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THE

SYDENHAM SOCIETY
INSTITUTED

MDCCCXLIII

,-^i^-

LONDON
MDCCCXLVI.
v/e^
s^
V
THE

SEVEN BOOKS
OF

PAULUS iEGINETA
TRANSLATED FROM THE GREEK.

WITH

A COMMENTARY
EMBRACING A COMPLETE VIEW OF THE KNOWLEDGE

POSSESSED BV THE

GREEKS, ROMANS, AND ARABIANS

f ON
s
ALL SUBJECTS CONNECTED WITH MEDICINE AND SURGERY.

BY FRANCIS ADAMS.

IN THREE VOLUMES.

VOL. II.

LONDON
PRINTED FOR THE SYDENHAM SOCIETY
SIDCCCXLVJ.
 " MULTVM EGEKUXT QLI AN'TE NOS
FVERrNT, SEP NON FEREGERLNT. SCSPICIENDI
TAMKX SUNT, ET KITU IlEORTM COLENDI." (SENECA, EPIST. LXIT.
)

PRINTED BY C. AND J. ADLA R D,

BAKTHOIOMHU CLOSE.
 CONTENTS
OF

THE SECOND VOLUME.

FOURTH BOOK.
SECT.
VI CONTENTS.
SECT. PAGE
29. For Sprains and Contusions 86
30. On Contusions of the Flesh and Ecchymosis 87
31. On Rupture and tearing of the flesh 88
32. On Scirrhus ib.

33. On Strumae, or Scrofula 91

34. On Steatoma, Atheroma, and Meliceris 94
35. Of Fa^i 97
36. On the simple Ulcer 99
37. On Agglutinants 101
38.
39.
40.
On
On
On
painful

hollow Ulcers
41. Medicines for cleansing foul Ulcers
42. For Worms in Ulcers
.....
and inflammatory Sores
uncoucocted Ulcers, and such as have not suppurated

....
102
103
104
106
107
43. On fungous Ulcers
•
. . . 108
44. On spreading Ulcers, putrid Ulcers, and Phagedaena 109
45.
46.

48.
On
On
....
Ulcers requiring Cicatrization

.....
the malignant Ulcers called Chironian and Telephian
47. For black Cicatrices
On sinuous Ulcers
112
114
118
119

....
'

49. On Fistula . . . . . 122

50. For Sores which break out again 125
51. On Ulcers in the Joints 126
52.
53.
54.
55.
On Wounds of the Nerves
On Ancylosis
....
Those things which extract Shafts, Javelins, Thorns, and the

.....
On Hemorrhage from Veins and Arteries

....
like ib.

127
132
137
56.

57.
58.
59.
On Worms
On Ascarides
•
.

.....
On Relaxation of the Joints
.

On Dracunculus, or the Guinea- Worm

139
ib.

144
150

FIFTH BOOK.

2.
. On
The general treatment
animal .....
the Preservatives from venomous animals in general
of all persons bitten or stung by any venomous
155

157
3.

5.

6.

7.
On
4. For the Bites of Dogs that are not mad

On Wasps and Bees

On the Phalangia, or venomous
On the Bite of the Spider
....
persons bitten by mad Dogs, and on Hydrophobia

....
Spiders
162
168
ib.

169
171
8. On the Sting of the Scorpion ib.
CONTENTS.
 CONTENTS.

.....
VIU

SECT.
55.
56.
Oh
On
Bulls' Blood
coagulated Milk ....
....
.....
PAGE
230
231
57.
5S.

59.
60.
On
On
On
On
Ileraclean

Gypsum
Ceruse
Honey

.....
.....
Lime, Sandarach, and Arsenic
232
233
234
235

......
. . •

61.
62.
63.
04.
On
On
On
On
Litharge
Lead
Mercury .....
white Hellebore, Thapsia, Elaterium, black Agaric, wild Rue,
Gith, and the Down of the Cactos
236
237
238

239
65. On domestic articles, such as Wine and cold Water 243

APPENDIX TO THE FIFTH BOOK.

On feigned Diseases, and the Detection of them 244

On professional Impostors
245

SIXTH BOOK.

1.

2.

3. .....
Preface to the Surgical part . .

On burning of the Head for Ophthalmia, Dyspnoea, and Elephantiasis

On Hydrocephalus
. .247
248
250
4.

5.

6.

7.
On Arteriotomy

the same
On Hypospathismus
On Periscyphismus
......
.....
. .

.
.

.
.

On Angiology, or section of the temporal vessels, and on burning

.
.

.
.

.
253

254
256
258
8. On suture of the upper Eyelid, and other modes of operating for
Trichiasis . . . . . . 259
9. On burning of the Eyelids by medicines . . . 264
10. On Lagophthalmos, or Hare-eye . . . . 265
11. On the suture of the under Eyelid, and the burning of it by medicines 266
12. On Ectropion, or eversion of the lower Eyehd . . 267
13. On Anabrochismus and burning with iron . . . 269
14. On Hydatids . . . . . .270
15. On adhesion of the Eyelids . . .
•
. 272
16. On Chalazia, or tumours resembling hailstones . . . 273
17. On Acrochordion and Encanthis . . . . 274
18. On Pterygia . . . . . .275
19. On Staphyloma . . . . . . 277
20. On Hypopyon of the eye . . . . 278
 CONTENTS. IX

SECT.
21. Ou Cataracts ....
22. On iEgilops, or fistula lachrymalis
PAGE
279
284

25. On Polypus
26. Ou Maimed Parts

27. On Epulis and Parulis

....
23. Ou imperforate Meatus Auditorius
24. On substances that have fallen into the meatus auditorius
286
287
289
292
ib.

28. On the Extraction of Teeth 294

29. On constriction of the Tongue, or tongue-tied persons 295
30. On Antiades, or indurated tonsils 297
31. On the Uva 298
32. On thorny substances fixed in the pharynx 300
33. On Laryngotomy 301
34. On Abscess 303
35. On Strumae, or scrofulous glands 307
36. On Steatoma, Atheroma, and Meliceris 309
37. Ou Anem-ism 310
'
38. On Bronchocele . 314
39. On Ganghon 315
40. On Venesection 316
41. On Cupping 324
42. On burning the Armpit 328
43. On preternatural fingers, and on persons having six fingers 329
44. On the operation of burning for Empyema 330
45. On Cancer 332
46. On male breasts resembUng the female 334
47. On burning over the Liver 335
48. On burning over the Spleen 336
49. Ou burning over the Stomach ib.

50. On Dropsies 337

51. On Exomphalos, or Prolapsus of the Navel 340
52. Ou Wounds of the Peritoneum, and on falUng down of the Intestine
or Omentum, where Gastroraphe also is described: from the
Works of Galen 342
53. On Deficiency of the Prepuce 346
54. On Hypospadiseum, or imperforate Glans Penis 347
55. On Phimus, or Phimosis ib.

56. On Adhesion of the Prepuce to the Glans 349

57. On Circumcision ib.

58. Of Thymi ou the Penis 350

59. On Catheterism, and Injection of the Bladder 351
60. On Calculus . . . 354
61. On the Pai-ts about the Testicles 363
62. On Hydi-ocele .
365
63. .On Sarcocele and Tophi of the Testicles 369
64. On Cirsocele and Pneumatocele 370
65. Ou Enterocele, or Intestinal Hernia
372
 CONTENTS.
SECT.
66. Oil Bubonocele, or Inguinal Hernia
67. On Rhacosis, or Relaxation of the Scrotum
68. On Castration
69. On Hermaphrodites
70. On Extirpation of the NjTnpha and Cauda Pudendi
71. On Thymi, Condylomata, and Hemorrhoids about the Female Parts
of Generation
72. On Imperforate Pudendum and Phimus
73. On Abscess of the Womb
74. On Embryulcia and Embryotomy
75. On Retention of the Secuudines
76. On burning the Hips
77. On Fistulae and Favi
78. On Fistulae in Ano
79. On HemoiTlioids, or Piles
80. On Condylomata, or Excrescences, and Fissures
81. On Imperforate Anus
82. On the Excision of Varices
83. On the Dracunculi, or Guinea-Worms
84. On Amputation of the Extremities
85. On Pterygia about the Nails
86. On a bruised Nail
87. On Clavi, Myrmecia, and Acrochordones
88. On the Extraction of Weapons
89. On Fractures and their Differences
90. On Fractures of the Bones of the Head
91. On Fracture and Contusion of the Nose
92. On Fracture of the Lower Jaw, and Contusion of the Ear
93. On Fracture of the Clavicle
94. On Fracture of the Scapida
95. On Fracture of the Breast-Bone
96. On Fractm-e of the Ribs
97.
98.
99.
100.
101.
On Fracture of the Arm ....
On Fractiu-e of the Bones of the Loins and Pubes
On Fracture of the Vertebrae, Spine of the Back, and Os Sacrum

On Fracture of the Ulna and Radius

On Fracture of the Hand and its Fingers
102. On Fracture of the Thigh
103. On Fracture of the Patella
104. On Fracture of the Leg
103. On Fracture of the Foot
106. On the Arrangement of the Limb
107. On Fractures complicated with a Wound
108. On the redundant Callus of Fractures
109. On Distortion from the L'uion by Callus
110. On Bones which have not united by Callus
111. On Luxations .
 CONTENTS. XI

SECT. PAGE
112. On Dislocations of the Lower Jaw 479
113. On Dislocations of the Clavicle and Acromion 482
114. On Dislocation at the Shoulder 484
115. On Dislocation of the Elbow .
-
489
116. On Dislocations at the Wrist and Fingers 492
117. On Dislocations of the Vertebrae of the Spine .
493
118. On Dislocation at the Hip- Joint 498
119. On Dislocation at the Knee 505
120. On Dislocation at the Ankle, and also of the Toes 506
121. On Dislocations with a Wound 509
122. On Dislocation complicated with Fracture 510
 PAULUS JIGINETA.

BOOK FOURTH.

SECT. 1. ON ELEPHANTIASIS.

Well, iu my opinion, did Aretseus the Cappadocian say, that

the power of remedies ought to be greater than those of dis-
eases ; and that for this reason elephantiasis is incirrable, be-
cause it is impossible to find a medicine more powerful than it.
For if cancer, which is, as it were, an elephantiasis in a parti-
cular part, is ranked among the incm-able diseases by Hippocrates

himself, how much more is not elephantiasis incui-able, which

is,as it were, a cancer of the whole body ? But the black
bile from which ha\ing a double origin,
this affection is formed,

(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 ma-
lignant, being accompanied with ulceration of the Avhole body
and falling off of the extremities, are
produced by the latter
variety, or that fi'om yellow bile overheated.Wherefore, those
who are abeady overpowered by the disease, must be aban-
doned; but when the affection is in its commencement, so as
that none of the extremities has fallen off, nor the siu-face of
the body become idcerated, 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 bm-uing
II. 1
2 ELEPHANTIASIS. [book iv.

the headj have prevented many who

beginning to be
Avere
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 occtir, 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 fre-
quently, proportioning the dose of the medicine to its strength.
Pui'ging with hiera also suits well with them. After the inter-
val of about ten days again, we must give them the Adnegar of
divided milk, not in less quantity than three heminse, nor in
greater than five, and on the following days they are to be sup-

ported with milk that is not divided into parts, or new-drawn

milk bv Avhicli means, if the affection vield, the same food
:

may be continued ; but if it remains in the same state, after

eating acrid things, they must be made to Aomit with radishes
and frumentaceous articles of food. After these things, purging
with Avhite hellebore is proper, twice if possible when in spring,
but once only if in autumn. Those, however, who are tho-
roughly overpowered by the complaint, must be neither bled
nor put on a coui'se of hellebore. For neither can a transla-
tion of the disease from the superficies to the inner parts, nor
a diminution of the offending matter, be any longer accom-
plished by these means ; but the matter is to be determined to
the stomach and bowels, and alteratives (metasjoicritica), used
to dry and constrict the skin. Dry-cupping is also to be applied
over the mouth
of the stomach and to the hj^pochondi-ia, and
dropaces used to the same places ; but after a short interval,
the same process is to be repeated, beginning by pui'ging with
hiera, and omitting the venesection, which would prove rather
deleterious than beneficial. This process is to be repeated three
or fom- 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 cedi'ia, 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 di-achm in one cyathus

of Avinc or, a tbachm of hartshorn and a cyathus of the vinegar
;

of squills, is given after the morning Avalk and

every day ;

other things are to be administered at the same season, such

 SECT. I.] ELEPHANTIASIS. 3

as drs. v of washed squills in honied water^ or in hone}^, as a

linctus
; Cwenaic juice, to the amount of a bitter vetch,
or
mixed with honey and butter ; or, dr. ss of the shavings of
hartshorn, with two cyathi of wine ; or, drs. iij of ^Ethiopian
cumin, with honey, as a linctus. But a more suitable remedy
is drachm of the theriac trochisk, tritm-ated in a cvathus of
a
fine wine, and drunk and a drachm of the trochisk of squills
;

may in like manner be taken in a cbaught. And they praise

the juice of calarnint as a most effectual
remedy when di'unk,
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 efi"ectual
remedy, both in a draught and when rubbed
in externally. But where plenty of these animals can be pro-
cm-ed, 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 usins; them
thus, happens that the
it
scales, or, as it Avere, the bark, falls
off from the skin.
The regimen
is to be as follows After sleep, having been
:

firstrubbed, and the bowels evacuated, let the patient have

recom'se to gestation and vociferation, then to friction and
gym-
nastic exercises of all kinds, partly by
leaping, but more espe-
cially 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 Avinged animal, or with fresh but-
ter; and after a short interval let him bathe, ha^dng 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 hom% 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 and of potherbs, the beet, the
barley flour,
4 ELEPHANTIASIS. [book iv.

lettuce^ the radish^ leeks, and cabbage sweetened in two waters,

and capers. Of he may take oysters, pelorides,
sea animals,
urchin, all shell fishes, limpets boiled "oith beets, and old pickle
in place of medicine. But let him abstain from wine dming
the whole continuance of the complaint, and from venery ; only
he may take a little thin watery wine at the time of his re-
covery from the purging, at which season all acrid substances
must be abstained from, except condiments. Give him ptisan,
eggs and chondi-us, milk and honey, ^dth 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 safii'on. He may take food twice
a day, as it is injiu'ious to subsist upon one meal. After taking
care of the internal parts, let him use detergent ointnients
(smegmata) in the bath, from the decoction of beet, or of
fenugreek with aphronitrum, soap, or mjo-obolan, and sometimes,
apply depilatories. Purslain tritm-ated with \dnegar is detergent
and also the slender houseleek, and the roots of dock boiled in
\-inegar, and alum with salts, and red arsenic in equal propor-
tions with wine and oil of lentisk. Also the composition for
alphos, consisting of alcyonium, nitre, m^Ttle, sulphur, and the
di'ied leaves of the wild fig,
being rubbed in dry with vinegar ;
and that from the bm'nt shell of the cuttle-fish, and pumice,
nitre, and burnt Cimolian earth, gum, luiripe galls in equal

quantity, sprinkled diy, or rubbed in with vinegar. And tliis

one is admirable Of the roots of dock a bunch to the amoimt
:

of a handful, of natron, dr. xl ; of fi'ankincense, di*. xxv ; of siJ-

phur, dr. xxv ; it is rubbed in with Egyptian vinegar. And
this one is efficacious : Of arsenic, di'. x; of sulphm* ^i^^.lm, dr.^iii;
of costus, di'. xii ; of quicklime, di\ iv ;
of wax, dr. iv ; of dried
bay benies, dr. xii ; these things are mixed with the juice of
white poplar leaves, or -\nth a thick decoction, and they are
rubbed in, having the consistence of honey. Another Two — :

fascicidi of the roots of dock are to be boiled in

vinegar, poimded
in a mortar and triturated, then of alcyonium, lb. j ;
of aphro-
nitrum, oz. viij ; of sulphur ^ivura, lb. j ; of the bm-nt shells of
cockles, oz. iv ; of chamaeleon with its roots, oz. iv ; these things
are pounded together until they are of the consistence of the
sordcs of the baths, and are then rubbed in often in the sun,
SECT. I.] ELEPHANTIASIS. 5

if summer, butif Avinter, in the bath, until it occasions

sweating.
And the dry smegma of ^sculapius 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 jmce of knot-grass or plantain ; or of pellitory of the
wall, triturated J
and the leaves of the gi'cen Melisian herb,
when pounded with axunge and applied, are wonderfully effi-
cacious, for they redden the parts, but the redness is easily re-
pressed 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
dyspnoea of persons laboui'ing under elephantiasis give a draught
of five or six slaters in tln-ee cyathi of honied water. And
some of the general remedies described for dyspnoea will be ap-
plicable 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 ser-
viceable to diink them. And the use of the sand of the sea-
shore has the same eff'ect, and so have all the sudorifics. But
since this aftection is one of those which are easily communi-

cable, no less so than the plague, they are to be removed as far

as possible fi'om cities, and lodged in inland and cold situations,
where there are few inhaliitants, 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 thev will not communicate the evil to others.

Commentary. Consult Lucretius i^A, 1112); Celsus (iii, 25) ;

Comm.

Phny (Hist. Nat. xxvi, 5) Scribonius Largus (102) Caelius

; ;

Aurelianus (Pass. Tard. iv, 1) Marcellus (De Med. xix)

; ;
 fi ELEPIIAXTIASIS. [book iv.

CoMM. Serenus Samonicus (11) Octa^ius Horatianus (i, 32) ;

Isidoms
^—' —'

(Orig. iv, 8) ; Yegetius (^Mulom. i, 9) ;

;

Aretseus (Curat. Morh.

Cliron. ii, 13) ; Plutarch (Symp. viii, Quest. 9) ; Galen (ad
Glauc. ii, 10 ; de Causis ]Morb. 7) ;
Oribasius (Morb. Curat.
iii, 62; SjTiops. vii, 5) ;
Pseiido Dioscorides (Euporist. i, 105) ;

Aetius (xiii, 120) ;

Actuarius (Meth. Med. ii, 11, and iv, 15) ;

Xonnus (Epit.233) ; Psellus (op. medicum) ;

Leo (vii) ;

Myrepsus (De !Med. comp.) ; A^-icenna (iv, 3, 3, 1) ; Serapion

(v, 14) Avenzoar (ii, 7,
; 12, 26) ;
Albucasis (Chirurg. i, 49) ;

Haly Abbas (Theor. viii, 15, Pract. i^-, 3, ix, 69) ;

Alsaharavius
(Pract. xxxi, 2) ; Eliases (ad ]\Iansor, v, 35, ix, 93, Contin.
XXXV, 26.)
AYe owe tbe earliest notice -wliicli Ave have of this disease to
the poet Lucretius, who briefly mentions it in the following
lines :

" Est
elephas morbus qui propter flumiua Xili
Gignitur /Egypto in media neque praeterea usquam."

Celsus says that elephantiasis is a chronic disease, almost

unknown in Italv, but \erv common in certain countries. He
calls itan affection of the whole body, even of the bones. The
upper part of the body is covered with frequent spots and tu-

mours, 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, ab-
stinence, then supporting the strength, purging, exercise, sudo-
rifics, and friction. Baths are to be rarely used; fatty, gluti-
nous, and flatulent articles of food are to be avoided, but wine
isto 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,
Idack maculffi, which sometimes sprejjd to the bones, the toes
and fingers being swelled.
SECT. I.] ELEPHANTIASIS. 7

Serenus Samoniciis, who is said to liave flourislied about the Comm.

" '

beginning of the third centuiy^ thus describes the disease

'
:

" Est
elephas morbus tristi quoque nomine dirus,
Non solum turpans infandis era papillis,
Sed cito praecipitans fnnesto fata venino."

His remedies are the juice of the bark of the juniper, the
ashes and blood of the weasel, mint, and various external appli-
cations, consisting of ceruse, Egyptian paper, roses, &c.
Scribonius Largus recommends sulphur with common oil for
" et
lepra, quam elephantiam dicunt," but he gives no descrip-
tion of the latter.
It is greatly to be lamented that Ctelius 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 me-
dicinal 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 helle-
bore. He approves of a sea voyage and change of scene. He
says the first author Avho described elephantiasis was Themison,

the same person that is damned to everlasting fame in one of

the lines of Juvenal " Quot Themison autumno occiderit
:
agros
uno." (Sat. X, If this statement be correct, it is clear
221.)
that Celsus cannot be of so early a date as is generally believed,
that is to say, the Augustan age, for Themison flourished to-
wards the end of the fii'st centurv, p. c. He was the founder
of the Methodical sect. Cselius also blames Themison for re-

commending bleeding and vomiting unseasonably, and disap-

proves of his directions respecting the applications to the skin.
It appears that he also disapproved of the theriac of \ipers, and
of gi\ing to drink water in which red-hot iron had been extin-
guished. There can be no doubt, from the circumstances which
he mentions, that the disease was thought contagious in his time.
Octa\dusHoratianus,who lived under the emperor Valentinian,
of
gives a pretty full detail of the treatment, but his description
 8 ELEPHANTIASIS. [book iv.

CoMM. the symptoms is defective, lie makes mention, however, of

' '
'
mucid(By which aflect 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 re-
commended by the other autliorities, namely, bleeding, purging,
vomiting, the theriac of vipers, and rubbing with the usual ap-
plications for scabies. He also speaks favorably of the natural
and the sea-water baths.
Marcellus the Eraperic, who is supposed to have flomished 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, erup-
tions on the face, and disease of the bones. He speaks of its
being endemic in /Egypt.
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 sur-
face of the patient'sbody resembles that of an elephant; or be-
cause a mighty affection, as the elephant is one of the
it is

largest of animals.
Aegetius, the great ancient authority on veterinary surgery,
describes elephantiasis as it affects cattle. The symptoms are
hardness and roughness of the skin, squamse, eruptions on the
feet and head, and a fetid discharge from the nose. He ap-
proves of bleeding, and the other means recommended by the
regular surgeons.
Weshall next give the descriptions of the Greek authorities.
Areteeus gives a most elaborate but surely somewhat over-
strained description of elephas, which he paints in colom-s the
most hideous and disgusting. We shall endeavour to convey
to the reader an idea of his sketch,
stripping his picture of its
flower}^ ornaments, and contracting its bulk. The disease is
called elephas, he says, from its leontium or morbus
magnitude,
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 no-

escaping
tice at first,being deep-seated and preying upon the A-itals, but
afterwards it is determined to the superficies,
commencing some-
times with the fiice, and at other times with the extremities.
The belly is dry, because, as he ingeniously remarks, the dis-
SECT. I.]
ELEPHANTIASIS. 9

tribution of the food is performed

regularly, and tlie vitiated Comm.
them as a pabulum to the
' '

parts strongly attract the chyle to '

disease. There are large callous eminences on the skin, and the
veins appear enlarged, owing to a thickening of the A^essels 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 af-
fected 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 then'
hair, and hang down Hke those of the lion. The general ap-
pearance 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 ofl"; and it is not uncommon for incm'able ulcers to break
forthon different parts of the bod3^ Dyspnoea, and a sense of
suffocation, are occasionally present. He says, it is dangerous
to have any intercourse with persons labouring under the dis-
ease, 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 ^dpers.
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 ^iuegar, and the hke, for the
same purpose. When the flesh is hvid, he dii'ects us previously
to make deep incisions in it. The diet is to be plain and di-

gestible sulphureous baths are to be used the patient is to

;
:

swim frequently in sea- water, to take a sea voyage, and other-

wise 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 par-
ticularly 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 ap-
 10 ELEPHANTIASIS. [book iv.

CoMM. pearance resembling that of a

satyr and in liis work entitled
— 'DeCuratioue ad Glauconem'he ranks
:

" — '
'

elephantiasis witk cancerous

swellings, and savs 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
temperatui'e of the place like-
of the
wise, he shrewdly remarks, determines the superfluities
to the skin. He recommends the treatment which we
system
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 dperae.)
Oribasius gives no description of the disease, but briefly re-
commends the theriac of vipers, and in certain cases pm-ging
and bleeding for the cure of it.
The account given by Aetius is principally taken from Ar-
chigenes, and is very circumstantial.
The disease, he remarks, •

has been called by the several names of elephantiasis, leontiasis,

Suspicions, he says, have been entertained
and satyriasis. 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 efflmda from their sores, and by
their respiration. The disease, he says, is insidious, for it be-
gins in a concealed manner internally, and does not make its
]\Ien are more
appearance on the skin until it is confu*med.
subject to it than women, and intemperate climates predispose
to it. The first symptoms of the disease are torpor, slow re-
spiration, constipated bowels,
urine like that of cattle, continued
eructations, and strong venereal appetites and when it is deter-
;

mined to the skin, the cheeks and chin become thickened and
of a li\'id 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 af-
fected with it become pusillanimous, and shun the haunts of
men. Though the disease, when confirmed, is of the most
hopeless desciiption, 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 colocpith
SECT. 1.] ELEPHANTIASIS. 11

or hiera, and vomiting with radislies or white hellebore. Some, Comm, ' '

he says, having remarked that eunuchs escaped taking this com-

'

plaint,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 apphcations, containing white hellebore, sulphur, rue,
natron, aloes, and even arsenic. He also speaks of cataplasms,
depilatories, and detergent ointments. He is very particular in
dii'ccting that the diet be light and. wholesome.
Actuarius elephantiasis a cancer of the whole body,
calls

which preys upon the flesh, and derives its origin from black
all

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 natiu'c. 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 recom-
mended by Aretseus, namely, bleeding, purging with hellebore,
detergent and desiccative applications to the skin, &c.
Some applications, seemingly of little efficacy, are recom-
mended for elephantiasis in the '
Euporista' of the Pseudo-
Dioscorides.
Nonnus, as usual, abridges our author's detail of the treat-
ment, and omits the description. He says it arises from a
melancholic humour, which corrodes the extremities. Accord-
ing 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 im-
perfect. The disease, he says, is produced by a melancholic
humour, which has become putrid, and corrodes the extremi-
ties. It is, he adds, almost incurable, but may be benefited
by purging with the dodder of thyme, by the theriac, and bm'n-
ing the head at the bregma. The affection, he says, is also
called satjTiasmus.

Myrepsus merely mentions some of the common remedies

for elephantiasis, such as arsenic, tm-pentine, litharge, &c. He
gives no description of the disease.
 12 ELEPHANTIASIS. [book iv.

"
CoMM.
'
We now proceed to the Arabians.
'
Avicenna gives a very circumstantial account of elephanti-
asis, under the name of juzam or judam, which his
translator
renders h\ 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 :
produced by li^ang upon the flesh of asses,
it is

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 li^ddit}'^; falling off of the hairs, enlargement of the
veins, affection of the breathing, thickening, and discoloration
of the lips ; and afterwards ulceration of difi'erent parts of the
body, corrosion of the cartilages of the nose, then falling off of the
nose and extremities, loss of voice. Sec. 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, colo-
cynth, 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 knoAvn by the name of the
Barbadoes leg. This complaint he dii'ects to be treated at first
with local ])leeding 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 oflF, the whole
aspect becomes hideous, the voice is changed,
the perspiration becomes ^dtiated, 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 per-
formed. 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
SECT. T.]
ELEPHANTIASIS. 13

to pm^ge aAvay the melancholic humour with scammony, colo- Comm.

'

cynth^ black hellehore, &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 Haly Abbas, namely, Stephanus Antio-
translator of
chensis, who says he wrote about the year 1127, describes the
disease which we have been treating of by the name of elephan-
tia. Like the others, Haly represents it to be a general cancer
arising from black He says it proves contagious by re-
bile.

spiration. Among the symptoms, he mentions falling off of the

ciliary and superciliary hairs, dryness of the nose, which some-
times 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 stimu-
lant 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, tlirough the medium of the re-
spiration. 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 oflF, the voice is
lost, ulcersbreak out on the skin, the extremities mortify and
fall away, and the breath is fetid. His treatment varies ac-
cording 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 appli-
 14 ELEPHANTIASIS. [book iv.

CoMM. cations of a stimulant nature^ among wlaicli lie mentions bury-

'
"

ing the leg in hot sand.

The
translator of Rhases also applies the term lepra to the

elephantiasis of the Greeks. The colom- of the eye, he savs, is

changed, the voice becomes rough, the face is swelled, hke a
bladder, and red Avith nodes, the hairs fall off, and the extre-
mities at last become sw elled and idcerated. There is
nothing
peculiar in his treatment. He describes, likevrise, the sicelled
leg by the name of elephantia or elephas. He says that, when
tubercles arise on it^ it is utterly inciu'able ; but that when

simply enlai'ged, 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 stimidant applications, contain-
ing pearlashes, sulphur, &c., and also tight bandages.
Such is the
histoiy of elephantiasis given by ancient authors.
The earlier
of oiu* modern writers on medicine, describe
elephantiasis as a species of lepra, of which they enumerate
fovu' varieties, namely, elephantia, leonina,
alopecia, and tp-ia.
This arrangement is evidently taken from Alsahara^-ius. Such
is the account which Platiarius In
gives of these diseases.
like manner, the Pseudo-Placer ranks elephantiasis with lepra:
" Est
leprse species elephantiasisque vocatm-," &c. Upon this
passage Cornarius makes the following annotation " Vulo-us :

medicoiiim xVrabas in hoc secuti lepram cimi elephantiasi con-

fundunt. 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, (^-i, 1.)
Rogerius remarks
that the disease is contracted per coitum. (i, 15.) And here,
by the Avay, we may be permitted to state that we have long
been conmiced 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, Avho gives a very
interesting disquisition on
'
Syphilis iu his History of Medicine.'
 SECT. II.] LEPROSY AND PSORA. 15

It appears that tlie disease in its ancient form is still preva- Comm.
' '

lent in certain parts of the world

*
; as^ for example^ in the Sar-
dinian States, where it is still looked upon as
being both con-
tagious and hereditary. It is also endemic in Konvay nay, :

it is reported to haye broken forth with all its ancient character

in the proyince of New Brunswick. In the East, elephantiasis

and leontiasis are still considered as aggravated forms of leprosy.
(See Heber's Travels, ii, 50; and Kiebuhr^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, ha\'ing their origin from a me-

lancholic huraoiu'. But leprosy spreads over the skin more
deeply in a circular form, throwing out scales Avhich 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
di'ied, and, Avhen going to use it, we ma}' dilute it in water
until it attain the thickness of the wrestler's sordes, and anoint.
— Another
: Of sage, of the tears of Ethiopian olive, of each,
dr. viij
; of the bark of cappei^'s root, of gum, of each, dr. xiij ;
anoint with vinegar, in the sun. Anemone, when applied, and
the root of the Avhite vine particularly, remove psora. But the
following are compound remedies Of the flour
: of darnel, one
chcenix ;
of the white cardamom, di*. iv ; of the scum of natron,
di'.
jj of copperas, dr.Aiij; of the middle roots of asphodel, dr. iv;
having triturated them in and made of the thickness
A-inegar,
of a cerate, anoint, having applied nitre to the part; and
first

ha^dng removed it, (which do about the third day,) and Avashed
with cold water, again anoint. Another— Of the juice of kings'
:
 16 LEPROSY AND PSORA. [book iv.

spears' roots, oz. vj ; of sulphur A-ivum, of manna, of each, dr. x ;

of natron, dr. anoint, mixing with vinegar.

viij ;
The following
simple remedies are particularly applicable for psora Staves- :

acre, bitter lupins, cardamom with vinegar, the root of lily Anth
honey, turpentine rosin, sulphur, chick peas, goat's dung ; and
these compound ones —
mix equal parts of chalcitis and misy
Avitli wine, and anoint the more humid kinds of psora. —
Another Boil the tender leaves of rose-bay in a sextaiius of
:

oil until they are dried, and, throwing away the leaves, add to
the oil oz.of white wax, and, after it is dissolved, cool and
iij

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. —
Anotfier : Of diachylon,of wax, oz. ij; of oil of roses, oz. j;
oz. ij;
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 drv^ things. —Another : Of
cenise, oz. ss; of starch, oz. ss; of lead, oz. j ; of red lotuses, or
of alkanet, oz.ij ; of wax, oz. \j ; 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 Ainegai* the yelks of them; ha\dug
triturated with rose-oil and what remains of the A-inegar a
moderate quantity of litharge, anoint, when of the consistence
of the sordes of oil in baths. Another Three yelks of eggs — :

out of -s-inegai'; of rose-oil, oz.vj; of sulphur vivum, oz. iij; haAdng

triturated the yelks of the eggs and the sulphur with the Aane-

gar, add the cerate. And litharge tritm-ated with rinegar 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 Avith leprosy and psora.

CoMM. See Humidorum, Usu Galen.

—
' — (Meth. Hippocrates
"
'

]Med. xiv
(de
de Causis Sympt. G ; iii, ;
Epidem.
ct ahbi)
ii)

;
;

Oribasius
(Morb. Curat, iii, 58) ; Aetius
(xiii, 134) ; Actuarius (Meth.
Med. ii, 11); Nonnus
234); Pseudo-Dioscor. (Euporist.
(Epit.
i, 128); Leo (vii,15, 18); Pollux (Onomasticon, iv, 9); yEschyhis
(Chocph. 274) ; Alexander Aphrodisiensis (Prob. i, 146, and
ii, 42) ;
Celsus (v, 28) ;
Scribonius Largus ; Octavius Horatianus
SECT. II.] LEPROSY AND PSORA. 17

(i, 31); Serenus Samonicus; Marcellus (deMed. xix); Isidorus Comm. ' '
*

(Orig. iv, 8); Psellus (op. jMedicum) ; Yegetius (Mulom. iii, 71) ;

Geopon. (xviii, 15) ; Serapion (v, 2) Avicenna (iv. 7, 2, 9) ;

;

Avenzoar (ii, 7, 4) ; Haly Abbas (Tlieor. viii, 16 ; Pract. iv^ 4) ;

Alsaharavius (xxxi, 1, 2, 3, 4) ; Rhases (ad Mansor. v, 31 et
seq. ;
Divis. 117^ et seq.) ; Contin. (xxxvi.)
in tbe preceding chapter, we shall here give a separate
As
account of the views of the Greeks, Latins, and Arabians, be-
ginning, in this instance, with the Greeks.
Hippocrates makes only casual mention of these diseases,
and has nowhere marked theii* 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 Ainegar, 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 afiections. Alphos,
he says, is much more superficial than leuce. In another, he
attributes these complaints to the melancholic humoui' 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 psy-

dracia. Psora is said to partake more of the nature of ulcera-
tion. Both are represented as arising from a saltish phlegm,
and as being cured by phlegm agogues, and ointments rubbed
into the skin. It is also stated that leuce is distinguished fi'om
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 aflected, and not the whole flesh. When a pituitous
humour is the cause of the complaint, it puts on the appearance
II. 2
 18 LEPROSY AND PSORA. [book iv.

CoMM. of alphos, and whenmelancholic, of melas.

tlie Lepra affects
' '

'
For all
mostly the deep-seated parts, and psora the superficial.
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 sulphm-, hellebore with vinegar, verdigris,

cantharides, &c.
Aetius, copying from Archigenes, thus marks the difference
between lepra and its cognate diseases. Lepra differs from
leuce and alplios, 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 the flesh below assumes an unnatural degree of
lerice,

whiteness, while the surface of the part is very smooth, and

when rubbed it soon becomes red, especially in those who are
the
readily cured ; and alphos is altogether superficial, having
of a scale fastened to the skin. Lepra differs from
appearance
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 treat-
ment so judiciously stated by our author, but his local applica-
tions are little different. They contain hellebore, sulphur, mis}^,
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 distinguished from psora by spreading deeper and
it is

having scales of a circular shape like those of fishes ; Avhereas,

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 alplios
that lepra does to psora, that is to saj^, leuce is more deep-seated,
and aft'ects the colour of the ban, while alphos is more super-
ficial, 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
SECT. II.] LEPROSY AND PSORA. 19

accurately. Lepra arises from a corroding humour^ and hence Comm. ' '
'
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 ingi'edients in them are hellebore, natron, sulphur,
quicksilver, sal ammoniac, quicklime, bay-berries, &c.
Alexander Aphrodisiensis mentions psora among the conta-
gious diseases, but says that lepra and leuce are not contagious.
Chrysostom alludes to the common opinion that psora is a
contagious disease. The poet Jjlschylus gives a short description
of leprosy in his ''Choepherae' by the name of lichenes. (1. 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 "''A\(}>og vo- :

—
catur ubi color albus fere subasper, et
est, non continuus, et

qusedam quasi guttse dispersse esse videantur : interdum etiam

latius, et cum quibusdum intermissionibus serpit, Mf Aac
colore ab hoc differt quia niger est et umbrse similis : csetera

eadem sunt. Leuce habet quiddam simile alpho, sed magis

in esique albi pili sunt, et lanugini
albida est et altius descendit
;

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 re-
marked 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 " Alteram :
—
genus pejus est, simile papulse ferae, sed asperius rubicandiusque,
figuras varias habens squamulee ex summa cute discedunt.
:
 20 LEPROSY AND PSORA. [book iv.

CoMM. rosio major est, celerius et latins procedit, certioribusque etiam

' '
'
quam prior temporibus et fit Kubra coguominatiu'."
et desinit.
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 summa cute fin-

ditiu*, et vehementius quoque squamosa sed nigra, &c.
rodit, ipsa
Nigrae cognomen His
est.'^account of the fourth species seems
to refer to the lepra vulgaris
" Quartum —
genus est qiiod cura-
:

tionem omnino non recipit distans colore nam sub-albidum est :

et recenti cicatrici simile: quasdam sub-

squamulashabet pallidas,
albidas, quasdam lenticulae quibus demptis nonun-
similes :

quam profluit sanguis." For all these diseases he recommends

a composition containing sulphur, natron, and rosin.
Scribonius Largus describes several compositions, "ad lepram,
quje quasi impetigo est cum prurigine cutis," and for scabies.
They contain sulphur, ^Ethiopian cumin, Aincgar, frankincense.
Serenus Samonicus makes mention of a few popular reme-
dies for scabies, prurigo, and papulse, but he gives no descrip-
tion 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 Vu'gil alludes to the scab of sheep
in this line: " Nee mala vicini pecoris contagia Isedant." (Eel. i.)
He mentions, as remedies for it, sulplnu', litharge, pitch, helle-
bore, &c. (Georg. iii, See also Geopon. (xvi,
449.) 18, xviii, 15) ;

Columella (viii, 5); and Gratius (Cyneget. 412).

Isidorus gives the folloAving definitions of the complaints we
have been treating of "
Lepra vero cutis asperitas squammosa
:

lepidi similisunde nomen accepit cujus color nunc in nigri- :

dinem vertitur, nunc in alljorem, nimc in ruborera. Scabies

tenuis asperitas et
squammata est. Impetigo est sicca scabies ;
prominens a corpore cum asperitatc et rotunditate formae.
Hanc vulgus sarnam appellat."
SECT. II.] LEPROSY AND PSORA. 21

Justin applies the terms vitiligo and scabies to the diseases Comm.
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 de-
scribed under the generic term of " inipetigines in quibus ex-
coriatur 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 me-
lancholic humour, and as casting off round scales. The latter
issaid to consist of pustules, which appear on different parts of
the body, are variously figured, and cast off furfiu'aceous 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 aJba and mgra. The morphea alba resembles the
white albaras (leuce) only that in the latter the aflFection of the
shin more deep-seated, and the hairs in it are turned to a
is

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 AA'icenna by BuUonensis, alphos
albus and niger are distinguished by the names oi 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 morphese 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 ex-
tracts bloodfrom the guada, but not from the baras.
makes mention of the morphea alba and nigra, but
A.venzoar
hus not described them particularly. These authors seem to
 22 LEPROSY AND PSORA. [book iv.

CoMM. have treated lepra and psora like tlie Greeks, by bleeding, me-
' '

lanogogues, 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 represented as a whiteness some-
is

times aifecting 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 morjihea 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
the the colour is said to be black, owing to
say alphos niger,
the prevalence of black bile, and if rubbed a fiu-fiu-aceous 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, spui'ge, &c.
Alsaharavius describes three varieties of morphea. 1st. The
morphea terrestris, which is attended with furfiu'aceous scales
on the skin, and tingling. This is evidently the psora of the
Greeks. 2d. The morphea alba, which consists of a more super-
whiteness of the skin than the albaras (leuce)
ficial 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 doAvn as incurable. This, of course, is the leuce of the Greeks.
He treats upon much the same principles as the morphese.
it

He appears not to make any distinction between the leuce and

the lepra.
Rhases describes the lepra of the Greeks by the term inqjetiyo;
SECT. II.] LEPROSY AND PSORA. 23

alphos albus by that of morphea alba ; alphos niger by that of Comm.

' '

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 a salt old and of the bath. For
by diet, wine, neglect
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 no-

sologists ; 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 ourmodern arrange-
ment ; 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 of the ancient authorities speak of scabies as
many
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, main-
tains that there is little necessity for distinguishing lepra, alphos,
melas, impetigo, gutta rosacea, and such like cutaneous com-
plaints from one another, as they are all varieties of the same
disease. Lanfrancus, however, is of a different opinion, (i, 3, 6.)
24 LICHEN. [book iv.

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 desicca-
;

tive applications. After general depletion, if necessary, the fol-

lowing simple medicines will be proper chick-peas, hellebore, :

the ui'chin 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 appli-
cation 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 aflected with hchen. 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 ^-inegar, are to be applied, or the
leaves of capers in like manner. The following are compound

applications Dissolve sulphur with rosemaiy in \^negar, or with

:

ammoniac, and anoint. A trochisk for lichen : Of artificers^

glue, dr. iv of frankincense, di'. of vinegai' half a cyathus;

;

dissolve in vinegar, and anoint. — iij ;

Another: Of chalcitis, of gum,

of each, dr. viij ; of sulphur vivum, of misy, of each, dr. \] ; of
the flakes of copper, of acacia, of each, dr. ij ; anoint with
vinegar.
—
Another : Of sulphiu" Aivum, of spuma nitri, of
each, dr. iv ; of the seeds of rosemary, Ix ;
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 flom' of lupines,
of burnt shell-fishes called buccina, of natron, of each, one
choenix: rub with it drv. Thev call that variety of lichen
agrius which is nowise remedied by moderately desiccative ap-
pUcations, and is exacerbated by more acrid ones. These cases
ai'e 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, wlicn dissolved, anoint. Another, for lichen and—
SECT. III.] LICHEN. 25

prurigo Of copperas, of sulpliur vi^-um, of natron, of frank-

:

incense, equal parts ; use for lichen with vinegar, and for pru-
rigo Toth wine.
—
Another, for lichen Of ammoniac perfume, :

of the flour of bitter vetch, of the flour of lupines, eqiial parts ;

add to vinegar.

Commentary. See Hippocrates (de Humor., de Afi'ect.) ;

Comm.
'
"
Galen. (Isagoge, de Med. sec. loc. v) ; Oribasius (Morb. Curat.
iii, 59); Aetius (viii, 16); Actuarius (Meth. Med. ii, 11);
Marcellus (19) ; Nonnus (236) ;
Celsus (v, 28) ; Pliny (H.N.
xx%i, 2) ; Serapion (v, 2) ; Avicenna (iv, 7, 3, 3) ; Alsaharavius
(Pract. xxxi, 7); Rliases (Divis. 117); Haly Abbas (Pract. iv, 10.)
Dr. Bateman states, the
exact acceptation of the
tliat

teim lichen cannot well be ascertained from the writings of

Hippocrates but Dr. "\^'illan 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 deter-
gent applications, for the preparation of which he gives various
prescriptions. One of these, which bears the name of Pamphilus,
is a powerful escliarotic, composed of orpiment, realgar, burnt

copper, and canthai'ides. (Med. sec. loc. v.) He says it aff'ects

principally the "chin, bufis apt to spread over the face.

Oribasius, Aetius, Actuarius, and Xonnus, treat of the com-

plaint in neai'ly the same terms as oiu- author. Their trans-
lators improperly render it by impetigo. Leo ascribes the
origin of the disease to hot and conrupted 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
 26 LICHEN. [book iv.

CoMM. ciypia 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 im-

From this account it is clear that the lichen of the
petigo.
Greeks, in its original form, was difterent 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 om- author's, namely, the saliva of a person fasting,
ashes of star-
compositions containing hellebore, natron, the
lings, &c.
In the translation of A^icenna it is likewise described by the
name It is called a species of dry achor, by which
of impetigo.
is no doubt meant papula. It is stated that it has a tendency
to pass into lepra or psora. The remedies which are recom-
mended are human saliva, the chaste tree, capers, leeches .

