielding to the touch, and the skin at the top is separated; I speak with regard to those that burst externally. If therefore, it has burst spontaneously, or from medicines, it is to be cured by means of pledgets spread with ointment, the pus being evacuated by degrees; but if not, it is to be opened in the manner to be described in the surgical part of the work.

Commentary. All the writers referred to in [the last Chapter] may be consulted on the treatment of abscesses. See especially Aëtius. He recommends when suppuration is not taking place properly to apply barley meal, or bread boiled in the decoction of figs, to which if necessary may be added nitre, turpentine, or the like. When suppuration takes place, the abscess is to be opened where the skin is thinnest. (See [Book 6].) The incision is to be made long and narrow, and if any putrid substance appear it is to be cut out. The opening is to be sprinkled with frankincense and suitable pledgets applied. When the neighbouring parts are inflamed a cataplasm will be the most proper application. When the ulcer is foul, turpentine and honey will serve for cleaning it; or applications containing verdigris may be used for the same purpose. After the ulcer is cleaned, first incarnants and afterwards incrassants are to be applied. For producing rupture of the abscess, he recommends various applications, such as ammoniac, and nitre triturated with vinegar, and the like. This account, however, is mostly taken from Galen.

The treatment recommended by Celsus is nearly the same in principle. At first if the part be soft he recommends applications of a repellent and cooling nature: but if it is hard he directs us to use applications which digest and produce resolution, such as dried figs pounded. To such applications may be added equal proportions of ammoniac, galbanum, bees-glue, and birdlime, with somewhat less than one half of myrrh. The plasters and malagmata for this purpose are likewise to be applied. When these applications do not produce resolution, we must conclude, he says, that the abscess will ripen. The symptoms of an unripe abscess are strong motion of the arteries, weight, distension, pain, redness, and hardness; to which are to be added horror and fever if the abscess be large. When there is a remission of these symptoms, and the part becomes itchy, and somewhat livid or white, the suppuration is ripe, and the matter is to be let out by medicines or iron. Unless the opening be large he properly forbids tents or pledgets to be put into it. When these are used, however, lentils and honey, or pomegranate rind boiled in wine are to be applied over them. Whatever is applied must not be tightly bound.

The Arabians mention a variety of applications for producing the rupture of abscesses. (See in particular Avicenna and Rhases.) Thus, they recommend a plaster consisting of cantharides and old oil. Some of their applications contain nitre, quicklime, and arsenic. Such a composition, by producing a slough, would no doubt effect the purpose for which it was intended. Haly Abbas recommends a poultice made of leaven, boiled figs, and the seeds of rosemary. He speaks of onions as an application to indolent abscesses. Alsaharavius treats of abscesses at great length.

By abscesses of the nervous parts it will be readily understood that our author does not mean that they are seated in what are now properly called nerves, but in tendinous and membranous parts, for all these were comprehended under the name of nerves by the older writers, namely, Hippocrates, Plato, and Aristotle. Galen pointed out clearly the distinction between these parts, but the term is often used in its old and popular acceptation by the writers subsequent to him.

The account which our author gives of deep-seated abscesses is highly interesting, but is mostly borrowed from Galen (ad Glauc. ii.) Rhases, in his ‘Continens’ (xxvii), gives an interesting outline of the opinions of all preceding authorities, with some ingenious observations of his own. When there is any hope of producing resolution he approves of scarifications. When the pain is violent he recommends hot and humid applications with the addition of narcotics. After the abscess has been opened with the knife, he says that desiccative applications are indicated, and not ointments containing wax or oil. He describes the leaven cataplasm, and others of a similar nature. He gives Antyllus’ directions for opening abscesses. Abscesses in the limbs are to be opened by a straight incision, but those about the ancles by a circular, as they are apt to terminate in fistulæ. He recommends it to be made at the lower part of the abscess, but mentions that Galen prefers the thinnest part.

SECT. XIX.—ON GANGRENE AND SPHACELUS.

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

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

Commentary. See the authors referred to in [the 17th Section].

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

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

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

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

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

SECT. XX.—ON HERPES.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SECT. XXI.—FOR ERYSIPELAS.

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

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

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

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

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

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

Aëtius, as he professes, merely copies from Galen.

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

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

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

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

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

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

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

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

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

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

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

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

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