(which are not mentioned by the Greeks), likewise gum arable

dissolved in vinegar, mustard and vinegar, salt Avater, the roots
of king's spear, &c. Haly Abbas recommends stimulant lini-
ments of a similar kind.
Rhases briefly recommends and ammoniac,
lotions of vinegar

and, when becomes inveterate, leeches, strong friction, &c.

it

His translator also misapplies the term impetigo to it.

The lichen appears to be the cutaneous complaint which
Alsahararius describes by the name of aJcoab. 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. xra, 17) ;
one of the alsara of Alsahara^ius (Pract. xxx, 8) ; and the hasef
of A^icenna 8).
(iv, See also Galen's 'Commentary'
7, 3,

(v, 261) ;
Galen says it is attended Avith prmitus,
ed. Basil.

asperity, and ulceration. A^icenna and Rhases particularly

commend bleeding, cleansing the skin, and the cold bath.
Most '
Continens,' recommend for
of Rhases' authorities in his
the asaf, or sudamen, cooling and astringent applications, con-
SECT. IV.] PRURITUS. 27

taining roses, myrtles, galls, sandals, camplior,

and the like. Comm,
'
"

Thev attribute the complaint to profuse perspii-ation. In certain

cases, Rhases dii-ects us to allay the pruiitus or tingling,
with
hot Avater and the flesh of melons. He also approves of purging
-«-ith tamarinds and myrobalans. (Cont. xxxvi.) See also
ad ]SIausor. (v, 30). ]Mercui'ialis is of opinion that Virgil alludes
to the sudamiua in the following Hues :

" Verura etiam ill^•isos si quis tentarat amictus,

Ardentes papul?e atque immundus oleutia 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 dm'ing the reign
of Tiberius, called mentagra by Pliny, in his curious description
of it, but which he says was named Uchenes by some. He re-
presents 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 aff'ected even the neck, breast, and hands.
The onlv means of cm-e was biu'ningwith caustics do^^n to the
bone. (H.N. xxxvii; see also Marcellus, 19.) are inclined We
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 hauy parts. He rcQommends for it elaterium, linseed, or
figs boiled in water,
&c. (^i, 3.)

SECT. IV. ON PRURITUS, OR PRURIGO.

The age is not to be thoroughly

prui'igo occiuTing in old
cm'ed, but may be alleAiatedby the remedies mentioned below:
but that which arises from a cacochymy in other ages, is to be
cm'ed by evacuation, being formed by a bilious or pituitous
humom' 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

28 PRURITUS. [book iv.

venesection; but if it offend rather by its quality, we must

evacuate it by corresponding medicines, and turn oui* 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 hu-

mectation. They are to be rubbed with the decoction of fenu-
greek, or of beet, or of barley-meal, or of Avild or of garden
malloAvs, or of ptisan ; and along with these may be joined the
flour of beans, or of lupines, or of myi'obalan (ben), or of the

detergent ointment called peponaton. If it is protracted, we

may use the bath in like manner, and foment with the decoc-
tion of sage, of tamarisk, of the herb mercuiy, of marjoram, of

pennp'oyal, of bay berries, of the root of the wild cucumber,

of capers, of strained ley, of ^dnegar 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 sulpliiu' vi'saim, of each, lb. j,
of cimolian earth, Ib.ss; or this: of aphronitrum, of sulphur
vivum, of burnt alcyonium, equal parts ; to be used dry, or with
some of the decoctions ah-eady mentioned and, if you please,
;

sprinkle some dried hellebore, without grease. But rub in

wdth \dnegar 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 tri-
;

tm*ated with honey or the roots of dock, or the detergent oint-

ments 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 sulpllIU'^i^nlm 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 and in
great service :

like manner, pelHtory of the wall and maple rosin dissolved

with rose oil, and rubbed in. —
Another : Bruise three ounces
of pure and very Avhite rice, and, having strained, triturate with
strong vinegar until it become of the tliickness of the sordes
 SECT, IV.] PRURITUS. 29

of the oil and adding separately of snlpliur vivum

in batlis ;

pulverized, oz. and mixing properly, use in the bath Avith

j ;

much friction. W^ien thei'e is a greater redundance of hu-

nioui's, it will be better to mix the ingredients in equal pro-

portions.

Commentary. See Hippocrates (Aphor. iii, 31) ; Galen Comm.

'
*
(Comment, et alibi) Oribasius (Morb. Curat, iii, 22) ; Aetius
;

(xiv, 20) ; Actuarius (Meth. Med. ii, 11) ; Nonnus (237) ;

Alexander Aphrodisiensis (Probl. i, 24) ; IMyrepsus (pluries) ;
Pliny (xxviii, 5) Octavius Horatianus (i, 31) ; Marcellus
;

(de Med. 4) ; Isidorus (Orig. iv, 8) ; Serapion (v, 6) ; Avicenna

(iv, 7, S, 6) ; Haly Abbas (Theor. viii, 17, and Pract. iv, 6) ;
Alsaharavius (Pract. xxxi, 5) ;
Ehases (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 in old age. is common
The reason which Galen is, that the assigns for this
superfluities
of the system are then not properly discharged by the skin.
He says in another place, that prui'itus 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.
Aetius speaks highly of the sulphureous bath for the cure of
this disease.
Actuarius characterizes the disease verv 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 batlis medicated with frank-

 30 PRURITUS. [book n^

CoMM. incense, natron and sulphur. He also says that the cold bath, and
friction with the oil of roses, myrtles, &c., Avill 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.
is clearly described by the Arabians, and is
This affection
rendered pruritus by most of their translators. Serapion re-
commends us, if there is a sanguineous plethora, to bleed, and
then to purge with myrobalans, colocynth, and black hellebore,
and along with these the w^arm bath is to be used, and the
liniments for remoAdng the pruritus, containing ^dnegar, 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. Prui'igo, 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 fi-om bile or a shai*pness of the blood.
Our author has omitted to treat of plithiriasis, for an account
of which see in particular CnehusAiu'elianus (de Tard.Pass.iv, 2);
also, Aristot. (Hist. An. v, 32) ; Galen (de Comp. Med. sec.
loc. i, 8); Pliny (Hist. jSTat. xxvi, 86); Haly Abbas
(Pract. iv,
7) ; Plutarchus (in Yita Syllfe.) The
authorities quoted by
Rhases recommend compositions consisting of stavesacre, white
hellebore, arsenic, nitre, sulphur, sublimed mercury, and the
like. (Contin. xxx\i.) Antiochus, Herod of Judaea, Phihp II
of Spain, and many other celebrated personages, are said to
have died of plithiriasis. Vu'ey accounts for the disease in the
followingmanner " II :
est, en eifet, tel temperament muqueux,
telle degeneration des humeurs lymphatiques, dans le plithiriasis
ou la maladie pediculaire, que ces insectes y trouveut une
pature inepuisable, qu'ils se propagent avec une extreme exu-
berance sous le peau, penetrent dans le tissu cellulaire, et
SECT, v.] LEUCE. 31

etablissent d'enormes coloniesparmiles ulceres qu'ils y forment." Comm. " '

(Hist, des INIoeurs des Anim. ii, 207.) Aldrovaudi 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 \^scid 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 moistnre be discharged, it is includable. 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 coloiu', it cannot
be cm'ed. 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 biu'uing, and the scar arising from it, as being no less im-
seemlv than leuce itself, have had recourse to escharotic medi-
cines, such as they say will produce a scar of the natural colour.
Others rejecting all these things on account of the difliculty 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 re-
newal of the afiection. We
must use, then, the under-mentioned
remedial powers : Of adarce, of rosemary seed, of sulphui' Aivum,
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 aphro-
nitrum, sulphur ^i^^im, 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 ha^dng
mixed a sufficiency of quicklime with fig-leaves,
iised them in
like manner :
or, he says, ha^ing rubbed the leuce with white
 32 LEUCE. [book iv.

of the same colour

hellebore until part i^erspire and become
tlie

as tlie rest of the body, anoint with sinopis or melian earth ;

until they bleed, anoint
or, ha^^ng perforated them
^ith needles
with sinopis in vinegar; or, ha^ing first rubbed them as formerly
said, anoint Avith the fi-csh juice
of figs, or rub in so much with
the leaves of it.

CoMM. Commentary. In the second Section we have stated so

^^""^ and the difference between it and
fully the natm-e of the leuce,
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, all the Arabian
and the baras of
translators, Avith 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 Avith a needle, and, bleed, the if it

cure is to be attempted ; but if a slight coloiuiess fluid issiie

from it, the case is to be abandoned as hopeless. They con-

sider it from debility of the assimilative faculty of
as arising
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 vaih. a strict abstinence
from gross food ; if there be plethora, venesection is to be pre-
mised; then drastic pui'gatives and emetics are to be given,
and the parts affected are to be rubbed with stimulant and
caustic applications, containing hellebore, nitre, sulphm*, misy,
red arsenic, &c., or even the actual cautery may be applied.
In short, all treat the disease in nearlv the same manner as
our author. (See in particular Serapion and AA-icenna.)
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 snoAv-white
leprosy" of the ancient Jews was the leuce
of the Greeks. Moses describes veiy correctly the method of
distinguishing it from the alphos and melas ; (LeA-iticus, c. xiii.)
The symptoms of leuce are given in the 3d Aerse ; of the alphos
in the 4tlij of the melas in the 6th. He calls it contagious.
 SECT, VI.] ALPHI. 33

which might lead us to suspect that elephantiasis was mixed Comm.

up with the leprosy of the Jews. This opinion is fiu'ther con- ——
'
*
'

firmed from what is mentioned by Josephus of its heing 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 ha^'ing evidently failed

to recognize the nice distinction between cognate diseases, laid
down by the Jemsh legislator.
Leuce is still common in tropical climates. Negroes af-
fected with it are called Albinos. It is merely an aggravated
variety of the Lepra vulgaris.

SECT. VI. ox 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 alj^hi affect the skin super-

ficially, 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 prodaced white,
but black fi'om the melancholic. Wherefore, a common applica-
tion 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 floiu' when applied as a cataplasm with Adnegar 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 man-

ner, that of starlings, when they are fed solely upon rice, and
the bm'ut shells of the cuttle-fish. The following is a com-
pound appKcation of alcyoniura, of natron, of each, oz. ij ; of
:

white hellebore, of sulphur Aivum, of each, oz. j ; and some

also add the bui'ut lees of wine. —
Another Of sulphur vivum, :

of the spuma nitri, of each, dr. iv ; rosemary seeds, vij ; tri-

turate with vinegar. But rub only the part affected with
alphos, not touching the unaffected parts, and when dry, wash
II. 3
 34 ALPHI. [book iv.

vriih cold -water. —Another Of tlie flour of lupines, of buc-

:

and natron, of each, a chsenix of wliite hellebore, dr.

cina,
viij ; nib 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 aud honey and anoint, and after an interval of an hour
wipe away with a sponge.
it It applies also for freckles, warts,

and other spots on the skin.

A remedy for white alphos of sulphur vivum, ii sex-
tried :

tarii,of quicklime whitened, oz. iv ; five whites of eggs, of

nard-oil and vinegar, a small quantity. The sulphur is first
then we add to it the oil of nard, and again tritu-
pounded,
rate; 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 sulphiu' vivum, dried fig leaves, aphroniti'um, alcyonium,

Cimolian earth, and myrtle, use Avith -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 remo^-iug the black alphos ; thus
having cleansed the part with natron, anoint -svith 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 -sdvum, 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.

CoMM. Commentary. "We have again to refer the reader to the

' '
•
second chapter for an account of these complaints, and an ex-
position of the diff'erences between them and the afiections to
which thev are allied. It -will be seen that they are varieties
of the genus vitiligo of Celsus, and that they bear a near re-
semblance to leuce, from which they are chiefly distinguished
as being mere superficial affections of the skin. The Ai'abians
SECT. VI.] ALPHI. 35

treat of them under tlie names of morphea alba and nigra. Comm.
' '

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 though the needle has only pene-
flows
trated the skin, the disease curable, but if the discharge be
is

it is incurable, inasmuch as the flesh is converted into

milky
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 aff'ect difl'erent 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 humoui*.

There is scarcely any difl'erence of opinion among the au-
thorities 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 in-
ternal applications are powerful detergents and escharotics, such
as hellebore, natron, sulphur, vinegar, arsenic, copperas, &c.
Celsus says nothing of internal remedies, but recommends ex-
ternal 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 phlegma-
gogues, and by abstergent apphcations 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.
 3G STIGMATA. [book iv.

SECT. VTl. ON STIGMATA, FROM THE WORKS OP ARCHIGENES.

You may remove stigmata by rubbing in that which sticks

to a chamber-pot, along with the most acrid ^•inegar, or rub of

quickhme, 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
Avith nitre (soda), cover it with an application of turpentine ;

then ha\ing bound it, let it remain for six days, and on the
seventh perforate the stigma "oith a needle, and ha-sdng wiped
away the blood Avith a sponge, after a little time rub with
some powdered salt. Then, having applied the medicine, allow
itto remain for five davs. It is this of frankincense, of :

natron, of the lye of quicklime, of wax, of each, dr. iv ; of

honey, dr. \i\j ; 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 j of orpiment, dr. j ;
of honey,

q. s. Anoint with it, have prcAdously 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 black-
ness, anoint with it again ; for, he says, it removes the com-
plaint 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. a-j ; of pepper, dr. iij ; of lime,
dr. iij ; of thapsia, dr. iij ; of oi*piment, 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.

CoMM. Commentary. Consult Aetius 12); Actuai'ius (Meth.

'— — Med.
*
'

Scribonius Largus (§ 231)

vi, 8) ;
(viii,

;
AAdcenna (iv, 7, 2, 7) ;

Pseudo-Dioscor. (Eupor. i, 116.)

Aetius explains that by stigmata are meant the marks of in-
juries on the face or any part of the body. To eradicate them
he recommends compositions containing quicklime, natron,
arsenic, &c.
SECT, viii.] EXANTHEMATA. 37

The Pseudo-Dioscorides recommeuds the iauunculus_, the Comm.

' '

juice of the leaves of capers, or that of maudragora, &c.

"

Actuariiis copies from our author.

Scrihonius Largus mentions a composition containing garlic^
cautharides, sulphur, chalcitis, &c.
Avicenna recommends friction with natron and the other
substances mentioned by oui* author.
Dr. ^yillan defines the stigma, " a small speck on the skin,
occasioning no elevation of the cuticle." The ancient authori-
ties, it will be perceived, apply the term in a wider sense.

SECT. VIII. ON EXANTHEMATA.

Exanthemata are formed by thick humoiu's 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
fii'st
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 eva-
cuate 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 calefa-
cients, more especially when the exanthemata happen to be
broad, for these are formed bv a cold and thick humour.
Wherefore, take of the tender leaves of bay, of manna, and of
rue equal parts, triturate together, and dissoMng frankincense
in honey, anoint with it ; or, having boiled and pounded ten-
der beet, apply as a cataplasm ; or, take of wax, dr. viij ; of
sulphm* the same quantity ; of salt, dr. vj ; triturate them dry,
and having poured on them half a cyathus of oil, boil all to-

gether, and use the plaster that is formed. But one must at-

tentively sit by while the boiling is going on. It is a very

excellent medicine.

Commentary. Sec Hippocrates (Epidem. et alibi) ;

Galen Cumm.
(Meth. Med. v) Alexander (i, 5) Oribasius (Synops.
; ; vii, 7) ;

Morb. Curat, (iii, 31) ; Aetius (v, 129) ;

Actuarius (Meth. Med.
 38 EXANTHEMATA. [book iv.

CoMM. 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 exan-

thema in a much laxer signification than it is applied in Dr.
"Willan's'System of Cutaneous Diseases.' Hippocrates in par-
ticular be mentioned as it to various classes of
may applying
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 afl:ections 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. Aetius in like manner gives from
Herodotus an interesting account of fevers which are accom-
panied with exanthemata. Both have been supposed to allude
to the smallpox, but we agree with Dr. Willan, that this inter-

pretation 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
pustulse. His words are " Earum plura genera sunt.
: Nam
modo circa totum corpus partemve asperitudo qusedam fit, similis
lis pustulis,
quae ex urtica, vel ex sudore nascuntur i^avOi] /xara :

Grseci vocant. Eseque 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 nm-se, 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 direc-
tions respecting the diet are particularly important, and appear
SECT. IX.] EPINYCTIDES. 3U

to be quite iu accordance with the practice of the modern phy- Comm.

' '

sicians, 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 pustulse parvse
in most of the translations of the Arabians. The exanthemata
is, we think, thespecies of Serie described by Haly Abbas.
first

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 Avould appear,

however, that the benat noctis was the same as the sera or
epinyctis. See Rhases (Cont. xxx\d, 2). The symptoms of it
are said to be itching, roughness of the skin, and small erup-
tions 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
oi 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 bullse, reddish, and when broken, dis-
charging 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 dis-
solved the juice of laserwort in water, apply it ; for it is desic-
cative without being pungent; or, having levigated hemlock,

apply it; or cnide cabbage with water, or triturate parsley

with polenta, and apply ; the leaves of henbane
or, triturate
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 spleuium or oblong pledget, apply or tiiturate ;
 40 EPINYCTIDES. [book iv.

maideu-hair with honey. They must avoid all acrid, acid, and
saltish things, also fomentations, baths, and insolation.

CoMM. Commentary. Celsus (v, 28) ;

Aetius (xiv, 61) ;
Oribasius
^~^ '

Actuarius (]Meth. INIed. 11

(Morb. Curat, iii, 54) ; ii, j vi, 8) ;

Pollux (Onomasticon iv, 24) ; Avicenna (iv, 3, 1, 13) ;

Sera-

pion (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, Avhence 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.
Aetius, 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 Serapiou recommends
bleeding required by the general symptoms, purging with
if

myrobalans and pinines and external applications, containing

;

sumach, savin, &c. Haly Abbas, who describes it as one of

his serie, approves of much the same treatment. Aricenna
and Rhases in hke manner recommend bleeding, gentle pur-
gatives, coohng lotions, and the tepid bath. Khases, 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 (xxxAd, 6.) As
" benat
stated in the preceding chapter, the epinyctis is also the
i. e.
" fiha noctis" of the Arabians. Marcus Aurelius
noctis,"
Severinus, therefore, is mistaken in distinguishing between the
epinyctis and the benat uoctis. Ingrassius admits their identity.
Fracastorius gives the following account of this affection :

**
Si inflammata et accensa sit cholera, pustulam illam facit,
quse iirivvKTig vocatur, quod stepissime noctu nascatur,
^^
Arabes Essere appellant. (Dc Morb. Cont. ii, 15.) Both
Lorry and llayer confess themselves unable to determine what
 SECT. X.] PHLYCT^N/E. 41

the epinyctis of the ancieuts was. It would appear to have Comm.

" '

been some peculiar species eczema, uow extinct.

'
of It must .

have been a more formidable disease than the nettle-rash,

modern authorities have taken for the epinyctis
Avhich certain
of the ancients.

SECT. X. ON PHLYCT^NiE OR BULL^,

As Bullae when thqy 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 closeup and the bullge fill up, it is to be evacu-
ated again in like and the incum-
manner, and pressed out ;

bent skin is to be kept pressed down until the ulcer below be

healed. Before the bullae break, apply boiled lentils tritiu-ated
; or, the shoots of pomegranate, having been warmed
with water
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 andplilyctana. 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 w ine. For hot eruptions, warm papidte, achores, incipient

furunculus, and burns, the composition of plumbago, and that
from eggs is applicable.

Commentary. See Aetius (xiv, 63) ; Oribasius (Morb. Comj

Cm-at. iii, 23) ; Actuarius (Meth. Med. y\, 8) ; Avicenna (iii, 3, 1 , 11 .)
'
^
This appears to be the pompholyx of Drs. Willan and
Bateman. Aetius remarks, that the disease principally attacks
women whose menses are obstructed. " it
(Bateman says,
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 appHcations.
Celsus describes the phlycta^ntc as a variety of the pustulse.
 42 BURNS. [book iv.

CoMM. Tliere is nothing particular in the treatment recommended by

' '
*
Avicenna.
Thucydides mentions small plilyctsense and ulcers among the
symptoms of the plague of Athens. (De Bello Pelopon. ii.)
Hippocrates gives the name of pemphyx to the cutaneous erup-
tion_, by which the plague of Athens was distinguished. (Epidem.
vi.) See Galen's Comment, (v, 453, ed. Basil.) Procopius
also takes notice of black phlyctsense 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 phlyctcense were meant petechie. See Prselect.
Marc. p. 301/

SECT. XI. 0\ BURNS.

Burnt parts require applications which are moderately de-

tergent, without being decidedly heating or coohng. "Where-
fore, 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 di-ies 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 pai't the brine of pickled olives, or apply olives them-
selves 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 lihes,
hyacinths, or narcissi with rose-oil, and having made it of the
consistence of the sordes of
oil in baths, anoint vriih it. But
Marcellus gives the following composition haAing 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. xyj.
For burnt parts already blistered, having triturated sumach
and polenta with vinegar, apply it ; or, mix quickhme Avith
cerate, put it on a rag, and apply. And the medicine called
SECT. XI.] BURNS. 43

Sphseria 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 ;
also the bark of pine and of
(this is an excellent application:)
spruce fir, or dried maiden-hair levigated, or the burnt leaves
of mjTtle, are to be tritiu-ated 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 Comm

"^^~"
(v, 27) ;
Galen
(de Simi^l. Med. et alibi.) Aetius (xiv, 64) ;
Pseudo-Dioscor. (Euporist. i, 178) Actuarius (Meth. Med. ;

vi, 6, 8); Nonnus (240); Serapion (v, 11);

A^icenna (iv, 4,
3, 12) ; Haly Abbas (Pract. 4, 25) ;
Alsahara^ius (xxix, 2, 8) ;

Rhases (Antid. i, 27) ; (ad Mansor.

18) ; (Div. i, 136.) xii,

The author of the Hippocratic treatise referred to above, re-

commends various applications to burns, such as old aximge
rubbed into thepart, 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 cop-
peras, especially when dissolved in vinegar, forms an excellent
application for the ulcers occasioned
by burning.
Aetius treats burns upon nearly the same principles as our
author. When he forbids an early opening to be
blisters rise
made in them. As an
application to them he recommends
alum with water and the white of an egg. Some of his ap-
plications 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 recom-
mends a composition containing ceruse, litharge, toasted barley
pounded, wax, and rose or myrtle oil.
 44 BURNS. [book iv.

Euporista^ Cimolian earth, litharge and oil, and

'
CoMM. In the
' '

applications are recommended.

*
many other
Actuarius recommends a composition of litharge, cernse,
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 He praises such things as are
such cases.
moderately astringent, such as alum dissolved in vinegar, &c.
Celsus recommends at first such things as are,
" mediocritcr

exedentia reprimentiaque," and aftenvards 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 re-

frigerant. 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 be rubbed into the part.
is to He also gives a
prescription for preparing a mixture of lime-water and oil,
similar to that which is nowused in cases of bui'us. (vii,28.)
exactly
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 oc-
casioned by hot water, he directs us to apply sandals, rose-
water, and camphor or a cloth dipped in congealed water is
:

to be kei)t constantly applied, and it will prevent blisters fi'oni

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 biu'uing 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,
SECT. XII.] SCOURGES. 45

which are to be changed frequently. Afterwards some emol- Comm.

' '

lient applications, such as the white of anegg', with gum arahic

'

is to be used. Whenthe burning is more severe, he recom-

mends us and use a cooling application, such as the
to bleed
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, de-
scribed above. He also approves of a white ointment, con-
sisting of ceruse, oil of roses, and wax. In liis ' Continens,'
he relates a case of severe burning, which he treated with li-
niments composed of sandals, camphor, and roses; a cloth
wetted in snow-water being applied externally to it. He ap-
proves of opening the blisters. To prevent them from forming,
lie 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 \dnegar, tlie 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 Cau-
liac, recommends us in cases of extensive burning to have re-
course to A^euesection, 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 blis-
ters, of afterwards dressing the part with desiccative remedies,
such as the ointmentof lime, seven times slaked. (Tr.vi,Doct.C.6.)

SECT. Xrr. 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
 46 HAIRS. [book iv.

day use the susinum separately ; or, of saffron, dr. j

tlie first ;

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 Avarm, of
all remedies cures the soonest, effecting this purpose in a day
and a night.
*

CoMM. Commentary. See Aetius (xiv, 62) Avicenna ; (iv, 4, 2, 7) ;

" '
*
Haly Abbas (Pract. iv, 26) Alsaharavius (Pract.
; xxxi, 2, 1) ;

Rhases (Contin. xxviii.)

Aetius 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. Aetius, 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 recom-
mends 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 admi-

nistered. 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 seris.
SECT. XIV.] EXCORIATIONS. 47

dr. j ;
form trocliisks with water, and keep. When going to
use, mix one part with eight parts of cerate.

Commentary. The Arabians mention various things which Comm.

' '
"
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 appli-
cable 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 :

seris with gj^sum, 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 excoi'iations, intertrigo, chronic ulcers, and old and tender
skin. Of golden-coloured litharge, dr. Ix of wax, dr. xx of ; ;

dried pitch rosin, dr. xij ; having boiled

of oil, iss C3^athus :

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 apphed ; for thus
they coalesce, even if it is black. When stripped of the skin,
the cicatrization is difficult, the ulcer being irritated and ren-
dered Excoriated parts are preserved from inflammation
foul.

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 sti'ipes, and contusions
of the joints. Of
Ktharge, of ceruse, of each, oz. j ; of wax, oz.
vj ; of pm'e 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) ; Aetius Comm.

"^^^
(xiv, 66, 67) ; Scribonius Largus (88) Marcellus (De Med.) ;
;
 48 MYRMECIA. [book iv.

'
CoMM. Avicenna
'
(iv, 4, 2, 9) ; Haly Abbas (Pract. iv, 10) ; Rliases
'
(ad Mansor. vi, 18,)
Our author copies closely from Oribasius.
Aetius recommends as a good application for intertrigo oc-
casioned by the friction of shoes, the warm liver of a pig or
lamb, or unwashed wool. Here he follows Dioscorides (ii, 37.)
He also several cooling applications, contain-
makes mention of
ing 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 Aetius in recommending the liver, and the oint-
ment 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, contain-

ing Armenian bole, galls, pomegranate flowers, or the like.

SECT. XV. FOR MYRMECIA AND ACROCHORDOX.

Each of these is a small rising of the skin, of a callous

nature, and for the most part cii'cular ; but the mp^mecia haw
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. "Where-
fore, elaterium with salts, when applied, removes these swel-

lings ;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 bui'nt,

verdigris burnt with sulphur %'i^-um, the leaves of basil with
copperas ; that which flows from green vine shoots when burn-
ing, sheep's dung with vinegar, a buck-goat's gall when rubbed
SECT. XV.] MYRMECIA. 49

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) ; OMM.
Cos
Aetius (xiv, 4) ; Oribasius (]\Iorb. Curat, iii, 55) ; Actuarius
(Meth. JNIed. \i, 8) ; Pollux (Onomast. iv) ; Ancenna (iv, 3, 1,
6) ; Khases (Divis i, 131, et seq. ; ad Mausor. \\\, 15, 16.)
Celsus defines these tumours in the
following terms " AVpo- :

^opSoj^a Grseci vocant, ubi sub cute coit ahquid dui'ius, et in-
terdum paulo asperius, colons ejusdem : infra tenue, ad cutem
latius :
idque modicum est quia raro fabse
magnitudinem exce-
dunt. Vix unum tantum eodem tempore nascitur sed fere ;

plura, maximeque in pueris ; eaque nonnunquam subito desi-

nunt ; nonnunquam mediocrem inflammationem excitant sub ;

qua etiam in pus convertuntur." He then describes the

Bvfiiov to be about the size of an Egyptian bean, and of the
.•olour of
thyme. He adds: "Myp^jjj/cm autem Aocantur hu-
miliora thymio durioraque quae radices altius exignnt, majo-
:

remque dolorem movent infra lata, supra autem tenuia

: minus ;

sanguinis mittunt; magnitudine \hi unquam lupini modum

exceduut. 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 consist-
ing 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.

Apphcations containing arsenic, chalcitis, quicklime, elate-

rium, sulphur, and alum are mentioned by Oribasius and
Aetius. See in like manner the ' Euporista^ of the Pseudo-
Dioscorides.
The myrmecia is by the La-
generally rendered formicaria
tin translators of the Greek medical authors, said /or77iica mili-
aris by those of the Arabians. A\icenna seems to confound
the myrmecia with the herpes.
Pollux defines the thymus, or thymiura, to be an excrescence
about the pudenda, anus, fingers, or face, of a red colour,
rough, bloody, and not difficult to remove. The acrochordon-
II. -i
 50 GANGLION. [book iv.

CoMM. he says, is white at the root, and it gets enlarged at the ex-
" '

"

tremity. The myrmecia he defines to be a hard, rough excres-

cence of a callous natiu-e, but bloody at its extremity.
The acrochordon is thus described by an intelligent modem
author " Est verruca subcutanea dm-ior et
: asperior, callosa,
atque plerumque teres, ciite concolor, in basi tenuis, summit atis
vero latioris, fabse magnitudinem raro excedens, juniores maxime
infestans."(Mangeti Bibl. Chiiurg. i, 72.) The terms, thy-
mus, mynnecia, 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 pressui'e, in many parts of the body, but par-
ticularly in those pai'ts which are moved, such
as the extremi-
ties of the handsand 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 ceiuse, of pine rosin, of old oil, of each, oz. j ;
:

of ammoniac perfume, of galbaniim, of each, oz. j ; of wax, oz.

iv ; or, he says, apply a thick plate of lead, like the vertebrae,
and larger than the ganglion, and bind it on ; for by its weight
this dissolves it in process of time. This we have used.

CoMM. Commentary. See Hippocrates (De Ariic. xxvi) ; Galen

'

(Comment., de Med. Simpl. ix) ; Celus (vii, 6)

'

;
Oribasius (De
Yirt. simpl. ii, in voce Plumbum) ; Aetius (xv, 9) ; Actuarius
(Metli. ]\Ied. A^icenna (iv, 3, 2, 6) Albucasis (Chirurg.
ii, 11) ; ;

ii, 50) j Rhases (ad Mansor. \\i, 15 Contin. xxviii.) :

Hippocrates points out the danger of opening these tumoui's

indiscriminately. They consist, as Galen remai'ks, of a "viscid
and mucous fluid. Galen and Oribasius agree with our author
in dii-ecting a piece of lead to be bound upon the ganglion.
i^
Nearly the same plan of treatment is recommended by Aetius,
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 "\rill be speedily dis-

solved. Albucasis approves of extirpating the tumour, unless it
SECT. XVII.] PHLEGMON. 51

be seated near a joint. Rhases as usual collects the opinions Comm.

" '

of Antyllus^ he says^ directed the

''

preceding authorities.
all

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 PHELGMON.

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 abun-
dantly to a part and from its quantity becomes seated in it,
the disease is that Avhich 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. ^'NHierefore,
we shall begin Avith what
properly called phlegmon, which
is

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 some-
times 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. Wlien 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 venesec-
tion, 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,
cataplasm of house-leek, and of the bark of the
therefore, a
pomegranate tree boiled in wine, with sumach and polenta :

when the pain not violent, this or such like applications are
is

to be used; but when there is a defluxion to the part with

 52 PHLEGMON. [book iv.

greater pain, then cataplasms of hot water and oil, or of po-

lenta, 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 composed from musk, rose-oil, and a little wax,

is

with unwashed wool containing much grease these things are :

to be prepared and applied cold in summer, but tepid if in win-

ter, 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 applica-
ble 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. AThen a change is thereby
effected, and no pus falls into the part, you may accomplish
the care by means of the plaster from chalcitis, or some of
those plasters of a similar natui'e, 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 injm*ed by moistening and heating applica-
tions, and if necessity require, you may scarify them with ad-
vantage. But in phlegmons arising from defluxion, scarifica-
tion, more especially at the commencement, may become the
cause of much mischief to the patient,

CoMM. Commentary. See Galen (ad Glauc. ii) ;

de Different.
^^'"^
Morb. (12); Meth. Med. (xiii, 2); Celsus (iii,10); Oribasius
(Morb. Curat, iii. 41) ; Aetius (xiv. 31) ;
Leo (vii, 4) ; Actuarius
pieth. ]Med. ii, 12) ; Avicenna (iv, 3, 1, 2) ; Serapion (v, 22) ;

Haly Abbas (Theor. viii, 9 ; Pract. iii, 27) ;

Alsahara^'ius
(Pract. xxix, 2) Ehases (Divis. 126, and Contin. xx\-ii.)
;

Galen explains that the term phlec/mone is used either to

signify inflammations in general, or a red, i*esisting, and pain-
ful tumour in particular. It is here used in the latter accepta-
tion. 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
SECT. XVII.] PHLEGMON. 53

with a deep-seated throbbing ;

it seems stretched and broken ;
Comm.
there a sensation of increased heat^ so that the part feels as
is

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 enu-
merates many causes of it, such as braises, fractures, and dis-
locations ; 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, hap-
pens 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 affec-

tions to be accomplished by evacuation.

is Reason and expe-
rience, he adds, teach us that the general system is to be
evacuated by the suitable means, and the inflamed part by em-
brocations 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, Aetius, Actuarius, and Nonnus, in like
manner, borroAv from him eveiything which they advance
upon this subject.
Celsus does not treat of phlegmon in particular, but he has
gWen an excellent account of inflammation in general." His
definition of inflammation is singularly appropriate Notpe :

inflammationis sunt quatuor, rubor, et tumor, cum calore et

dolore.^' Isidorus attempts the same not so successfully :

" est fervor cum extensione et dolore ; sive est in-

Phlegmone
quietudo cum rubore, et dolore, et extensione, et duritie,
et

vastitate et febris inse-

:
quse quum ceeperit fieri, inquietudo
quitur."
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 particu-
;

lar. He joins Galen in recommending a free incision when it

is apprehended that the member in which it is seated will be-
come corrupted. Serapion's treatment is nowise dissimilar.
 54 ABSCESSES. [book iv.

CoMM. 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 de-

fluxion upon the part. He which takes
attributes the collection

place in a part to its debihtv, which makes it unable to cast off"

the load which is thrown upon it. AYhen seated in a vascular
part, phlegmon, he says, is attended with a throbbing pain.
He approves of fi'ee 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 suppiu'ation, boil

bread in water and oil, and apply it as a catasplasm ; or apply
barley flour prepared in Hke manner ; and bathe the part with
an infusion of marshmallows. But when the swelling is
difiicidt, 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 floirr added to it. And if the swelling is resolved
but imperfectly, you may boil with the figs hyssop or mar-
joram ; 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 vou
perceive any such thing, you must boil ^rith the water the root
of wild cucumber, or of marshmallows, or of bn^onv. But
the root of the dracunculus is
stronger than these and more
discutient ;
and the medicine formed from the di-acunculus itself
isvery discutient. Sometimes, therefore, you may apply de-
coctions of these things alone; but at other times you may add
dried figs, and mix polenta with fat. And the oil of dill is dis-
cutient, and adapted for concocting crude humours, and uncon-
 SECT. XVIII.] ABSCESSES. 55

cocted swellings. And pitch, more especially the liquid, con-

hard and unconcocted swellings, when added to the
cocts all

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, add to liquid pitch, and

di*.
vj ;

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 evacu-
ated, taking care not to apply to it water or oil; or, if it be
necessaiy to clean the sore, it must be done with honied water,
oxy crate, wine, and wine and honey ; and if it become in-
flamed, the cataplasm of lentils is to be applied; but if it is
not inflamed, we may use some of the plasters to such open-
ings, 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 en-
deavour 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 jiarts
of dry pitch and Cretan bee-glue, produce the rupture of ab-
scesses and promote cicatrization.

Dionysian plaster, a wonderful epispastic application for

TTie

abscesses, to the breasts and to buboes, dissipating by the insen-

sible 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, —
56 ABSCESSES. [book iv.

iiu epispastic : Of ammoniac perfume^ oz. vj ;

of vrax, of tur-

pentine, of eaeli, oz. iv of sulphur vi\Tim, oz. iij ; of natron,

;

oz. iij ;
and the application called smilium, and tliat from gar-
licare strongly calculated to promote the breaking of abscesses

already formed. But that Avhich consists of the juice of lin-

seed 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 witliin 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 afiirm 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 Anne. 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 cor-
iniption 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 mehceris, 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 ab-
scess 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 swellmg 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
SECT. XVIII.] ABSCESSES. 57

neighbouring glands. "When the abscess is fairly formed, the

most of these symptoms are diminished, the pungent pain be-
comes itchy and somewhat dull, the swelling is more sharpened
intoan 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 Chap- Comm.

" '

ter may be consulted on the treatment of abscesses. See espe- '

cially Aetius. He recommends when suppuration is not taking

place properly to apply barley meal, or bread boiled in the de-
coction of figs, to which if necessary may be added nitre, tur-

pentine, or the like. AVhen suppuration takes place, the abscess

is to beopened where the skin is thinnest, (See Book 6.)
The incisionis 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 neighboui'ing 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 tdcer
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 appli-
cations 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, galbauum, bees-glue, and bird-
lime, -with somewhat less than one half of myrrh. The plasters
and malagmata for this purpose are likewise to be applied.
When these apphcations do not produce resolution, we must
conclude, he says, that the abscess will ripen. The symptoms
 58 ABSCESSES. [book iv.

CoMM. 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
to be put into it. When
large he properly forbids tents or pledgets
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 can-
tharides and old oil. Some of their applications contain nitre,

quicklime, and arsenic. Such a composition, by producing a

it was in-
slough, would no doubt effect the purpose for which
tended. 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 under-

stood 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 be-
tween 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.) Khases, 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 de-
scribes the leaven cataplasm, and others of a similar nature. He

gives Antyllus' directions for opening abscesses. Abscesses in

SECT. XIX.] GANGRENE. 59

the limbs are to be opened by a straight incision, but those Comm.

' '

about the ancles by a circular, as they are apt to terminate in '

fistulse. 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
from the violence of the inflammation,
to mortifications arising
when they are not yet formed but forming ; and if such a state
is not speedily cured, the afl'ected part readily dies, and the
disease seizing upon the surrounding parts, kills the person.
But when the parts thus afl'ected become totally insensible,
the aff'ection is no longer called gangrene, but sphacelus. This
affection happens also to the bones when the flesh that sur-
rounds them engendering noxious humours impregnates the
bones therewith, and causes them to putrefy. When, there-
fore, 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 skinby 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
for The nettle also cleans them, and
applications gangrene.
the juice of spurge, when applied in season and in proper
quantity. Tlie decoction of bitter lupines, poured on the part,
is also beneficial. Some after the incision, for the sake of
in which cases we must use salt
security, apply the cautery,
with leeks afterwards, in order to remove the eschar, we may
:

of wheaten flour
apply a cataplasm of bread, or of barley, or
boiled in Avater and oil ; or the dry cephalic powder with honey,
and the tetrapharmacon ; and that called the Macedonian may
 60 GANGRENE. [book iv.

be used. The eschars may be properly removed by bread tri-

turated with parsley^ or basil, or by ii'is, panacea, or birthwort,
or by the sweet-fla"; with honey, or by frankincense. And the
medicine of Machserion takes away the eschars in a proper
manner, and the iris spread upon pledgets with honey; but
in soft bodies the floiu^ of tares, with honey, is sufficient.
From the ivorhs
of Orihasius, for gangrene. Of scraped
verdigris, of vermihon, of stone alum, equal parts ; triturate in
water and anoint. The flour of darnel, with radish and salts,
and sometimes with vinegar, will, when apphed 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 Avalnuts, and mp'tle leaves boiled in wine and
ti'iturated with honey. Radish, with vinegar, breaks the
eschars even to the bone.

CoMM. Commentary. See the authors referred to in the 17th

Section.
Paulus copies freely from Oribasius (Synops. -sii, 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, Aetius, Paulus, and all the subsequent writers on
this subjecthave 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 accomphsh 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 Encyclopedic
Methodique, art. Gangrene, 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
SECT. XX.] HERPES. 61

venesection, if the strength permit, and of a restricted diet ;

Comm.
" '
'

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 bv 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 escha-

rotics such as arsenic, quickhme, 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 inflam-
mation threatens to terminate in mortification, it is to be treated
by scarifications, stimulant applications, and the cautery.
The earlier modem sui'geons followed the ancient practice of
of gangrene.
applying the cautery in cases

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 but if it is thin, less acrid
called herpes exedens ;

and hot, it on the surface of the skin like

raises small blisters

millet-seeds, and hence has been called herpes miliaris. Accord-

ing 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 de-
 62 HERPES. [book iv.

siccant things to the affected part.At the commencement,

therefore,we may apply cataplasms from vine shoots, bi'amble,
and plantain but afterwards we may add lentil to them, some-
;

times with honey and polenta. And the cataplasm recom-

mended phlegmons from defluxiou may be applied without
for
the house-leek. But idcerated 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 senice, 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 'svill be convenient applications. —
Another : For herpes phlyctsenodes having triturated the di'oss
:

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. \iij ; of fissile alum, dr.
j ; add to wine
and myrtle oil.

CoMM. Commentary. The writers on phlegmon treat immediately

—
' — afterwards
*
'

of herpes and erysipelas. Fabricius ab Aquapen-

dente, 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, how-
ever, distinguishes the ignis sacer from zona, which, he says, was
SECT. XX.] HERPES. 63

called herpes by the Greeks. The ignis sacer of Octavius Com M.

Horatianus likewise appears to be erysipelas. And Isidorus
"
^
states decidedly that the ignis sacer was erysipelas :
— " Ery-

sipelas est quam Latini sacrum ignem appellant, id est, exe-

crandum, 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.) Ha\dng
thus stated the doubts which prevail respectrug 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
aff'ected either healing, or becoming ulcerated from the rupture of
the pustules and discharging a humour intermediate between sa-
nies and pus. The breast and sides are mentioned as being fre-
quently 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 be-
coming swelled, hard, and of a colour compounded of black and
red. It afiects 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 hei'pes circinatus
of his arrangement. Bayer rather supposes it to be the dartre
squameuse centrifuge Ahbert. 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, quickhme,
&c.
Pollux defines herpes to be inflammatory and pungent pus-
 64 HERPES. [book iv.

CoMM. tules, which spread most commonly about the neck, but some-
'— — times
'
'

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 herjies exedens. But if thinner,
it burns as it were the surface, when it is called by the
only
generic term of herpes.
Of the other two varieties, the one,
as has been said, is called exedens, and the other mUiaris, because
it is attended with many small bullse (phlyctsense) 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 pur-
gatives for proper herpes. Wlien the ulceration is of a mahg-
nant nature and attended with putridity it requires the most
acrid medicines, and such as in power resemble fire, namely,
misy, chalcitis, quicklime, and sandarach.
arsenic, For, he
adds, these medicines burn like fire, and often when they fail,
we must have recourse to fire itself.
Aetius gives an accurate account of herpes, but it is pro-
fessedly 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 erup-
tion of vesicles (phlyctseuse) We shall here notice what Dr.
— " The ancient
.

Bateman says respecting this division of herpes

:

division of herpes into three varieties, miliary {KEyyrpiac:),

vesicular {(p\vicTaivu)^r]g), and eroding {iaOioiisvoQ), mayl)e pro-
perly discarded, for there appears to be no
essential diff'erence
between the first two, which difi'er 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 phlyctsenodes.
makes mention of only two varieties of the disease,
Palladius

namel}^, 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 diAdsion of any, as the
exedens is eWdently a disease of a very different nature
herpes
from the other varieties.
SECT. XXI.] . ERYSIPELAS. .
6.5

The Pseudo-Dioscorides recommends strong stimulant appli- Comm.

' '

cations 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 estiomenos 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, for-
mica 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 pre-
vailing 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 par-

ticularly about the head ; so that if active treatment be not

resorted to, it wiU sometimes prove fatal to the patients by
suflbcation. At its first appearance then we must open a vein
II. 5
(16 ERYSIPELAS. [book iv.

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 defiuxion, and with moderately heating and moist-
is collected, before
ening things so as to dissipate that which
the parts become hvid or black ; but the parts which are anointed
are to be kept constantly in a wet state, by frequently changing
the which may be done by cleansing them with
applications,
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 moist-
ening, 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 stillbetter but polenta, Avith some of the
:

aforementioned cooling herbs, cool verj^ 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 stri'chnos, or
litharge with rose-oil, or chalcitis with oil and must ; or ceruse,
with Ainegar and bvickthorn ;
or acacia, with vinegar. When
the effeiTescence subsides we may use these simple applications,
native sulphm* and mint, "odth 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 cop-

peras, of fissile alum equal p.arts, use with vinegar. AnotJter — .•
SECT. XXI.] ERYSIPELAS. 6/

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-mal-
:

lows, lb. j ; ha^dng boiled in water and

oil, triturate properly,
and adding of of litharge, of ceruse, of each,
rose-oil, oz. iv;
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 tritiu'ated with vinegar. cerate for ery- A
sipelas 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
hAdd, incisions must be made in the part, and cataplasms more-
over 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 Comm. " '
^
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 A-ery particular ac-
count of the disease. In one of his aphorisms he states that cold
is useftd 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 1

river water, and the like. When refrigerants fail to produce

the sulphur, ceruse, and
effect, 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 honev and rosin, and treated
upon general principles.
We have stated in the preceding Section that the ignis sacer
 CS ERYSIPELAS. . [book iv.

CoMM. of Scriboniiis Largus is not herpes. That it was erysipchis

'~~^^—' between his applications for
seems probable from the similarity
it and those which Celsus and the other authorities recommend
for erysipelas, Tims for ignis sacer he recommends Cimolian
chalk, diluted with the juice of solanum, or
the solanum by

itself, or Avith bread ;

or a mixture of sulphur vivum, ceruse,
and litharge.
We may remark furtherin this place that the ignis sacer, or
St. Anthony's of
firethe middle ages, would appear to
have
l)een some varietj^ of erysipelas.
Galen's account of erysipelas is particularly deserving of
attention. In the 14th Book of Meth. Med.,' he is at
his '

pains to state the nature of the disease, and the difference be-
tween it and plilegmon. The common symptoms of both are
heat and swelUng. But they differ, first and principally in
colour, Avhicli is red in plilegmon, but pale or yellow, or
a com-

pound of both, in erysipelas. Throbbing is also a character-

istic symptom of a great phlegmon, for it is deep-seated, whereas

erysipelas is rather in the skin. Erysipelas, he pointedly in-

culcates, 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, consequent^, 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 prolonga-

tion 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 appli-
:

cations are to be used until the part change its colour, but are
not to be continued until it become black or livid. It is ne-

cessary, therefore, as soon as a change of colour in the affected

part is remarked, to exchange them for those of a contraiy
nature. His cooling applications consist of strj^chnos (solanum?)
and the other articles mentioned by our author. When the
part becomes livid, he directs us to make incisions, and after-
wards to apply cataplasms and fomentations with hot water, to
SECT. XXI.] ERYSIPELAS. (39

wbicli salt or vinegar may sometiraes be added. It is only at Gomm.

be added to tlie
^
this tiine tliat quicklime may safely applica-
tions ;
for it wovdd prove liigbly prejudicial at first. With
respect to the general treatment^ he approves strongly of chola-
gogues^ Ijut does not think bleeding necessary in ordinary cases.
When erysipelas from idcers or any obvious causes^ ho
arises
recommends scarifications and cataplasms of barley flour, lie
i-ecommends much the same plan of treatment in his 'Therapeut.
ad Glauc' ii. He speaks highly of early incisions.
Aetius_, 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 Avater, or water with
salt and brine.

Actuarius states the danger of carrying refrigerant and re-

pellent applications too far, and recommends something
discu-
tient to be added to them.
Octavius Horatianus approves of bleeding (unless contra-indi-
cated by the want of strength), and of cholagogues, with free
incisions and fomentations.
Avicenna states that bleeding in general does no good, un-
lessthe humour be seated between the two skins. He approves
most of cholagogues and of applications strongly refrigerant ;

lest the disease

only he cautions us not to carry this plan too far,
be determined to an internal part, or terminate in gangrene.
the name
Serapiou treats of the disease very accurately by
of al massire, but in nearly the same terms as Galen. He
of cooling and repellent applications at the
approves decidedly
commencement. Serapion and Avicenna notice the eruption
of bullss in erysipelas.

Haly Abbas directs us, when erysipelas is not attended with

to the part,
swelling, to use cooling and repellent applications
and to administer gentle cholagogues, such as myrobalans, ta-
marinds, and i^runes. But if and if there
swelling be present,
is nothing to contra-indicate venesection, he recommends us to
bleed and apply cataplasms.
Alsaharavius describes three varieties of erysipelas ; namely.
 70 ERYSIPELAS. [book iv.

CoMM. the eiTsipelas properly so called, the ignis Persicus, and tlie
' '
"
erysipelas inflatiAa. The variety, he says, is attended
first

solely -with redness of the cuticle. It is to he treated hy hleed-

ing, piu'ging, and local applications of a cooUng 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 eiysi-

pelas inflatiA'a arises with a sudden swelling, and blisters, like
those produced by fire. It is to be treated by bleeding and

cooHng apphcations, 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 deci-
dedly favorable to bleeding as Rliases. Like the others, he
attributes it to heated bile. He, and most of the authors
'
quoted by him in his Continens,^ approve of cooling applica-
tions, but he cautions against carrpng this practice too fai*.
He remarks that vesicles like those from bm'uing often arise
on the part.
Fabricius ab Aquajjendente is a strong advocate for the
ancient theory, of which he gives a full explanation. The sys-
tem, he says, being loaded with vitiated bile, the more important
organs cast it off: it is, therefore, sent outwardly, and is de-
tained by the cuticle when its pores are obstructed. He at-
tempts to reconcile the contrary opinions of the ancients with
regard to venesection. He himself approves decidedly of bleed-
ing 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 re-
commends camphorated spirit of wine.modern
The earlier

surgeons, as, Brimus and Theodoricus, decidedly

for example,
recommend cold applications at the commencement. When the
disease not thereby resolved, they direct us to liave recourse
is

to leeches and scarifications. They approve much of chola-

gogue purgatives, but do not recommend bleeding unless in-
flammatory symptoms run high.
SECT. XXII.] PHYMA. ^
71

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

According to Galeu, phjona, bubo, and pliygetblou, are affec-

tions of the glands bubo being an inflammation of a gland
: ;

phygethlon, an inflammatory erysipelas, or an erysipelatous in-

flammation of a gland; and pliyma, an inflammation of a
gland passing rapidly into suppui'ation. But, according to
others, all tumoui's of the nature of apostemes, which arise in
any part of the body, are called phymata. For Hippocrates
" Those in whose urethra form are relieved when
says, phymata
they suppurate and biu'st.^^ Wherefore those buboes which
are occasioned by accidents, either ulcers or pains, are not dan-

gerous but those which occm* 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
firstkind, as is the case in every other inflammation, we must
endeavour to put back with cooling and astringent applications,
either apphdng a sponge out of oxy crate, or wool out of \^dne
and raAv oil, or oil of roses, or oil of apples, or oil of lentisk,
or oil of mjTtles ;
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 in a state of inflammation, it is to be mitigated by
is

wool soaked in some of the emollient oils, and the Avhole bmb
is to be wrapped theremth. 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 pre-

pared from apyranon, and that from herbs called botanica.

When resolution is not thereby accomplished, Ave must forward
the rupture as in the other abscesses, and cure it in like man-
ner as them. In those buboes which arise in fevers or from
a collection of humours, we must abstain from all repellents,
lestthe 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
 /z2 PHYxMA. [book iv.

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 tlie 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 par-
ticular : maiden-hair ;
orache ; pellitory of the wall ;
the root
of marsh-mallows, boiled in wine ; ammoniac, softened with
honey, and applied birdlime, Avith the rosin cerate.
;
But bee-
glue, bitter lupins applied with ^dnegar, 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.

CoMM. Commentary. The account here given of these glandular

* '

*
inflammations is taken from Galen (ad Glauc. ii.) See also
'
de Tumoribus^ and '
Comment, in Hippocrat. Epid.^ vi.

Celsus describes
phyma resembling furunculus, but as
as

being larger, and turning to pus. According to Rayer, his

description of phyma applies better to the boil than his account
of anthrax. (]Malad. de la Peau, p. 229.) The phygethlon, he
says, is a tumour not high, but broad, and containing something
resembling a pustule. It occurs mostly in the armpits, neck,
or groins. He proposes applications of a repellent and refri-
gerant nature ; but if the swelling is hard, digestives must be
had recourse such as dried figs bruised, &c.
to, He also re-
commends a composition of sal ammoniac, galbanum, bee-glue,
and mistletoe, with a small proportion of myrrh. His treatment
is
considerably different from our author's. "\^Tien matter is

formed, he directs us to let it out by medicines or the lancet, but

lie decidedly forbids the use of cerates. In another place, how-
ever, he recommends an application containing lime, spuma
nitri, round pepper, galbanum, and salt mixed with rose cerate.
Scriljonius Largus recommends a malagma containing pitch,

aphronitum, pine-rosin, wax, bay-berries, axunge, ammoniac,

Ilh'rian ii'is, galbanum, and white pepper, for discussing phy-

gethlon.
SECT. XXIII.] FURUNCULUS. 73

Oribasius and Aetuarius mark the distinction between these Comm.

" '

affections in the same terms as Galen, and direct us to ti'eat them '

with emollient, concoctive, and discutient applications. For

concocting phymata, the Pseudo-Dioscorides recommends
southernwood, boiled Avith raw barley flour; figs, boiled with
yeast, &c. ; and for breaking them, the juice of thapsia, with
sulphur ; cantharides, mixed with turpentine, &c. (Euporist, i,
156.)
Nonnus^ account is mostly abridged from our author's. Thus,
he recommends at first venesection, and sponges squeezed out
of oxycrate and the like then digestives are to be applied ; and
;

aftervv ards cataplasms and such things as will favour the rupture
of the abscess, namely, compositions containing bee-glue, bitter

lupins, vinegar, nitre, yeast, or figs and pitch.

Avicenna describes these aff'ections by the name of ulthaum.
It isremarked by his translator that the Arabian recommends
the same medicines as Paulus, but neglects the distinction which
the latter properly makes between the bubo when attended
with pestilential fever and when without it.
The phyma seems to have been merely an acute inflamma-
tion of a gland, terminating in suppuration. The phygethlon
was an erysipelatous inflammation of a gland. These complaints
are Avell defined and described by Fabricius ab Aquapendente
(1, i, 23.)
Dr. Willan uses the term phyma in a difterent sense
from that of our author. The term occurs in Marcus Antoninus
(ii, 16), where see the note of Gataker.

SECT. XXIII. ON FUKUNCULUS.

is an apostematous swelling, formed of thick

Furunculus
humours in the fleshy parts of the body most especially ; being
mild when it is formed in the skin only, but of a malignant cha-
racterwhen it rises up from a deep-seated part. Fm'unculus
may be discussed and concocted by wheat, chewed and applied ;
by Egyptian mastic ; by raisins, deprived of their stones, and
triturated with salts, and applied — (this either discusses or
breaks the swelling) or apply dried figs boiled in hydromel ;
;

or rosin may be mixed with the figs and applied or the figs ;

themselves, when they are fet, may be split open and applied ;
or
 74 FURUNCULUS. [book iv.

leaven with nitreor linseed with honey ; or the leaves of

;

henbane, triturated with butter of compound applications, that

:

which is prepared from leaven and fine flour, and that which is
particularly named Dothienicon,
are very applicable. Foment
with soft sponges frequently dipped in hot water, and then
apply the medicines.
f
CoMM. CoMMENTAKY. In this and the two folloAvdng Sections, see
the authorities on phlegmon.
Ij
The furunculus, according Galen, is an inflammatory
to
afi'ection which is of a malignant nature when deep-seated, and
differs from phyma only in hardness. (De Tumoribus.)

Furunculus, says Celsus, is an acute tubercle, attended with

inflammation and pain, more especially when converted into
pus. After it has been opened, and the pus discharged, there
appears part of the flesh below converted into pus and part cor-
rupted, of a whitish or reddish colour, which they call the ven-
tricle or belly of the furunculus. He says that the disease is
not attended with danger, and that medicines are necessary
solely for removing it the more expeditiously. For this purpose
he particularly commends galbanum. If repellent applications
do not succeed, suppurative ones may be used; and, failing
these, rosin or leaven. When pus is formed, no further treat-
ment is required. According to Kayer, Celsus' description of
furunculus applies to the malignant pustule and not to the boil.
(Malad. de le Peau, 233.)
The simple remedies recommended by our author are bor-
rowed from Oribasius.
It is to be remarked that Galen, Celsus, Pliny (Nat. Hist,

xxiii, 7), Octa^dus Horatianus, and Avicenna concur in recom-

mending figs for furunculus or the boil. It was with a lump

of figs that the prophet Isaiah cured Hezekiah's boil.
Avicenna and Khases treat furunculus judiciously by bleeding
and purging, which prevent the formation of a large abscess.
"When there is throbbing in the tumour, they direct us to use

maturative applications. When it is ripe, and does not break

readily, they recommend us to open it. Haly Abbas says, that
boils arisefrom gross and depraved humours. (Theor. viii, 11.)
Alsaharavius also ascribes them to a full and unwholesome diet.
He mentions that he often succeeded in stopping the formation
 SECT. XXV.] ANTHRAX. 75

of the furunculus it with a piece of

by cauterizing myrtle or any Comm.
other wood. When the pain is violent, he recommends an
"
*
'

application of the leaves of henbane and poppies with the yelk

of an egg. When the boil is indolent, he approves of a sti-
mulant plaster. (Pract. xxix, 4.)

SECT. XXIV. ON TERMINTHUS.

Oribasius says, that terminthus is a species of phyma, but

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

Commentary. Aetius gives the same account of terminthus, Comm.

' '
*
which is a species of phyma. See Hippocrat. (Epidem. ii, 11 ;

de Humor,. xi, 1); Galen (Comment, in Epidem.); Oribasius

(Sjmops. vii, 136.) A\dcenna describes these affections by the
name of albothin (iv, 7, 3, 1.) He says that thev are ulcers
produced by black bile ; that they appear upon the leg, and are
of the same nature as varices.
The terminthus would appear to have been the cutaneous
disease to which Willan applied the name of ecthyma.

SECT. XXV. ON CARBUNCLE OR ANTHRAX.

When the blood having become more melancholic than na-

tural, ferments and fixes in a part, the diseases called carbuncles
are formed, which are sloughy ulcers, for the most part begin-
ning with bullse, like burnt parts, but sometimes without them ;
and the patients at first rub the part for its itchiness, whether

one bulla is formed or several small ones,

like millets, which,

having burst, a sloughy ulcer takes place, resembling those

occasioned by cauteries, the eschar being sometimes of a
ciueritious colour and sometimes black, along with its being
 '

76 ANTHRAX. [book iv.

fixed to the base, and in a certain manner nailed to it, and it

flesh is in a fiery
spreads at the same time, the surrounding
state, black in the colour, and shining
like bitumen and pitch.
Such is the true black bile. But carbuncles that form in the

flesh arc speedily circumscribed ; whereas those which take

place in membranes or nerves remain long,

and affect sym-
pathetically the parts below, so as to give origin to erysipelatous
inflammations. Not a few terminate in suppuration, and most
cases are attended with fever.
Carbuncles also sometimes arise from epidemic causes. We
must treat them, unless they are very small, by venesection, car-

rying evacuation as far as to occasion deliquium animi ;

and after
venesection it will not be improper to make deep scarifications

in the part, on account of the thickness of the humour. To

the aftected part we may apply such things as are moderately
repellent and discutient, as the cataplasm of plantain
and boiled
lentil,receiving the tender part of bread baked in an earthern
pan, neither very fine nor foul ; and above the ulcer we must
put some of the strong applications, such as those of Aiulron,
of Poly ides, and of Pasion, mixing them with must, until they
are of the consistence of the sordes of oil in batli^s. And so
also the dry ISIassaleotic powder, which may be diluted in like
manner. And the root of dracunculus, or of birthwort, or the
juice of laserwort, or the Cyrenaic juice may be properly rub-
bed in, each of these with vinegar. Cases of an erysipelatous
nature may be anointed Avith the applications for erysipelas ;
but those parts which are suspected of being sympathetically
affected are to be wrapped in unwashed wool, out of wine and
oil. AVhen the inflammation abates, we must apply to the
cai'buncles the cephalic cerates spread upon pledgets. That
from herbs is an excellent one, and that from natron, and the
dry application for spreading ulcers, separately and with rose-
oil. When the hardness remains, we must use the one from
apples ascribed to Serapion. But we must hasten the suppu-
ration of the carbuncles as much as possible, by changing the
cataplasms and medicines twice during the day, and once
during the night. In order to root out the carbuncles, and
free them from their attachments to the surrounding parts,

having divided sour jjoniegranates, boil in vinegar, and wiien

softened, triturate, put into a linen rag, and apply. When
SECT. XXV.] ANTHRAX. 77

dried, let thera be moistened ynth vinegar. The carbuncle is

made to snppm'ate and burst, by tlie inner pai-t of old walnuts,
or even of that which isnot old, and bv the leaves and slioots
of cypress, or by its young and tender balls (pilule), Avith
barley-flom- by raisins deprived of their stones ; by dried
;

figs boiled in wine ; by the flowers of horned poppy ; by the

juice of laserwort, with rae and some honey ; by liquid pitch
with raisins and axunge.
An excellent oppUcat'ion for carbuncles. Of lithai'ge, lb. j ;

of old oil, lb. j ; of arsenic, oz. j ; boil the oil and litharge
until they do not stain, and taking them off the fii'e, add the
arsenic, and then boil it imtil it become black, and having

levigated it in a mortar, use upon pledgets.

For gangrene, old ulcers, those called cMronia, strumons
ulcers, and the gout : it is a tnost adn^irable application for

carbuncle, particularhj in the eyelids. Of opium, of acacia,

of toasted misy, of flakes of copper, of each, dr. ij of cop- ;

peras, dr. j ; of the seed of henbane, dr. j ;

triturate in water,
and use. Tliey say also that tlie ointment called tetrapharmacon,
ha-ving a fifth part of frankincense, is an excellent application.
But for carbuncles in the pudenda, take of clialcitis, of cop-
peras, of each, dr. viij ; of aphronitrum, dr. ij ; triturate with
water, and use. Sheep's dung roasted with honey is also a
ffood remedv. In Alexandria thev use the sreen serapias,
which is and triorchis, with crumbs of bread,
also called orchis
as a cataplasm for carbuncles and all sloughy ulcers ; and when
the eschai' falls oft\ thev cm-e them as a common ulcer.

Commentary. The carbuncle is brieflv treated of bv Hip- Comm.

pocrates (Epidem. ii, 1), and is frequently mentioned by
him
as a symptom of the pestilential fever. (Epidem. iii.)
Celsus gives a veiT minute description of cai-buncle. ^^ itli

regard to the treatment, nothing, he says, answers so well as

immediate burning, which produces no pain, as tlie flesh is

dead. The sore is to be treated like other burnt parts. Under
the use of eroding applications a crust is formed, which, being
removed from the liA-ing flesh, carries all the corrupted parts
along with it, and leaves a clean caAity, which, is to be filled

up by incarnants. When the disease is superficial, corrosive or

caustic substances may be substituted, of such a degree of
 78 ANTHRAX. [book iv.

CoMM. strength as to produce a sepai'ation between the dead and

But if these apphcations fail, recourse must be
' '
•
sound flesh.
had to burning. He recommends abstinence from food and
wine at the commencement, and directs water to be given freely,
especially if fever be present.
Pliny gives an indistinct account of an epidemical anthrax,
which, he says, prevailed in the province of Narbonne. (Nat.
Hist, xxvi, 4.)
Galen ascribes the carbuncle to a defluxion of hot, black,
and thick blood, which gives rise to blisters, ulcers, and eschars.
He directs us to apply to the eschars those medicines the pro-

perties of which resemble fire, such as misy, chalcitis, arsenic,

quicklime, and sandarach. His particular remedies are quite
similar to our author^s. (Meth. ]\Ied. xiv), and (ad Glauc. ii.)
He mentions the carbuncle as a very unfavorable symptom of
the plague. (Epidem. iii, and de Diff. Febr. i, 6.)
The account of the carbuncle given by Aetius is full and
accurate, but is entirely derived from Galen. Oribasius,
Actuarius, and Nonnus also repeat his doctrines. Actuarius
says that the disease is occasioned bv melancholic blood over-
heated. This is much the same as Galen's theory.
Octa-sius Horatianus recommends bleeding at the commence-
ment, and external applications of an acrid and caustic nature,
or the actual cautery itself. When danger is apprehended from
a hot cauterv, he directs us to use a cold one.
In the Latin translation of Avicenna the carbuncle is de-
scribed by the names of pruna and ignis Persicus. It was
called pruna from a black slough which is formed in it,

resembling a burnt coal. His account of the disease is am-

ple, but mostly copied from Galen and his successors. Rhases
approves of venesection at the beginning, and of the actual
cautery. He also recommends an application containing mus-
tard and figs. Alsaharavius describes the varieties of anthrax
by the names of alcubam and alcoasat. (Pract. xxix, 12.) At
the commencement, he approves of general bleeding and leeches,
and afterwards of refrigerant and analeptic medicines, to obviate
the tendency to sinking. "When these things do not succeed,
he directs us to use powerful caustics or the actual cautery.
Serapion, like Avicenna, describes it under the name of the
ignis Persicus.
SECT. XXVI.] CANCERS. 79

Procopius mentions the anthrax as one of the symptoms of Comm.

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

SECT. XXVI. ON CANCERS.

Cancer occurs in every part of the body ; for it takes place

in the eyes and uterus (as we have stated when treating of
those parts), and in most other parts of the body ; but it
ismore particularly^ frequent in the breasts of women, because
owing to their laxity, thev readilv admit the thick humours
which occasion it. For cancers are formed by black bile over-
heated and if particularly acrid, it is attended Avith ulceration.
;

On this account, they are darker than phlegmons, without

being attended with the same degree of heat. The veins are
filled and stretched around hke the feet of the animal called

cancer (crab), and hence the disease has got its appellation.
But some sav that it is so called because it adheres to any
part which it seizes upon in an obstinate manner like the
crab. OAving to the thickness of the humour Avhich occasions
it, cancer is an incurable disease, for it can neither be repelled

nor discussed; not yielding to purging of the whole body, re-

sisting the milder applications, and being exasperated by the
stronger ones. It may be possible, however, to prevent inci-

pient cancers from increasing, by evacuating the melancholic

humour before it becomes fixed in the part. may eva- We
cuate, first, if nothing prohibit, by vensection, and aftei'wards
by purging at the commencement, Avith the simpler purgatives,
 80 CANCERS. [book iv.

such as giving dodder of thyme to the amount of oz. ivss ; in

whey or honied water, and afterwards hiera, containing the
black hellebore.
The juice of strvchnos may be applied to the ulcerated
folded and wetted
parts without exciting pain, a linen rag being
in and laid on but externally to this, we must apply soft
it, ;

wool, which also has been soaked in the juice, and care must
be taken that they do not become dry, by frequently pouring
on some of the juice. In all carcinomatous ulcers of a chronic
nature, one may use the preparation from pompholyx; and
those remedies which were mentioned in the Tliii'd Book for
cancers in the womb may be applied with advantage.
For carcinomatous and maUgnant ulcers, for rugose ulcers on
the fundament, and for inflammations on the pudenda, testicles,
and breasts. In a leaden mortar, and "uith a leaden pestle,
having tritm-ated the Lemnian earth with oxycrate and honied
water or milk, so that it become black, or ha^^ing tritui'ated
rose-oil, or the oil of unripe olives^ or the juice of house-leek,
or that of wall-pennywort, or of lettuce, or of fleawort, or of
unripe grapes in hke manner, anoint with them. The pa-
tient's diet shonld consist principally of the juice of ptisan and
the whey of milk, and from among pot herbs, of mallows,
orache, blite, and gourd, of the fishes which live among rocks,
and of all kinds of fowls, except those that live in marshes.
From Archigenes,for carcinomatous and maligna7it ulcers.
Levigate equal parts of bui'ut river crabs and calamine, and
sprinkle or apply the ashes of crabs with cerate ; or apply the
seed of hedge mustard triturated with honey.

CoMM. Commentary. See Hippocrates (Epidem. v) ; Galen (de

' '
'
Tumoribus ; jNIeth. ISIed. xiv ; Therap. ad Glauc. ii) ; Celsus
(v, 28) Scribonius Largus
; ; Aetius (xAi, 43) ; Oribasius (^lorb.
Ciirat. iii, 28) ; Actuarius (]\Ieth. Med. iv, 16) ;
Avicenna (iv,

3, 2, 15) ; Serapion (v, 24) ; Alsaharavius (Pract. xxix, 1, 16) ;

Avenzoar (ii, 7, 27) ; Haly Abbas (Pract. iii, 32) ; Rhases (ad
]\Iansor. rii, 9 ;
Contin. xx^ii.)
Hippocrates relates a fatal case of cancer in the breast, at-
tended with a sanious discharge, but he does not explain the
nature of the treatment.
Oiu' author's description of cancer is abridged from Galen
SECT. XXVI.] CANCERS. 81

(de Tumor. 1. Tlie ti'eatment is derived from the 14th Comm.

Book of the '
c.)
Meth. Med.' He recommends melanogogues to
——
'

'
'

remove the material cause of the disease. In external apphca-

tions he places Httle confidence^ but prefers those prepared from
metallic substances "which have been burnt and washed. The
only chance of a radical cure consists, he says, in making a
complete excision of the part but in doing this he forbids us
;

to secure the arteries with ligatures, as they will occasion a

recurrence of the disease. The part, he says, is loaded with a
thick, black, or recrementitious blood. When the cancer is
idcerated, he disapproves of cutting and burning.
Celsus describes carcinoma as an immovable and unequal
tumour, attended Avith swelling of the veins, which are pale or
lirid. His account of the treatment is so important that it
deserves to be in his own words " Quidam usi sunt me-
given :

dicamentis adm'entibus ; quidam ferro adusserunt quidam ;

scalpello exciderunt :
neque ulla unquam medicina profuit sed ;

adusta, protinus concitata sunt, et increverunt donee occiderent;

excisa, etiam post inductam cicatricem, tarn en reverterunt, et
causam mortis attulerunt cum interim plerique nuUam vim
:

adhibendo, qua toUere id malum tentent, sed imponendo tantum

lenia medicameuta quae quasi blandiantur, quo minus ad ulti-
mam senectutem perveniant, non prohibeantur." In another
place, however, he recommends compositions containing arsenic,
copperas, cantharides, galls, &c. (v, 22.) He makes a distinction
between the cacoethes, or malignant tumour, and the true carcino-
ma, but says that the difference between them is to be recognized
"
only tempore et experimento.'^ He marks the gradations of ma-
lignant disease with singular precision first, there is cacoethes ;
:

then carcinoma without ulceration ; and last, there is the fun-

gated ulcer. (The reading in the edition of Milligan is a great
improvement.) In doubtful cases he directs us, first to apply
caustics or heating medicines, and, if the disease is alleviated,
to proceed to the scalpel or burning, according to circumstances;
but if it is exacerbated, we are to conclude that it is of a carci-
nomatous natm'e, and must abstain from all acrid and vehement
applications.
Scribonius Largus recommends for all malignant ulcers, even
such as are cancerous, an application consisting of arsenic, p. \^ ;

of squama seris, p. iij ; of elaterium, p. j ; of burnt paper, p. iij*

II. 6
 82 CANCERS. [book iv.

CoMM. Aetius gives from Arcliigenes and Leoniclas an interesting

" '
'
account of the disease, wliicli liedi^•ides into ulcerated cancer,

and cancer without idceration. He describes the disease in

the female breast as consisting of a large tumour which is un-
equal and resisting, extending its roots far, and being attended
with varicose veins : its colour is either cineritious, verging to
redness or livid it but is in reality very hard ; is
; appears soft,

accompanied with a pungent pain, and gives rise to malignant

phlegmons in the armpits. The pains shoot to the clavicle
and scapula. An ulcerated cancer, he says, goes on corroding
and spreading deeper, nor can it be stopped; it discharges a sanies
of an abominable smell, and is aggravated by medicines and
handling. The disease he considers as generally incurable.
His surgical treatment will be stated in the Sixth Book. He
recommends purging with hiera and the theric, iSIithridatic
.
antidote, &c. Apparently, in order to mitigate the 'S'iolence
of the pains, he du*ects us to make an application containing
equal portions of plantain, poppy heads, the seed of the wort,
and other things of the like kind. For ulcerated cancer he
j
recommends emollient epithemes, such as the one containing
I
litharge, axunge, white wax, oil, and the yelks of eggs.
1 Oribasius and Actuarius supply nothing of importance that
is not to be found in our author. Nonnus, according to
Sprengel, the
isonly ancient author who attributes cancerous
idcerations to acrimony of the bile. But Nonnus merely
copies the words of our author.
The Arabians agree with the Greeks in representing the
disease as being produced by black bile. They were, no doubt,
led to form this opinion from remarking that the blood in the

part is thick and black, Avhicli they considered owing to its not
being properly pmged of its recrementitious sediment. The
moderns deride this theoiy, but they have substituted nothing
satisfactory in its stead. Van Swieten thinks more favorably
of the ancient doctrines. (Comment. § 485.) A"\dcenna speaks
highly of a milk Serapion likewise approves of milk de-
diet.

prived of its butter, and of a vegetable diet. He speaks of no

other treatment as being likely to prove remediable, with the
exception of excision and the cautery. Haly Abbas rather ap-
proves of excision when the disease is seated in a part which
admits of this operation. However, like Galen, he disapproves
SECT, xxvii.] (EDEMA. 83

of tying the arteries. The characteristic symptoms of the dis- Comm.

' '

ease, he says, are a stony hardness and distension. The ac- ^

count given by Alsaharavius is nothing different. Rhases has

Httle confidence in excision. After ulceration has taken place
he approves of using a cooling application, containing ceruse,
tutty, rose-oil, the juice of nightshade, and some other such
things of a cold nature. He mentions a case of cancer of the
breast, in which the whole mamma was extii'pated, but the dis-
ease retui'ued on the other side. One of his authorities,
Antyllus, describes the cancerous sore as ha^ing a tendency to
spread inwards, its edges being thick, large, and everted, and
the discharge thin and acrid. When the disease cannot be
got completely extirpated, he forbids us to meddle with it.
Theodoricus and all the earlier modern wi-iters on medicine,
the cancer by the name of apostema melancholicum, and
call

recommend the same treatment for it as the Greeks and

Arabians.

SECT. XXVII. ON (EDEMA.

Having treated of swelKngs formed by hot humours, we

shall now treat of those from the opposite, beginning with the
oedema. For as erysipelas is formed by a bilious humour, so
is oedema by a pituitous, being a loose swelling devoid of pain.
We are aware also, that oedematous swellings occur in the
feet, in dropsical aflFections, in phthisis, and in cachexia, but
in them the oedema is a symptom of the complaint under which
the person is labom-ing, and requires no very particular treat-
ment; for it will be sufficient in general to rub the limbs
sometimes with vinegar and rose-oil, and sometimes with oil
and salts, or the salts may be added to the vinegar and rose-
oil. Whenthe oedema is occasioned by a pituitous humour
being determined to the part, a sponge soaked in oxycrate

may be properly applied with a bandage loosely put on, be-

ginning below and terminating above. The sponge ought
to be new, but if such a one is not at hand, that which
is
may be cleaned with natron, or more especially Avith what
is called strained lye. If the swelling do not thereby subside,
we may mix some alum. And a very convenient application
 84 EMPHYSEMA. [book iv.

is fluid, and applied.

a tender wick of a lamp, soaked in sucli a
A good remedy also is horned poppy. When the cedema has
become chronic, ha\ing first anointed the part with oil, and
then applied a sponge out of lye, bind it firmly, and you will
effect a cm-e. Eveiy kind of earth discusses and represses
(Edematous swellings, more especially the ^Egyptian, and also
the matured Avoad.

CoMM. Commentary. See Galen (ad Glauc. ii ; de Tumoribus) ;

' '
*
Aetius (xv, 1) ; Oribasius (Morb. Curat, iii, 51) ; Leo. (vii, 5) ;

Actuarius (Meth. Med. iv, 16) ;

Nonnus (251) ; Serapion (v, 23) ;

Avicenna (iv, 3, 2) ; Haly Abbas (Theor. viii, 11 ; Pract. iii, 30) ;

Alsaharavius (xxix, 13) ; Rhases (ad Mansor. Aii, 12.)

Our authoi-^s account of this disease is taken from Galen,
Oribasius, Aetius, and, in fact, all the Greek, Latin, and
Arabian authorities adopt his \dews, without any material alter-
ation. They all concur in recommending coohng and astrin-
gent applications, with suitable bandages ; and, in certain cases,
friction. Rhases recommends that the limb should be buried
in heated sand. He also approves of various coohng and
astringent applications with bandages. In the translation of
Alsaharamis, the oedema is described by the name of apostema
flegmaticum ; in those of A^acenna, Haly Abbas, and Serapion,
by that of undemia. The celebrated Paracelsus used the term
undemia for oedema. In some late works we have seen it
stated that the undemia was a species of erysipelas, but this
is
evidently a mistake.

SECT. XXVIIT. ON EMPHYSEMA.

Emphysema is formed by a flatulent spirit, collected some-

times under the skin, sometimes under the periosteum, or the
membranes which surround the muscles. And it is also
sometimes collected in the stomach and intestines, or between
them and the peritoneum, in those kinds of dropsy which are
called tympanitic ; and it diff'ers from oedema in this, that the

parts do not pit upon pressure like it, and that it sounds hke
a drum. The density of the body co-operates in preventing
the flatus from being dissipated, at the same time that the
SECT. XXVIII.] EMPHYSEMA. 85

flatus also is of a tliick nature. Wherefore, the indicatiou of

cure is and attenuate the thick air ; which
to rarefy the body,
is to be accomplished by means of attenuant and heating

remedies. When the complaint is seated in the stomach and

be brought about by a fine oil, having rue,
intestines, this is to
cumin, or parsley seed boiled in it. And sometimes a large
cupping instrument without scarificators, applied two or three
times to the navel, will discuss it. T\Tien the muscles from
contusion are inflated, so as to sound like an emphysema, the
parts will not bear very heating and acrid applications. Where-
fore, atthe commencement, we must use paregorics liberally,
and, when the disease is on the decline, discutients. Thus
we may use sodden must with a small quantity of oil, appMng
them Avarm upon unwashed wool, or mixing the cerate of un-
washed wool. And we must take care that the heat be pre-
served, for it is not expedient that the part be cooled. When
the patient has been soothed, we are to mix vinegar and nitre
or aphronitrum, and afterwards some lye ; and lastly, we may
use discutient plasters, for the removal of the complaint such
as the following having boiled the sordes of the oil used in
:

baths, strain it first, so that it may become pure, and again

throw it into the pot, and having tritiu'ated slaked lime hke
flour, sprinkle until it become of the consistence of clay, and
use. A still more eflectual application is the compound medi-
cine from sycomores.

Commentary. See Galen (Meth. Med. xiv) ; (Therap. ad Comm.

^'^
Glauc. ii) ;
Aetius (xv, 2) ; Oribasius (Synop. \T.i) ; Actuarius
(Meth. Med. ii, 12) ; Nonnus (252) ;
Scribonius Largus (§ 119) ;
Avicenna (iv, 3, 2, 20) ; Serapion (v, 23) ; Alsaharavius (Pract.
xxix, § 1, 14) ; Khases (Divis. 127, Cont. xx^ai.)
Our author has copied closely from Galen.
The great in-
dications of cure, as laid down by him and acknowledged by
all subsequent authorities, are to rarefy the containing parts
and attenuate the spirit. By spirit, as we stated in another
place, the ancients meant a thick air or gas. The indications
which we have mentioned are best fulfilled by friction Avith oils,
in which calefacient medicines, such as cumin, parsley, anise,
and the like, have been boiled. When, however, any inflam-
mation is suspected, he properly forbids us to use acrid or
 86 SPRAINS. [book iv.

CoMM. heating medicines. Wlien the pain of the bowels is violent

"
'
in cases of tympanites, he allows medicines containing opirnn,
which are to be given by the mouth if the small intestines be
affected, but are to be administered in a clyster if the large in-
testines be the seat of the disease. the disease is in a When
muscular part, he directs us to use a combination of attenuants
and emollients. In certain cases he recommends dry-cupping.
Oribasius, Aetius, Actuarius, and Nonnus, adopt the ^iews of
Galen, without anv alteration.
For tympanites, Scribonius recommends cumin internally.
A"sdcenna, like our author, in ordinary cases recommends
combinations of attenuants and calefacients, diy-cupping and
the like, for dispelling the spu'it ; but when the disease arises
from contusion of the muscles, he directs us to use resolvents
and paregorics. Serapion approves of similar treatment.
Alsaharavius recommends attenuant and calefacient remedies
externally and internally. In the translation of his works,
the disease is called
iuflatio. Rliases recommends friction
with calefacient he remarks that the disease occurs most
oils ;

commonly in the stomach and intestines. He calls it by the

name of apostema inflatum.

SECT, XXIX. FOR SPRAINS AND CONTUSIONS.

Sprains of the joints and contusions are remedied by un-

washed wool, or a sponge soaked in ^-inegar and oil, and ap-
plied by the tender parts of boiled bulbous roots Avith honey,
;

by the leaves of the chaste tree, salts, and roasted nitre, tritu-
rated with cerate. The affusion of sweet water, or of hot sea
water, may be used. But after the inflammation and pains
have subsided, apply rubbing to the sprained parts.

CoMM. Commentary. See Aetius 71 ) Oribasius (Synops.-vii, 14) ;

(xiv, ;

Actuarius (Meth. Med. ii, 35) ; Scribonius Largus (§ 209) ;

Rhases (Di^-is. i, 140.)

Aetius makes mention of all the remedies recommended by
our author, with the exception of the affusion of water ; which,
however, is a method of ti'eatment deserving of attention.
Oribasius mentions particidarly the affusion of hot sea water.
SECT. XXX.] ECCHYMOSIS. 87

Scribonius Largus recommends a plaster containing litharge, Comm." '

'

alum, aerugo, ammoniac, &c. Rliases dii'ects us to use attenuant

ointments, sedative plasters, and loose bandages, Avith rest.

SECT. XXX. ON CONTUSIOXS OF THE FLESH AND ECCHYMOSIS.

The flesli being bruised by some weight falling upon it,

and the small veins in it being ruptured, blood is poured out
from them by exhalation, and collecting under the skin, is
called ecchymoma. When the skin is not divided, a soft
it is pale, and for the
yielding tumour is the consequence ;

most part unattended with pain. Our object, therefore, is to

discuss the contained blood, and that quickly, before it become
black and at first, astringents are to be mixed Avith the dis-
;

cutients, because the bruised coats of the veins stand in need

of condensation. After these things, we must use those ap-
plications which are merely discutient without astringency.
And by scarifying the ecchjinomata at the commencement,
we may thus apply the subsequent treatment. For chronic
cases of ecchymoma, radish in the form of a cataplasm is a
suitable remedv, but it must be taken away when it becomes

pungent ; or a cataplasm of the juice of radish with crumbs of

bread, may be applied. The diseases called hypopion and
hyposphagma, are species of ecchymosis, and also the eflPusion
of blood below the nail from a blow ; of these, the first two
are treated of in their proper places in the Third Book and ;

the affection of the nail will be handled in the Sm-gical part of

the work.

Commentary. This is taken almost word for word fi-om Comm.

Oribasius (Synops. vii, 14) ; Aetius directs lis to scarify the
with ecchymosis, and then it the in-
to apply to
part affected
side of citrons (xiv, 68.)
Avicenua approves of scarifications, provided the extravasated
blood cannot be got otherwise removed, (iv, 4, 3, 3.)
 88 SCIRRHUS. [book iv.

SECT. XXXI. OX RUPTURE AND TEARING OF THE FLESH.

Rupture is altogether attended with ecchymosis. It is

cured by medicines which are moderately heating, as the
acopon from black poplars, and such as resemble it. But
when the rupture is deep-seated, we must have recourse to
such remedies as are more acrid and cutting. The use of the
cupping instrument is likewise beneficial to them. Should
therefore the whole ecch^Tnosis be discussed, the separated
flesh readily unites ; but if it continue a long time, and sordes
form under it, the ruptured flesh can no longer unite and we ;

must only apply the lips together, so that a small occasion

may readily separate them, and that the intermediate space
may be filled with some moisture, and in a certain manner an
eccli}Tnosis may be formed as at the commencement, except
that it is sooner discussed, as containing a thin humour, whereas
that at the commencement was formed of blood. Yulsion
takes place when certain fibres are torn asunder, and it only
requires soothing applications until the pain is removed; for
they cannot be made to coalesce. \^'herefore, the round
birthwort, if any, is a convenient application to ruptiu-ed
and torn parts ; and in like manner, the root of the large
centaury, and the juice of it, rhubarb, costus, and bdellium,
drunk with oxvmel.

CoMM. Commentary. These remarks are taken from Aetius (xiA-,

' '
"
69, 70) ; (Synops. vii, 14) ; and they are copied
or Oribasius

by Nonnus (Epit. 254) ; and Actuarius (Meth. Med. iv, 16.)

The Arabians treat these accidents upon exactly the same
principles. See in particular A^icenna, as quoted in the pre-
ceding section.

SECT. XXXII. ON SCIRRHUS.

Genuine scirrhus is a preternatural

swelling, hard and devoid
of sensibility ;
biit that which is not genuine is only attended
with diminished sensibility. That which is whollv insensible,
then, is utterlv incurable : but that which is attended onlv
SECT. XXXII.] SCIRRHUS. 89

with diminished sensibihty is not incurable^ and yet it is not

easily cured, for it is occasioned by a viscid and thick humour,
which is fixed in the hardened parts, so as to be difficult to
get discharged. Sometimes, then, the scirrhus is the original
complaint, and goes on to increase ; but for the most part, it
is occasioned
by the physicians applying too cooling and as-
tringent remedies to erysipelas and phlegmon.
If one, therefore, apply strongly discutient medicines to
indurations of the body, one will indeed produce a visible
diminution of the scirrhus in a short time, but will leave the
remainder of the complaint in an incurable state ; for the thin
moisture being dissipated, what remains is rendered dry and
hard as a stone. The discutient application, then, ought to
be in a certain degree emollient, without possessing manifestly
heating and desiccant qualities. Such are all kinds of marrow,
more especially that of a stag or of a calf, and the grease of a
lion, of a panther, or of bears, or of a bull, and among birds,
that of geese, of domestic fowls, or of pheasants but that of
:

bucks and he-goats is drier. And to these may be added,

ammoniac perfume, bdellium, more especially the Scythian,
the humid and fatty storax, and the Egyptian mastich. To
all other parts of the body, when in a scirrhous state, these

things may be applied singly, and in composition; but for

tendons and ligaments, we are to dissolve in the strongest
vinegar some stone that has been heated in the fire. If pos-
sible, the one to be used should be pyrites, or if not it, the
lapis molaris or millstone. In this, therefore, the aflFected part
is to be moved, so that it
may receive the vapour which arises
from and afterwards, an emoUient medicine is to be ap-
it j

plied. A thin oil then, and not water, is to be poured on the

part, by all means once a day, and sometimes one may boil in
the oil the root of marshmallows, or of wild cucumber. The
patients ought to abstain from the use of the bath, at least
from the frequent use of it. But when the sciiThus is mode-
rately softened, the softestammoniac is to be dissolved in very
strong vinegar, and the part rubbed with it for several days in
succession ; after Avhich, we must again have recourse to an
emollient apphcation, ha\dng the fattest galbanum and opo-
ponax added to it. Such are that from bacon, that ascribed to
Amvthaon, and those which we are about to describe for scrofula.
 90 SCIRRHUS. [book iv.

CoMM. Commentary. See Galen (De Tumoribus; Metli. Med.

" '

xiv; Therap. ad Glauc.

'

ii) ; Oribasius (Synops. vii^ 34) ; Aetius

(xv, 3, 4) ;
Leo (vii, 4) ; Actuarius (]Meth, Med. iv^ 16) ;

Serapion (v, 23) ; Avicenna (iv, 3, 2, 12) ; Haly Abbas (Pract.

iii, 31) j Alsaliaravius (xxix, 1, 15) ; Ehases (Antid. i, Cont.
xxvii, Antidot. i.)

This section is entirely taken from Galen (Ther. ad Glauc.

1.
c.)Galen's account, however, is somewhat fuller than om*
author's, and contains a case treated upon the principles which
he lays down. It was a case of hard swelling in the thigh,

arising from an erysipelas which had been improperly treated

by astringent and cooling applications. Galen informs us that
he began by pouring upon the limb an attenuant oil, namely,
the Sabine after which he caused it to be rubbed with maiTows
;

and fats medicated with bdellium, mastich, ammoniac perfume,

and the like. After this he bathed the whole limb with a solution
of ammoniac in very acrid vinegar. When the swelling had
been lessened, but not completely removed by these means, he
afterwards applied one of the pitch medicines, and at length
effected a cure. In another place he states that scirrhus is
sometimes allied to cancer.
Oribasius likewise recommends a combination of emollients
with discutients and Actuarius approves of the same prac-
;

tice.

Aetius has a valuable chapter upon this subject. Besides

the articles mentioned by our author, he recommends various
rosins, turpentine, frankincense, and the like. He forbids the
use of aluminous, sulphm'eous, and chalybeate baths. For
indurations of tendons he recommends things possessed of at-
tenuant and cutting properties combined with emollients, such
as ammoniac dissolved in rinegar Avith melons.
The iVi'abians treat of scirrhus in much the same terms as
the Greeks. Avicenna properly directs us to bleed when
there is congestion of black blood in the part, and afterwards
to use applications of a solvent and emollient nature. He and
Serapion mention the same identical remedies as those of
Paulus. For dissolving hard tumours he recommends an oil
containing fenugreek, cyperus, and aromatic reed. Haly Abbas
ascribes the formation of scirrhus to the same causes as our

author, and recommends relaxant and emollient applications.

SECT. XXXIII.] STRUMA. 91

Alsahai'RA'ius dii'ects us to procure evacuations of black bile, Comm.

' '

and gives prescriptions for various emollient and discutient *

applications. When the usual remedies do not succeed, he

advises recoiu-se to be had to the operation. Rhases di\ddes
scirrlius into two varieties, that accompanied with sensibility,
and that which is insensible. He mentions that Antyllus
ajjproved of extirpation and the actual cautery when the disease
is of a corroding and cancerous natm^e.

XXXIII. ON STRUMA OR SCROFULA.

Strumse are indurated glands forming principally in the

neck, armpits, and groins. Their general treatment therefore
is the same as that for scu'rhus, but in particular the floui' of

bitter lupines isto be boiled in oxj-mel and applied (this also

answers with phyma ;) or apply cows' dung boiled in vinegar.
This discusses all indurated swellings. But strumse may be
properly discussed by means of quicklime mixed with honey,
the sordes of baths, oil, or axunge ; or, equal parts of quick-
lime and natron, and four times the quantity of cardamom
and fenugreek may be boiled with honey for an emollient
ointment and aj)phed. This one discusses hard strumas, and
produces the rupture of suppurated swellings ; the floiu* of
darnel boiled with pigeon's dung, or linseed and wine or, :

green olives, either wild or cultivated ; or, the white cardamus

triturated with liquid pitch and made into an emollient oint-
ment may be apphed ; or, the ashes of the dried root of the
wild cucumber, and the burnt di-ied leaves of the bay, may be
mixed with tm'pentine and applied ; or, equal parts of staves-
acre and of natron, with double the quantity of rocket may be
apphed, with rosin or, goats' or cows' dung boiled in vinegar
; ;

or, the flour of bitter vetches soaked in the urine of a young

person not come to manhood, and added to melted pitch, wax

and oil; or, a dead snake may be thrown into a pot, and
being covered over Avith gj^sum, it is to be put into a furnace,
the ashes of it mixed with equal parts of fenugreek, and then
added to honey and used. And the composition from asps is
an admii-able one, also that from fullers' herb, that from the
wild cucumber and that from cedar rosin. The following one
 92 STRUMA. [book iv.

produces suppuration^ or resolution of strumse Of m^-rrh, :

dr. X of ammoniac perfume, dr. ij ; of the mistletoe of oaks,

•

dr. viij ;
of galbanum, dr. iv ; of bee-glue, di\ j ; pound in a
mortar.
For strujna and hardness of the breasts. Of wrouglit bird-
lime, of dry rosin, of wax, of each lb. j ;
of galbanum, oz. iij.

For struma ulcerated and not ulcerated. Of wax, of pine

rosin, of aximge not salted, of horehound, of scraped birdlime,
of each oz. vj.
An application for strumce. Of old oil, lb. i
j ;
of wax, lb. j;
of colophonian rosin, oz. iv; of natron, oz. iv; the heads of
garlic xij. Take away the cloves (nuclei) of the garlic, mace-
rate in oil for three days, then having boiled until they are
softened, throw them away, and melt in the oil those ingre-
dients which are soluble, and after they are taken off the fire

sprinkle on it levigated natron. It also breaks apostemes. —

Another: Of the ashes of figs, oz. ij ; of fissile alum, oz. j ; of
aphronitrum, oz. j ; of hquid pitch, oz. vij.
A septic for scrofula.
application Of fissile alum, of
realgar, of each, dr. iv ;
of the flakes of copper, dr. j ; of orpi-
ment, dr. j ; sprinkle the strumae with it in a diy state ; but if
thev are of a cancerous nature, mix with rose oil and use twice
a day.

CoMM. Commentary. See Hippocrates (De Glandulis) Galen

'— — (Meth.
'
'

Med. xiv, 11) ; Oribasius (Synops. vii, 29) ;

;

Aetius xv,
5) ;
Actuarius (Meth. Med. iv, 16) Nonnus (Epit. 124) ; ;'

Celsus (v, 18) ;

Scribonius Largus (153) ; Myi'epsus (56) ;

INIarcellus(36) Serapion ; (v, 25) ; Avicenna

(iv, 3, 2, 10) ;

Albucasis (Chirurg. ii, 42) ;

Alsahara^-ius (Pract. xxix, 1, 23) ;

Haly Abbas (Pract. iii, 33) Ehases (ad Mansor. vii. 8 ; Cont.
;

xxvii) Avenzoar (i, 10, 10.)

;

Hippocrates mentions struma as being one of the worst

diseases of the neck, originating in inflammation, and being

produced by a pituitous and indolent defluxion.

Galen directs us when scrofulous glands are not situated
near large vessels to extract them with the kuife, or consume
them with septic applications. In another place he relates a
case in which an imprudent surgeon, while removing a scrofu-
lous gland of the neck, cut the recurrent nenes, and thereby
SECT. XXXIII.] STRUMA. 93

occasioned loss of speech. (De Loc. Aff. i, 6.) For an account Comm.
' '
*
of the operation see the Sixth Book.
Part only of oiu' author's applications are derived from
Oribasius.
A very minute account of these complaints is given by
Aetius. He divides strumse into the mild and the malignant.
The mild are without inflammation or pain^ and are attended
with a moderate degree of hardness ; the malignant are accom-
panied with inflammation, and a throbbing pain, feel unequal,
have enlarged veins, and are exacerbated by handling or medi-
cines. The latter are said to be incurable. He mentions,
upon the authority of Leouidas, the accident related by Galen.
He approves, however, of the operation in general. Incipient
strumse, he states, may be discussed like scu-rhi, by a combi-
nation of emollients with discutients. He gives a long list of
prescriptions for remo\ing scrofulous tumom's. One of them
contains arsenic mixed -^-itli the fat of a goat or ox. With
regard to the general treatment, he recommends laxatives, re-
stricted diet, emetics, and the theriac.
Actuarius and Nonnus, as usual, borrow from our author.
Celsus remarks that strumse occur most frequently in the
neck, armpits, groins, sides, and the female breasts. He re-
presents them as indolent afi'ections of the glands, which come
slowly to matiuity and prove very troublesome to the physi-
cian. Some, he says, give white hellebore in these cases, and
use applications for bringing them forward or for discussing
them. Others have recourse to caustics, and when the eschar
is removed, they heal the ulcer
upon general principles. When
the sore becomes clean he recommends exercise and a nourish-
ing diet.
Scribonius Largus, INIarcellus, and Mp^epsus give
nearly
the same prescriptions as our author. Arsenic is an ingredient
in the septic applications of Myrepsus.
A\^cenna recommends emetics, phlegmagogues, bleeding in
the arm, attenuant food, and avoiding all gross things and
repletion. As a discutient he and Serapion' commend the'
diachylon plaster. Haly Abbas likewise mentions this appli-
cation, and also directs the swellings to be bm'ut with caustics.
AlsaharaA-ius briefly recommends excision or bm-ning. Serapion
evidently copies from our author. Avenzoar gives a very full
 94 STEATOMA. [book iv.

CoMM. account of scrofulous swellings, -vrliicli, lie says, are formed in

'

general of a gross and viscid phlegm. Except in very particu-

lar cases lie disapproves of bleeding. He approves in general
of discutient applications ; but when the swelling tends to
suppuration, he directs us to promote it ; and when pus is
fairly formed he recommends us to let it out, but cautions the
surgeon not to attempt this operation unless he has a practical
acquaintance with anatomy, lest he wound any of the veins,
arteries, or nerves.
Rhases forbids the knife when the scrofula is in the neck
or deep seated. In certain cases he approves of destroying
the tunic with septic applications.
Brunus, and the other surgical wi'iters of that age, in imita-
tion of the Arabian authorities, direct scrofulous tumom-s to
be treated with discutients, excision, or septics. A discutient
ointment recommended by Brunus consists of litharge, common
oil, and the juice of melons and fenugreek. His septic medi-
cine is a mixture of arsenic and quicklime, which is to be ap-

plied with honey. (Chinu'g. Minor. 19.)

XXXIV. ON STEATOMA, ATHEROMA, AND MELICERIS.

These things belong to the class of apostemes, as we said

when treating of them, and each receives its peculiar appella-
tion from the substance contained in the tumour. Thus one
of them is like fat, another like honey, and the thii'd like pap.
The them all is to discuss the contents,
indication of cure in

l^roduce the putrefaction of them, or to cut them out. Some

tumours fall under all these three indications of cure, namely,
those which contain a thin fluid, as the meliceris ; others come
under two of them onlv, can onlv be
as the atheroma, for it

cured by excision or putrefaction. But the steotoma admits of no

cure except by a sm'gical operation, for it can neither be discussed
nor made to putrefj'. The diagnosis of each of these may be
found in the Surgical part of the work, while the materials of
which the discutients are formed are mentioned under the head
of scrofula. This apphcation ispeculiarly adapted for discuss-
ing meliceris Twenty raisins without their stones ; of squama
— Another
:

peris, di\ iij ; having first fomented, apply. : Of

SECT. XXXIV.] STEATOMA. 95

Cretan cistus, of bdellium, of galbanum, of ammonise perfume,

of bee-glue, of turpentine, equal parts ; to be pounded together
in a mortar. It applies to scrofula, parotis, furunculus, and

pbyma. But Arcliigenes applies to meliceris apbronitrum, and

double the quantity of hellebore, with hard cerate. But sep-
tics cannot be applied while the skin remains entire ; we must
therefore in thefirst place lay bare the meliceris, atheroma, or

strumae, with caustic medicines, of which the most simple is

that consisting of quicklime (calx viva,) soap, and strained lye.
The following one is more complex, and admits of being kept :

Of calx viva, dr. iv ; of red natron toasted, of burnt lees of

wine, of each, dr. ij ; of vermilion, dr. j ; triturate in lye; and
having made it of the consistence of liquid honey, boil three
times, until it is of the proper thickness, and
lay it up in a 1 <£;
leaden vessel, pouring in some lye, so that it may not quickly
become dry. It applies to acrochordon, myrmecia, pterj^gium,
clavus, callus, and excrescences of the gums. The lees of wine
should not be older than two months. Anoint the skin with
this, and when it away with a sponge,
begins to dry clean it

and anoint again ; and when the skin becomes black, wash
away again, and use escharotics. When the eschars fall off,
apply the septic medicines. A septic application which is not
Of squama seris, dr. iv ; of realgar, dr. ij ; of black
irritating :

hellebore, dr. ij ; use with rose oil.

—
Another : Of squama
seris, of realgar, of nettle seeds toasted, equal parts ; use with
rose oil. —
Another : Of burnt sea-urchins, of the shell of the
cuttle fish, of arsenic, equal parts ; use with rose oil, but rub
all the parts around with cerate and oil. This also is a good
application : Of quicklime, p. ij ; of chalcitis, p. j ;
of arsenic,
P- J.

Commentary. See most of the authorities referred to in Comm.

the preceding section.
' ——
•
'

Our author's definitions seem to be taken from Galen. (De

Tumoribus and Meth. Med. xiv.) Galen states that the stea-
toma is to be cured solely by a surgical operation ; that the
meliceris may be treated by discutients, septics, or excision
with the knife and that the atheroma admits only of excision,
;

or the application of septics.

Aetius may be referred to as an interesting authority upon
 96 STEATOMA. [book iv.

CoMM. this subject. The steatoma, he says, is a preternatural tumour,

'
'
'

free from discoloration, and soft to the touch. He recom-

mends excision for it. The 'contents of the atheroma consist
of a pultaceous substance surrounded by a membranous tunic,
within which are also sometimes found hairs ; nay, Philoxenus
aflirms that he had found animals like gnats and flies. The
meliceris also has a membranous coat, and its contents resem-
ble honey. He approves also of the surgical operation for the
meliceris and atheroma, but permits to attempt their reduction

by means of discutients consisting of such ingredients as am-

moniac, ceruse, turpentine, galbanum, vinegar, &c. He makes
no mention of septics ; indeed arsenic does not enter into any
of his compositions.
Oribasius and Actuarius lay down the same rules of treat-
ment as our author. Nonnus as usual epitomises him with
some shght alterations. The active ingredients in one of his
septic applications are sandarach and hellebore. Leo is brief
and indistinct,
Celsus marks the dififerences of these tumours with his cha-
and precision " Atheromati subest
racteristic terseness :
quasi te-
nuis pulticula meliceridiHquidior
: humor ideoque pressus
;
fluit :

steatomati pingue qaiddam.^' He recommends excision. (vii,6.)

Avicenna^s plan of treatment is so like our author^s, that
we need not give it in detail. The steatoma is to be removed
solely by an operation. For the two others he permits the use
of septic applications, such as arsenic, quicklime, hellebore, the
lees of wine, &c. Haly^s definitions are similar to those of
our author, and he recommends either excision or the use of
septics, such as vitriol. The treatment laid down by Alsaliara\ius
isquite the same. In the barbarous translation of his works
they are called by the names of alsahamia, asalia, and accida.
(Pract. xxix, 1, 22.)
Vegetius, the veterinary surgeon, describes these tumours as
they appear in cattle. He directs them to be treated by exci-
sion. (Mulom. ii, 30.)
It will be remarked from the text, that the ancients were
well acquainted Avith the caustic powers of the calx cum kali.
In fact, our author in this section has given a prescription for
the paste noAV commonly used for forming issues.
It appears from the works of Fabricius of Aquapendente,
SECT, XXXV.] FAVI. 97

that the practice of treating atheroma and meliceris

by septic Comm.
common
' '

appHcations was sufficiently in his time. Andreas "

Laurentius approves of removiiig scrofulous tumours in this

way
when they are deep-seated and have a broad base. He thus
enumerates the septics used in his age " Secundo extrahi
:

potest struma caustico, nunc affixo in ejus medio candente

ferro, nunc admotis erodentibus et putrefacientibus ut sanda-
raca, arsenico, argento liquido usto, oleo quod ex atramento
sutorio igne elicitur, calce 'non extincta cum
sapone, axungia
porcina cum argenti subhmati portiuncula, pulvere merciuui,
erinaceorum cumbustorum, testae saepise, aui'ipigmenti." He
also recommends us to tie the base of the tumour with a thread
wet in a solution of arsenic (De strum, nat.) The treatment of
atheroma by caustics is well described in the ' Bibliotheca
'

Chirurgica of Manget.

SECT. XXXV. OF FAVI.

The favus is a swelling on the skin, having perforations

through which a honey-like fluid is discharged. Wherefore
dried grapes with rue are to be applied to it ; or, the tender
leaves of the fig tree with honey; or, cresses with linseed in

honey; or, the root of the garden cucumber with honey; or,

sulphiu*vivum with cerate or turpentine. You may vary the

treatment of favi by transferring hither what is said in the
Third Book regarding achores.

Commentary. Alexander states that the favus resembles comm.

the achores, differing from them solely in magnitude for the :
——
'

'
'

openings of the pores by which the fluid escapes resemble the

combs of bees, whence it takes it appellation ; but in achores
we cannot see the pores by which the fluid issues.
Aetius gives a similar description of the complaint, which,
he says, mostly attacks muscular parts, as the limbs, soles of
the feet, over the sixth vertebra of the neck, and the sides.
When it attacks the head, he says, it sometimes spreads to the
skull. In this case he directs us to treat it with acrid appli-
cations, and even the actual cautery. For incipient favus he
II. 7
 98 FAVI. [book IV.

CoMM. recommends an application consisting of sulphur, barley tlour

^~^~'
and meal.
[
Nonnus recommends the following application : of litharge,
I ch'. ; of alum, dr. iij ;
of the leaves of rue, dr. ij ;
of wine
ij

and rose-oil, q. s.

Celsus^s description is so important, that we shall give a

considerable part of it in his own language. He mentions two
" Alterum est
species of the favus, or kij^iov. subalbidum, fu-
runculo simile ;
sed majus, et cum dolore majore :
quod ubi
maturescit, habet foramina, per quse fertur humor
glutinosus
et purulentus ; nee tamen ad justam maturitatem pervenit. Si
divisum est, multo plus intus corrupti, quam in furunculo, ap-
paret, altiusque descendit. Raro fit nisi in capillis. Alterum
est minus, super corpus eminens, durum, latum, subviride, sub-
palHdum, magis exulceratum siquidem ad singulorum pilomm
;

radices foramina sunt, per quse fertur humor glutinosus, subpal-

lidus, crassitudinem mellis, aut visci referens, interdum olei :

si inciditur, viridis intra caro apparet. Dolor autem, et in-

flammatio ingens est, adeo ut acutam quoque febrem movere
consuerint." For the second species he recommends as external
applications a dried fig, linseed boiled in mulse, and emollient
plasters. To the other he also directs us to make appliciitions
containing figs, turpentine, rosin, &c. But when these have not
the effect, he recommends us to cut the fungous excrescences
down to the sound flesh, and then to dress the sore upon general
principles, (v. 28.) The above account of an afl'ection of the
scalp, which we have often met Avith in practice^ is the most
accurate to be found in any author ancient or modern. We
are even in doubt whether the complaint be at all noticed in
modern works on surgery. It is not to be confounded with the
Porrigo favosa, or Porrigo scutulata, of Dr. Bateman,
A\icenna's description of the aclior and favus is far from
distinct, (iv, 7, 3, 1.) The favi appear to be the pustulse capi-
tis quse dicuntur His
c/saAc/a of Alsaharavius. (Pract. i, 11.)
description, however, by no means distinct.
is He approves
of general evacuants, and local of a stimulant
applications
nature, such as sulphur, mercury, bii-th^^ort, &c. Serapion
has not described the favus very accurately, but he has given
a full account of the treatment. He properly forbids strong
SECT. XXXVI.] ULCERS. 99

applications at first, (i^ 3.) Rhases recommends much the same Comm.
' '

appHcations as Serapion. (Ad Mansor.

*
v, 16.)

SECT. XXXVI. ON THE SIMPLE ULCER.

Since a simple ulcer is merely a division, if one will bring

together the parts which are separated, and apply a circular
bandage around, the divided parts will adhere together without
more ado. It is necessary, however, when at one of its Hps
the ulcer is everted obliquely, to begin the bandaging there,
and turn it to the opposite side. When
it is deranged both

ways, it will be proper to use a double-headed bandage, and

thus to bring the Ups together ; for when nothing has fallen
between the lips, such as a hair, or a sand, or oil, or filth, or
the Uke, the ulcer will adhere completely. When the ulcer is
large, so that the separated parts cannot be completely brought
together by the aforesaid bandaging, they are to be first united
with sutures, and then bandages are to be thus applied, and
those remedies used which are called agglutinants, which have
the power of drying and consuming the collected moisture, and
prevent more from flowing to the part.

Commentary. On ulcers the following ancient authors may Comm.

' '

be consulted :
Hippocrates (De Ulceribus) ;
Galen (Meth. •

Med. iii, & iv) ; Oribasius (Synops. vii) ;

Aetius (xiv) ;
Actuarius
(Meth. Med. iv, 16) ; Nonnus (Epit. 259) ; Pliny (H. N. xxxii,
44) ; Celsus (v) ; Octavius Horatianus (i, 19, 20) ; Scribonius
Largus (94) ; Avicenna (iv, 4, 1, 2, 3) ; Serapion (vii, 28) ;

Averrhoes (CoUig. vii, 32) ; Haly Abbas (Pract. iv, 18) ;

Alsaharavius (Tract, xxix, 2, 2) ; Rhases (Ad Mansor. vii, 3 ;

Divis. i, 138 ; Contin. xxviii.)

The author of the Hippocratic treatise quoted above parti-

cularly praises wine as a lotion for ulcers ; and we may men-

tion that Dr. Hosack, an intelligent American writer, states it
as his opinion, that the surgeons of the present day might
learn from him an important lesson upon its utility in such
cases. He condemns the use of oils and fat.
Of all authors, ancient or modern, Galen has laid down the
principles upon which ulcers ought to be treated with
the
 ULCERS. [bqok IV.
100

CoMM. greatest precision. He defines an ulcer to be, " a solution of

"-^—'
and
continuity/' a definition evidently very comprehensive,
of ulceration.
including wounds as well as cases spontaneous
Hisdii-ections for the treatment of a simple ulcer
or fresh

wound are similar to those of our author ;

that is to say, he
secui-e them
directs us to bring the lips of it together, and
with a bandage, or, if that is not sufficient, by sutures or clasps.

Wine he to be the best of all applications to ulcers,

pronounces
in as far as they are ulcers.
Oiu- author copies very closely from Oribasius.
In applying the bandage, Aetius directs us to begin above
the sore if one simple bandage is to be used, but if two
only
are necessan^, as in fractures, he recommends us to begin at the
upwards, and in like manner to begin again
at
ulcer andproceed
the ulcer and roll downwards. He forbids us to loose the
and directs us not to
bandages oftener than every alternate day;
to remove the sanies with a soft,
apply water to the ulcer, but
dry linen cloth.
Celsus describes very accurately the treatment of a recent
wound or simple ulcer. He approves, according to circum-
stances, of bandages, clasps, or sutures,
and his directions respect-
ing the application of them are highly important, but too long
for our limits. After the sore is dressed he dii'ects us to
if that cannot be
apply over it a sponge soaked in vinegar, or,
borne, in wine or cold water. This practice is desernng of
imitation. He says afterwards :
''
Optimum etiam medicamen-
tum quies est : moveri et ambulare nisi sanis alienimi.''

OctaA-ius Horatianus dii'ects us to avoid the bath, the fire,

the sun, cold air, loud cries, intoxication, venery, and passion,
lest these should occasion a rupture of the parts which had
adhered.
AA-icenna with his usual good sense gives judicious direc-
tions for the treatment of simple ulcers, but his principles are

nearly the same as those laid down by

Galen. He defines an
" a solution of
nicer to be continuity, attended with a discharge
of sanies or pus." This seems to be an unexceptionable defi-
nition. He forbids all oily and watery applications, and re-
commends us to observe that no body inten^ene between the
the wound when the bandage is Ehases gives
lips of applied.
similar dii'ections. He condemns the practice of those who
SECT. XXXVII.] AGGLUTINANTS. 101

put oil wound, and who allow the patient to take wine Comm.
into a
" '

and heating Averrhoes lays down similar rules with con-

food. *

siderable precision. Haly Abhas and Alsaharavius follow the

practice of Galen without the slightest alteration.
Considerable difference of opinion has prevailed respecting
the nature of the clasps (Fibulte
ayfcrr/ptg)
recommended by
Celsus and other ancient authorities. Rhodius and Le Clerc
maintain that no more was meant than a simple interrupted
suture, but to this opinion we cannot subscribe. (See Le Clerc,
Hist, de la Med. iv, 2, 5, and Fabricius of Aquapendente
CEu^TCs Chirurg. ii, 108.) They would appear to have been
metallic clasps of a peculiar construction.

SECT. XXXTII. ON AGGLUTINANTS.

Oak leaves applied, and those of the willow and cabbage ;

the fruit, leaves, and bark of the mezereon, and the juice of
the more austere plantain, papyrus soaked in oxycrate or wine,
and wrapped round in a circular manner. The following are
agghitinants of fresh wounds the leaves of the pine and
:

spruce and their

fii', fresh bark wrapped round like a bandage,
with water, oxycrate, or wine and new cheese pounded. But
;

we must apply externally the leaves of dock, or of vine, or of

beet, or of lettuce. But cheese made of acid milk cures even
the larger sores; and the wild pears repress the discharge.
The horse-tail (Hippuris) may be applied with advantage, even
if the tendons are diAided asunder; and the matui*ed woad

may be used to indiuated bodies even when they occur in the

heads of muscles. The leaves and shoots of cypress, and its
recent and soft balls (pilulse) may be applied to indurated
parts, but we must mix with it some of the fine dust taken
from a wall near a mill. INIyrrh nibbed with water, or frank-
incense and earth worms, agglutinate even the divisions of
tendons ; also, cinquefoil leaves Avith honey, and garlic burnt
and applied. Old ulcers again are remedied by barley burnt
with cerate, and by ceruse with a quadruple quantity of myrtle
cerate. For ulcers on the head sprinkle diied myrrh, and do
not moisten it, for it will speedily produce adhesion. Or,
having triturated dried aloes or Ijirthwort, and having boiled it
 102 INFLAMED SOKES. [book iv.

with honey in wine until it is of a proper consistence^ spread

upon a pledget and apply it. Of the compound aggluti-
nants are those called the Barbarous^ the Golden^ that ascribed
to Nicolaus, that from willows and dittany, and others of a
similai' nature, which can produce the adhesion even of very

large sores.

CoMM. Commentary. Celsus gives the following list :

glutinant
' '
"

\Tilnus,myrrha,thus, gummi, prsecipueque acanthinum, psyllium,

tragacautha, cardamomum, bulbi, lini semen, nastuii;ium, ovi
album, gluten, ichthyocolla, ^itis alba, contuse cum testis suis
cochleae, mel coctum, spongia, vel ex aqua frigida, vel ex vino,
vel ex aceto expressa, ex iisdem lana succida si levis plaga est
:

etiam aranea.
Our list is copied from Oribasius.
author^s Aetius has a
long chapter on the composition of applications for agglutinat-
r ing fresh wounds. The ingredients of them are most various :

I sumach, litharge, wax, galbanum, bee-glue, tiu'pentine, alum,

j chalcitis, &c. Actuarius merely extracts a few articles from
oiu' author^ s list.

A^icenna^s list scarcely differs in any one particular from

our author's, and nearly the same may be said of Haly's. Isaac
(ap. Ebasis Contin. xxA^iii) particularly commends bdellium and
mprh, with honey and wine.
Galen has explained at considerable length the principles
upon which these applications should be used. Agglutinants,
he remarks, are austere and astringent medicines, being such
as occasion a contraction and condensation of the fleshy fibres ;
and they must not possess detergent properties. They are
principally applicable in the case of plane ulcers, that is to say,
ulcers without loss of substance. (See Meth. Med. iii.)

SECT. XXXVIII. ON PAINFUL AND INFLAMMATORY SORES.

To painful and inflamed wounds desiccant and anti-inflam-

matory remedies must be apphed. Of hquid remedies the best
is wine, but oxycrate is also a good
remedy. But if the ulcer
is foul as well as inflamed, much diluted
hydromel may be
used. Of diy medicines, those in general will apply which are
 SECT. XXXIX,] UNCONCOCTED ULCERS. 103

mentioned for phlegmons, except such as are oily and acrid.

This a particularly excellent one
is Ha^dng boiled the sweet
:

pomegranate in wine and pounded, apply it. This is an admi-

rable application and much used, for it applies to ulcers of the
head, and those of the privy parts, and to very painful sores
on all parts of the body, and to inflammations of the eyes.
But if the erj-sipelas or the like attack an ulcer, we must have
recourse to the remedies described for them.

Commentary. Hippocrates gives a long list of applications Comm.

for inflamed sores. We have mentioned above that wine was ——
'

"
'

one of his favorite remedies. If erysipelas come on, he directs

us to purge either upwards or dowuAvards.
Galen explains general principles. Our author copies closely
from Oribasius.
Avicenna and Rhases agree with Paulus in approving of
cooling or desiccative applications, such as a decoction of sweet
pomegranate in Pontic wine. This application is recommended
by Haly Abbas, who also mentions a cataplasm containing
opium.

SECT. XXXIX. ON UNCONCOCTED ULCEUS, AND SUCH AS HAVE

NOT SUPPURATED.

Recent ulcers, and such as being in an inflammatory state

have not suppurated, may be digested and made to suppurate
by these things of simple things, tepid water poured on them,
:

wheat flour, or chondi'us, or bread, or

glue for books, applied
with turpentine, wax, saffi'on, frankincense, pitch, rose oil,
axunge, or the fat of calves; but the compound application called
tetrapharmacon may be applied upon a pledget mixed with
rose oil. Old and callous ulcers are concocted by these simple
medicines the dried grape, storax, galbanum, myrrh, Cretan
:

cistus, pitch, rosin, butter, Egyptian mastich and unwashed

wool ; and by these compound ones Galen's plaster without
:

wax, dissolved in oil of ricinus, and applied upon a pledget

with old oil, or oleum ricini ; and in bke manner those called
dichromos and basilicon, and the like.
 104 HOLLOW ULCERS. [book iv.

CoMM. CoMMEXTARY. Cclsus's not very different from our

list is
' '

Concoquunt et movent pus, nardum, myrrha, costum,

'
author's :

et cortex,
balsamum, galbanum, propolis, styrax, tliuris et fuligo
These
bitumen, sulpbm*, resina, se^iim, adeps, oleum.
pix,
articles furnish the ingredients of most of our modern appli-
cations. For further information respecting each article, the
reader is referred to Dioscorides, Galen, and Serapion.

SECT. XL. ON HOLLOW ULCERS.

The hollow ulcer requires the filling iip of the deficient flesh,
the materiel of which is a moderate quantity of good blood.
Wherefore we procure a moderate supply of it by a sufficiency
of food, and produce a proper temperament of the sore by food
of wholesome juices, and a suitable temperament of the part in
which the sore is seated. With regard to the discharge, that
which is thin renders the sore more humid, and that which is
thicker makes the sordes adhere to it on that account it
;

requires applications that are moderately desiccant and deter-

gent such as frankincense, the flour of barley, that of beans
;

and tares, iris, birthwort, calamine, panax, and pompholyx.

When one incarnative remedy does not answer another must
be tried. But if the sordes of the ulcer appear greater, and
the ulcer more humid, it is to be understood that the medicine
has not dried properly, and its powers are to be increased by
a mixture of honey. If it is clean, but with less moisture
than natural, the medicine has dried more than was proper,
and we must apply a cerate mixed with more oil. It some-
times happens when the application is too strong, that the flesh
is melted down, so that the ulcer appears foul and moist, like
those which have been imperfectly dried ; but that from the
melting of the flesh becomes more hollow, its lips are callous,
and it is red and inflamed; and sometimes the patient has
very acute pain. But the other, which arises from the
applications being less desiccant than proper, is attended with
none of these characters. Wherefore the caries of wood, more
especially of such as
possessed of a moderate degree of
is

astringent and detergent qualities, as that of the elm, purges

and incarnates clean ulcers; or anemone may be applied for
the same purpose. Having shaven down the bark of the pine
SECT. XL.] HOLLOW ULCERS. 105

aud pounded it with cerate, and rubbed it upon pledgets, apply

it to hollow ulcers, more especially to such as are recent, for it
will fill them. The compound medicines for ulcers which are
clean, are, that from snails, that ascribed to Manetho from the
lees of wine, that from aloes, the dry powder called meletera,
that containing equal parts of starch, of manna, of halica, and
of tares; and in like manner, the composition from frankin-
cense aud that called aphroditarium. But when the iilcers are
fouler the powders called cephalic are to be applied, and of
those applications that are made upon pledgets, that called
trophos, the isis and the athena, and that from distaff-thistle
(atractylis,) and moreover that called Italicum, and any others
of tried efficacy.

Commentary. The resemblance here pointed out between Comm.

" '

an ulcer too strongly stimulated and one too little is highly "

deserving of attention. Our author appears to have borrowed

his description from Oribasius, who however
abridges it from
Galen. Galen and Aetius give a somewhat fuller account than
our author, but their principles of treatment are the same.
They remark that frankincense in humid intemperaments en-
genders flesh, but in dry ones only pus. Pompholyx burnt
and washed ; calamine and the shells of oysters ai'e said to be
incarnant and dissiccant without pungency. Galen inculcates
that the greatest difficulty in treating these ulcers, is to find out
the nature of the intemperament of the part, and correct it.
Celsus gives the following list of incarnants Carnem alit
:

et ulcus implet resina pinea, ochra attice, vel asterace, cera,

butymm. He recommends the use of hot water; an applica-
tion consisting of butter, roses, and a small
portion of honey ;
or the tetrapharmacum with roses. He approves of giving
wholesome and nutritious food, such as fowls, venison, pork,
and even wine. The hst of the Pseudo-Dioscorides contains
nearly the same articles as that of Celsus. (Euporist. i, 186.)
Octavius Horatianus recommends a
composition of equal
parts of honey, turpentine, rosin, and wax, melted in a vessel ;
or a mixture of powdered rosin, wax, and fat.
Scribonius Largus recommends basilicon, and a
composition
consisting of calPs marrow, the fat of geese, butter, stag's mar-
row, wax, turpentine, honey, and roses.
 106 FOUL ULCERS. [book iv.

CoMM. Avicenna remarks^ that in treating hollow ulcers we must

" '
"
not use very desiccative applications, as they dry up the fluids
which are necessary for forming flesh ; nor for the same rea-
soUj very astringent applications, nor abstergents of any greater
strength than to remove the sordes. Rhases recommends a
mixture of equal parts of olibanum, aloes, sarcocolla, and dra-
gon's blood. Camphor is an ingredient in one of his incarna-
tive applications. Alsaharavius makes mention of an apphca-
tion from olibanum, like that of Rhases.
All the ancient authors say that round ulcers are more difii-
cult to heal than those of any other shape ;
and Cassius Medi-
cus and Alexander Aphrodisiensis assign various reasons for
this, the most probable of which seems to be, that in this case
the sound parts are further removed than in any other.
Apollonius Dyscolus states that ulcers are prevented from
healing by pregnancy, by disease of the spleen, and by varicose
veins. (Histor. Mu'ab. 42.)

SECT. XLI. MEDICINES FOR CLEANSING FOUL ULCERS.

Foul ulcers, whether hollow or level with the surface, may

be properly cleansed by birthwort in honey, turpentine with an
equal portion of rose oil and honey, or instead of rose oil butter
may be substituted, with lUyrian iris and honey ; and by pickled
olives applied. To nervous
parts, turpentine melted with
butter may be applied. When the sores are very foul and
spreading, horehound with honey is a good application, which
removes the eschars. The following are compound appHca-
tions Of boiled lees of of scummed honey, of the species
oil,
—
:

of alum called phormion, equal parts. Another : Of the diied

serapias, called also triorchis, of Illyrian iris, of dried hore-
hound, of birthwort, of each, dr. \iij ; of the flour of tares,
dr. X use in a powder and with honey.
; And for foul ulcers
the Egyptian cerate is useful, also those from salts when
melted, the Indian, that called athena, the green plasters
diluted, the powder of dried pumice stone, those from tares,
the trochisk called melauchlorus, and in like manner that
called criogenes.
SECT. xLii.] WORMS IN ULCERS. 107

Commentary. The following are the most important arti- Comm.

' '
*
cles in Celsus^s of substances for cleansing ulcers Pur-
long list :

gantj serugo, auripigmentum^ quod dpatviKov a Grsecis nomina-

tur ; (huic autem et sandarachse in omnia eadem vis, sed validior
est) squama seris, thus, resina, et pinea, et terebinthina liquida,
misy, chalcitis, galla, sulphur, pix, oleum, ruta, ammoniacum,
&c. Hippocrates makes mention of many of these, namely,
arsenic, verdigris, flowers of copper, frankincense, myrrh, helle-
bore, &c.
Scribonius Largus recommends honey, Illyrian iris, and a
compound application containing arsenic, scales of copper, ela-
terium, and burnt paper.
One may find in Galen and Aetius many compound appli-
cations,but as they are all formed from much the same ingre-
dients as those of our author, it will be unnecessary to take
further notice of them. Aetius commends a combination of
turpentine and honey.
Avicenna and Haly Abbas recommend the same applications
as our author. They make no mention of arsenic. Alsaharavius

gives very particular directions for treating these ulcers ; when

the edges are hard, he directs us to rub them until they be-
come red, or to cut them off and apply to the sore the green
ointment; and when the ulcer is covered with much sordes,
he recommends us to dress it with the Egyptian ointment.
Rhases mentions antimony as an excellent application for
cleansing foul ulcers. He properly recommends us to consider
whether the foulness of the ulcer be the effect of too much or
too little stimulation. He relates a case of the former descrip-

tion, in which the sore got worse under the application of the
gi'een ointment. (Cont. xx\'iii.)

SECT. XLII. FOR WORMS IN ULCERS.

For worms which form in ulcers, the first thing to be done

is to stop the humidity and the putrefaction which occasion
them. Worms may be killed by all the things in general
which are described for those in the ear. But for those which
fomi in ulcers Archigenes says, mix equal parts of ceruse and
poley with liquid pitch, and anoint with it.
 108 FUNGOUS ULCERS. [book iv.

CoMM. Commentary. Aetius recommends dried plantain, the ashes

' '
*
of the wood of iigs, and the juice of calamint. Galen and
Avicenna also mention calamint.
Pliny mentions the gall of frogs.

SECT. XLIIl. ON FUNGOUS ULCERS.

The funo-ous flesh of ulcers is to be removed bv medicines

which are powerfully desiccant, such as diphiyges sprinkled
upon it, the squama seris, all the testacca burnt, both the
echini (the hedgehog and sea-urchin,) burnt entire. But the
following things are moderately cleansing, and repress the
fungous flesh the flower of the Asian stone, and still more
:

powerful than it, the sori and cluysocolla, chalcitis and misy
(when burnt they are less caustic,) and the flos eeris in like
manner but verdigris is the most powerful of all. Salts,
;

when burnt, consume the foul flesh, and in like manner

charpie that has been soaked in strong brine and dried, con-
sumes fungous flesh that is moderately large. But verdigris
with the squama is seris
powerfully repressing. Of the com-
pound applications the pov.der called rhodium, and the psarum,
and that named yellow, repress fungous growth without being
pungent. But the trochisks called phaustiani, when levigated
and sprinkled on the sore, and the dry medicine (or powder)
called heliocaes, make fungous flesh slough off" to the bottom.
But the application consisting of equal parts of calx viva,

squama seris and manna, answers with fungous flesh with ;

honev it cleanses such as resemble a mushroom, and with

cerate it proves incarnating.
A powder for dovm fungous Of litharge, of
—
:
'keeping flesh
chalcitis, of verdigris, of
plumbago, equal parts. Another,
which represses strongly without being pungent, and applies
also to spreading ulcers, and more especially the epulis of the
gums, and whitens the teeth Of quickhme, lb. j ; of arsenic,
:

oz. yj ; baring triturated the diied arsenic with water, add the
lime washed like calamine, and, having rubbed them together
dry and use. And of the trochisks, that called pantolmios,
and those described for polypus, are excellent for repressing
fungus in ulcers. But the green plasters, more especially the
SECT. XLiv.] ULCERS, l(t<)

one from Cappadocian salts, and in like manner tlie isis, are
most effectual in preventing fungous flesh in ulcers.

Commentary. The powerful applications mentioned by our Comm.

' '

author will be found amply sufficient to fulfil every intention '^

in conducting the treatment of these ulcers. Many of them

are mentioned by Hippocrates.
Galen lays it down as a rule that these fungous excrescences
are to be represhed by powerfully desiccative substances, such
as misy, chalcitis, or more especially verdigiis; when burnt
and washed they become mild detergents. (Meth. Med. iii.)
Aetius gives many useful prescriptions for such preparations,
but they are entirely formed of the ingredients which enter into
those of our author.
Celsus gives a long of caustics highly applicable in such
list

cases :
Adurunt, auripigmentum, atramentum sutorium, chal-
citis, misy, aerugo, calx, charta combusta, sal, squama seris,
veratrum et album et nigi'um, cantharides, sandaracha, alumen
scissile, &c. Pliny speaks of a composition of unwashed wool,
with barley flour, and verdigris.
Octavius Horatianus recommends the Phrygian stone pulver-
ized, and a powder consisting of the recrementum plumbi, ver-
digris, aloe, and quicklime.
Rhases and Avicenua copy from our author. Haly Abbas
speaks of removing the superfluous flesh with an instrument.

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

PHAGED.^NA.

Spreading and putrid ulcers are to be bathed with \dnegar

and oxy crate, an astringent wine, cold water, sea- water, or the
decoction of lentil, of pomegranate rind, of the flowers of the
wild pomegranate, of lentisk, of myrtles, of Egj^tian thorn,
or some other astringent and desiccant medicine. Cataplasms
are to be applied to them of the flower of tares and liquid'
alum, the inner part of bread made of similago, an old goby
fish, or some other old pickle, unwashed flesh, and liquid tur-

pentine these things are to be all pounded together in equal

;

proportions. Or the parts may be anointed with equal pro-

no ULCERS. [book IV.

portions of birthwortj and the juice of tlie leaves of tlie Palma

Christi, and half the quantity of verdigris, made with water to
the thickness of honey ; but if is not removed an
the eschar
equal proportion of elaterium be mixed with the verdigris.
is to
For putrid ulcers sori levigated and sprinkled on them is an
effectual remedy, and above is to be put diied charpie ; or the
round bii-thwort and galls in equal quantities may be rubbed
in with oil; or the root of the wild cucumber, or of cabbage,
or of beet, or the leaves of dock are to be bound in a piece of
linen, and put into ashes ;
when they are softened triturate
with saltand apply; they will cleanse powerfully. Or apply
green olive leaves boiled in wine with honey
; or apply clial-

citis, or parsley seed levigated, or apply linseed triturated with

copperas, or use an application of thyme, dried grapes and
boiled figs, or of fig leaves triturated with honey ; or of nitre,
cumin, and fine flour with honey ; or of the root of the wild
cucumber, or of squill boiled with honey ; or of sori, dr. xij ; of
chalcitis, dr. x ; of misy, dr. iv ; triturate with half an hemina of
the strongest vinegar until it is dried, and taking it off use by
dipping a specillum in it, and rubbing it over the ulcer, and
placing above it a double pledget out of wine and oil. But if
it is inflamed apply henbane with polenta, or cabbage with

honey.
For putrid and spreading ulcers on all parts of the body. —
Of quickhme, of chalcitis, of each dr. ij ; of arsenic, dr. j. This

may be used for pterygia of the fingers, for phagedsena and car-
buncle, with honey if on the genital organs, but dry if on any
other part of the body. Above apply an oblong pledget with
rosin.
An universally applicable powder for all spreading sores, and
those of the mouth, for hemorrhages, and for represhing fungous

flesh. Of chalcitis, of misy, of both in a crude state, dr. xx ;

of squama ferri, dr. yj ; of immature galls, dr. viij.
For spreading and putrid sores. Of salts, dr. ij of any ;

species of alum which has been burnt, dr. j ; of squama seris,

"ofburnt pumice stone, equal quantities. Scraped verdigris,
with bm'nt misy mixed with liquid pitch; and the flakes of
iron with oil also answer well.
For spreading ulcers of the pudendum. These things will
apply to them, and also the composition called mehterium, the
SECT. xLiv.] ULCERS. Ill

powder of the wild myrtle, and that from paper also the com- ;

position from oxymel called coracion, the trochisk of Andron

and the like, will answer with all spreading ulcers. The same
things also apply with phagedsena ; for phagedsena is an ulcer
that spreads by eating.
For foul and fetid ulcers. The Lemnium sigillum (Lemnian
earth) mixed with vinegar, oxymel, oxy crate, or wine, until it
is of the consistence of clay, may be nibbed on them with

advantage or the leaves of cypress, its shoots, and tender

;

balls or the ashes of dried goiu'd bm-nt, or of the

(pilulse),
burnt bark of the plane tree, or of burnt dill in like manner,
or of foul wool burnt, or of plaintain also woad by itself or
;

with polenta, or the dried root of hog^s fennel.

Commentary. It will be remarked that the milder appli-

cations mentioned in this section are all powerful desiccants ——
'
^0^,^,
v

and astringents. Most of them are mentioned by Dioscorides

as possessing these properties.
Galen recommends the compound applications mentioned
by our author, containing verdigris, squama seris, &c.
For these spreading and putrid sores Aetius, among other
prescriptions, gives one which would no doubt be applicable in
" Of crude
the worst cases :
misy, of crude chalcitis, a dr. Aiij ;

of ochi'e, dr. iij ; of sandarach, dr. iv; of quicklime, dr. ij ; of the

scales of copper, of alum, a dr. ij ; of diphryges dr. iij ; m."
These caustic and escharotic medicines enter into the compo-
sition of many of his applications. Some of them contain as-

tringents and desiccants, such as sumach, galls, alum, fossil

salts, frankincense, calamine, birthwort, pomegranate rind, &c.

In short the ingredients in his applications correspond with
Celsus's list of corrosive substances Rodunt, alumen liqui-
:

dum, sed magis rotundum, aerugo, chalcitis, misy, squama seris,

sed magis rubri, ses combustum, sandaracha, galla, thus, auri-
pigmentum, calx, nitrum et spuma ejus, alcyonium, resina,
squama fern, athrumentum sutorium, veratrum, &c.
The other authorities give only combinations of these sub-
stances ;
for a full account of which preparations we refer the
reader to Galen. (Med. sec. gen. iv.)
Octavius Horatianus recommends lentils boiled and mixed
with honey ; the leaves of cabbage, coriander, or ivy, all mixed
with honey.
 112 ULCERS. [book IV.

CoMM. The Arabians, although they supply nothing new, add their
' '

authority in confirmation of the remedial virtues which the

'

Greeks assigned to the substances mentioned above. A^-icenna

and Rhases recommend arsenic, copperas, misy, sori, chalcitis,
flos quicklime, alum, galls, ammoniac, the trochisk of
ccris,

Andi'on, &c. T\Tien a part becomes black and putrid, Haly

Abbas directs us to open a vein leading to it, if the age and
state of the patient permit, and afterwards to apply odoriferous

things, such as camphor, &c.

SECT. XLV. ox ULCERS REQUIRING CICATRIZATION.

By drying and constringing the flesh of ulcers requiring

cicatrization to such a degree as not only to dissipate the pre-
ternatural superfluity, but also to touch upon that which is in
itsnatural state, we may render the surface of the sore like
skin,and make the ulcer cicatrize. This is promoted by im-
mature galls, the moderately desiccant bark of pomegranate,
and whatever without being possessed of pun-
else is desiccant

gent astringency. And

such things as these promote cicatri-
zation myrrh, litharge, and oysters if burnt, for they must be
:

sprinkled on the sore dry. And these things often produce

cicatrization pine bark with myrtle cerate, ivy flowers with
:

cerate, the root of the lily "with rose-oil, dried pine-rosin, burnt
pumice stone, the flakes of copper ; they are to be used in
equal proportions diy. The following also repress mix a :

small quantity of manna and of diphryges with levigated

pumice, and use ; or of lithai'ge p. j ; of diphryges p. ss, apply
on a pledget with cerate. Birdlime with frankincense cica-
trizes old ulcers, also verdigris with an equal portion of diph-

rjges and vtdth myrtle cerate, or the small centaury applied

fresh. To the more humid apply the root of cypress. To
those about the anus and pudendum, more particularly if in-
flamed, use levigated aloes, either in a dry state or with water,
or squama seris ; or soften chiysocolla in the sun with wax, and
apply.
A dry application for producing cicatrization. Of oysters,
dr. xij of manna, dr. vj of calamine, dr. iv. It applies also
to spreading
;

sores. —Another ;

: Of birthwort^ dr. x] ;
of pine
SECT. XLV.] ULCERS. 113

bark, dr. vj ; of manna, dr. rj ; of pumice, dr. iv ; of Colopho-

nian rosin, dr. iv ; of iris, dr. iv. —
AnotJter : Of hart's horn
burnt, dr. iv ; of pine-bark, oz. vj of ceruse, oz. iv ; of scraped
—
:

verdigris, oz. ix; of calamine, dr. xviij. Another: Of the

flowers of pomegranate, of copperas, of each, dr. xvj ; of squama
geris, of fissile alum, of each of galls, dr. j.
dr. viij ;
Another : —
Of ceruse, of litharge, of each, oz. viij ; of the dross of lead, of
galls, of dried myiTh, of each, dr. iv.
A Take of fissile alum, oz. j ; and
cicati'izing ajjplication.
having macerate in a sextarius of water when
le\'igated it, :

dissolved in the water soak pledgets in it, and having dried

them apply.
A plaster for cicatrizing the more simple ulcers. Of wax,
dr. xl; of- litharge, dr. xxxv ; of
diphryges, dr. viij ; of myrtle-
oil, half a hemina. The plaster called phcenicinum, that from
calamine, the myrsinatum, and the like, are also applicable in
such cases. For ulcers of difficult cicatrization Of wax, of :

mp-tle-oil, of each, dr. vj ; of calamine, oz. vj ; of lead, of

frankincense, of each, dr. ij ; of fissile alum, of bm^nt copper,
of each, oz. j ; of scraped verdigris, dr. ij ; dissolve them singly.
For chronic ulcers, and such as are of difficult cicatrization :

Of calamine, ;
of chrysocolla, dr. "vdij ; of fissile alum,
dr. ^iij
dr. viij j of verdigris, of the flakes of
copper, of each, dr. j ; of
pine-rosin, dr. xl ;
of wax, dr. c ; of myrtle-oil, q. s.
—
Another :
Of wax, of pine-rosin, of each, oz. vj ; of calamine, oz. vj ; of
crude chalcitis, oz. iij ; of myrtle-oil, q. s. The calamine and
the chalcitis are to be triturated with wine during the season
of the dog- star ; use it upon a broad compress, and apply above
it a pledget and sponge out of wine. —
Another : Of burnt
copper, oz. ij ; of fissile alum, oz. ij ; of sal ammoniac, dr. ij ;
of wax, oz. ^g ; of Colophonian rosin, oz. vj ; of myrtle-oil, oz.
ij ;
the dry things are to'be triturated in the vinegar in the
sun for twenty days, and when it becomes of the consistence
of honey, having melted the wax, mix it and soften. The medi-
cine from pumice-stone, the isis, and the like, are also appli-
cable in such cases.

II. 8
 114 ULCERS. [book IV.

CoMM. Commentary, Celsus gives the following list of the more

' '
'
active articlesof this class Crustas iilceribus tanquam igne
:

adustis iuducunt, pr^ecipiie, clialcitis, utique si cocta est, flos

seris, ferugo, auripigmentura, misy, et id quoque magis coc-
tum.
For a variety of applications suitable to this class of ulcers,
we refer the reader to Galen's 4th book of ' De Med. sec. gen.'
The ingredients of them are powerfully desiccative, astringent,
and escharotic. Many of our author's prescriptions will be

recognized in it. For an account of the isis, and the other

compound medicines mentioned towards the end of this section,
we refer the reader to Galen (1. c.) and to the Seventh Book
of this work. Galen, in another place, and after him Aetius,
giA'e the following important directions for the use of these
applications. The ulcers to which this mode of treatment is
applicable, being very foul and filled with a vitiated discharge,
are first to be wiped clean with a soft linen cloth, and then the
caAdty of them is to be filled with the medicine, and a splenium
(oblong compress) applied externally. Then having put a piece
of linen above the splenium and bound it on, we are to place
over it a sponge squeezed out of cold water or wine, endea-
vouring to keep the sponge cold during the whole time of the
treatment, which may easily be done by pouring cold water
upon it without loosing the bandages. They are not be re-
moved until the third day. Galen states that the articles
which answer best in such applications are galls, pomegranate-
rind, alum, chalcitis, misy, and the like.
A similar mode of treatment, without any material altera-
tion, is described by the Arabians. Haly Abbas remarks,
that cicatrizing medicines are powerfully desiccative with some
astringency, such as galls, alum, and the like.

SECT. XLVI. ON THE MALIGNANT ULCERS CALLED CHIRONIAN

AND TELEPHIAN.

Old ulcers which are difficult to get cicatrized are called

chironian, as if requiringChiron himself to cure them ; and
telephian, from Telephus having long laboured under such a
SECT. XLVT.] ULCERS. 115

sore. We must attend then whether the whole body being

in a state of cacochymy, sends such defluxions to the ulcer,
and the prevailing humour is to be evacuated by appropriate
remedies. Or if it is a varix which sends these humours to
the legs, the ulcer being in it, it is to be cured as will be
described in the Surgical part of this work ; or the humours
are to be evacuated by venesection, taking away blood fre-

quently, and then using topical applications which have the

property of extirpating the disease without being pungent.
These therefore are simple applications ; those from pumice and
diphryges, and flakes of copper, verdigris, and hme moderately
washed; sprinkle fissile alum levigated, or of unwashed wool,
dr. iv ; of dried grapes, dr. iv ; of natron, dr. ij ; having pre-

viously anointed with honey, sprinkle of flakes of copper, dr.

X ; of alum, dr. ij ; and having softened in the sun with dr. x
of wax, apply.
These are compound medicines. A plaster for chironia. Of
ceruse, oz. viij ; of of the flakes of copper,
fissile alum, oz. ij ;

dr. ij ; of sal ammoniac, of frankincense, of scraped verdigris,

of pomegranate rind, of each, oz. ij ; of quicklime, oz. j ; of
wax, lb. j ; of myrtle-oil, lb. j. ss ; triturate the dry things with
wine. At first it removes callus ; and it is laid by and kept,
and at last when used, being softened with myrtle-oil, it cica-
trizes. —Another : Of litharge, lb. j ; of oil, lb. ij ; of black
chamseleon, of the roots of birthwort, of immature galls, of each,
oz. j ; of galbanum, of ammoniac perfume, of frankincense, of

each, oz. ij ; prepare, stirring Avith the roots of green reeds.

From Archigenes, for chironia, and malignant ulcers in the
legs and breast, for struma, and parotis. Of the fat of an ox
lb. iij ;
of turpentine, oz. v ; of manna, oz. vij : of the earth
called sarda ha^dng put the soluble and
which painters use, oz. v
dry articles together and melted, use.
:

Another, of Archigenes
— :

Of wax, oz. iv ; of oil of unripe olives, of manna of frankin-

cense, of diphryges, of the flakes of copper, of each, dr. iv ;
hav-
ing tritm-ated the powder with vinegar, and made of the thick-
ness of honey, mix with the cerate, and use upon a pledget. —
Another, for the malignant ulcers of women, and of other persons
having a soft skin : Of Tuscan wax, dr. viij ; of bulls^ fat, of tur-
pentine, of burnt lead, and of pepper, of each, dr. j ;
use on a
pledget with rose-oil or mvrtle-oil.
 116 ULCERS. [book IV.

CoMM. Commentary. Celsiis describes the chironian ulcer as being

" '
•

large, and having hard, callous, and swelled edges, with a

copious discharge of thin sanies. It is attended with no inflam-

mation, the pain is moderate, it does not spread, and therefore

it is not dangerous, although not readily cured. Sometimes,
he says, it becomes covered with a thin cicatrix, and then again
the ulcer breaks out. It occurs mostly in the feet and legs.
From this descriptionevident that by the chironian ulcer
it is

Celsus meant merely an ill-conditioned ulcer, and that he dis-

tinguished between it and the cacoethes, or malignant ulcer,
which last he held to be nearly allied to the carcinoma. How-
ever, most of the Greek authors apply the term malignant to
•

the chironian ulcer. For the cure of it Celsus recommends an

application consisting of squama ?eris, lead burnt and washed,
calamine, wax, and a small quantity of roses.
Galen furnishes us Avith an account of the manner in which
Thessalus the INIethodist proposed to cure all chironian and
malignant ulcers. Thessalus lays it down as a rale for the
treatment of all sores which are difficult to cure, or which
break out again when healed, to remove the exciting cause,
wdiether local or constitutional, by means of proper alteratives.
He adds " In cases of chronic ulcers which cannot be got
:

healed, we must remove the

parts which prevent adhesion, and
convert the sore into the state of a recent ulcer; and then
having allayed the inflammation proceed accordingly. Those
sores which heal up and break out again during their exacer-
bations, and when ulcerated, are to be cured like recent in-
flammations by soothing applications until the irritation sub-
side, after whicli cicatrizing applications are to be used, and
then the sm-rounding parts are to be covered with a malagma
of mustard, or some other rubefacient and alterative, to remove
the indolence. If this is not sufficient, we must attend to the

general health, attempting to efl'ect a change of the system by

repeated exercise, gestation, a diet increased or diminished
according to circumstances, and at the commencement by ad-
ministering an emetic of radishes, or even the white hellebore."
(Galen, INIeth. INIed. iv.) Although Galen, who all along dis-
plays a strong hostility to the Tltessalian asses, (so he calls the
Methodists,) has animadverted in severe terms upon the rules
here laid down, they would appear to be highly proper and in-
SECT. XLvi,] ULCERS. 117

geuious. Galen in another place (Med. sec. gen. iv) gives Comm.
from Asclepiades, Andromachus^ and others^ a great collection ' ——
'

of applications for chironian, malignant^ and indolent ulcers.

One by Asclepiades consists of the scales of copper, scraped ver-
digrisj wax, and larch rosin. Others by Andromachus con-
tain sori, misy, chalcitis, verdigris, alum,
turpentine-rosin, and
the like, mixed with wax. Hippocrates directs us to treat a
callous ulcer by applying to it septic medicines to make the
hard parts slough off, after Avhich the edges are to be brought
together. (De locis in homine.)
Thedirections of Aetius, more especially respecting the con-
stitutional treatment, are highly
important. In cases where
there is a redundance of blood he recommends
venesection, in
others both purging and bleeding; and in certain cases he
directs us to pay attention to the state of the liver and
spleen.
He relates a case of an ulcer on the hand, which he cured by
opening a vein leading to it. He also directs us to scarify or
cut off the callous edges of the idcer. He gives various pre-
scriptions for sores of this description, containing verdigris,
burnt copper, alum, &c.
sori, chalcitis,
Octavius Horatianus recommends a plaster consisting of
equal parts of chalcitis, wax, and alum. For phagedsente Pliny
mentions an old shad-fish triturated with saudarach. (H. N.
xxxii, 44.)
Tlie Arabians treat of these ulcers very fully. Avicenna in
particular gives very proper directions for the constitutional
treatment. When the state of the ulcer is occasioned by an
intemperament, to be corrected, and if the blood is defi-
it is

cient in quantity or quality, this is to be remedied by a proper

diet ; and when on the contrary it is connected with plethora,
venesection is to be had recourse to, and if the veins leading
to it are varicose, it
may be proper to open them. When the
sore kept from healing by a spiculum of bone, we are to cut
is

down and remove it. His applications consist of the same

ingredients as those used by the Greeks, namely, the flower of
copper, copperas, alum, ceruse, lime, arsenic, &c., mixed with
wax and oil. The directions given by Rhases are less circum-
stantial, but to the same purpose. He particularly directs us to
remove the by friction, scarifications, and septics.
callous edges
He speaks of turpentine as an excellent addition to other oint-
 118 CICATRICES. [book iv.

CoMM. ment. (Contin. xxviii.) He mentions that in case of malig-

" '
"
nant ulcer on the leg connected with varix, Galen opened the
enlarged vein.
The cacoethes of Celsus was evidently the disease called noli
me tangere by Theodoricus a very absurd appellation^ which
;

however has been retained to the present day. Celsus has

pointed out its resemblance to carcinoma^ and recommended
the only mode of treatment which ever does any good in these
caseSj namely, the application of septics, such as arsenic, quick-
lime, &c., or the actual cautery. As our limits will not permit
us to enlarge further on this subject at present, we must be con-
tent with referring to No. 108 of the ' Edinburgh Medical and
Surgical Journal,^ where we have given a full exposition of the
ancient principles of treatment. (See also the Commentary on
s. xxvi of this Book.)

SECT. XLVII. FOK BLACK CICATRICES.

Let the root of the white and black bryony be boiled in oil un-
tilthey are reduced to the state of juice, and the oil applied will
take away black scars ; and so in like manner calamint boiled
in wine, and litharge washed with white rose-oil. But the scars
from lichen, and all other kinds are made like the other skin
by anointing them with the fat of asses ; or the seed of rocket
triturated with the gall of a goat, of an ox, and of a sheep may
be rubbed in Avith litharge ; or a Iambus foot burnt may be tri-
turated with austere wine for the same purpose ; or, ammoniac
perfume may be rubbed in with swines' gall. These are com-
pound Of litharge, of mint, of frankincense, equal
applications
—
:

parts with honey. Another : of natron, of ammoniac perfume,

of sulphur vivum, of myrrh, equal parts ; having triturated with
vinegar, white wine, or water, rub in but a very little, so as not
to produce an ulcer. —
Another : Of Cimolian earth, of pigeons'
dung, of soap, of frankincense, equal parts with vinegar. A
detergent ointment for black scars Of Cimolian earth, dr. xiij ;
:

of aphronitrum, dr. v ; of white hellebore, dr. v ; of the greasy

dregs of nut-ben, dr. iv ; scrub with it while in the bath.

SECT. XLViii.] ULCERS. lit)

Commentary. Avicenna condenses all the information Comm.

'

contained in the authors Avho preceded him. He sets out with *

stating that the class of medicines which are applicable in such

cases are the abstergents j of which he enumerates verdigris,
stavesacre, the scales of copper^ and even arsenic. Among the
less active ingredients he mentions, like our author, the fat of
asses. We need not give extracts from the other authorities,
as no one has treated of this case so fully as Avicenna.

SECT. XLVIII. ON SINUOUS ULCERS.

When the skin adjacent to an ulcer is not united with the

parts below, we call such a complaint a sinus. When, there-
fore, the sinus extends upwards, the ichor readily flows out
from the sore, and adhesion easily takes place ; but when it
extends downwards the ichor by remaining within corrodes the
continuous parts, and unless you first make an incision for its
discharge, you will be able to effect nothing for the sores can
;

neither be incarnated nor the parts made to unite. But if the

sinus is in any of the limbs, as the arms or legs, one may pro-
duce adhesion without a counter-division by putting the limb
in a declining position. Thus when the sinus is the arm, m
and the mouth of the sore is near the elbow, by placing the
hand in an elevated position, you will render the discharge from
the ulcer below easy. And when the sinus is in the thigh,
and has its outlet near the knee, you must make the position
declining by putting a soft pillow below the back part of the
knee, so that the groin may be in a lower position than the
knee ; and if the sinus does not require incarnation, forthwith
by means of a straight and hollow pipe having a bladder attached
to it, syringe it with honey so diluted with water that one could
drink it, in order to clear away the ichor
from the sinus. For
promoting adhesion when about to take place, do it with wine,
or wine and honey, and then proceed to the agglutinating me-
dicine. But if the sinus being hollow requires incarnation,
first inject a little of the composition from dried paper with
much rose-oil, then plug up the mouth of it with charpie, and
afterwards the plaster of iris, or of Machaerion, or of some siich,
may be melted with liquid rose-cerate, and injected in like
 120 ULCERS. [book iv.

manner. If the sinus is moderately incarnated you may apply

some of the agglutinating medicines, as if you were curing a case
of recent bloody wound. Such are those called the barbarous,
dichromos, and gilvus ; and more especially that prepared from
the oil of palma Christi and the metals without wax which is
called the dun plaster of Galen, is applicable. After the appli-
cation of the medicine, a recent sponge out of wine and honey,
or wine alone, is to be put on particularly in a soft manner,
and the bandaging is to commence at the bottom of the sinus
and end at its orifice. The folds of the bandage should bind
the bottom of the sinus firmly, yet so as not to occasion pain,
but ought to be gradually relaxed towards its orifice and the ;

plaster which is put on should be so cut as to leave an opening

at the orifice for the escape of the matter, but another small

plaster of the same materials should be applied to it in a loose

state, so as to favour the discharge. This is to be left on till
the bandages are loosed, which is to be done on the third day,

when they are to be taken and changed, but the applica-

off"

tion along the sinus is to be left. You may judge whether the
bottom of the sinus has adhered, from obser^'ing if the matter
be small and well concocted, or if there be no discharge at all ;

and moreover if there be no sensible pain along the sinus nor

swelling, but the whole part is contracted, dry, and free from
pain. But if you see a little well concocted pus at the orifice,
you may still more confidently entertain good hopes. If on
the second or thii'd day a thin ichor be discharged from the
sinus, you need not despair that adhesion has taken place, for
often the strength of the medicine squeezes out from the parts
below a thin fluid, which being discharged the parts become
drv and adhere. But if on the third or fourth day from the
commencement the matter appear imconcocted as it runs from
the opening, you may be sui-e that the sinus has not adhered,
and you must persevere with the same application. When
owing to the moisture of the part it falls off, as is not unlikely,
it will not be
improper to make some change in the medicine
itself.

On sinuous ulcers ivith a thin covering of skin. AYhen the

abscess is too long opened, owing either to the unskilfulness of

the surgeon, or the timidity of the patient, the skin which lies
over it becomes thin and ragged, and it cannot be removed.
SECT. XLviii.] ULCERS. 121

then after the syringing which has been described^ we must

have recourse to an agglutinating application of a humid con-
sistence, but of desiccative properties, such as that from chalcitis
called phoenicinum, dibited with old oil, so as neither to be very-
hard nor of such a consistence as not to stain the finger ; and
afterwards it is to be mixed with moderately old wine, and ap-

plied in a circular form with corresponding bandaging. To

skin in this ragged state honey, as was said, is not one of the
least proper applications when boiled to the consistence of a

plaster and applied. It will be better, however, if after spread-

ing it on the rag you sprinkle over it from a sieve some myi-rh
finely pulverized, or aloes, or frankincense,
or all of these to-

gether. I have also found the lesser centaury a wonderful ap-

after which
plication for the same puqaose ; next to it is comfrey,
is the root of the Illyrian iris, and after these is the flour of

tares. Sometimes during the process of boiling we sprinkle

these upon the honey when the vessel is about to be taken off
from the fire. It is better, however, to do so after it is taken
off, and then it is to be stirred about, and when it becomes
tepid applied to the sinus, and bandaged as aforesaid.

Commentary. Similar directions are given by Galen and Comm.

' '
*
Aetius, but upon the whole those of our author are superior ;
and as those of the other two supply no additional information,
it wiU be unnecessary to multiply extracts from them. (See
Galen, Therap. ad Glauc. ii.)
Actuarius, in like manner, briefly dii'ects that unless the
sinus open downwards, it shall be cut open and dressed with
an agglutinative apphcation. You may think weU of the case,
he adds, when the part is drj^ and free from pain, or when only
a little weU-concocted pus is discharged from it.
In the translations of the Arabians, the sinus is described
by the names of absconsio and caverna. Avicenna states that
the sinus differs from the fistula in having a larger cavity, and
its edges not being indurated. He lays down very correct
rules of treatment, but they are all copied from Galen. Thus
he directs, when the orifice of the sore is above the cavity of
the sinus, that it should be cut open ; or, if this cannot be

conveniently accomplished, he recommends us to introduce a

tent smeared with some incaruaut or detergent application.
 122 FISTULA. [book iv.

CoMM. Upon the authority of Dioscorides he recommends the lesser

' '
•
centaury in such cases. His directions for the application of
the bandages are similar to those of our author.

Celsus,and other of the ancient authorities, do not treat of

the sinus separately from the fistula.

SECT. XLIX. ON FISTULA.

Fistula is a callous sinus formed for the most part from ab-
scesses, and deriving its appellation from the pipes of reeds

(fistula). If, therefore, it terminate

with a bone, it cannot be
cured without a surgical operation, unless in process of time a
scale of the bone come off spontaneously. But if it does not
for
terminate with a bone, it is to be cured by the applications
removing callosities, and the agglutinative medicines.
The
are such as these the root
applications for removing callosities
:

of spondylium scraped around and applied removes the callus

of fistulte. And in like manner black hellebore applied removes
the callus in two or three days ; also lees of oil boiled and in-
jected ; sori in a crude state, or
burnt and injected with some
diluted wine, or sori and crocomagma with hydromel. Or
make coUyria by mixing elaterium with turpentine, and apply.
Or syringe with the juice of the root of laserwort. This melts
down the callus of verdigris, dr. xij of ammoniac, dr. ij
:
; ;

mix with vinegar, and form into an oblong coUp'ium.

A collyrium which I use for reynoving the callosities offistuloi.
Mix with vinegar equal parts of ammoniac perfume, of copperas,
of verdigris, of misy, of chalcitis, and of gum. Another, from —
the surgical works of Heliodorus Of calamine, of misy, of cop-
:

peras, of burnt copper, of gum, of each, dr. iv ; of crude chal-

citis, dr.iij
mix with
;
the urine of a young person not come
to manhood, and form collyria. Put this collyrium into the
fistula, and apply externally the inner part of bread soaked in
water, changing it until the inflammation subside, and the
eschar fall off".
—
Another, which I received in Alexandi'ia Of :

the roots of alkanet, of toasted misy, of chalcitis, of verdigris,

of fissile alum, of copperas, of aloes, of each, oz. j ; triturate
along with fine cantharidcs in vinegar, and make collyria.
—
Another : Of copperas, dr. ij ; of chalcitis, of verdigris, of each,
SECT. xLix.] FISTULA. 123

dr. j ;
mix with ammoniac and use, and when the callus is

thrown off, cleanse with verdigris and eight times the quantity
of the purest honied water; but after the discharge of the
callus, incarnants must be used.
An incarnative collyrium :

of aloes, of myrrh, of ammoniac, of the cinders of egg shells,

having triturated with water form coUyria, and
equal parts
apply.
;

—
Another : Of myrrh, of aloes, of frankincense, of pome-
granate rind, equal parts, mix with water ; but
some use bull's
gall. The oil of unripe olives is incarnative when injected, I

knew a person who injected cedar-rosin into fistulse, and suc-

ceeded surprisingly. After it is incarnated we must have re-
course to the agglutinative medicine, according to the plan
" When the fistula is narrow and
described for other sinuses.
" and does not
long," says Galen, appear to me to contain
callus internally, but only sordes, I first inject lye into it, and
then allowing it to remain in the fistula until I expect that the
sordes has fallen completely ofF, I afterwards apply the medi-
cine." It was the one from the oil of palma Christi, mentioned
above.

Commentary. We shall have occasion to refer to the Comi

Hippocratic treatise De Fistulis,'

'
in the Sixth Book.
"
^
Celsus treats of fistulse with more than his wonted mi-
" Id nomen est ulceri
nuteness. This is his definition : alto,

angusto, calloso.'^ He has described

all the complications of it

with great accuracy. He directs us to commence by making

an inspection with a probe or sound, so as to ascertain the
state of the parts and of the discharge. If a soft body is felt
at the bottom, we conclude that the fistula terminates in the

flesh, but if a hard one is felt, we know that it ends with a

bone. If the probe from
slide readily over the bone, it is free

caries, but if it does not so, and yet no inequalities are felt on
it, taken place, but it is still smooth: if it feel
caries has
and rough, the bone is eaten with caries.
For a sim-
unequal
ple and recent fistula, not deep-seated or in a joint, the plaster
for recent wounds will be sufficient, provided salt, or alum, or
the scales of copper, or verdigris, or any of the other metals,
be added to it. The application is to be made upon a piece
of linen, and a soaked in vinegar is to be put over it,
sponge
and is to be removed on the fifth day. The patient must live
 124 FISTULA. [book iv.

CoMM. upon nutritious food. If the fistula is at a distance from the

"

prsecordia^ emetics with radishes are said by him to be proper.

'
"

When the fistula is old it becomes callous^ and requires stronger

applications, containing such ingredients as calamine, atramen-
tum sutorium, verdigris, galls, lime, orpiment, or realgur. He
mentions as a very ready application a solution of ammoniac
in vinegar, with some verdigris added to it. However, he re-
marks, any other caustic Avill accomplish the same purpose.

If the fistula long and transverse, an incision is to be made

is

at its commencement, after which the collyrium may be applied.

When the fistula is double, or consists of still more passages,
he recommends us to blow in with a m riting pen the medicines
in the form of powder, or to apply them dissolved in wine,
mulse, or \inegar. But whatever the internal dressing be, he 1
recommends us to apply on the outside of it something of a
refrigerant and repressing nature, as the parts around are gene-
rally affected with inflammation. When the dressings are re-
moved the fistula is to be sj^iuged with wine if the discharge

of the pus is copious, with vinegar if its edges are callous, but
with mulse, or a decoction of tares, if the passage be clean.
By the means we have been describing it will generally happen,
he says, that the inner coat of the fistula will slough oft', and
leave the ulcer in a clean state. Agglutinants are then to be
applied, especially a sponge smeared with boiled honey. When
the sides of the fistula are clean there need be no apprehension
lest they do not adhere, since, he remarks, we often see in
ulcerations of the fingers that without great care one finger is

apt to adhere to another.

'
In the '
Euporista of the Pseudo-Dioscorides, it is recom-
mended first to dilate the fistula with a piece of sponge, and
then to use a stimulant application containing verdigris, am-
moniac, &c.
Aetius gives an excellent account of fistula, but it is mostly
borrowed from Galen. We can afford room only for a few
extracts. When a fistula extends obliquely, nothing can be
done without making a free incision, for which purpose he
directs us to introduce a sound and cut along it. His direc-
tions for examining into the nature of a fistula are such as

ample experience alone could have dictated. He seems to be

decidedly of opinion that, except in cases of a recent fistula, or
SECT. !>.]
SORES. 125

when it is not deep-seated, an incision ought always to be made Comm.

' '
'
at first ; after which applications for removing the callus may
be used. When, however, the patient refuses to submit to an
operation, and the case is recent, the cure may be attempted
by means of escharotics and incarnants, such as verdigris, misy,
alum, &c., mixed with frankincense, aloes, and myrrh.
Oribasius briefly recommends white hellebore, a mixture of
equal parts of verdigris and ammoniac, and a few other such
articles, as applications for fistulse.
Scribonius Largus mentions several compound applications
containing misy, chalcitis, verdigris, alum, &c.
Marcellus gives one consisting of ceruse, ammoniac, and oil.
Actuarius gives a brief but distinct account of the nature
and treatment of fistula, but it is taken almost entire from our
author.
A\'icenna inculcates that a fistula is only to be cured by a
free incision, or by removing the callous sides of it by bm'ning
with or caustic medicines, such as arsenic, ammoniac, sul-
fire

phur, the flour of copper, or mercury. This in fact is the sum

of the medical practice in such cases. There is nothing parti-
cularly interesting in Haly Abbas. Alsaharavius truly states
that a diseased bone is the common cause of fistulous ulcers
not healing, and inculcates that in this case there can be no
hope of recovery until the carious portion be removed. Rhases,
upon the authority of the celebrated Antyllus, directs us to use
corrosive applications when a fistula cannot be operated upon
with the scalpel. He intimates that this is particularly the
case when the disease is seated in the groins.
'
The earlier modern surgeons, such as Gulielmus de Saliceto,
Arnoldus, Rogerius, Rolandus, and Guy of Cauhac, in imita-
tion of the Arabians, dii'cct fistula to be treated by the appli-
cation of septics, the actual cautery, or incision. Rogerius
recommends a tent spread with quicklime and soap, or with
arsenic. Guy of Cauliac, like Avicenna, speaks favorably of
sublimed quicksilver or corrosive sublimate.

SECT. L. FOR SORES WHICH BREAK OUT AGAIN.

Some sores which have become cicatrized, often after no long

time become inflamed and break out again ; for a bone being
 126 THORNS. [book iv.

diseased, sometimes the flesh which covers it heals up readily

and appears sound, but in a short time a strong defluxion tak-
ing place from the corrupted bone below, inflammation super-
venes, and pus is formed which corrodes the cicatrix. What
then is the cure of such ulcers ? Dry the diseased bone to
such a degree that it may exfoliate. But the diseased part of
the bone may easily be brought up if you apply a cataplasm,
consisting of fig leaves triturated with fine dried barley flour
and wine. Or you may apply equal parts of the reed of hen-
bane and of copperas triturated together. The root of hog's-
fennel speedily removes the laminae of bones.

CoMM. Commentary. This chapter is copied from Aetius, who

' '

gives some additional prescriptions, such as one consisting of

•

the scales of copper, frankincense, alum, sal ammoniac, pome-

granate rind, and ceruse, with or without cerate ; and another
consisting of red arsenic finely triturated with bear's fat.
Avicenna recommends strong attractive applications, such as
a plaster of the leaves of the black poppy with fig leaves ; and
another containing the atramentum sutorium (sulphate of
copper.)

SECT, LI. ON ULCERS IN THE JOINTS.

The joints being drier than the fleshy parts, they therefore
require when ulcerated more desiccative applications. Where-
fore the trochisk of Polpdes, when rubbed with wine until of
the consistence of the sordes of baths, is an excellent applica-
tion ; and in manner all equally desiccative medicines.
like
And we have seen them benefited by bathing with sea-water
and brine frequently. Wherefore we must use the most desic-
cative applications to the joints.

CoMM. Commentary. This is copied from Oribasius. (Synops. vii, 19.)

SECT. LIl. THOSE THINGS WHICH EXTRACT SHAFTS, JAVELINS,

THORNS, AND THE LIKE.

Javelins, reeds, and shafts, and thorns, are extracted by the

two pimpernels, the round birthwort, ammoniac with honey.
SECT. LTTT.] HEMORRHAGE. 127

the fruit of henbane triturated and sprinkled upon the part.

Mix the pounded root of calamus with honey, put it into a piece
of hnen, and use in great quantity it will speedily extract
;

them.

Commentary. This subject will be more fully treated of Comm.

' '

'
in the Sixth Book.
Our author copies from Oribasius. (Synops. \\\, 17.)
Most of the articles here enumerated are mentioned by Dios-
corides as possessing strongly attractive properties. Avicenna,
Rhases, and Haly Abbas, speak of similar articles, without any
new remedies of consequence. See in particular Haly. (Pract.
iv, 24.)
The
applications mentioned by Pliny are ridiculous, (H. N.
XXX, 42, and xxxii, 43.)

SECT. LIII. ON HEMORRHAGE FROM VEINS AND ARTERIES.

In cases of hemorrhage from parts, the contrary position to

that for sinuses will be the proper one, that is to say, the up-

right, but th-at must not be in too great a degree, for there is
danger of pain being excited, and of the blood bursting forth
from the vessel again ;
for nothing produces hemorrhage and
increases inflammation more than pain. Wherefore apply your
finger immediately to the part from which the blood flows, put-
ting gently upon the orifice
it of the opening in the vessel, and

pressing it so as not to excite pain, for

by this means you will
restrain the bleeding, and block up the opening with a throm-
bus, and should the bleeding vessel be deep-seated you will
thereby ascertain most correctly its situation and magnitude,
and whether it be an artery or a vein. After this, if the ves-
sel be small we must use some of the styptics. The best of
these are the obstruents, composed of roasted rosin, of fine flour
of Avheat, and of gypsum, and such like, mixed up with the
white of an egg and applied upon the down of a hare. When
the vessel is large seize it with a hook, stretch and twist it

moderately. When the bleeding is stopped, endeavour if it is

a vein to restrain the blood Avithout a ligature, by the same
medicines. But if it is an artery, one of two things must be
128 HEMORRHAGE. [book iv.

done, either apply a ligature around it, or cut the vessel asunder,
by which means you will restrain the blood. Sometimes, too,
we are obliged to apply a ligature to large veins, and also occa-
sionallv to cut them asunder transverselv. We
are sometimes
with regard to veins which arise from
di'iven to this necessity
a deep-seated place, more especially when they run through a
narrow passage or important parts, for thus the portions will
be retracted on eitherside, and the wound will be blocked up
and covered by the parts above it. But the safer practice is
to do both these things, applying a ligature to the root of the
vessel and then dividing it. Hanng done these things, the
wound is to be incarnated as quickly as possible, before the
ligature slip from the vessel. For if it is not speedily incar-
nated, but the emptied portion is dilated, the disease called
aneurism is formed. You may know whether it is a vein or
an artery that pours forth the blood, from this, that the blood
of an artery is brighter and thinner, and is evacuated by
pulsations, whereas that of the vein is blacker and without
pulsation.
The most excellent of all the incarnative medicines which we
know, that used with safety for hemorrhages from the menin-
is

ges of the brain, and which may be used in woimds of the

neck, even for those of the jugular veins ; for it will restrain
the bleeding from them without a ligature. It contains of the fat-
test frankincense, p. j; and of aloes, when appbed to soft bodies,

p. ss ; but when too hard, an equal quantity, and instead of the

frankincense manna is to be substituted. These are to be
mixed with the white of an egg until they become of the con-
sistence of honey, when it is to be applied upon the soft down
of a hare to the vessel and the whole wound ; and a bandage
is to be put on externally, the first fom* or five turns of which
we are to make upon the bleeding vessel, and from thence ex-
tend to the root of it. Then ha^^ng loosed it on the third day,
if the medicine should still be
properly applied to the wound,
we are to put on another one all around, soaking it, as it were,
and then bandaging. But if the first pledget come away of
itself, the finger
is to be pressed
gently upon the root of the
vessel, so as toprevent all discharge, and it is to be removed
softly and another pledget applied. Thus it is to be treated
until the vessel heal up, the upiight posture being still pre-
SECT. Liii.] HEMORRHAGE. 129

served, but so as not to excite pain. Those things which form

sloughs render the part more exposed than it was naturally,
owing to the falling off of the sloughs ; for in many cases a
hemorrhage which can hardly be restrained supervenes upon the
falling off of the sloughs. And yet we must have recourse to
them when a great necessity compels us. A
great necessity for
using escharotics, or cauteries with fire, occurs when the bleed-
ing proceeds from the vessels being corroded by mortification ;
and indeed, when in such afi'ections we cut off the whole mor-
tified part, it is safer to burn, as were, its root, or to use
it

escharotic medicines. This happens more especially upon the

pudendum and fundament. The object of escharotics is to pro-
duce heat with astringency, as in chalcitis, misy, and copperas.
Those from quicklime are stronger indeed, but owing to the
want of astringency in the lime, the eschars from them fall
sooner away ; but it is better that they should remain longer,
for thus will flesh have time to form pre^iously at their root,
and become as were a cover to the vessels.
it In such cases
of hemorrhage matured woad (isatis sativa) when sprinkled upon
the part is excellent for restraining the bleeding, or burnt galls,
but they must first be heated in the fire, and extinguished in
vinegar or wine. The following Simples stop hemorrhages :

Aloes, frankincense, manna, Samian earth, the rust of iron, the

ashes of burnt wool finely powdered, the dung of an ass or of a
horse, a small quantity of bitumen, pomegranate-rind, diphryges,
galls, dried myrtle, all kinds of alum whether crude
or burnt,
roasted rosin, the bark or green leaves of the vine, and the down
of the peels of the plane tree, more especially when the vessels
throw off their crusts. In particular, hemorrhage from the
nostril is to be restrained by the application of the fruit of the

sharp rush, the juice of nettle leaves, chalcitis, burnt anthyliis,

the down of a hare, the middle part of a ferule when burnt
with vinegar, an ass^s dung dry or moist, the juice of leeks
with frankincense applied upon lamp-wick. The following are
compositions for restraining all kinds of hemorrhage HaA'in^. :

soaked a fresh sponge in liquid pitch, and smeared it with bitu--

men, bum it in a new pot. Mix together of the ashes of it, p. ij
of lead, p. j ; of antimony, p. j. —
Another : Sprinkle on the
;

part equal quantities of the manna of frankincense, and sulphur

vivum. —Another : Of chalcitis, dr. viij ; of frankincense, or of
II. 9
 130 HEMORRHAGE. [book iv.

its manna, dr. xvj of roasted rosin, dr. of burnt gypsum,

di*.
viij.
— ;

Another, an escharotic st}"ptic

viij
: Of
;

chalcitis, of burnt

copper, of copperas, of roasted misy, equal parts. And the

medicine called the Rhodian, and that called the yellow, are
excellent styptics.

CoMM. Commentary. See Celsus (v, 26) ; Galen (Meth. Med. \,

et alibi) Oribasius (Med. Collect, x, 22 ; Morb. Curat, iii, 36 ;
;

Synops. y\\, 20) ; Aetius (xiv, 51) ; Actuarius (]\Ieth. Med. yi, 4);
Palladius (Comment, in Hippocr. Epidem. ed Dietz. ii, 189) ;
Albucasis (Chirurg. i, 58); Ayicenna (iv, 4, 2, 16) ; Averrhoes (in
A^'icennse Cantic. ii, 2, and CoUig. \i\, 23) Serapion (v, 16) ;
;

Halv Abbas (Pract. iv, 21); Ehases (Divis. i, 139; Contin.

xxAiii.

Contrary to what is often stated in modern works on sur-

gery, the ancients appear to have been very well acquainted

with the proper treatment of hemorrhage. Celsus directs us
when a dangerous hemorrhage is apprehended from a wound,
to fillup with dry pledgets, then to apply a sponge
it

squeezed out of cold water, and to make pressm-e -with the hand.
If the bleeding does not stop, he directs us to change the

pledgets often, and if dry ones do not answer to soak them in

vinegar. For fear of inflammation he recommends us not to use
caustics and escharotics except in m'gent cases. When all other
means he directs us to seize upon the vessels (vense) which
fail,

pour forth the blood, and ha^dng tied them in two places about
the wound, to cut them asunder, so that they may contract and
still have their mouths shut If circumstances prevent this
iip.
from being done, they are to be burnt with a red-hot iron.
He also speaks of stopping bleeding by re^iilsion, as for exam-
ple, by applying a cupping-instrument to the hindhead for

bleeding in the forehead.

Galen has treated of this subject at great length in the Fifth
Book of the ' Meth. Med.^ "When blood is discharged from a
tvounded artery, he directs us to apply a finger to the orifice of
the vessel firmly, yet so as not to occasion pain, and thus a
thrombus be formed that will stop the flow of blood. When
-^^11

the vessel deep-seated he advises us to examine acciu-ateh'

is

into its situation and size, and to ascertain whether it be an

arteiy or vein ; after which it is to be seized with a hook and

SECT. Liii.] HEMORRHAGE. 131

twisted moderately. If the flow of blood is not

stopped thereby, Comm.
' '

he recommends us, if the vessel is a vein, to endeavour to '

restrain it without a ligatm'e by means of styptics, or

things of
an obstruent nature, such as roasted rosin, the fine down of
wheaten floiu', gypsum, and the like. But if the vessel is an
artery, he says, one of two things must be done,
—
either a liga-
ture must be applied to it, or it must be cut across. He
adds, we are even obliged sometimes to apply a ligature to
large veins and cut them across. From this extract of Galen's
practice, it will be readily perceived how much our author is
indebted to him. He makes mention of the ligature in many
other parts of his works. He also recommends the actual
cautery.
To stop bleeding, Oribasius directs, in the first place, cooling
and astringent applications to be used, and if these do not
succeed, caustics, such as misy, chalcitis, copperas, or the actual
cautery. Upon the whole, his account of hemon-hage is nearly
the same as our author^ s, only he says nothing of the ligatm'e.
Aetius treats of this subject in the same terms as Galen, re-
commending the ligature under the circumstances mentioned
by him. Some of his styptics are powerful escharotics and
astringents, such as copperas, chalcitis, alum, galls, quicklime,
rosin,and frankincense. He informs us that Ammonius, the
famous Alexandrian lithomist, used a composition of arsenic,
sandarach, chalcitis, and quicklime.
Actuarius recommends a composition containing burnt cop-
per, chalcitis, galls, frankincense, &c.
' '
Palladius, in his Commentary on the Epidemics of Hippo-
crates, treating of hemorrhage says, we often stop the bleeding

by applying a ligature to the divided vessel.

Albucasis mentions fom' methods of stopping the discharge
of blood from an artery 1, by the cautery ;
:
2, by dividing
the artery across; 3, by using the ligature ; 4, by styptics

applied upon a bolster or compress, and tightly bandaged.

Averrhoes recommends to stop bleeding by styptics, the cau-
tery, or the ligatm'e. He says distinctly, that when the bleed-
ing cannot be stopped, the artery or vein is to be secured with

a thread.
A^dcenna treats of all the modes of stopping hemorrhage with

singular accuracy, but at so great length that we can only aff'ord

 132 WOUNDS OF NERVES. [book iv.

CoMM. room for a few remarks. He recommends stupefying things^

" '
*
cold water, exposure to cold, escliarotics, and the actual cau-
tery. He also directs in extreme cases the vessel to be cut
be applied, namely, a flaxen thread.
across, or a ligatm'e to
His description of the process of taking up and tying an
arteiy has quite a modern complexion. He also recommends
the application of a compress with tight bandaging when the
hgature cannot be apphed.
E-hases makes mention of the cautery, of the application of
snow, of the ligature, of styptics, and of cutting the vessel
across. He mentions that Galen in certain cases approved
of two ligatures, as it sometimes happens that the inferior por-
tion will pour forth blood. He further speaks of his having
occasionally used two or three ligatures for the sake of greater
security. He also mentions torsion of the artery.

Haly Abbas gives an interesting account of hemorrhage, and

makes mention of bandages and the ligatui'e. He and Serapion
agree in recommending strongly as a styptic a mixture of one
part of frankincense, with a half part of aloes, applied upon the
down of a hare. This is the application called the plaster of
Galen, and is much recommended by Zacutus Lusitanus (Pract.
Admin, i, 85), by Scultet (Arsinal de Chirurg. Tab. 33), by
Brunus (Chirm-g. Maj. i, 12), and Lanfrancus (Chir. parva. 5.)
The early modern writers on surgery make mention of all
the ancient methods of stopping hemorrhage. Guy of Cauliac
recommends the ligature upon the authority of Galen and
A^icenna. (iii, 1, 3.) It is also recommended by Bi'unus

(i, 12),
Theodoricus (i, 13), Rolandus (ii, 1), and Lanfrancus
(iii, 1, 9.) It appears, therefore, that the use of the ligature
for stopping hemorrhages was well understood by the ancients,
and had never been lost sight of even in the darkest ages.

SECT. LIV. ON WOUNDS OF THE NERVES.

"When the nerves are wounded or pricked, they experience

great inflammation and pain owing to theii' great sensibility ;

and therefore fever and convulsions supervene upon them, and

in some cases deliriiun, owing to the continuity of the nerves
with the brain. And sometimes phlegmons and abscesses form
SECT. Liv.] WOUNDS OF NERVES. 133

in the other parts adjacent to the wound, arising from the

wounded nerve, owing to their continuity with it. Wherefore
we must preserve the wound of the skin from adhering, that
the ichor may escape by it. And in punctures, if they appear
blind, the part must fc3 di\dded by two incisions intersecting
one another. With regard to the treatment, if the body is
plethoric,and the inflammation strong, it will be proper to begin
with venesection and when the body appears to be in a state
;

of cacochymy, purging must also be had recourse to. We must

apply to the wound medicines for allaying pain, and for increas-
ing the discharge, more especially if the cross incisions have not
been practised. It is necessary to know that warm water, which
is most applicable to other inflammations, is inimical in these

cases, and it is better to bathe the part with a thin oil which
has no astringency and is warm to the feeling for nothing ;

either very cold or very hot can be applied without detriment.

Of medicines turpentine-rosin is beneficial by itself in the case of
children, women, and persons of tender flesh, but softened with
etiphorbium for those of a firmer fibre ; and if it become too
hard it is to be mixed with some of the thinner oils. To nerves
in a state of inflammation and mortifications, we may use ca-

taplasms consisting of the flour of barley or of beans, or by

boiling that of tares in trained lye with oxymel. But with-
out boiling we may use the following cerate for punctures of :

Avax, oz.iij ;
of euphorbium, oz. j ; or of pigeon^s dung ; for
harder parts, of oil, oz. ij ; and sometimes of turpentine, oz. j.
When you wish to give the medicine the form of a plaster, you
may add to the preparation from euphorbium, of wax, of boiled
rosin, of oil, and of fat pitch, of each, oz. vj
;
but you will make
it by substituting the fattest bee-glue instead of the
better
rosin. The following is a good remedy for punctured nerves,
applying also to persons bitten by mad animals Of vinegar one
:

sextarius, of fat pitch, lb. j ; of opoponax, oz. iij ; having dis-

solved the opoponax in the vinegar triturate it more, and hav-
ing melted the pitch, boil. This medicine is applicable to
punctures of the allowing the mouth of the
nerves not
puncture to close up, as case of persons bitten by
in the
rabid animals it does not permit the wound to cicatrize. But
it answers only with hard bodies, and when you wish to apply
it to the punctures of children, or of persons of soft skin, you
134 WOUNDS OF NERVES. [book iv.

must melt it in some discutient article such as the oil of mar-

joram, of opobalsam, or old oil.
—
Another suitable application
is basilicon with the addition of natron, or quicklime, or euphor-

bium, or sulphur vivum, or wild pigeon's dung, or opoponax,

or sagapene, or Cyrenaic juice, or castor, adding to a pound of
the ointment an ounce of one of these medicines. It answers
well for wounds of nerves, and more especially punctures. And
in the country when one
not supplied with any other medi-
is

cines, one may apply fresh and fat bee-glue to the wound, or
leaven more especially if old, by itself or mixed with bee-glue,
or with the juice of tithymal. But cataplasms may be applied
made of oxymel, or of strained lye, with the flour of beans, or
of tares, or of chick-peas, or of bitter lupines, or of barley, or
of the flour of polenta, not only when in a state of inflamma-
tion, but they may be used from the commencement. But re-

laxing cataplasms are to be entirely rejected for wounds of

nerves. If the nerve is not cut, but laid bare by a wound, the
surrounding skin being divided so that the nerve appears naked,
and is wounded longitudingly and not transversely, we must

use none of the afore-mentioned from euphorbium, nor any

thus acrid, for the nerve being bare will not bear their power
which is strong, but one may use lime that has been washed

often in the warm season mixed with much honey. The pre-
paration from pompholyx, and that from honey melted with
much rose-oil, are also excellent ones. But these things must
not touch the wound, for the nerve is sensitive, of a cold tem-
perament, and continuous with the most important part. And
neither is it proper to bathe such an idcer with oil, for it will
make it become foul, and we must onlj- wipe away the ichor
with soft wool wrapped about a probe. When all things
succeed agreeably to our wish, there will be no danger in
fomenting with must. For stronger persons the trochisk of
Polyides with sodden must may be used upon a warm pledget.
After the exposed nerve has been covered over, we must apply
externally pledgets, with some of those things which are fitting
for narrow wounds, such as that from euphorbium, or that from
pigeon's dung, taking in also much of the sound parts. When
the wound is transverse there is greater danger of convulsions,
but everything relating to the cure is in this case the same,

except that while the wound is recent some have used sutures
SECT. Liv.] WOUNDS OF NERVES. 135

and certain of the agglutinative applications but the sutures

;

must not be applied very superficially lest the part below remain
ununited, but more deeply, taking care however that the nerve
be not punctured by the needle. It is to be known once for

all, that in Avounds of the nerves the medicine which cures

punctures being of a bitter nature, it is not possible to cui-e
with it the division of the nerve, as the parts cannot endure
pungency and inflammation. And neither does the medicine
which cures incisions answer with punctures. For its strength
does not reach the bottom of it, the incision of the skin being
narrow. A spare diet is to be allowed, and a soft couch and ;

warm oil is to be applied to the armpits, head, and neck but ;

when the wound is in the leg, the medicine is to be applied to

the groins, pubes, and the parts there. Baths, until the in-
flammation is on the decline, are to be abstained from, water
not agreeing with these wounds, as we have said. But since
some from habit cannot bear to want the bath, if the wounded
part be the hand it must not, if possible, be wet in
hot water, and
still less but when the wound is in the foot, since it
in cold ;

is impossible to preserve it from being wet, when about to go

into the bath apply to the wounded part some of the plasters,
and externally a compress consisting of many folds and moist-
ened with oil and again external to that a linen bandage and
; ;

after having done these things when the person affected is about
to take his seat in the bath pour oil once more upon the band-

age. When he comes out of the bath take away all those ap-
plications, and have recourse to
the treatment described above.
When there is only contusion of the nerve, if along with it there
be contusion of the skin and ulceration, the cataplasm of the
flour of beans and of oxymel will be a fit one, but you may add
sometimes the flour of tares, and some iris; and when the con-
tusion is attended with pain, you may mix a little liquid pitch
with it. If there be no contusion of the skin, it will be more
discutient to bathe frequently with an oil of a heating nature,
I mean that of of rue, of iris, or of marjoram.
dill,
When
the whole nerve cut asunder no danger will result from
is

it, but the part will be

mutilated ; and the treatment is to be
conducted as in the case of other ulcers. The treatment of
the wounds of nerves by simples is sufficient for accomplishing
the whole cure, but some are in the practice of using compound
 136 WOUNDS OF NERVES. [book iv-

applications in such cases, as the plaster from metals, those

called barbarous, and the cissinum, that from groundsel, the me-

lanchlorum, the indicum, harmonica, and athena, the composi-

tion of which, and the manner of using them you will find
described in the Seventh Book. And since some very wealthy
people are fond of using expensive applications to wounds of
the nerves, Galen has described the following for punctures of
the nerves : Of cinnamon, oz. j ; of dittany, oz. j ; of marum,

oz. j of amaracus, of wax, oz. viij ; of opobalsam, oz. x ;

;

of tui'pentine, oz. x. —
dr.ij ;
Another : of cyrenaic juice, oz. j ; of
wax, oz. iij ; of opobalsam, oz. xij. This is an application for
exposed nerves Of wax used for ointments, oz. iij of the oint-
:
;

ment called spicatum, or foliatum, or that of nard, oz. xij ; of

washed pompholyx, oz. j ; of spikenard, oz. j of amomum, oz. j
; ;

of the leaf (malabathi-um), oz. j. And these, Galen says, are

superlatively excellent.

CoMM. Commentary. Galen has devoted a whole book of his work

'
'
De Med. sec. genera to the consideration of wounds of ten-
dons, membranes, ligaments, and nerves properly called, and
he also treats of them more generally in the sixth book of his
work 'Meth. Med.' He professes to have had ample expe-
rience in the treatment of these cases while attending wounded
gladiators. As our author has given a very comprehensive
abstract of Galen's piinciples of cure, it will be unnecessary for
us to enter into any minute detail of them. He states very
decidedly that cold applications, especially cold water, are highly
dangerous, and inculcates that calefacient oils are the most pro-
per applications. He particularly praises oils medicated with
spurge, or sagapene, or turpentine-rosin. They are to be ap-
plied upon soft wool. In certain cases, he says, I have mixed
the powerfully desiccant substances, such as quicklime, misy,
chalcitis, pompholyx, arsenic, and sandarach, with the oils or
cerates. When tendons are cut across he directs us to unite
the ends together by sutures. Wounds of membranes and
ligaments are said to be less dangerous than those of tendons.
In general he further recommends either bloodletting or
purging.
Oribasius, Aetius, and, in short, all the subsequent authori-

ties, like our author, copy everything from Galen. As a spe-

sicT. Lv.] ANCYLOSIS. 137

ciraen we shall give an abstract of the method of treatment Comm.

' '

recommended by Octavius Horatianus, who, it is probable, be- '

longed to the Methodical sect. He commences with stating

that wounds of nervous parts are in general very dangerous,
and recommends applications of a digestive nature to avert the
violent symptoms and pains. In such cases he dii*ects us to
bleed and pm'ge, forbids all fomentations of warm water, but
approves of those made with tepid oil, after which dressings
composed of tm'pentine-rosin, either by itself or with some
sponge, are to be applied. But for women and children of a
dehcate frame he recommends turpentine alone ; for others,
however, he recommends tui-pentine Avith spurge and oil, to
which occasionally may be added bee-glue, sagapene, assafcetida,
and opoponax. He also from personal experience speaks favor-
ably of an application prepared from lime washed in watei",
spurge, sulphur, turpentine, wax, and pitch. He mentions
other preparations from rosin, spurge, with oil and sea water.
The Arabians copy from Galen very closely. Thus Avicenna
condemns cold applications, and recommends calefacient ones.
He approves of sutures when the tendons are cut asunder.
Haly Abbas cautions against cold water, and particularly com-
mends wool dipped in hot oil of violets. When spasm (tetanus)
supervenes owing to the wound of a nerve, he directs us to
divide it asunder lest the affection of it spread to the brain and

prove fatal. Rhases also forbids all relaxing applications. He

commends hot stimulant oils, and basilicon mixed with spurge,
natron, lime, assafostida, castor, &c.
Gulielmus de Saliceto, Guido de Cauliaco, Severinus, and
Lanfrancus in laying down the treatment of wounded nerves
and tendons, follow closely the principles delivered by their
Arabian masters. They approved of sutures when the tendon
is cut across.

SECT. LV. ox ANCYLOSIS.

Contractions of joints arising from impacted humours, or

some nervous tension, we are accustomed to call ancvlse and
ancylosis, which cases require emollient and relaxing applica-
tions. Wherefore, in general, those things recommended for
 138 ANCYLOSIS. [book iv.

scirrhous parts, but still more particularly the applicatious to

paralysed members will be proper, and more especially pouring

upon the part water and oil, in which linseed, fenugreek, marsh-

mallows, bay, the root of theAvild cucumber, and the Sicvonian

have been boiled.

oil itself, After bathing we may apply first
the more simple acopa, such as that from poplar, that from fir,
the one called bromium, that ascribed to Basilius, and the
pyxis ; and after these the Aristophanian,
and that ascribed to
Azanites. But the strongest are those called lysoponium and
varium. Of plasters, that ascribed to Amathaon, and the
anicetum. This is a most excellent one Of bdellium, of
:

calves^ fat, of ammoniac perfume, of lUman iris, of each, dr.

xvj of opoponax, of galbanum, of the seeds of rosemary, of

;

storax, of frankincense, of each, dr. viij ; of pepper, clx grains ;

of wax, lb. ss. ; of turpentine-rosin, lb. ss. ; of the lees of the
oil of iris, q. s. ; of wine, q. s. ; the medicine is pounded. It

forms a good acopum when diluted with oil of iris, of privet, or

of bay. Intermediate between the acopa and plasters is the

preparation from bacon called polymigmaton.

The acopa are
to be used with soft and continued friction, along with gentle

attempts to bend and stretch the affected joint.

CoMM. Commentary. The principles of treatment here laid down

" — '
'

are the same as those inculcated by the other all authorities.

For a complete account of the formation of malagmata, we refer
the reader to Galen (Med. sec. gen. vii), and to Aetius (xii, 42.)
Actuarius recommends an acopum composed of old oil, the
oilsof bay, iris, and storax, with turpentine, spurge, castor,
ammoniac, pepper, opoponax, galbanum, and stages marrow.
He remarks that emollient and relaxing medicines are indicated,
(iv, 16.)
Celsus recommends,
" ad recenti \Tilnere contractos
articulos,

quas ayKvXag Grseci nominant,^^ a malagma consisting of frank-

incense, rosin, galbanum, ammoniac, and bdelhum, with wax.
(v, 18.) AAicenna makes mention of a similar one. Scribonius
Largus gives a prescription for ancylosis consisting of bdellium,
opoponax, ammoniac, galbanum, calves^ fat, &c. (civ.)
SECT. Lvii.] WORMS. 13!)

SECT. LVI. ON RELAXATION OF THE JOINTS.

The joints oftenbecome relaxed from protracted febrile com-

plaints, and from colic, and paralytic affections, especially when
a hot and humid intemperament seizes them and hence the
;

motion of the joint is impeded. In these cases the juice of

acacia mixed with water may be poured upon the part ; or a
decoction of bramble, of myrtle, of lentisk, or of the bark of
elm roots will answer well ; or the rind of pomegi-anate may be
formed into a cataplasm, or mjTtle leaves with myrtle ointment
may be applied. For the ligaments require to be strengthened
by astringent and desiccative powers and such applications
;

are therefore to be made to the joints, as that from willows,

that called oxyrum, and the phoenicinum, with the addition of
an astringent wine or vinegar. Some imagining that the weak-
ness of the joints proceeds from cold, and having had recourse
to more heating remedies, have only increased the mischief.

Commentary. Our author has correctly stated that relax- Comm. ' '
*

ation of the joints is to be cured by astringent desiccant appli-

cations. Aetius makes mention of the simple articles enume-
rated here (xiv, 72),
and Oribasius recommends a few of the
same. (Synops. "vii, 23.) Our author is much fuller than
Oribasius on this head. (Ibid.)

SECT. LVII, ON WORMS.

There are three different sorts of worms, the round, the broad,
and thirdly, those called ascarides. They are all the offspring
of crude and thick pituitous matters with a suitable putrefac-
tion, such matters collect in children,
and others who take too
much food. But they do not grow from hot, acrid, or melan-
chohc humours ;
for these being too strong for nutrition, are
inapt for the generation of worms ; and,
on the contrary, bilious
superfluities are particularly
destructive of them. Or if at any
time yellow bile be discharged along with worms, either down-
wards or by vomiting, you may be sure that they have been
formed in the intestines, whereas the bilious humour had been
140 WORMS. [book IV.

collected at the moutli of the stomachy or in some other part.

We shall now describe the form^ generation, situation, diagno-
sis, and cure of each variety, beginning with the round.
Of the round worms. The form of the round worms must
be known to everybody, because they are more common than
any of the others. They are generated principally in the small
intestines, and are very prevalent in the stomach ; wherefore
they are often discharged by the mouth, and sometimes by the
nose. They are most common in children, more especially in
fever. For they are formed about the commencement of fevers
from a corruption of the matters ; at their acme from the ma-
lignant nature of the disease ; and during the decline from a
change of the whole system to a better state. Wherefore
" it is a
Hippocrates says, good symptom when round worms
are evacuated at the crisis of the disease, and these speedily
die." Those who have round worms experience pain of the
intestines and stomach, small dry tickling cough, and in some
cases hiccough, sleep with palpitations and irregular startings ;
'

and some start from their sleep with a scream, and again fall
over asleep. The pulse is unequal, and the fever has irregular
exacerbations,making its attacks with coldness of the joints,
and coming on three and sometimes four times in the day or
night without any stated form. Children have mastication and
projection of the tongue without cause, and grinding of the
teeth ; they shut their eyes and wish to remain silent, and are
offended when disturbed. Their eyes appear bloody, their
cheeks red, and again change to pale. But these things occur
at intervals in a short time. Sometimes the worms crawling:
up to the stomach occasion nausea, gnawing pain, and anorexia
to the patients. When forced to take food they can scarcely
swallow for nausea, or they vomit what they have taken, or
their bowels are loose with corruption of the food, or are inflated
like a bladder ; but the rest of the body is wasted in an unac-
countable manner, there being neither famine nor any extra-
ordinary evacuation. But one must not expect to find all
these symptoms in all cases, but certain ones, according to pre-
vailing circumstances, and occasionally the most of them.
These symptoms occur from the animals turning themselves
about in the intestines and biting them, aud the febrile heat
raising noxious vapours to the brain from putrid humours col-
SECT. Lvii.] WORMS. 141

lected in the belly, in "wliich case we must sometimes pay atten-

tion alike both to the fever and the worms, and sometimes we
must bestow little attention to the fever, and dii'ect our efforts
to remove the worms from the body. Many having neglected
them have been eaten through by them, and have died con-
\Tilsed. And others say that they have seen them come out
from the groins of the patient. You may remove them fi'om
the body by killing them, and you may kill them principally by
using bitter remedies. When both the treatment of the fever
and of the worms is common, the simple remedies will be pro-
per. Wherefore the patients must first drink a decoction of
camomile, and of the fruit of the sebesten plum, or these me-
dicines themselves may be given boiled. We may also give
the juice of endive, or coriander seed, triturated with hot water
or with oxycrate ; or a decoction of the herb mouse-ear, or the

shavings of hart's horn, or sinopic vermilion finely levigated.

And they may swallow by degrees two spoonfuls of the oil of
bitter unripe olives, for by its bitterness it kills them, and by
its lubricity it drags them along and evacuates them with the
faeces. When inflammation and distension of the intestines are
present, we must have recourse to a cataplasm of Unseed and
of the flower of lupines, and of wormwood, and of the roots of

bryony in hydromel, or pour upon the hypochondria the oil of

camomile, wine, and the infusions of the fruit of wormwood
and aloes. When the fevers are not very troublesome we may
mix with the sebesten plums some mint, and give them and :

when there is no fever we may administer the more drastic

medicines, such as the decoction of seriphum, or of calamint, or
of fern, or the seed of cardamon, or a decoction of the root of
acid pomegranate reduced to one third, or of toasted cumin,
and of tawny-coloured natron, of each, scr. iij ; or wormseed,
or southernwood, or both made into pills with honey, or scr. iij
of bitter lupines, or the levigated seed of cabbage or of rocket,
or wormwood which is often sufficient alone. may give ofWe
washed aloes to the amount of scr. iij ; which is one of our
most celebrated remedies ;
but to stronger persons we may give
the unwashed. And since children will not take the aloes from
a cup, they are to be secured upon their back, and their mouth
being forced open by a spoon, we are to inject in spite of them
the aloes by means of a syringe having a strong pipe, throwing
142 WORMS. [book iv.

it in as far as possible. This is an admirable method with

children who can hardly be prevailed upon to take medicines^
and in this way we may often inject soup in cases of anorexia.
And cyphi and masuaphium may be properly administered^ and
burnt hart's horn Avith pepper in honey or oxymel and we ;

may also endeavour to give the other medicines in oxymel.

But the Ainegar of squills will be still better, especially when
given to adults. Or mustai'd with oil and vinegar may be
given to the amount of a spoonful. Those whose bowels are
troubled with a flux owing to worms may take a potion of the
juice of plantain, or the plaintain itself may be given in a dry
state, for it is of use both for the flux and the worms. We
may apply to them cataplasms of crude barley flour, of fern, of
wormwood, of the flower of lupines, of wormseed, and of south-
ernwood, and likewise pomegranate rind, acacia, galls, and the
flowers of the wild pomegranate are to be mixed with them.
And since many people often loathe bitter draughts, we may
give of those we have mentioned, such as are not decidedly
bitter, and in addition, ground pine and horehound, elecam-
pane, bay berries, cassia, thyme, pennyroyal, carpesium, cyperus,
polypody, iris, bastai'd-safiron, madder, Egyptian thorn, with
an equal quantity of pepper, to the amount of scr. yj, to a
decoction of mint, the juice of the root of mulberrj', or the de-
coction of stone parsley, or of other aromatic seeds. Externally
we may use aloes with the oil of apples and wine. This also
whets the aj^petite,which is a thing to be much attended to.
With the aloes we may often mix wormwood ; or the navel may
be with bulPs gall along with some of the bitters formerly
filled

mentioned; or the oil of rose-bay may be constantly rubbed

in, or cedar-pitch may be apphed alone and along with cerate
to the whole belly ; or dried pitch may be levigated and sprinkled
on it ; or it may be anointed with mint and gith in rose-oil ;
or we may mix with them the decoction of seriphum ;
or we
may triturate peach leaves and apply. We
may use stag's
marrow in the form of an ointment to the navel, pubes, and
loins ; and, if necessary, we may apply the cerate of aloes, of

wormwood, of the flour of lupines, of seriphum, of gith, of each,

scr. vj ;
of wax, oz. jss ;
of oil of camomile q. s. ; triturate the
powders with bull's gall. We may give them frequent injections
of honied water, that the worms may be attracted downwards
 SECT. Lvii.] WORMS. 143

by the sweetness of the houey. But if they putrefy in the deep-

seated parts, and are not discharged, but on the
contrary raise
effluvia, we must evacuate them by giving aloes, or the medi-
cine called picra, prepared from it. In certain cases a moderate
evacuation, by means of a suppository, is not unusefulto them.
Of the hroad worm {tcenia) The broad worm is (if I may
.

say so) a conversion of the membrane which lines the inside of

the intestine into a living body, which is often either
discharged
whole, when its size appears incredible to be seen; or it is eva-
cuated in parts ; but when loosed from its attachment it does
not form again. It occurs most frequently without fever, but
sometimes in fever after a protracted disease, when it brings on
constant gnawing pains of the stomach, and an insatiable desire
of food ; for the animal which is formed in the intestines seize
the food lying there, so that another
supply is straightway re-
quired, and, if not furnished with it, the worm will bite the
bowels. It is accompanied with emaciation of the
body and
loss of strength, with anomalous but the most un-
symptoms :

erring Avhen certain substances, like the seed of

symptom is

gourd, are discharged with the fseces. The cure resembles that
of the former kind ; taking the bitter draughts,
eating garlic,
drinking or injecting a decoction of fern, or of centaury, or of
calamint, of dittany, or of pennp-oyal. And we may also
inject brine. The patient may also drink this potion, which is
not unserviceable to those who are troubled with other worms,
if they happen to have fever : Of red natron, of pepper, of car-
damom, equal the dose with wine or hot water.
— parts : is gr.
iij,

Another, ^Ymciu^: Of pepper, of pure bay berries, of Ethiopian

cumin, of mastich, equal parts ; of honey, q. s. ; the dose is a
spoonful taken in the morning and at bedtime. But if you
wish to make it stronger, add an equal part of red natron.
—Another : Of elecampane, of ammoniac perfume, of pepper,
(in another formula, of fern,) of each, dr. v, with hot oxymel ;
and after an interval give adults one or two drachms of euphor-
—
bium in a draught. Another: Of fern, an acetabulum; of
natron, dr. give it in a hemina of water, but it will be better
if a little
ij ;

scammony be added to it. —Another : Of the bark of

the roots of sour pomegranate stripped of its rind above, dr. iv;
of pepper, dr. iv; of cardamom, di\ vj; of horehound, dr.
ij; give
it in to the patient after he has
honey previously eaten of garlic.
144 WORMS. [book iv.

until the affection is completely removed. Give also of theriac,

when not prevented by strong fever.

LVIII. ON ASCARIDES.

Ascarides, as we formerly mentioned, are a kind of intestinal

worms resembling earth-worms, being formed about the ex-
tremity of the rectum and the beginning of the sphincter ani,
and occasioning a great itching of the parts. This species ^s
formed by bad diet, cold, and indigestion of the food. Where-
fore they are to be discharged, in children, by suppositories of

honey with a moderate quantity of salts or natron ; but in adults

by acrid brine, or a decoction of centamy with natron and

honey, or of colocynth, or of wormwood, or of chamaeleon, or

of alkanet, or of bastard saflron, or of hyssop, or of pennyroyal,
or of calamint, or of lupines. After the injections we may
anoint the rectum with these simples Acacia, or hypocistis with
:

natron, or Syriac sumach \vith Hquid alum ; and in those which

are bound, with Lemnian earth in wine, and with these com-

pound medicines, the trochisk of Andron and the like. And we

may give them an injection of cedar-rosin with a syringe having
many perforations, such as those used for the uterus ; or salted
flesh is to be adapted to the part and secured with a bandage,
as long as can be allowed to remain, and changed often. In
it

general all worms derive benefit from fumi-

those infested Avith
gations with the hairs of ichneumon. The food should contain
wholesome juices, and such as are easily distributed over the
system, neither increasing the cause which engenders the worms,
nor allowing the strength to sink ; and on that account we may
give some diluted wine. And we must give food frequently on
that account, and in order that the worms may not bite the in-
testines for want of their food. The best time for taking food
is when the worms are full. If there be a defluxion of the belly

you may be sure that the worms ai'C on the increase, the food

not being properly distributed, and we are to give soups with a

mixture of astringents, such as pears, apples, and pomegranates,
more especially such as are acid
; and we may apply to the belly,
externally, astringent remedies as mentioned above.
SECT. Lvii, Lviii.] WORMS. 145

Commentary. On this curious subject consult Hippocrates Comm.

'—^~'
(Aphor. iii, 26 ; De Morbis, iv, 27) ; Aristotle (H. A. v, 9) ;
Celsus (iv, 17) Cseliiis Aurelianus (Pass. Tard. iv^, 8) Scribonius
; ;

Largus (36) ; Serenus Samonicus ; Marcellus (31) ; Octavius

Horatianus (ii, 30) ; Dioscoricles (pluries) ;
Galen (Mpth. Med.
xiv ; Isagoge ;) Aetius
(ix, 39) ;
Curat, iv,
Oribasius (Morb.
90) ;
Actuarius (Meth. Med. i, 21) ; Nonnus (172) ; Myrepsus
(8) ; A^dcenna (iii, 16, 5) Serapion (iii, 30) ; Averrboes (Collig.
;

vii,37) ; Avenzoar (ii, 7, 22) ; Haly Abbas (Theor. viii, 28 ;

Pract. vii;,, 29) ; Alsaharavius (Pract. xvii, 2, 9) ; Rhases (Divis.
169; Contin. xx-vd) ;
Alexandri Tralliani Epistola ap. Alb. Fa-
bricii Bibl. Grsec. xii, 602, and ed. Ideler, 1842.

Hippocrates states that the round and broad lumbrici are

often passed with the first discharges from the bowels of chil-
dren. This is a fact very difficult to account for. When, and
how did the seed of the worm
get access to the belly of the
child ? He rejects the opinion that the rings of the broad lum-
bricus (taenia) which are passed from the bowels are its offspring.
He says it does not occasion death, but continues to live as
long as the man lives.

Aristotle divides intestinal worms into the lumbrici teretes,

the 1. lati, and ascarides. He remarks that the broad pro-
duce something resembling the seeds of the gourd. He believed
in spontaneous generation.
The pomegranate seems to have been a popular remedy for
intestinal worms. Cato the Censor gives directions for medi-
cating wine by the addition of pomegranate and fennel,
of
" Id vinum tinias perpurgat et lumbricos, si
which, he says,
sic concinnes.^^ (De re rust. 127.)
For the cure
Celsus treats of the lumbrici lati and teretes.
of the former he recommends a draught containing lupine and
the bark of mulberry, with the addition of hyssop, pepper, or
scammony. He also recommends emetics with garlic, orpT)me-
granate rind with some nitre. For the teretes he recommends
the same, and also the seed of nettle, or of cabbage, or mint,
or wormwood, or hyssop with mead, or the seed of cresses with
vinegar. He ad\dses, likewise, to eat garlic, and use clysters of oil.
first garbc and old soft cheese to
Scribonius Largus directs
be eaten, and then Macedonian fern to be taken with honey.
After four horu's a mixture of aloes and scammonv with honied
II. 10
 146 WORMS. [book iv.

CoMM. water to be given, and a clyster of warm water administered.

is
'

He
'
•
recommends wormseed and tlie shavings of hart's horn.
also
Marcellus mentions the same remedies.
Serenus Samonicus recommends hartshorn, calamint, garlic,
southernwood, coriander, pennjT:'oyal, horehound, &c.
The beginning of the chapter of Cselius Anrelianus on lum-
bici unfortunately is lost. He mentions the usual symptoms
which accompany them, namely, occasional deliquium, agita-
tion, grinding of the teeth, change of colour, con^oilsions, &c.
Worms are discharged by the mouth or anus, sometimes sin-
gle, and at other times in great numbers rolled up in a ball ;

sometimes dead, and at other times alive and they are of

;

various colours. For ascarides he recommends when there is

inflammation of the rectum an injection of oil, to which may
sometimes be joined a decoction of wormwood and centaury.
But if bloody scrapings of the bowels are discharged, lie directs
us to give a decoction of pomegranate-rind, and, if the com-
plaint continue, equal parts of burnt paper and of arsenic, to
the amount of six drs., with the infusion of plantain. Surely
there must be some mistake as to the amount of the dose, for
so great a quantity could not be injected with safety. When
there is putrefaction he recommends an injection of salt water,
with other suitable remedies. When complicated with any
other disorder he properly directs us to pay attention to it ; after
which the animals may readily be discharged by drinking oil,
or a decoction of sebesten plums (myxse), or of liquorice these
:

things, he says, will obviate constriction and swelling, while by

lubricating the bowels they will promote the discharge of the
worms. When complicated with relaxation he recommends
astringents externally and internally, such as vinegar with
honey, lupine, the shavings of hart's horn, &c. Sometimes, he
says, in order to expel them we must have recourse to acrid
subsfances, such as onions, garlic, mustard, cresses, cardamus,
assafoetida dissolved in vinegar, wormwood, &c. In stating the
detail of the treatment he mentions various other anthelmin-

tics, such as the hiera of aloes, gentian, mulberries, squiUs,

spurge, alkanet, colocynth, and scammony. All these things
may be given by the mouth or in injections, with a considera-
ble admixture of oil. For the lumbricus latus he directs, first,
an emetic of oil, and next day a clyster with nitre or salt.
 SECT. Lvii, Lviii.] WORMS. 147

Saltish things are also to be given in drink, with liquorice, or Comm,

scammony, or polypody, &c. When the animals are discharged,

' '

'

to prevent a renewal of the complaint, he recommends friction,

vomiting, acrid food, calefacient plasters, sinaj^isms, paroptesis,

and the like.

Pliny recommends the ashes of hart's horn for tsenia. (H. N.

xxviii, 59.)
Dioscorides ascribes anthelminthic properties to various acrid
and bitter substances, such as garlic, cresses, fern, gith, mul-
berry, pomegranate rind, lupine, cabbage, nettle, hyssop, mint,
calamint, wormwood, wormseed, rue, coriander, thyme, &c.
Similar remedies are recommended in the ^Euporista,' which
is falsely ascribed to him.
Galen mentions that bitters in general are destructive of in-
testinal worms. The teres, he adds, is killed by the absin-
thium but the latus and ascaris require stronger medicines,
;

such as the filix. The author of the '

Isagoge,' a work gene-
rally ascribed to Galen, divides intestinal worms into the broad,
the round, and the ascarides. The round are about the length
of a span or somewhat more, especially such as are formed about
the stomach. The ascarides are short, and form in the rectum.
The broad, called also fascise or tsenise, from their resemblance
to tape, are said to be sometimes the length of the intestines.
The round are most common in children, the ascarides before
manhood and these are difficult to remove except by
; bitters,
elecampane, and acrid food.
Oribasius treats briefly of lumbrici, recommending for the
1.
rotundus, southernwood, wormwood, calamint, gith, &c., taken
internally or applied outwardly ; for ascarides, the juice of cala-
mint, and cedar rosin, in like manner; and for the taenia the bark
of the root of mulberry, and the roots of fern in honied water,
and also the root of the white chamseleon and costus.
Aetius gives a full and accurate detail of the symptoms and
treatment of lumbrici, but as his remedies are much the same
as our author's, it will be unnecessary to deliver any account of
them. He remarks, that anthelminthics either kill worms by
their acrimony, or remove them by their bitterness, or irritate
them so as to expel them, or by lubricating the parts facilitate
the expulsion of them.
Actuarius gives a sensible account of the formation of worms,
 148 WORMS. [book iv.

CoMM. wliich he ascribes to putrefaction or indigestion. White worms,

' '
*
he says, are the product of indigestion, but the red, and those
of any other colour, arise from putrefaction.
Nonnus merely abridges our author^s account of this subject.
The ingredients in the compositions recommended by
Myrepsus, are such as aloes, scammony, southernwood, and
bitter almonds.
Octavius Horatianus gives a good account of worms, but it

contains scarcely anything that is not to be found in our au-

thor's. He says, that from long experience he had great con-
fidence in a purgative draught consisting of scammony, the
ashes of burnt peas, euphorbium, and nitre, given in sweet
wine. But garlic, and other acrid things, are to be fii'st eaten.
The Epistle of Alexander Trallian on worms, first published
by Hieronymus Mercurialis, and afterwards by Albertus
Fabricius, and again lately by Ideler, contains an interesting
exposition of the ancient views on this subject. He divides
intestinal worms into three genera the ascaris, the strongylus
:

or round, and the latus or broad. He remarks that the small

worms (ascarides) are generally found in the large intestines, the
round in the small intestines, and hence they are often vomited
up ; while the broad worms (tsenia) are sometimes as long as
the intestines, some having been discharged sixteen feet in
length. He states that they are engendered by corruption of
the food, and putrefaction of crude humours. He lays down
at great length the plan of treatment, which he varies accord-

ing as they are with or without fever. His remedies consist

of cathartic, acrid, oily, acid, and bitter substances. Of purga-
tives he mentions scammony, and hellebore of acrid
aloes, ;

articles, garhc, cresses,and the like ; of oily medicines, the oil

of roses, castor oil (oleum ricini), and common oil boiled with
rue ; of acids, salt and nitre (soda) and of bitters, southern-
;

wood, wormwood, hyssop, fennel, and the like. For the expul-
sion of the strongylus he
speaks favorably of a decoction of
gagate stone (jet). For ascarides and lumbrici he recommends
juniper. He concludes his treatise by
a lavement prepared from
stating that "ten thousand'' other things had been recom-
mended as anthelminthics
by the ancients.
Avicenna in worms condenses all the informa-
his account of
tion contained in the Greek authors, but we do not find that he
SECT. Lvii, Lviii,] WORMS. 149

supplies anything new. He in particular copies freely from Comm.

Aetius and our author.The same may be said of Serapion, '
—— -

who recommends wormwood, bitter lupines, calamint, peach

thyme, colocynth, &c.
leaves, cabbage, onions, Aven'hoes says
that the lumbrici in general are removed by bitters, such as
wormwood or wormseed, but that the cucurbitini (tsenise) require
strong medicines. Of the pineae nuces he says, " Occidunt
vermes qui sunt in ventre.^^ (Collig. v, 42.) Probably this
hint may have led to the use of turpentines for the cure of
taenia. Avenzoar attributes the formation of worms to ill-
digested food in the stomach, and recommends much the same
remedies as the Greeks. Haly Abbas describes the three spe-
cies of worms, and details the symptoms of them. He remarks
that these animals are to be killed by medicines of a hot and
dry nature, such as bitters. He recommends wormwood, fern,
and the like, pounded with honey, vinegar, &c. The remedies
mentioned by Alsaharavius are oils, bitters, and drastic purga-
tives. He treats of lumbrici very fully. Rhases recommends
in general terms bitters ; for the round, wormwood, for the
broad, (tsenise, called by him semina cucurbita) seriphium, bitter
lupines, narcissus, &c. And for the ascarides he directs us to
apply a suppositoiy of wool dipped in the gall of a bull. He
remarks that they occur most frequently in autumn, being en-
gendered by fruit. He states correctly that they often bring
on epilepsy, and looseness of the bowels. He much commends
the oil of unripe olives.

Vegetius recommends nearly the same medicines for remov-

ing the vermes of cattle as those already mentioned, namely,
wormwood, cresses, coriander, fenugreek, and the like, boiled in
oil, and administered by the mouth and in clysters. (Mulom.

i, 44; see also Columella vi, 25.)

According to Michaelis and Sprengel the ancient Brahmins

were acquainted with the anthelminthic properties of the doli-
chos pruriens.
We have stated above that the most celebrated of the ancient
savans believed in the spontaneous generation of animals. This
doctrine, although generally rejected at the present time, has
been advocated by many modern naturalists of great eminence,
such as Baron BufFon and Professor Rudolphi. Yirey gives a
very impartial statement of the arguments for and against this
 150 WORMS. [book iv.

CoMM. physiological doctrine. (See Hist, des Moeurs et de V Instinct

' — — des Animaux, 121.)
'
'

ii, Mr. Madden, the traveller, relates that

the bark of the pomegranate is still considered in the east as a
specific, not only for ascarides,
but also for the tape- worm. He
" I have seen it fail in the cure of taenia.
says, rarely They
make a decoction of two oz. of the fresh bark in a pint of water,
this they drink daily till the worm is expelled, which it gene-
rally is the third day.'' (Travels in Egypt, ii, 371.)

SECT. LIX. ON DRACUNCULUS, OR THE GUINEA-WORM.

In India and the upper parts of Egypt a class of worms

called dracunculi, resembling the intestinal, are formed in the
muscular parts of the body, such as the anns, thighs, legs, and
in the sides of children, under the skin ; and they move in a
perceptible manner. Then in process of time at the extremity
of the dracunculus matter is formed in the part, and the skin
being opened the head of the dracunculus comes forth. But
if the worm be dragged it occasions pains, and particularly

when it breaks.Wherefore some say that it is proper to fix a

piece of lead to the worm in order that its discharge may not
take place at once, but gradually with the weight of the lead.
Some disapproving of this practice, inasmuch as the worm is
apt to break with the weight of the lead and occasion violent
pains, du'ect the part to be put into hot water, in order that
the dracunculus being warmed may come fonvard, when it is
to be seized with the fingers and dragged forth by degrees.
But Soranus is of opinion that the dracunculus is not an animal
originally, but a nervous concretion, which has only the ap-
pearance of monng. Whether this or the former be the true
account of the matter, it appears to Soranus, Leonides, and
others, that they are to be treated with the affusion of warm
water, and digestive cataplasms made of honied water and the
flour of Avheat or barley ; and they approve of sometimes using
a plaster possessed of similar properties. Wherefore that from
bay-berries, and the one from honey are proper. For by the
use of these the dracim cuius or concretion dies and falls out.
But when suppuration takes place, if it does not fall out, the
skin is to be divided, and the part being laid open, that which
«ECT. LTX.] WORMS. 151

is contained in it is to be taken out, when a tent is to be put

into the skin, and then the treatment for suppurations is to be

applied.

Commentary. The following authors treat of the vena Comm.

medinensis, or dracuncidus, now generally called the Guinea '

worm Galen (De

: vi, 3 ; Isagoge ;) Aetius xiv, 85) ;
Loc. Affect,
Pollux (Onomast. iv) ; Plutarch (Symp. viii, 9) ; Theophrastus
(H. P. ix) ; Actuarius (Meth. jNIed. vi, 8 ; iv, 16) Avicenna (iv,
;

3, 2, 21) ; Avenzoar (ii, 3, 20) ; Haly Abbas (Theor. ^dii, 18) ;

Alsaharavius (Pr. xxviii, 12) ;

Rhases (ad Mansor. vii, 24 ; Cont.

xxvi.)
Galen admits that he had never seen the di-acunculus, and
that therefore he could not be positive respecting its origin
and nature. He had known many persons, however, who had
seen it, and was inclined to believe that it is of a nervous na-
ture, and resembles lumbrici only in colom- and thickness. The
author of the Isagoge states that di-acunculi resemble varices,
and that when they project or move about they occasion great
pain,and are to be removed by making an incision of the skin
as for varices.
Plutarch brieflv mentions the dracunculus as being a disease
which had newlv attacked the inhabitants of the country ad-
joining the Red Sea.
Aetius professes to derive his account of the dracunculus
from Leonides. He savs, like our author, that it is formed most
commonly in the legs and muscular parts of the arms in India
and Ethiopia, and that the generation of it is not dissimilar to
that of intestinal worms. He adds, that in process of time
suppuration takes place at the end of the worm, when an open-
ing is made in the flesh, and the head of the dracunculus pro-
trudes. If dragged out considerable disturbance is produced,

especially if the worm should be broken, for what remains occa-

sions the most excruciating pains. He directs us, therefore,
to put a ligature round the arm, and to tighten it every day so
that the di-acunculus may come forth by degrees without break-
ing. The part is to be washed with honied water, with oil in
which wormwood or southernwood has been boiled, or with some
such anthelminthic decoction ; but all acrid things are to be
avoided for fear of inflammation. He recommends us to forward
 152 WORMS. [book iv.

"
CoMM. suppuration
'
by means of maturative cataplasms, and the other
"
means mentioned by our author,
Pollux the dracunculus a piece of corrupted nerve which
calls
sometimes comes from the sores of Ethiopians, but seldom
troubles other people.
Actuarius, like our author, mentions that the dracuncuh
occur most commonly in the region above Egypt, being gene-
rally formed in the muscular parts,
and that in process of time
the part becomes li^dd and suppurates. They are kiUed, he
adds, by and
bitter acrid things.
A^icenna comprehends in his account whatever information
could be gleaned from preceding writers. He says the dra-
cunculus is called vena medine, from Medine, the name of the
It occasions a blister in
country where it is most prevalent.
the part which brursts, when a red and somewhat blackish sub-
stance protrudes and gradually increases in length. He directs
us to correct the habit which gives rise to it by baths, humid
food, and the like. His treatment is similar to that of Aetius
and our author, namely, binding a ligature round the arm,
fastening a piece of lead to the worm, using fomentations of
warm water, and the like.
Halv Abbas mentions the vena as being a worm which forms
principally in the legs of the inhabitants of warm countries,
such as India, Egypt, Ethiopia, and Lybia.
Avenzoar says that the complaint most commonly attacks
negroes, being fonned by gross humours, for dispelling which
he recommends internally various sharp and acrid medicines,
such as squills, nettles, colocynth, &c. He further du'ects a
piece of lead to be bound firmly over the worm so that it may
be made to crawl out gradually, which, however, he says, will
not be accomplished in less time than a year.
Alsahai'avius states the danger of breaking the worm (vena).
He recommends the same treatment as Avicenna. The con-
clusion of his chapter on the di'acunculus decides him to be the
same person as Albucasis.
Albucasis recommends us to fasten to the end of the animal
a piece of lead from one to two drs. in weight, and thereby to
extract it gradually. He says that in some cases the animal
is as long as fifteen palms, nay, that he had seen one twenty
palms long.
SLOT. LIS.] WORMS. 153

Rhases says tliat the dracunculus takes place in hot and Comm.
' '

squalid bodies,and is formed by the use of potherbs and fruits. *

He recommends gradually increased doses of aloes, and when

the animal protrudes it is to be wrapped round a leaden reed
one dr. in weight, so that it may be dragged out gradually.
He it in the
cautions us not to leave any part of body. He
also approves of incision as described
by our author. In his
'
'
Continens he collects the opinions of Galen, Paulus, and
others. He says that it forms most commonly in the bodies
of persons who bathe frequently, and drink much wine. He
says that he had seen it extracted by making free incisions.
See an interesting account of the guinea-worm in No. 66
of the 'Edinburgh Medical and Surgical Journal,' by Mr.
Scott, surgeon, Madi'as.
Bertapalia, of Cauliac, and all the early modern writers
Guy
on medicine, repeat the ancient accounts of the vena civilis vel
medine. They direct us to extract it by attaching a small
piece of lead to its Ambrose Pare adopted Galen's
extremity,
notion, that it is
corrupted animal matter ; but Andry held
that it is a real animah It appears, however, from some state-
ments which we have seen in the periodicals of the day, that
some of our English surgeons in the East Indies still advocate
the doctrine of Galen ; but we are inclined to think that the
other opinion is the more correct one.
 BOOK V.

SECT. I. ON THE PRESERVATIVES FROM VENOMOUS ANIMALS

IN GENERAL.

In gi\ang an account of animals which emit poisons we shall

begin with some general remarks upon them, treating of the
preservatives from them in the first place. If therefore a per-
son be compelled to sleep in places infested by venomous ani-
mals, especially in such as salamanders, phalangia, or reptiles
abound, it will be proper to shut up their holes under ground
with garlic pounded in water, or some of the herbs about to be
mentioned ; and to fumigate with hartshorn, the hoofs or hairs
of goats, gagate stone, bitumen, bdellium, galbanum, the shav-
ings of the cypress or cedar, gith, hog^s fennel, the leaves of the
chaste tree, calamint, sagapene, castor, the root of rosemarj^,
fleabane, orsome of the strong-scented things. Gnats in par-
ticular are drivenaway by fumigations with copperas, the seed
of wQd gith, and of cumin in equal proportions, and by cows'
dung. In addition to these, frequent fires should be lighted,
for reptiles commonly flee from the light. A couch should be
prepared by strewing asphodel, calamint, chaste tree, penny-
royal, poley, fleabane, and southernwood ; or if it is not possi-
ble to make a couch entirely of these, they should at least be
laid around the bed. Attention should be paid to such things
as are to be boiled, to the water, and wine vessels that thev be
properly covered uj). Fires for the pui'pose of cooking should
not be lighted under particular ti'ces, more especially pitch trees
or pines, for salamanders and deadly caterpillars abound on
them, which being warmed by the heat of the fire fall upon the
victuals, or any other vessels which happen to be uncovered.
Those who wish to be particularly guarded, anoint their bodies
with a liquid cerate composed of wax, rose-oil, and a little gal-
 156 VENOMOUS ANIMALS. [book v.

banum, and with a little of tlie shavings of hart's horn, or

Ethiopian cumin. The leaves of mallows triturated with oil
when rubbed on the skin protect in an especial manner from
bees and wasps.

CoMM. Commentary. The following is a list of the ancient au-

' '
*
thorities on Toxicology :

Nicander (Theriaca et Alexipharmaca) ; Dioscorides (Liber

de Venenis) ; Celsus (v) Scribonius Largus [47, et seq.) Galen
; ;

(Ther. ad Pison.;,Meth. Med., De Antid.) Aetius (xiii); Phny ;

(Hist. Nat. pluries) ; Oribasius (de Morb. Curat, iii) ; Solinus

(Polyhist. 40) Serenus Samonicus
; Nonnus ; Simeon Seth ;

(de Alimentis pluries) ; Actuarius (Meth. Med. v) ; Vegetius

(de Mulo-medicina, iii, 77) ; Avicenna (iv, 6) ; Rhases (ad
Mansor. viii, and Cont. xxxv); Haly Abbas (Pract. iv, Theor.
viii) ; Alsaharavius (Pract. xxx) ; Serapion (pluries) ; Anonymi
Fragmentum apud Bernardi Reliq.)' The work of ^lius
Promotus on Venomous Animals and Poisonous substances,
which exists in MS. in the Bibliotheca Vaticana, has never
been pubhshed as far as we know. It is quoted by Hiero-

nymus Mercurialis (Var. lect), and is noticed by Albertus

Fabricius (Bibl. Grsec. xiii, 780.) Fabricius supposes it to be
the production of ^schrion Empiricus. It is proper to state
that whenever we quote the work, it is from the extracts given
in Schneider's Annotations on Nicander.
It be borne in mind that the work on Poisons, usually
is to

published as the production of Dioscorides, is not held to be

genuine by his latest editor, Sprengel; still, however, it is
acknowledged by all to be a work of considerable antiquity and
of great authority on the subject of ancient Toxicology. The
work ' Euporiston,' which is also published with the works of
Dioscorides, is generally admitted not to be genuine. It con-
tains, however, some valuable matter on Toxicology and other
medical subjects.

These directions of our author for dri\dng away reptiles

are mostly taken from Nicander, who recommends fumigations
with hartshorn, gagate-stones, sulphur, bitumen, galbanum,
juniper, and other such articles. (Ther. 35.) See also Diosco-
rides (M. M.) Orpheus (de Lapidibus) and
; ; Geopon. (xiii, 8) ;
SECT. II.] VENOMOUS ANIMALS. 157

Nonnus (Epit. 261) ;

also Aristot. (H. N. iv, 8) ;
and Pliny Comm.
""^^
(H. N. X, 90).

Virgil makes mention of this practice :

" Disce et ocloratam stabulis accendere cedrum,

GalVjaneoque agitare graves nidore chelydros."

— Georg. Hi, 314.

See a long of substances used in fumigations for driving

list

away serpents In Lucan. (Pharsal. ix^ 916.) It is different from

that of Nicander and our author. For example it contains :

tamarix, costus, thapsoSj &c. Arsenic occurs among the articles

mentioned by Rhases. (Cont. xxxv.) It is also mentioned in
the Geoponics (1. c.)
Nicander affirms, and it has been generally believed, that
human saliva proves destructive to serpents. Galen says that
it will kill the scorpion. Aristotle states, that it is destructive
to most venomous reptiles. (H. A. viii, 28.) Redi maintains
that this is an ancient en'or ; but Andreas Laurentius declares
that he knew from experience that the human saliva is de-
structive to serpents.
Nicander recommends a composition containing cedar-ber-
ries, fleabane, sage, and other such articles for preserving the

body from venomous reptiles. Paxamus directs us to smear

the face with a composition made of the roasted flour of fenu-
greek, with the juice of the wild mallows and oil. (Geopon.
XV, 6.) He says it preserves the face from the stings of bees
in particular.
The K(ov(i)tp,
here translated gnat, as it is in the Enghsh
version of the scriptures, (Matt, xxiii, 24,) is proved by
Bochart (Hierozoon. iii, 442) ; and by Harris (Nat. Hist, of
the Bible), from Aristotle, Plutarch, and others, to mean pro-
perly a kind of insect that is bred in the lees of wine.

SECT. II. THE GENERAL TREATMENT OF ALL PERSONS BITTEN

OR STUNG BY ANY VENOMOUS ANIMAL.

If a person happen to be bitten or stung by any venomous

animal he ought immediately to get the part sucked. The per-
son who sucks it should not be fasting, and he ought first to
rinse his mouth with wine and retain oil in it ; and then, if
the part admits, it should be cupped with much heat, scarify-
158 VENOMOUS ANIMALS. [book v.

ing also the surrounding parts ; for tlie poison is forced

back
out of tlie body along with the sijirits and blood Avhich are
dra-wn out. The part in which the wound is situated ought
also to be burnt and eschars formed on it, and amputation of
the exti-emities mav then be seasonably practised if the animal
that inflicted the bite be of a deadly nature, such as the asp,
the cerastes, the viper, and the like as Galen relates that a
:

certain vine-dresser being bitten by a viper, and knowing the

animal, immediately cut off the finger that was bitten with his
pruning hook, and was entirely freed from the danger. But if
the poison be aheady distributed over the body, venesection
ought to be had recourse to immediately, especially if the per-
son bitten be plethoric and pepper and garHc given to eat
;

with the food, and strong wine to drink, whereby the system
will be filled with fresh vapoiu'S and a suitable heat. After-
Avai'ds cataplasms are to be apphed that can warm and stimu-

late the bite, such as a mixture of the ashes of cabbage or of

fie: -with vinesrar, or with the strained Ive, or with the
sauce of

pickle. Likewise onions may be mixed

with polenta or bread,
and strong leeks with or wai'm liquid pitch with salts, or
salts,

cedar-rosin, or goat's dung. It will also be proper to pour

upon the parts hot vinegar in which calamint has been boiled,
or with vinegar and sea water, or with brine. We
are to apply
to the part fowls, moreespecially hens, cut up and still warm,
or other such animals, for they absorb the poison and soothe
the pains. And we must have recoiu'se to plasters, such as
that formed from salts, that from rosemary and adarce, and on
the whole such things as are of an acrid natm'C. And in ge-
neral all persons bitten or stung by any venomous animal
ought, unless the deep-seated parts are wholly unhurt, to take
in the first place potions containing endive, heath, or astraga-
lus with vinegar, or bitumen and Christ's thorn in like manner,
or a decoction of Christ's thorn ;
or two drachms of dried weasel
with wine, Avhich is a cried-up remedy or the blood of the
;

sea-tortoise, or a di'achm of castor with diluted wine, or a drachm

of frankincense, or of Sicyonian root, or the juice of leeks, or
ground pine, or alsander, or cinnamon, or bii'thwort, or the
seed of the chaste tree, or cypress balls, or seseli, or pepper, or
the seed of trefoil, or bay hemes, or river crabs roasted or
boiled. Use the following compound theriac.
SECT. II.] VENOMOUS ANIMALS. 159

A theriac for venomous animals, and deleterious substances,

and for persons bitten by vipers and scorpions. Of bryony, of
opoponax, of Illyrian of the root of rosemary, of ginger, of
iris,

each, dr. iv ; of birthwort, dr. v ; of frankincense, of "w-ild rue,

of each, di*. iij ; of the flour of tares, dr. ij ;
form trochisks
with wine, and give three oboli with wine. Purging will also
be proper for them, with sudorifics, and taking the theriac of
vipers.

Commentary. These general directions are mostly taken Comm.

" '

from Dioscorides, who is greatly indebted to Nicander. Nei- *

ther of them, however, makes mention of venesection among

his remedies.
The remedial means recommended by Dioscorides are scari-

fication,cupping, sucking, excision and in extreme ; cases,

amputation ; clysters, and acrid applications to the part in
order to clear out the venom pure wine, must, or acrid sub-
;

stances to extinguish it and counteract its effects; and finally

as adjuvants of these means, purging of the bowels, sweating,
and some other particular remedies as stated under their

proper heads.
The general remedies mentioned by Nicander are, sucking
the wound, applying cupping instruments to it, and afterwards
strong stimulants, hot irons, and leeches. He directs that the
person who sucks it should not be fasting ; from which it may
be inferred that he had a correct idea that the vessels absorb
most readily when in an empty state. This physiological
doctrine was lately announced as a new discovery ; but frequent
allusions to it are to be met with in the works of Galen, our

author, Avicenna, Avenzoar, Averrhoes, and Haly Abbas.

The dangers resulting from an empty state of the vessels,
whether produced by fasting or venesection, is well expressed by
Gorrseus in his Preliminary Dissertation on the Alexipharmics
of Nicander Nee vero id tantum incommodi habet fames,
:
'^

sed in multo majus periculum adducit hominem, quando et

venee plurimum exinanitse et cibum vehementer appetentes,
venenum a\idius ad se pertrahunt et in intima viscera, cor-
" Quod etiam abundare
disque arcem immittunt." si quis
eorum repugnet quse sunt in vensesectione
videatur, et nihil
observanda, sanguinem audacter mittamus, non quidem per
 100 VENOMOUS ANIMALS. [book v.

CoMM. initia (sic enim in venas deleteria tralierentur, a quibus omni

' '
"
studio atque industria excludi debent) sed post vomitus alvique

dejectiones/^ &c.
Serapion, contrary to most of the autborities^ recommends
that the person who sucks a poisoned wound, should be in a
fasting state; but as he is a servile copyist from his prede-
cessors, it might be suspected that the text is in fault, if the
same directions were not given by Rabbi Moyses, with this
explanation that a fasting person will perform this office with
:

more risk to himself, but with greater advantage to the patient,

than one who had taken food immediately beforehand. (De
Venenis, i, 1.) All this shows how well the ancient savans
were acquainted with the physiological fact, that the absorbent
powers of the vessels is in the inverse ratio of their state of

repletion.
Celsus recommends nearly the same general remedies as
Nicander. Thus he directs us in the first place to apply a
ligature round the limb, but not too tightly, for fear of occa-
sioning torpor; and then to extract the poison by sucking, or
by a cupping instrument along with scarifications. His local
applications are of a hot stimulant nature. As internal
remedies he recommends emetics, which may be supposed to
expel the poison from the system by the concussion which
they produce, and various articles of a calefacient nature,
such as wine and pepper; because, says he, '^maxima pars
venenorum frigore interimit."
Isidorus states in still more general terms that the poisons
act by oppressing the vital heat. He says, " Omne autem ve-
nenum frigidum est, et ideo anima quae ignea est, fugit vene-
num He states, likewise, that poisons do not act
frigidum.^'
upon the system unless mixed with the blood " Venenum :

autem dictum eo quod per venas vadit. Infusa enim pestis

ejus per venas vegetatione aucta discurrit et animam extin-
guit. Unde non potest venenum nocere nisi hominis tetigerit
sanguinem." Lucanus : "Noxia serpentum est admixto san-
^^
guine pestis.
This, however,is an imperfect account of the action of
poi-
sons, whether such as act by being introduced into the stomach,
or those that prove deleterious when applied to a wound.
Perhaps the classification given by Avicenna may be mentioned
SECT. II.] VENOMOUS ANIMALS. 161

as the most complete of any proposed by the ancient authori- q^ MM.

ties. He states that poisons act either by some certain qualit}^
or by their whole substance. Of the former class some are
corrosive and putrefactive, like the lepus marinus some in-;

flammatory and calefacient, like euphorbium some frigorific

;

and stupefying, like opium some prove obstruent of the respi-

;

ratory jjassageSj like litharge some act with their whole sub-
;

stance, as the wolFs bane, and these are the most deleterious of
all. Of these some act upon one member in particular, as
cantharides upon the bladder, or the lepus marinus upon the
lungs, and some upon the whole body as opium, (iv, 6, 1.)
'
Schulze, in his Toxicologia Veterum,^ has stated the ancient
arrangement somewhat differently, and we are at a loss to
think what authors he has followed. He says, the ancients
arranged poisons according to their properties into the frigorific
{ipvKTiKo.), corrosive (8ta/3jj3pwor/c»n'ra), and septic ((rrjTrfSovwSr/).
The frigorific, he properly remarks, are those substances now
called narcotics ;which class, as Galen mentions, the conium,
to

poppy, henbane, and mandrake belong. On the action of

narcotics, see section xliii. Galen remarks that the human
frame becomes habituated to bear the action of these medi-
cines without injury. He mentions the case of an old Attic
woman, who by little and little had accustomed herself to take

hemlock in any quantity. (De Simpl. iii.)

Avicenna states that the great indications of cure in all cases
of poisoning are to comfort and rouse the vital heat, and to
resolve (neutralize ?) or expel the poison. When the poison is
distributed over the system, his remedies are venesection, purg-

ing, and the like. He states decidedly that the proper time
for venesection is either when the poison is distributed over the

body, more especially when it is in a plethoric state, or when

the poison is a substance not likely to be absorbed. His other
remedies are such as expel the poison from the body, namely,
emetics and sudorifics, or such as prevent it from entering the
system, namely, ligatures to the extremities, prohibiting sleep,
applying cupping instruments, or leeches, sucking the wound,
amputation of the limb, using actual and potential cauteries,
and keeping the wound long open. Upon the whole the general
remedies recommended by him and the other Arabians are little
TI. 11
 162 MAD DOGS. [book r.

CoMM. different from those of the Greeks, especially of Dioscorides,

' '

*
who the great authority upon theriacs.
is

Haly Abbas allows bleeding when the poison is distributed

over the body, and like the others also, makes mention of cup-
ping with heat and of amputation. He also joins in the gene-
ral praise of the theriac.
Alsaharavius recommends strong ligatures, cupping, and, in
urgent cases, amputation. He also approves of applying the
still warm.
bodies of hens Serapion approves of bleeding under
the same circumstances as the others, and of the same general
treatment that they recommend. Rhases recommends sucking
and cupping the wound, and the application of stimulant
dressings, such as a plaster consisting of mustard, lime, and pitch.
He, and most of the ancient authorities on toxicology, recom-
mend salt as an application to the wound. Most of them also
join Dioscorides in recommending the application of caustic
leys. They also in general direct us to prevent sleep. The
ligature to prevent absorption is recommended by Rhases, as
it is in fact by most of the ancient authorities. As a matter of
course all of them speak highly of the theriac, and acquiesce
in Galenas celebrated eulogy upon its virtues. (Ad Pison. ii,

457, ed. Basil.)

The Arabian authorities notice cursorily the treatment of poi-
soned weapons of war, more especially of the Armenian arrows.
Galbanum and assafoetida administered internally, and applied
to the wounds in various forms, are the two articles which are
most generally approved of by them. They also recommend
sucking the wound, as in other cases of poisoning by a wound.
(See further, B. vi, 88.)

SECT. III. ON PERSONS BITTEN BY MAD DOGS, AND ON

HYDROPHOBIA.

We
have placed the account of persons bitten by mad dogs
before the others because these animals are numerous and
all

domestic, and are frequently seized with madness ; because the

complaint to guard against, and the danger inevita-
is difficult

ble, unless one have recourse to many and suitable remedies.

SECT. III.]
MAD DOGS. 163

Dogs most part become mad during violent heat, but

for the

also, as Lycus says, sometimes in extreme cold. When mad

they shun drink and food, for they are thirsty but do not
drink, and for the most part they pant, hang their ears, and
emit much frothy saliva. Generally they utter no sounds, and
are as it were delirious, so that they do not recognize persons
with whom they are familiar. Wherefore they attack equally
without barking all animals, whether wild beasts or men, and
bite them. Their bite atoccasions nothing disagreeable
first

except the pain of the but afterwards it brings on the

wound ;

aflFection called hydrophobia, which makes its attack with con-

vulsions, redness of the whole body, but especially of the coun-

tenance, sweating, and anxiety ; and those affected shun water
Avhen they see and some every fluid that is presented to
it,

them. Some barklike dogs and bite those who approach them,
and so doing they occasion the same affection. The cause of
the other symptoms is obvious, being occasioned by the poison
affecting all the parts, but as to the dread of water some have
said that occasioned by inordinate dryness, as if the whole
it is

fluids of the body had undergone a change. But Ruffus has

pronounced be a species of melancholj^ which affects them,
it to
the poison putting on the nature of that humour in like man-
ner as we know other melancholic persons dreading some one
thing and some another ; which reason accords also with those
who say that they think they see the image of the dog that bit
them in the water. Of persons falling into this affection we
know none Avho has been saved, except that we have learned
the histories of one or two cases, and these Avere of persons who
had been bitten, not by a mad dog, but by some person who
had been bitten and imparted the disease to them. But before
the affection has made its attack many, even of those who have
been bitten by a dog, have been saved. Wherefore we must begin
the treatment from thence. And since often from the attack of
hydrophobia having not yet come on (for most commonly it comes
on about the fortieth day, and in some cases after six months, nay,
instances are related of its coming on after seven years,) some
supposing that the dog who inflicted the bite was not mad, and
making haste to heal up the wound have thereby given rise to
the complaint. By the following experiment you may ascer-
tain whether the bite was inflicted by a mad dog or not Pound
:
164 MAD DOGS. [book v.

walnuts carefully and apply them to tlie wound, and next day
take and present tliem for food to a cock or lien. At first
indeed lie will not touch tliem^ but if he is compelled by hun-
ger to eat of them, observe, for if the dog that inflicted the
bite was not mad, then the fowl will live, but if mad he will
die next day ; and then you must hasten to open the wound,
and after a few days repeat the same experiment ; and when
the fowl does not die you may bring the wound to cicatrization,
inasmuch as the patient is then freed from danger. Oribasius
recommends this experiment If from the s^anptoms which we
:

have mentioned we know for certain that the dog is mad, we

must have recourse to medicines for laying open the sore, the
principal of which is that from pitch, very acrid vinegar, and
opoponax, which is described accurately in the section on the
wounds of nervous parts. But if the person who has been
bitten has a tender skin, it is to be diluted with oil of iris, of
balsam, or the Hke ; or having first fomented the sores, apply
a cataplasm of garhc. This also forms eschars. A dry escha-
rotic for persons bitten by mad dogs : Of fossile salts, dr. viij ;

of chalcitis, dr. xvj ; of squills, dr. xvj ; of green rue, dr. iv ;

of scraped verdigris, dr. iv ; of the seed of horehound, dr. j ;

use at first dry that it

it may form an eschar, and then with
rose-oil that the eschars may fall ofi". Keep the parts from
cicatrizing for forty-two days at least. A
cataplasm for persons
bitten by mad dogs, which keeps the mouth of the wound open :

Apply a cataplasm of onions with salts and rue, or of laser-

wort with salts, or of old pickle, or of the cinders of burnt
wood with oil, or of garlic, or apply the leaves of the elder tree,

or mint, or baum, each with salts, or walnuts with onions, salts

and honey, or the ashes of figs mixed with cerate. Wash the
sore with a decoction of camomile in water, and the root of the
wild dock. But some burn the sore with heated irons. They
ought in the first place to get draughts of simple things, such
as buckthorn,wormwood, the juice of laserwort, germander, the
water germander, and poley. These are compound applica-
tions : Of river crabs, of the shoots of the white "sdne burnt in
a vessel of copper or bronze two spoonfuls, of gentian root tri-
turated one spoonful, give to drink for forty days, with two
cyatlii of old undiluted wine. Some add two spoonfuls of the
blood of the partridge. The crabs are to be taken when the
p
SECT. III.] MAD DOGS. 165

moon on the increase before sun-rising.

is But to those who
do not drink it
every day give a double doze, and sometimes a
triple. And the theriac from vipers may be given with advan-
tage. The patient is to be purged with the preparation from
the wild cucumber, which is to be given every day with the de-
coction of sage, or with the Heraclean ironwort, which is also
called alysson. Some also give the liver of the dog that inflicted
the bite to eat. Such a diet is to be given as blunts and ex-

tinguishes the power of the poison, and at the same time pre-
vents it from being carried deeper into the system. Both these
ends may be accomplished by drinking old sweet wine that is
both undiluted and strong, or milk, and in like manner by eat-
ing garlic, onions, and leeks. But if from some hinderance at
the commencement the remedies which we have described have
been neglected, scarification, cupping, or burning the wound,
must not be had recourse to, because the poison has already
been carried to the deep-seated parts ; but we must use the
remedies called metasyncritica, that is to say, when the attack
of hydrophobia has not come on. Purging with liiera and
divided milk is also to be had recourse to, with sudorifics ; and
calefacient plasters, and sinapisms are to be applied to every

part of the body. But the most eff'ectual of all remedies is a

course of hellebore frequently repeated.

Commentary. Aristotle is the first author who mentions Comm.

hydrophobia, but his accoiint of it is remarkably incorrect, if

the text be not corrupted. He says, all animals that are bit-
ten by a rabid dog are afi'ected with the disease except man ;
and that the disease proves fatal to all animals but man. (H. A.
viii, 22.) But see the Annotations of Schneider. (1. c.) Ovid
ranks inveterate gout and hydrophobia among the incurable
diseases :

" Tollere nodosam nescit medicina podagram,

—
Nee formidatis auxiliatur aquis." JE!r Ponto, i, 3, 24.

Celsus, also, was well aware of the fatal nature of the disease,
for which he says the only remedy is to plunge the patient un-
expectedly into the cold bath, after which, to prevent convul-
sions, he is to be put into warm oil. He also approves of
 166 MAD DOGS. [book v.

CoMM. giving undiluted wine. As a preventive of the disease lie directs

' '

*
the woimd to be cauterized, (v, 27.)
Pliny in like manner reckons the disease dangerous^ and
mentions hellebore as a remedy for it. (H. N. ^dii, 63 ; xxix^ 32.)
But without doubt the best account of hydrophobia con-
tained in any ancient author is that given by Caelius Aurehanus.
We shall now give a short abstract of it. He says the disease
may be produced not only by the bite, but likewise by the
breath of a rabid dog. This fact is mentioned by other au-
thorities, such as Aretseus (Morb. Acut. ^ii), and Yegetius
(INIulo. Med.
iii, 84) ; and it is confirmed by modern writers,
as Gokel, Lister, Rhazoiiz, and others. He also relates the
case of a sempstress who fell into the disease from liaA'ing sewed
a robe which had been torn by a mad dog. Similar cases
are related by Hildanus and Heister. He likeAvise states, what
is confirmed by the Arabian authorities, and also by modern

experience, that the disease may be brought on by the bite of

wolves, bears, leopards, horses, and asses. He mentions the
case of a person in whom it was occasioned by a wound inflicted
with the spurs of a cock Sometimes, too, he
Avhile fighting.

adds, it arises in the human

subject without any manifest cause,
which also is confirmed by modern experience. once saw We
the horror of loater in a case of Phrenitis. He mentions a sin-
gular case of hydrophobia in a child which was afli'ected with a
horror of its mother's breast. His description of the symp-
toms, compared with modern descriptions (for example that
if

given by Dr. Goden in Hufeland's Journal,' Jan. 1816), Avill

'

be found in every respect complete and accurate. Thus Cselius

says that the pulse is densus, parvus, inord'matus, and Goden
found it intermittent and irregular. Cselius says there is a

frequent desire of making water, wliich Goden found to be a

constant attendant of the disease. Cselius thought that the
stomach is more deranged than any other part, and Goden is

of opinion that the splanchnic nerves are particularly affected.

In short, Cselius maintained that it is an incendhnn nervorum ;
and it appears from him that some of the ancient authorities
believed it an inflammatory aftection, and treated it by bleed-
ing. He treats it upon much the same principles as Tetanus,
that is to say, his great object seems to have been to remove
SECT. III.] MAD DOGS. 167

constriction, and with, this view he recommends friction with Comm.

' '

tepid oil, venesection, and allremedies of a relaxant nature.

He also directs us to administer clysters of tepid water and oil ;

and proposes to quench the thirst by forcing a cooling injec-

tion up to the stomach for which purpose pressure with the
;

hands is to be applied externaUy. He makes mention of the

internal administmtion of hellebore, but disapproves of it. The
use of white hellebore, however, is favorably mentioned by
Aetius (vi, 24), by Actuarius (Meth. Med. vi, 11), by Theom-
nestus (Geopon. xix, 3), by Dioscorides (ii, 3), by Alexander
Trallian (i, 15), and by Avicenna (iv, 6, 9.)

Galen, in his work on 'Antidotes,' gives prescriptions for

several compositions of this sort for the prevention and cure of

hydrophobia ; and mentions the disease incidentally in several

of
parts of his works, but has nowhere given any description
it. Dioscorides' account of the symptoms, and his plan of
treatment are nearly the same as our author's. He strongly
recommends the cautery.
The external application of the cautery is also commended
by Celsus, Galen, Pliny, Scribonius Largus, Aetius, Actuarius,
Nonnus, Avicenna, Khases, and Alsahara^dus.
See a good account of hydrophobia in Haly Abbas (Theor.
viii, 20) and in Alsaharavius (Pract. xxx, 2, 30.)
;
None of
the ancient authorities insists with so much earnestness as Haly

Abbas on the necessity of applying strong stimulants to the

wound, namely, the most acrid vinegar, copperas, and the like,

so as to keep up a discharge from it for a considerable time.

Rhases is a strong advocate for bleeding when the poison is
distributed over the system. (Cont. xxxv.)
Perhaps Alexander Aphrodisiensis is correct in stating that
the disease in the dog is a species of fever. (Problem.)
'
There is a sensible account of hydrophobia in a Fragment'
of an anonymous Greek author, published in Bernard's 'Re-
liquiae.' The complaint is said to arise either from the bite of
a dog, or from humours engendered in the body. It is cor-

stated that affected with it dread all liquids, so

rectly persons
that at the bare mention of them they start up with a scream,
trembling, cold sweats, and chattering of the teeth. Among
other things cold applications over the stomach and chest are
recommended.
 168 WASPS AND BEES. [book

SECT. TV. FOR THE BITES OF DOGS THAT ARE NOT MAD.

On the bites of dogs tliat are not rabid, as even in this case
they possess some poisonous quality, immediately sprinkle some
vinegar, and strike the bite with your hand spread out, and
th'en having nibbed nitre with vinegar, pour it from above upon
the part. Afterwards, having soaked a new piece of sponge in
vinegar or in the vinegar and nitre, apply it for three daj^s, and
moisten it ; for it will effect a complete cure. Or apply the flour
of tares mixed with oil, or new sponge, or unwashed wool soaked
in vinegar and oil may be applied; or tritui'ate the leaves of bram-
ble with vinegar, and apply ; or onions triturated with honey^
or equal parts of the hair of marjoram^ of salt, and of onions
with honey or black horehound, Avhich they also call ballotes,
;

with salts. When the bites have already suppurated^ ^Pply

the flour of tares mixed with honey, for it is particularly appli-
cable. "When they are inflamed anoint with litharge triturated
with water.

CoMM. Commentary. See Rhases (ad Mansor. viii, 9; Cont. xxxv);

Haly Abbas (Pract. iv, 28),- Alsaharavius (Pract. xxx, 2, 31).
Haly adopts the treatment laid down by our author. Alsaharavius
recommends a composition of fat^ wax, pitch, and galbauum.

SECT. V. ON WASPS AND BEES.

Those who have been stung by bees experience pain, red-

ness, and swelling in the wound, the surrounding parts become
tumefied, and the sting remains in the wound and those stung
;

by wasps experience the other symptoms, and that in an

all

aggravated degree, only the sting does not remain. Both

cases are remedied by rubbing the parts with clay, or cow^s

dung, or with the juice of figs, or with the tritm-ated leaves of

sycamore, or of mallows ; or by applying a cataplasm of barley
flour mixed with vinegar. Foment also with brine or sea-
water.
SECT. VI.] PHALANGIA. 169

Commentary. See a similar plan of treatment recom- Comm.

mended by Aetius, Dioscorides, Nonnus, and Rhases. Simeon
Seth recommends the decoction of mallows^ which appears to
have been a domestic remedy generally used in such cases. See
also Geopon. (xii^ 12); and Pliny (H. N. xx). Virgil alludes to
this practice in a passage which has been often misunderstood.

(Georg. iv, 230.) Haly Abbas recommends cold water or snow,

also Armenian earth with vinegar, and other applications of the
same nature. (Pract. iv, 34.) Alsaharavius mentions the same
remedies as Haly, but expresses himself sceptical as to their
efficacy. (Pract. xxx, 2, 29.) Rhases, among other applications,
mentions a composition of camphor and vinegar; and another
containing opium, henbane, and camphor, to be used along with
a cloth moistened in snow-water. The Arabian writers on hus-
bandry also recommend the composition from mallows and oil,
as a preservative of the face and hands from the stings of
bees and wasps. (Casiri, Bibl. Arab. Hisp. 335.)

SECT. VI. ON THE PHALANGIA, OR VENOMOUS SPIDERS.

When a person has been bitten by a phalangion the part

itself appears red, and as if pricked by a sharp-pointed instru-
ment, but it does not swell, nor is it very warm, but it is mo-

derately red, cold, and

itchy. Those who have been stung ex-
perience a great sense of cold, trembling, heaviness of the body,
a cold sweat, constant pain, paleness, and a perpetual desire to
make water some cases there are dysuria, erection of the
; in

genital member, humid eyes, and spasmodic distension about

the groins and thighs, a violent gnawing pain of the stomach,
loss of taste in the tongue, vomiting of water, or of substances
resembling webs, and sometimes these substances are discharged

by the urine or bowels. By going into hot water they are

freed from pain, but the pain returns again with violence. They
are relievedby the application of the ashes of figs mixed with
salts triturated inwine, or of the pounded root of the wild
pomegranate, or of birthwort with barley flour mixed with
vinegar. Bathe the ulcers with hot sea-water, or with the
decoction of baum, the leaves of which may also be applied.
Recourse must also be had frequently to baths, and potions
 170 PHALANGIA. [book v.

composed of these tliings_, the seed of southernwood^ dill, birth-

Avort, wild chick-peas, Ethiopian cumin, pounded cedar-berries,
the bark of the plane tree, the seed of the herb trefoil, the fruit
of tamarisk ; give two drachms of each of these with one hemina
of Avine, or a decoction of the green parts of cypress, or of its balls
mixed with "oiue. Some say that the river crab when reduced
to juice, with milk^ and the seed of parsley, and given, removes
the mischief.

CoMM. Commentary. Nicander describes several species of pha-

" — -
langia, whose
'

bites occasion a variety of symptoms, such as a

cold horror, trembhngs of the limbs, and in some instances
tension of the genital members. On the phalangia, see Aris-
totle (Hist. Anim. ix, 39); Xenophon (Memorab.
i, 3); Pliny
(H. N. xix, 9, and xxix, 27); iElian (H. A. x\ii, 11); Soliuus
(Polyhist. xvii) ; Phile. (66). The distinction between the
phalangia and common spiders isthus stated by Humelbergius :

"Araneorum prima divisione duo genera sunt, unum eorum

qui innoxii sunt quos Grseci arachnas, Latini araneos dicunt,
quorum etiam a Dioscoride duo genera recensentur, unum quod
holcon et lycon vocat, alterum vero dicit esse quod Candidas,
tenues et densas telas operetur. Alteram genus est eorum qui
noxii sunt, quos et Grseci et Latini phalangia vocant.^^ (Apud
Apuleium.)
Similar modes of treatment to that of our author are re-
commended by Dioscorides [xi, 42) ; Celsus (v, 27) ; Nonnus
(270) ; Aetius (xiii, 16) ; Actuarius (Meth. Med. \i, 10) ;

Haly Abbas (Tlieor. viii, 22) ; and Alsahara^-ius (Pract. xxx,

2, 26).

Sprengel allows that there is considerable difficulty in

determining the nature of the ancient phalangia. He attempts,
however, to refer the diiferent species described by Nicander
to their proper names in the Linnsean classification. (Comment,
in Dioscoridem.)

Many modern authorities, for example, Gesner, Bagh^d, and

Andreas Laurentius, have held that the Tarantula, so famous in
the annals of the Dancing Mania, was a species of the phalan-
gium. See further Hecker's Epidem. 113. This seems to be
confirmed by Rhases calling a species of the phalangium by
the name of tarantula (Contin. xx and xxii) and, indeed. ;
SECT. VIII.] THE SPIDER, 171

Ardyen seems to settle the question that the tarantula is a Comm.

'

species of the phalangia. (De Venen. viii, 5.)

SECT. VII. ON THE BITE OF THE SPIDER.

There iskind of spider, the sting of which occasions

also a
intense pains about the middle of the hypochondrium, diffi-
culty of making water, eiythema, and sometimes convulsions.
Those who are stung by such animals, are relieved by the
Theban wild cumin, the seed of the chaste-tree, and by
draughts fi-om the leaves of the white poplar, or by applying
garlic alone, and taking full draughts of undiluted wine.

Commentary. For the sting of the spider, Celsus recom- Comi

mends garlic mixed with rue and pounded in oil. (vi, 27.)
See also Pliny (H. N. xxix, 27); Haly Abbas (Pract. iv, 35) ;

Alsaharavius (Pract. xxx, 2, 24).

SECT. VIII. ON THE STING OF THE SCORPION.

When one has been- stung by a scorpion, the part imme-

diately begins to inflame, becoming hard, red, tense, and

painful, being seized at one time with heat, and at another

with cold; and when pain is an attendant symptom, it has
remissions and exacerbations. These symptoms are followed
by sweating, a sense of shivering, trembling, coldness of the
extremities, tumour of the and erection of the genital
groins,
member : a discharge of flatus by the anus
sometimes there is

with a loud noise, and horripilation, and a painful discoloration

on the skin, the pain resembling the prick of a needle. These
are immediately relieved by having the juice of the fig poured
into the wounds, and the scorpion which stung the person may
be pounded and applied to the bite; afterwards salts triturated
with linseed and the seed of marshmallows may be apphed.
Native sulphur, mixed with rosin or turpentine, is also of ser-
vice; and in like manner, galbanum, spread out into the
shape of an oblong pledget and applied, or calamint pounded
and applied ; and crude barley-flour prepared in wine and the
 I

172 THE SCORPION. [book v.

decoction of rue and in like manner the pounded seed of the

;

herb trefoil
may be applied with advantage. They may also
take propomata containing Uyo drachms of birthwort, more
particularly of its bark with wine ; or gentian pounded^ or
pennyroyal properly boiled, and ten bay-berries bruised, and
calamint long boiled with oxycrate, and cyperus with wine ;
and in like manner, rue, the juice of the fig, and laserwort, if
at hand ; but otherwise we must use the Partliian juice. The
^ fruit of trefoil and the seed of basil-royal may be taken in a

draught with advantage. Sih^er immediately applied to the

wound has a wonderful effect. The benefit of all these may
be increased by the frequent use of the bath, copious perspira-
tions, and drinking strong or diluted wine. The following
compound propomata may be taken : Of sulphur "vivum to the
size of an Egyptian bean, with eight grains of pepper in half
a hemina of vdne, or the juice of laserwort triturated with
crabs in wine, or equal parts of gith, Ethiopian cumin, and
the seeds of the chaste-tree in wine.
For severe stings of scorpions and phalangia. Of the lees of
wine, dr. xvi ; of pellitory, dr. iv ; of the seed of wild rue, dr. iij ;
of castor, of the seeds of rocket, of each, dr. ij ; let them be
mixed with the blood of the sea-tortoise. The dose is four
oboli with Avine, or three cyathi of unmixed vinegar. Another: —
Of pellitory, of birthwort, of each, oz. iv ; of pepper, dr. ij ; of
the juice of the laserwort, dr. j.
The dose is the size of an
Egyptian bean.

CoMM. Commentary. Nicander describes several species of the

' '

*
scorpion. The white, he says, is innoxious. The red occa-
sions a fiery heat with restlessness and great thirst. The
black brings on inquietude, delirium, and laughter. The green
occasions chilliness with horror. The symptoms superinduced
by the other species are also detailed. (See Theriac. 775.)
tEHus Promotus gives a very circumstantial description of the
effects produced by the sting of the different species of scorpions,
but it would appear to be mostly taken from Galen and other
Greek authorities. On the nature of the scorpion, see further,
Pliny (H. N. xi, 25); and iElian (vi, 20.)
On the medical treatment, see in particular Dioscorides (vi,
44) ; Aetius (xiii, 19) ; Nonnus (269); Actuarius (Meth. Med.
SECT. VIII.] THE SCORPION. 173

vi, 10); Celsus 27); Rhases (ad Mansor. viii, 3); Haly Abbas c OMM.
(v,

(Theor. \-iii, and Pract. iv, 33) ; Alsaliaravius (Pract. xxx,

22^
2, 20); Avicenna (iv, vi^ 5.)
Galen gives a variety of prescriptions for the composition of
antidotes for the cure of persons stung by scorpions. The
following one may be taken as a specimen of them: Of birth-
wort, dr. iv; of pepper, dr. ij; of opium, dr. j; of pellitory,
dr. form into trochisks of the size of an Egyptian bean,
iv;
and give to swallow along with two cyathi of undiluted wine.
(De Antidot. ii.) Rhases gives another receipt of Galenas for
the sting of the scorpion, viz. equal parts of opium and of the
seed of henbane given with honey. (Contin. xx, 24.)
Onthe use of venesection for the cure of the sting of the
"
scorpion, Celsus says, Cogno"\i tamen medicos qui ab scorpione
ictis nihil aliud quam ex brachis Rhases
sanguinem miserunt.^^
has pointed out the proper time and cncumstances which require
" When
venesection :
you have administered the theriac, and
the pain has subsided, if fever supen^ene, bleed the patient on
the following day in the morning, and give him barley-water
and diluent food." The symptoms
as detailed by Haly Abbas
are pain, swelling, hardness, and inflammation, which occa-
sionally superinduce asphyxy and epilepsy. He directs a
ligature to be put immediately around the member, and a
bruised scorpion to be applied to the wound. He also men-
tions cataplasms with olive oil, and recommends the internal
use of wine either alone or Avith garlic. The treatment as given
by Alsaharavius is
very similar. Dioscorides, Aetius, Haly
Abbas, Alsaharavius, Actuarius, and Nonnus, omit to mention
venesection.
The veterinary sm'geons recommend bleeding, scarifications,
and burning with red-hot irons. See Vegetius (Mulom. iii, 77,
and Geopon. xvi, 20.)
Sprengel remarks that Nicander^s division of scorpions is
adopted by modern naturalists. (Hist, de la Med.) Cornad
Gesner gives a very elaborate dissertation on them. The
Scorpio Europceuft, L., is not venomous. The African, however,
is a very dangerous reptile. The inhabitants of Morocco, at
the present day, treat its bite with the ligature, the cautery, and
by applying the body of a dead scorpion to the wound. See
Jackson's Morocco (108). The Arabian authorities describe a
 174 SCOLOPENDRA. [book v.

CoMM. liiglily venomous species of scorpion, whicli they call scorpius

' '
*
rastellans, cai'rareti, and algreta. See in particular Rliases,
Haly Abbas, and Alsallara^•ius.

SECT. IX. ON THE LAND AND SEA SCOLOPENDRA.

When one is bitten by a scolopendra the general symptoms

. are li^idity of the parts around the bite, and swelling; some-
times it is of a feculent appearance, and sometimes, though
rarely, red ; and a painful and ill-conditioned ulcer takes
place, beginning with the part that is bitten ; and in addition
to these, there is a sensation of primtus over the whole body.
Those bitten by the sea scolopendi'a in particular have a watery
and transparent swelling, whereas that occasioned by the land
scolopendra is red. It is proper therefore to apply to the
wound pounded salts, or levigated rue, or ashes mixed with

^dnegar, or squills. Bathe the part ^dth vinegar and brine ;

but Archigenes directs it to be done with much hot oil, and

thus to apply the things formerly mentioned ; and to administer
potions containing birthwort with wine, or wild thyme, or
calamint, or wild rue, or trefoil, or the juice of the root of
asphodel to the amount of half a hemina with wine.

CoMM. Commentary. Nicander says, that the scolopendi-a has

—
' — two heads,
'
'

and walks in both directions upon its many feet.

Avicenna admits that he was wholly unacquainted with it.
See in particular ^'Ehan {H. A. iv, 22 and ^ii, 35.) Oui*
;

author and Actuarius copy almost every word from Diosco-

rides. See also Aetius (xiii, 15); Tsonnus (272); Alsahara^dus
(Pract. XXX, 2, 23) ; Avicenna (iv, vi, 3.) AAicenna calls them,
saculufudurni ; and Alsahara^vius, alhatrabay. AlsaharaAius
approves of wine with birthwort, rue, mint, &c., internally;
and of salt, A^ith
honey, vinegar, &c., externally. The Pseudo-
Dioscorides recommends salt with veriiix, pitch, and honey.
(Euporist. ii, 121.) We need have no hesitation in deciding with
Sprengel and the other authorites on this subject, that the laud
scolopendra is the scolopendra morsituns, and the sea, the
aphrodite oculeata, L.
SECT. XT.] SPOTTED LIZARD. 175

SECT. X. ON THE STELLIO OR SPOTTED LIZARD.

Those bitten by tbe spotted lizard experience intense pain

and lividity of the part, but are reHeved by the immediate
appUcation of cataplasms consisting of onions and garlic to the
wound and some by eating these things and drinking undi-
;

luted wine have been cured.

Commentary. That the galeotes and ascalabotes are but Comm.

'

names for the same animal is evident from Aristophanes

different •

(Nubes, 170, et seq.) ;

and from the Scholiast's note on Nican-
der (Ther. 484.) " Hunc Grseci
Pliny says of the stellio :

coloten vocant et ascalaboten." (H. N. xxix, 28.) On the

stellio, see further Bochart (Hieroz. ii, 510) ; Harris (Nat. Hist,
of the Bible, in the word spider) ;
and Dr. Martyn on Virgil
(Georg. iv, 244.) All agree that it was a kind of lizard. In
short it is the lacerta stellio, L. A learned modem authority
says it is venomous
in Greece, but innocuous in Sicily. He
describes it as resembling the lizard in shape, and the chamse-
leon in nature. (Agricola de Anim. Subterran.)
Dioscorides does not treat of the stellio. Aetius recommends
\erv nearly the same treatment as our author, (xiii, 12.)
Avicenna and Rhases direct us to get the wound sucked, to
put the patient into a warm bath and administer the theriac.
The harbse of Aricenna is probably only a species of the stellio.

Alsahaya and alvesghe of Alsaharavius seem to have been

two species of stellio. (Pract. xxx, 2, 27.) He approves of the
same treatment as that recommended by A\dcenna and Rhases.

SECT. XI. ON THE MUS ARANEUS OR SHREW-MOUSE.

When persons are bitten by the shrew-mouse, throbbing

pains supervene, erythema of every part pierced by a tooth,
blisters along the skin filled with an ichorous fluid, and all the

surrounding parts are hvid ; and if the skin be stripped off from
the bhster, the ulcer appears white, owing to the skin being
torn into nervous membranes. In addition to these symptoms,
the mortified parts drop off, the disease extending like a
 176 SHREW-MOUSE. [book v.

spreading ulcer ; and besides tormina supervene^ with dysuria

and the discharge of a cold fluid. They are relieved by the
application of galbanum in the form of an oblong pledget, by
itself,or triturated with vinegar, or of barley-flour mixed up
with oxymel. And the shrew-mouse itself which inflicted the
bite may be torn in pieces and applied^ and pellitory may be

applied, or the boiled rind of the sweet pomegranate, or wild

mallows, or pounded garlic, or mustard triturated with vinegar ;
and the parts may be bathed with warm brine, and then a
cataplasm of burnt barley with vinegar may be applied. They
may take propomata of southernwood boiled in wine, or sisym-
brium, or wild thyme, or rocket, or galbanum, or sage, or the
tender balls of cypress with oxymel, or pellitory with Avine, or
the root of chameleon, or the rennet of a kid or of a lamb, or
gentian root, or vervain. These things may also be adminis-
tered in the form of a cataplasm. But some give in a potion
the shrew-mouse itself that inflicted the bite, having triturated
itwith wine. This one also is eflPectual Of mjrrrh, dr. vj ; of
:

the bark of birthwort, dr. iv. To the bites of the shrew-mouse

and of the scolopendra apply salts with liquid pitch, or cedar-
rosin with honey, or garlic with the leaves of the fig-tree and
cumin, or the leaves of calamint, or barley with vinegar.

CoMM. Commentary. Nicander says that the bite of the blind Mus
' —»
— araneus is Our author's plan of treatment is taken
mortal.
from Dioscorides. Oribasius recommends garlic and cumin,
mixed with oil. (De Morb. Curat, iii, 70.) Aetius says that
the Mus araneus is an animal resembling the weasel. His
plan of treatment is similar to our author's, (xiii, 14.)
" Mus
Isodorus says of it :
araneus, ciijus morsu aranea
moritur, est in Sardinia animal perexiguum, aranese forma, quae
solifuga dicitur, eo quod diem fugiat." (Orig. xii, 3.)
Vegetius, the veterinary surgeon, recommends garlic pounded
with nitre, or with salt and cumin. (Mulom. iii, 82.) See also
Columella {xi, 17) ; and ^Elian (H. A. ii, 37.)
Most of the Arabians treat of this case in the same terms
as the Greeks.
Without doubt it is the sorix' araneus, L. The accounts
which the ancients give of its venomous qualities are said by
Buffbn and Sprengel to be exaggerated. Probably Agricola
SECT. XII.] VIPERS. 177

states the matter correctly wlien lie says, tliat the mus araneus Comm.
is venomous in warm climates, but innocent in cold. In size,
" ——
'
'

he says, it is
nearly equal to a small weasel. (De Anim. Suhter.)

SECT. XII. ON VIPERS AND ECHIDNiE.

"When persons have been bitten by the viper or echidna, or

some such venomous animal, pain supervenes, at first of the
part which has been bitten, but afterwards of the whole body.
In the bite there appear two perforations at a little distance
from one another, from which there is a discharge of blood
and ichorous fluid, and afterwards of an oily one, but in all
cases of a poisonous fluid, which they affirm to be the
poison of
the reptiles. Swelling comes on around the wound, Avliich is
reddish and livid there is paleness of the whole body,
; vertigo,
and resolution of the stomach, deliquium animi, and in some
cases bilious vomitings and dysuria. Around the bite blisters
arise, asfrom burning with fire, the disease spreads by extend-
ing to the surrounding parts, and the gums discharge blood.
Trembling, heavy sleep, and a cold perspiration succeed these
symptoms. Those bitten by the echidna appear to escape with
less danger than those by the viper ; and of these they run the
least risk who have pre^dously taken food. In treating them
the most eff'ectual remedy is eating garhc and drinking wine, so
that if one can endure this course he will not stand in need of
any
other remedy. And let them eat also leeks, onions, and acrid
pickle. Some
likewise give frogs prepared with sauce to eat.
The following things are eff'ectual, each of which may be taken
with wine the dried blood of the sea tortoise with wild cumin,
:

the rennet of a hare or a hind to the amount of three oboli, a

drachm of the dried testicle of a stag, a whole alkanet with the
slender leaves, which also some apply as an amulet. In like
manner the juice of leeks, to the amount of half a hemina, in
honied water, the juice of baum leaves, wild rue, the brains of
domestic fowls, the root of panacea boiled in wine, one drachm
of agaric, juniper berries, the root of asphodel,
pounded pista-
chia, the seed of the chaste tree, two drachms of dried weasel,
the root and juice of vipers' bugloss, river and sea crabs alone
or with stavesacre, salts and
poley, the root of birthwort with
II. 12
 178 VIPERS. [book v.

equal parts of myrrh, gentian, and bay-berries mixed with honey.

The following is an admirable remedy of Oribasins for persons
bitten by vipers Of anise, an acetabulum of pepper^ dr. iv
:
; ;

of the bark of birthwort, of opium, of castor, and of myrrh, of

each, dr. j triturate with must, and form to the size of a
;

Grecian bean, and give according to the patient's strength in

three cyathi of diluted wine. —
Another, from the works of
Lycus, a medicine for the bites of ^^pers Of myri'h, of castor,
:

of pepper, of purslain, of each, dr. j ; of the seed of dill, an

acetabulum ; triturate in must, and give. —
Another, from the
works of Archigenes Pound carefully twenty crabs with a
:

suSicient quantity of wheaten flour in a mortar, and having

mixed some calamint and salt with it, form trochisks of it, and
dry. Use in a cataplasm with milk, and give one in a draught
with honied water. But, says he, if you have not river-crabs,
use sea-crabs. Goat's dung applied externally to the wound
with wine is a powerful remedy ; or bay -leaves boiled with oil,
or bay-berries, or calamint, heath, rue, parsley, southernwood,
galbanum on a pledget, green marjoram pounded ; also young
fowls torn in pieces, and applied warm and frequently changed,
the flour of tares mixed with wine, the pounded bark of radish,
boiled squills, raw barley-flour in oxymel, the leaves of the wild
cucumber with fine polenta, the lees of wine in like manner with
fine polenta, me with salts and honey, bran boiled in vinegar,
ashes with vinegar, cedar-pitch with salts, liquid pitch with
salts. Bathe also with the decoction of trefoil, or of penny-
royal, or with vinegar and brine. "When the blisters become
bloody let out their contents without taking off" the skin, then
bathe with much water, and apply a cataplasm of boiled lentils
with honey till the cure is completed. The antidote of vipers
is particularly efiicacious, both when taken in a draught and
apphed externally.

CoMM. Commentary. Most of the ancient authorities appear to

'
*""*
have considered the echidna the female viper ; but, as will be
seen below, there is reason to suppose that it was a difi'erent
species altogether. It is the colubra of Celsus. (v, 27, 3.)
Our author's description of the
symptoms is closely copied
from Nicander, who also recommends similar treatment.
Dioscorides in like manner directs us to give wine, and various
 SECT. XII.] .
VIPERS. 179

articles of an acrid and calefacient nature, such as garlic, Comm.

" '

onions, pepper, squills, &c.

*
Archigenes (ap. Aetium, xiii, 21)
affirms that eating garlic and drinking undiluted wine, con-
stitute the most effectual part of the treatment. Of /course
these things were given upon general principles with the view
of supporting the strength and vital heat. Hence it may be
understood why the ancients reposed so much confidence in the
theriac of Andromachus, most of the ingredients of which were
stimulant, acrid, and calefacient substances. The body of the
vij)er,
which entered into this famous composition, is said by a
modern authority on the Materia Medica, Moses Charras, to
contain a certain volatile oil. (See Book VII, sec. ii, of this
work.)
A^dcenna delivers his plan of treatment at great length, enu-

merating many Arabic

substances, the nature of which cannot
now be easily determined. His general principles, however,
seem to have been much the same as those of our author. He
recommends in the first place the ligature, and cupping with
scarifications. Wine and the theriac are to be given unless
inflammatory symptoms come on, in which case the patient is
to be bled, (iv, 6.)
In another place he praises the juice of
the citron as a remedy against the sting of the viper. Haly
Abbas recommends immediate amputation of the pad; when this
is practicable, and otherwise directs us to
apply a ligature around
it, to make scarifications, and use stimulant applications, such

as onions, leeks, &c. Like most of the other authorities, he

recommends the theriac, and Avine, with other stimulants, such
as pepper, birthwort, bay-berries, &c. In certain cases he
also approves of bleeding. (Pract. iv, 32.) Alsaharavius re-
commends cupping, the ligature, and in short nearly the same
plan of treatment as Haly. (Pract. xxx, 2, 18.)
Garlic was used in common cases as a substitute for the
theriac, both internally and in cataplasms. (See, in particular,
Geopon. xii, 30.)
On ^han (H. A. x, 9) Phile (70) Galen
the viper, see ; ;

•(Ther. ad Pison.) The ancient stories of the fatal copulation of

the male viper with the female, and of the loves of the muraena
and viper, are probably fabulous. (See De Pauw, apud Phile.)
The latter story is told by Aristotle (H. A. v, 10) ;
^Han (i, 50);

Oppian (Hal. i, 554) ; Pliny (ix, 23) ;

Athenseus (vii) ;
Achilles
 180 AMPHISBiENA. [book v.

CoMM. Tatius i.) One of Atlienseus's authorities^ however^ questions

' '
'
the truth of it. (Deipn. 1.
c.)

According to Sprengel, the Asiatic ty^lBva

is the coluber

j^gyptius ; the ty^iQ, probably the C. ammodytes ; and the

European i/i^ua, the C. berus. (Comment, in Dioscor.)
It is clear^ however, from Nicander^s description of the viper,
that the term was apphed to a considerable variety of ve-
eyrig
nomous snakes.must not then be supposed to apply in all
It
cases to the coluber ammodytes. It is also certain, as will be
seen under their proper heads, that other serpents, to which
specific names were given, such as the cerastes, the hsemorrhus,
and the asp, were merely varieties of the vipera.
The seps is not treated of by the Greek authorities on Tox-
icology, except Nicander, but is briefly noticed by the Arabian
under the name of famusus. Avicenna states that the treat-
ment of the viper applies to it. (iv. 6, 3, 48.) From the de-
scription of it given by Nicander, it would appear to have been
a variety of the hsemorrhus. (See Theriac, 320, with the Com-
mentary of Eutecnius.)

SECT. XIII. ON THE AMPHISB^NA AND SCYTALA.

The same symptoms follow their bites, and the same reme-
dies are applicable to them therefore it is unnecessary to treat
;

of them particularly.

CoMM. Commentary. Nicander

amphisbsena that the is a
'— — small serpent with two heads, says
»
'

and small eyes. The scytala, he

says, is like the amphisbsena, but thicker and larger towards
the tail.Avicenna doubts whether the amphisbsena moves
both ways. He says it is a serpent of equal thickness at both
extremities, which probably gave rise to the supposition that it
had two heads. He calls it a snake of the fragile nature, which
description evidently points to the blind-worm. (See further,
Matthiolus, Comment, in Dioscor.) We
suppose the altahban.
and alhuidia of Alsaharavius are the amphisbsena and scytala.
(Pract. XXX, 2, 19.) He recommends general treatment, namely,
the ligature, cupping, scarifications, with cold water to drink.
Sprengel inclines to think that the scytala was the anguis
 SECT. XIV.] DRYINUS. 181

eryx. He makes the amphisbsena to be the anguis f7'agilis, L. ; Comm.

' '
'
he questions, however, the accuracy of the ancient accounts
respecting its venomous quahties. (Notse in Dioscor.) But,
indeed, Aetius states distinctly that these serpents are not ve-
nomous, and that their sting merely occasions inflammation like
that of wasps and bees. (1. c.) Nicander also merely describes
these serpents, and says nothing about their being venomous.

SECT. XIV. ON THE DRYINUS. THE INTRODUCTION FROM

GALEN.

The dryinus, that lives at the roots of oaks, is so pernicious

and destructive an animal, that if one tread on him he will
excoriate one's foot, and great swelling will seize upon the whole
limbs ; and, what is more wonderful, they say that if one at-
tempt to dress the wound, one's hands will be excoriated and ;

that if any person attempts in defence to kill the animal, he

emits such a stench as overpowers all other smells. When one
has been stung by the dryinus, tumefaction of the part takes
place with redness, and blisters on the surrounding parts, along
with a discharge of a watery ichor. These symptoms are fol-
lowed by cardialgia and tormina. Birthwort given as a draught
with wine is ser\dceable in these cases, and the herb trefoil, and
the root of asphodel, taken in like manner, and the fruit of all
kinds of oak triturated and taken in a draught. In like man-
ner the roots of the ilex pounded and applied to the part are
of use.

Commentary. Nicander says it is also called chelydros and Comm.

hydros. He makes a distinction between the chelydros and * ' '

the chersydros, but subsequent authorities confound them toge-

ther. (See below.) He
says it inhabits lakes and marshy grounds,
feeding upon locusts and frogs. Its back is black, and its
smell fetid. The symptoms occasioned by its sting are livid
swelling, delirium, cutaneous pustules, dimness of vision, sup-
pression of urine, coma, singultus,and vomiting of blood or bile.
Haly Abbas calls it adresa, and says that it emits a fetid
smell, and brings on inflammatory redness with an aqueous dis-
charge from the wound. (Theor. viii, 21.) Avicenna calls it
 182 ILEMORRHUS. [book v.

CoMM. kednsu dvras. Isidorus says^

"
{\x, 6, 3.) Chelydros serpens
^~^
qui et chersydros dicitur quia et in terris et in aquis moratui"/^
(Origines.)
Virgil translates Nicander^s account of this serpent into verses
of inimitable spirit and elegance. It "will be remarked by the
curious reader that he mixes up together circumstances col-
lected from Nicander's separate descriptions of the chelydros
and diyinus. (Georg. iii, 425.) Though critical emendation
of the text of ancient authors be foreign to the design of this
work, -we cannot omit the present opportunity of stating that,
from a comparison of the descriptions given by the Greek and
Latin poets, we are inclined to think that the 434th line of
Yirgil should run thus :

Sae^-it agris asperque siti atque exterritus oestro.

This founded upon the 417th line of Nicander's Theriacs.

is

It seems to be the chersydros which Dante alludes to in the

following verses :

" Come le rane innanzi alia nemica

Biscia per 1'
acqua si dileguan tutte,
Finch' alia terra ciascuua s' abbica."
Inferno, canto vs..

For an account of the hydrus, see the sixteenth section.

According to Sprengel, the dryinus is the coluber lebetinus.

(Notse in Dios.)
Agricola finds fault with Lucan for distinguishing the cher-
sydros from the hydi"us or natrix. He remarks that the boa
is a species of hydrus. (De Anim. sub.) are now gene-
They
rally held to be different. See, however, our commentary on
the sixteenth section.

SECT. XV. ON THE H.EMORRHUS, PRESTER, OR DIPSAS.

Those bitten by the hsemorrhus experience riolent pains, and

both longitudinal and lateral contractions of the porous parts
of the body, occasioned by the persistence of the pains. From
the bite there is a copious discharge of blood, and if there happen
to be a sore on any part of the body it bursts out and discharges
blood. The alvine evacuations likewise are bloody, and the
Idood which is evacuated is thrombous. When they cough they
SECT. XV.] H^MORRHUS. 183

bring up blood from the lungs, and they die at last vomiting
blood irremediably. Those bitten by the dipsas experience
intolerable heat and intense thirst which is insatiable and un-
ceasingj so that they swallow copious draughts, and yet they
feel as if they had never drunk; and the whole system is affected,
as in dropsy, owing to constant ingestion of drink. Hence
the animal has been called prester, causon, and dipsas. Bj
most of the ancients those bitten by the hsemorrhus and dipsas
were given over as incurable. But if we have no particular
remedies for this reptile we ought to make trial of the general
applications, and immediately have recourse to scarifications
and burning, and, if the part permit, to amputation of the ex-
tremities. Then acrid cataplasms may be applied. All kinds
of acrid food are also useful, especially that from pickles,

drinking undiluted wine, and using baths. These things are

to be applied perseveringly, and repeated at short intervals,
before the complaints make their attacks ; for after they make
their appearance no advantage can be derived from medical aid.
We find these topical remedies described for their bites, namely,
for those of the dipsas, the powdered leaves of piirslain with
vinegar, polenta, and bramble leaves powdered with honey, plan-
tain, hyssop, white garlic, leeks, rue, and nettle and for those
;

of the hsemorrhus the same things, and, in addition, boiled vine

leaves triturated -svith honey. By the mouth the burnt head
of the animal itself may be taken in a draught, or garlic with
oil of iris. They may likewise eat dried grapes.

Commentary. According to Nicander, the hsemoiThus is Comm.

'

about a foot in length, of a black or fiery colour, Avith two *

horns on its head, and eyes like those of locusts. The symp-
toms brought on by its bite, as described by Nicander, appear
to have been very similar to those of the disease called purpura

hsemorrhagica, namely, a discharge of blood from the gums,

nose, ears, bladder, bowels, or
any open sore. ^Elian gives

exactly the same account of it. (H. A. xv, 13.)

It appears from Dioscorides that the dipsas was also some-
times called prester and causon. (vi.) See also ^lian (H. A.
vi, 51.) Lucian and Isidorus, however, make a distinction be-
tween the dipsas and prester. Lucian says that it resembles
the viper de dipsadibus. In fact the dipsas seems to have
 184 H.EMORRHUS. [book v.

CoMM. belonged to the viper kind. (See Bocliart, Hieroz. ii, 367.)
he was informed by the Marsi, who made a
' '

'
Galen states that

living in Rome by dealing in serpents^ that the dipsades were

not a peculiar species of serpents, but a variety of the viper
found on the sea-shores of Africa. (De Simpl. x.) Isidorus
thus defines them: " Haemorrhois aspis nuncupatur, eo quod san-
guinem sudet qiii ab eo morsus fuerit ita ut dissolutis venis,
:

"
quicquid per sanguinem evocat."
vitse est Dipsas genus est
aspidis quaj Latine situla quia quem memorderit siti perit."
(Orig. xii, 4.) The effects produced upon the system by the
sting of the dipsas seem to have been of a highly inflammatory
nature. According to Nicauder, it kindles a flame in the heart,
the become parched, and the person is seized with an un-
lips
quenchable thirst. These symptoms are strongly portrayed
by Lucan :

" Ecce subit virus

taciturn, carpitque medullas

Ignis edax, calidaque accendit viscera tabe.

Ebibit humorem circum vitalia fusum

Csepit.
Ille vel in
....
Pestis, et in sicco linguam torrere palato

Tanaim missus, Khodanumque, Padumque,

Arderet, Nilumque bibens per rura vagantem.
Accessit morti \ji\iye,factique* minorem
Famam Dipsas habet terris adjuta perastis."
Pharsal. ix, 754.

The Arabians give a similar description of its eff'ects. Haly

Abbas says, that it occasions great heat and burning. Dioscorides
treats the wounds of the dipsas and hsemorrhus upon general

principles, namely, by the external application of cauteries and

cataplasms ; and the internal administration of wine and acrid
food. Actuarius, in like manner, recommends undiluted wine
and acrid food, and also directs us to amputate the part, or
apply acrid cataplasms according to the degree of danger.
Most of the ancient authorities concur in recommending the
theriac; for an account of the modus operandi of Avliich in
this case, see Alexander Aphrodisiensis (Prob. i, 152.)
"We may mention that, after considering the descriptions
given by Nicander, his commentator Eutecnius, Galen, Actu-
arius,and Avicenna, we are disposed to think that the text of

* Sic
lege wonfactiq.
SECT. XVI.] .
HYDRUS. 185

our author at tlie beginning of this section must be corrupt ; Comm.

" '

but we have not ventured to deviate from it, as we could not *

hit upon a conjectural emendation to satisfy us. None of the

others mention contractions of the interstices or porous parts
of the body, and all state that there is a discharge of blood
from the pores of the skin. Noav it is not probable that our
author should have omitted a symptom so striking as this cuta-
neous hemorrhage, and substituted one which the others take
no notice of.

Sprengel makes the dipsas to be the coluber prester, and the

hsemorrhus the C. cerastes. That they were both vipers is
quite obvious from the ancient descriptions of them, and more
especially from the account of them given by Galen. (1. c.)

SECT. XVI. ON THE HYDRUS, OR WATER SERPENT.

When a person has been bitten by a water serpent, the

wound becomes broad, large, and pale, and a black, copious,
and fetid discharge, as from a spreading ulcer, takes place, and
the cure of the mischief is accomplished only after a length of
time, and with difficulty. Wherefore powdered marjoram
mixed with water is to be applied to their bites, or oak ashes
mixed with oil, or barley-flour with melted honey is given to
drink, and birthwort to the amount of two drachms in diluted
wine, or two cyathi of oxycrate and afterwards the juice of
;

horehound, or decoction with wine, or wild cresses, or the

its

fruit of asphodel, or the flour or the seed of hog's fennel, with

wine. A fresh honeycomb may also be eaten with vinegar.

Commentary. This section is taken almost word for word Comm.

' '

from Dioscorides. The chersydros, says Nicander, is like the

•

asp, and its bite is followed by malignant symptoms. The

skin about the wound becomes parched and
putrid, along with
heat and pains all over the body. Isidorus says of it "
Hy- :

dros aquatilis serpens a quo icti obturgescunt.^^ (Orig. xii, 4.)

See also Pliny. (H. N. xxix, 22.) Haly Abbas says, it occa-
sions lividity of the part, from which a black fetid discharge
takes place. (Theor. viii, 21.)
Bochart makes this to have been the serpent which so
 18G CENCHRINUS. [book v.

CoMM. annoyed the children of Israel in the wilderness. (Hier.

^^^
ii, 421.)
According to Sprengel, it is the coluber natrix. (Notse in
Dioscor.) Gesner and Dr. Milligan make it to have been the
coluber lutrix vel It is now generally held not to
chersea, L.
be venomous. We
have alluded in our commentary on the
fourteenth section to the confusion of the Iwdrus with the
dn,'inus. Schneider has a learned annotation on this subject
^
in his ^ Curse posteriores to Nicander's Theriacs^ (1. 432.)

SECT. XVII. ON THE CENCHRINUS,

When a person is bitten by the cenchrinus, the bite is like

that of the echidna, mortification supervenes, and the flesh melts

away, having been previously swelled as in dropsy, and he

becomes lethargic and comatose. Erasistratus says that the
liver, bladdei', and colon are affected for upon dissection these
;

parts were found corrupted. Wherefore they are remedied by

a cataplasm composed of the fruit of lettuce with linseed, and
by pounded savory, and by wild rue, and by wild thyme tri-
turated with asphodel; and two drachms of the root of cen-
taury shovdd be immediately given in a draught with three
cyathi of wine, or the root of birthwort in like manner, and so
also cresses and gentian.

CoMM. Commentary. According to Nicander, the cenchrinus, called

' '

body of varied size, and marked Avith punc-

also the lion, has a
•

tated squamse.
Dioscorides and Actuarius give exactly the same account of
this serpent as our author. Haly Abbas in like manner de-
scribes it as occasioning mortification and putridity of the part.
Isidorus says of " Cenchi'is
(Theor. viii, 21.) it, serpens in
flexuosis quisemper iter rectum efficit. De quo Lucanus Et :

semper recto lapsurus limite cenchris.'^

Sprengel conjectures that it is a variety of the coluber berus,
or viper, which is highly probable. According to Belon, it is
three palms long, of the thickness of the little finger ; of a cine-
reous colour, Avith black spots. Aetius makes it to be the same
as the acontias, which there can be no doubt was the same as
SECT. XVIII.] CERASTES. 187

the jaculus of Lucan. Yet Lucan treats of the jaculus and Comm.
' '
'
cenchris separately. (Phars. ix.)

SECT. XVTII. ON THE CERASTES AND ASP.

According to Galen, there are three kinds of asps: that called

the land asp, the chelidonian, and the third the ptyas, which is
the most pernicious of all ; for, stretching its neck, and mea-
suring a convenient distance, Avith great sagacity, it disgorges
the poison into the body. This is said to be the kind of asp
which Queen Cleopatra, when Augustus, having vanquished
Antony, wished to seize on her, took and applied to her left
breast, and being bitten by it she died very quickly. When a
person is bitten by the cerastes the part becomes tumefied, with
hardness and blisters, and from the bite there flows an ichor
which is sometimes black and sometimes pale, and like leeks ;

the whole system becomes of a dark pale colour, with erection

of the privy member, and mental alienation ; then dimness of

sight comes on, and they die at last convulsed, as in tetanus.

When a person is bitten by an asp, the bite resembles the prick
of a needle, being very small in appearance, and without tume-
faction, and it discharges blood not copiously but in small
quantity, and of a black colour. Straightway dimness of the
eyes seizes them, and various pains all over the body, which are
altogether slight, and not without enjoyment, supervene where- ;

fore Nicander has properly said,

" and without
sufi'ering dies
the man." The colour is changed and becomes as green as
grass, there is agnawing pain at the orifice of the stomach, the
forehead constantly drawn upwards, the eyelids are moved
is

insensibly as in sleep, and with these symptoms death cuts off

the man before the third part of a day has passed over. In
both these cases speedy amputation of the extremities averts the
e^dl. Wherefore the bitten part is to be amputated without
delay, if possible, or the flesh is to be cut off immediately down
to the bone, in order that the poison may not pass through the

parts which are bitten and the adjacent ones. Then what
remains is to be seared by cauteries. For the poison of these,
like that of the basilisk and bull's blood, quickly coagulates
the blood and spirits in the arteries.
 188 CERASTES. [book v.

CoMM. Commentary. According to Nicander^ the most pestiferous

" '
'

asp is about an ell in length, its colour squalid, its eyes of a

drowsy appearance, and when it bites a person it leaves a very

small wound
neither swelling nor inflammation is perceived,
;

" and the man without ^^

pain sinks into a profound sleep. This
is the serpent which Cleopatra despatched herself with. See
some curious remarks upon this event, and the nature of the
serpent in Galen (Ther. ad Pison.), from which our author
borrows his account of it.
Xicander says of the cerastes that it resembles the male
viper, only that the latter has no horns, whereas the former has
either two or four. Isidoi*us says of them,
"
Aspis vocata quod
morsu venena immittat et aspergat tog enim Grteci venenum
:

"
dicunt, et inde aspis quod morsu venenato interimat (Orig.
and of the cerastes, " Cerastes serpens dictus eo quod
xii, iv) ;

in capite cornua habeat similia arietum sunt autem quadri-

:

gemina cornicula, quorum ostentatione, veluti esca illiciens

sollicitata animalia
perimit.''^ (Ibid.) Harris says, " The she-
phephon (Gen. xlix. 17) is probably the cerastes, a serpent of
the viper kind." (Nat. Hist, of the Bible.) Bochart, however,
has proved that the shephephon signifies both the cerastes and
the hsemorrhus, which are very much alike, being both vipers.
(Hier. ii, 416.) Spreugel, in fact, makes the hsemorrhus to
be the same as the cerastes.
Oiu' author^s treatment is piincipally taken from Dioscorides.
Aetius, however, gives the fullest account of them. He says
the sting of the most fatal species of asp proves fatal in three
hours ; and that those wounded by the cerastes generally live
nine days. He represents the asp as occasioning great cold-
ness, torpor, and at last convulsions. Besides the local reme-
dies applicable in all such cases, he recommends in an especial
manner vinegar, which is to be administered in great quantities.
Celsus thus explains the way in which vinegar proves effica-
cious for counteracting the effect of a fi-igorific poison " Credo :

quoniam id (acetum) quamvis refrigerandi \dm habet, tamen

habet etiam dissipandi. Quo fitut terra respersa eo spumat,
Eadem ergo \i verisimile est spissescentem quoque intus humo-
rem hominis ab eo discuti, et sic dari sanitatem."
The author of the work '
Euporiston,' usually published with
those of Dioscorides, recommends, in the case of a person stung
SECT. XIX.] BASILISK. 189

by tlie asp^ constant shaking, beating, and movement of tbe Comm.

' '
*
whole body, with the affusion of hot salt water. (Euporist.
ii, 120.)
Pliny says the poison of an asp proves immediately fatal
when introduced into a fresh wound, more slowly when the
sore is and that it is perfectly innoxious when swallowed
old,

by the mouth. (N. H. xxix, 18.)

The account which Avicenna gives of these serpents is mostly
taken from Aetius and our author.
Agricola describes the asp to be four feet long, and of the
thickness of a spear. The cerastes, he says, in other respects
resembles a Adper, except that it has two or four substances on
its head Hke horns.

Madden, a late traveller in the East, gives a different account

of the horned serpent (coluber cerastes) ; he says that of two
which he purchased from the Psylli one was a foot long, and
the other a foot and a half. A
lancet smeared with the venom
of one of them killed a dog in three hours. The French na-
turalists who attended the expedition to Eg}-pt found a Adper,
called hage by the inhabitants, which they held to be identical
with the asp of the ancients. We need have no hesitation
then in deciding that the coluber ^Egyptiacus is the celebrated
asp of antiquity. That the cerastes was a variety of the asp
seems highly probable from the description which Nicander
gives of both. (Theriac 177 and 259.) See also Wilkinson^s
'Thebes,^ p. 378. In fine, the asp and cerastes were merely
varieties of the common ^aper of Egypt.

SECT. XIX. ON THE BASILISK.

This reptile seldom comes under the sight of men ; but

Erasistratus says, when the basilisk bites one the wound becomes
of a faint golden colour, and he also says that three di'achms
of castor taken in a draught proves a remedy in such cases,
and in like manner the juice of poppy; but we have had no
trial of these things.

Commentary. The basilisk, according to Nicander, has a Comm.

sharp body about three palms in length, of a bright yellow
 190 BASILISK. [book v.

OoMM. colour, and is called the king of reptiles, because all the others
'

Pliny, Solinus, and most of the ancient

'
flee from his hiss.
authorities seem to copy Nicander's description of the basilisk.
The symptoms produced by his sting are said to be inflamma-
tion of the whole body, lividity and putrefaction of the flesh.

(Theriac. 1. c.) See also Galen (Ther. ad Pison.)

Avicenna states that the basilisk stupefies birds and other ani-
mals which approach him. He relates the case of a soldier who
transfixed a basilisk with his spear, and the poison proved fatal
both to him and his horse, whose lip was accidentally wounded
with the spear. Lucan relates the case of a soldier in the
army of Cato, who having wounded
a basilisk with a spear, and
having hand
aS'ected
felt his with the poison, saved his life by
immediately cutting it off with his sword. (Pilars, ix, 830.)
Similar histories are given by Pliny, Dioscorides, Actuarius,
and Isidorus. Solinus affirms that it proves fatal to all beasts,

birds,and vegetables.
For an exj)lanation of the passages of scriptui'e wherein
mention is made of the basilisk, see Bochart (Hier. ii, 339.)
Spreugel says :
''
Linnaeus omnem fabulam (de Basilisco) ad
Lacertse genus, capite cristato, Iguance proximum, reduxit."
(Comment, in Dioscor.) M. TAbbe Bonneterre also affirms
that the basilisk is not poisonous. (Encyc. Method.) It may
be doubted, however, if we be now acquainted with the basihsk
of the ancients. would appear to us almost certain that the
It
ancient basilisk must have been either the cobra di capello, or
one of the serpents described by an intelligent traveller under
the names of buskah and el effah as being still found in
Morocco. (Jackson's Account of Morocco, 109.) The former of
these, indeed, judging of it from the draAving which he gives
must be a variety of the cobra or coluber naja, L. We may
add that a very intelligent modern authority on the toxicology
of the ancients, Ardoyn, gives such a description of the
basilisk as applies very well to the cobra. The crown (corona)
on the head can refer to no other serpent than the hooded
snake. (De venenis, vi.) It is now Avell ascertained that the
cobra is indigenous in Africa.
SECT. XX.] «EA PASTINACA. 191

SECT. XX. ON THE SEA PASTINACA AND MUR^NA.

In the case of sea animals, such as the fire-flaire and murenCj

the diagnosis obvious, for these fishes are well known. Those
is

who are bitten by them are remedied by four drops of the

juice of or a little more, with three or four small branches

figs,
of wild thyme in a draught, and those things used for echidna.

Commentary. Nicander says that the sting of the pasti- Comj

naca occasions putridity in the flesh of a man who is wounded ^ '

by it, and that it proves fatal to a tree in like manner. The

same thing is asserted by Aetius, Oppian, Phile, and vElian.
Our author and Actuarius copy from Dioscorides.
Avicenna recommends an embrocation of hot vinegar, and
ointments composed of bay-leaves, oil of pellitory, and so forth ;
and in like manner recommends various calefacient medicines
internally.
The murene of the ancients was that elegant species of eel
to which the scientific name of murcena helena is now applied.
It is rarely found on the British coasts but is common in the
Mediterranean. The pastinaca marina of the ancients, was
the raia pastinaca, L, tryg on pastinaca, Cuvier, namely, the
i.
q.,

sting-ray or Sprengel affu'ms that its sting is not

fire-flaire.

venomous, as the ancients represent ; but there can be no doubt

that it is capable of producing inflammation. See Yarrel (British
Fishes, ii, 588.) We may mention in this place that the account
of the copulationbetween the viper and the murene which is
given by Nicander, Oppian and other ancient authors, is held
to be fabulous by Andreas, the physician, as quoted by the
schoHast on Nicander. (Ad Theriac, 822.)

SECT. XXI. ON THE SEA-DRAGON.

Bub the wound inflicted by the sea-dragon with lead, or

apply a cataplasm of pounded wild thyme, or of boiled lentil,
or of sulphur with vinegar, or the dragon itself may be torn in

pieces and applied. Wash the part with human urine, and
give potions of wormwood with diluted wine, or of sage, or of
 192 SEA-SCORPION. [book v.

fig brandies steeped in sweet wine, or of the brains of the

fish itself.

CoMM. Commentary. A
great variety of remedies for the wound
"

For an account
'
*
of the sea-dragon are described by iSTicauder.
of the draco, see Dioscorides (vi, 45)|; Aristotle (H. A. riii, 13) ;
^lian (H. A. xiv, 12) ;
Nonnus (276) ; Pliny (H. N. xxix, 20);
Aetius (xiii, 39) ;
Phile (80) ; Avicenna (iv, 6, 3.)
We
need have no hesitation in referring the sea-dragon of
the ancients to the trachinus draco, L., Angl., the great weever
or sting-ball. This is agreed upon by all the best commen-
tators, as Rondelet, Artedi, Coray, and Sprengel. Fishermen
are still very apprehensive of its sting. See Yarrel (Brit.
Fishes, i, 25.)

SECT. XXII. ON THE SEA-SCORPION.

The wound of the sea-scorpion is cm'ed by a surmidlet torn

in pieces and applied, by sulphur \-i's-um rubbed with vinegar,
or by tlu'ee bay-berries pounded and drunk.

CoMM. Commentary. SeeDioscor. (vi, 45); Konnus (277) ; Aetius

' '

40); Athenseus (353, ed. Casaubon.); Avicenna (iv, 6, 2t,

'
(xiii,

23.)
Bochart says of the sea scorpion " Is cum terrestri nihil :

habet commune prseter venenatos aculeos, non in cauda sed in

capite et toto corpore sparsos," (Hierob. ii, 635.)
According to Sprengel, it is either the scorpana scrofa or the
coitus scorjrius Bloch. (Comment, in Dios.) It is a fish still

very much di-eaded on account of its sharp spines. See Yarrel

(Br. Fishes, i, 76.)

SECT. XXIII. THE PREPARATION OF THE BLOOD OF THE SEA-

TORTOISE.

The blood of the sea-tortoise is to be prepared for keeping

in this Having stretched the tortoise with its belly
way.
upwards on a wooden or earthen vessel, cut off its head quickly.
SECT. XXIV.] CROCODILES. 193

and when its blood is coagulated, divide it into many parts

with a reed, put a sieve upon the vessel in place of a lid and
lay it up in the sun. When dried take it and use for bites of
two drachms with one cyathus of vinegar,
capers, as aforesaid;
on the second day four drachms with two cyathi of vinegar,
and on the third eight drachms with three cyathi of vinegar.

Commentary. This section is copied from Aetius (xiii, 24.) Comm.

'
In our translation we have followed the text of Aetius, that
of our author being manifestly corrupt.

SECT. XXIV. ON PERSONS BITTEN BY CROCODILES,

For the bites of the crocodile apply levigated natron until

the ulcer be cleansed, then fill it with honey, butter, stag's
marrow, or the fat of geese. But Galen says, that he has
knoAvn persons bitten by crocodiles manifestly relieved by the
application of the fat of the crocodiles themselves to the wounds.

Commentary. This case is more fully treated of by Aetius Comm.

'

mostly of an acrid stimulant nature

*
(xiii, 6.) His remedies ai'e

such as misy, pickle, salts, myrrh, verdigris, &c. The appli-

cation recommended by our author upon the authority of
Galen is ascribed by Aetius to Apollonius.

SECT. XXV. ON PERSONS BITTEN BY A MAN.

It will not be foreign to my subject along with venomous

animals also to treat of persons bitten by men, since the bites
inflicted by men are much more mahgnant than other ulcers,
more especially if the person who bit happens to be fasting,
or had previously eaten some pulse, particularly dried lentil.
Wherefore, the general remedies for poisonous animals may be
applied externally to the bite with advantage at the com-
mencement, with the exception of such as are very acrid and
caustic ; in particular haring first rubbed the bite with oil,

apply a cataplasm of the roots of hog's fennel with honey, or

apply the flour of beans with oxycrate, and \'inegar and rose
"

II. 13
 194 ON POISONS. [book V.

oil, sponging it
frequently. And use tlie following plaster: Of
squama ?evis, of garoanum, of verdigris, of each, oz. 3 ; of wax,
lb. y, of molybdsena, lb. ij ; of oil, one sextarius. The molybdsena

being first boiled in tlie oil receives the verdigris and squama

seris, and when it thickens it receives the soluble substances.

When the inflammation subsides treat it as a common ulcer.

CoMM. Commentary. Similar treatment isrecommended by Aetius

'~^^~'
(xiii, 1) ; Apuleius (9, 2) ;
Serenus (45) ; Pliny (H. N. xxviii, 4);
Oribasius (de Morb. Curat, iii, 71) ;
Avicenna (iv, 6, 4) and ;

Haly Abbas (Pract. iv, 28.)

It may be proper to mention in this place that instances
have not been wanting in modern times to confirm the accounts
given by ancient authorities, of fatal effects being occasioned
by the bite of a man. See liildanus (Chirurg. i) Forestus ;

(xxx, 12) ;
Hoff'man (Diss, de saliv. et op. morb. 5) ;
Zacutus
Lusitanus (Prax. adm. iii, 84, 89.)

SECT. XXVI. ON POISONS.

Having given a compendious account of venomous animals,

we shall next treat of deleterious substances, giving an exposi-
tion of the simple ones, and detailing the symptoms of them
with their general and particular remedies. As to the com-
pound ones we leave them to be treated of by any person who
chooses for some have described the compositions of certain
;

deadly medicines which are more likely to prove injurious than

beneficial to the reader. For neither are the exact symptoms
which occurred in those who took them described, by which a
suitable remedy might be found out for the symptoms ;

varjdng according to the nature of the prevailing ingredient,

one might, from conjecture, vary the remedies according^.
Wherefore here again we must begin with the prophylactics.

CoMM. Commentary. We now enter upon the consideration of

'
the second and most important di^dsion of toxicology ; namely,
alexipharmics, Avliich treats of poisonous substances taken in-
wardly. All the writers on theriacs treat also of alexipharmics,
and of these the most ancient, and one of the most interesting.
 SECT. XXVII.] PRESERVATIVES FROM POISON. 195

isthe Colophonian poet Nicauder. Of the subsequent authors, Comm.

'

Dioscorides and Aetius among the Greeks, and Avicenna and '

Alsaharavius among the Arabians, are most

particularly de-
serving of notice.

SECT. XXVII. ON THE PRESERVATIVES FROM POISONS.

Of
the doctrine of poisonous substances, the most difficult
part the prophylactic ; because those who administer poisons
is

in a concealed manner, prepare them so as to deceive the most

skilful. Thus they take away the bitterness of deleterious
substances by mixing them with sweet things, and the fetid
smell by a mixture with aromatics. Sometimes in diseases,
while appearing to administer such things as wormwood,
southernwood, opoponax, and castor, for a beneficial purpose,
they mix poisons with them ; or they give them in the food,
namely, in the harder and more complex articles, mixing the
poisons with them. Wherefore a person who entertains sus-
to avoid all prepared dishes and
picions, ought every intense
) quality, such as sweetness, saltness, and acidity ; and in parti-
cular to take plenty of water, for when the
,
appetite is satiated,
the particular qualities are afterwards easily detected. There
/ is likewise another efficacious mode of for
prophylaxis :
they
who suspect anything of this kind should take such things as
will blunt and take away the eff'ect of the
poisons, as dried
grapes with walnuts, rue, a lump of salt, and citrons. Let
them also take rape-seed to the amount of a drachm in
wine,
or the leaves of calamint, or Lemnian earth, and
twenty leaves
of rue, and they will not be hurt by And certain
any poison.
antidotes taken with wine every day to the amount of an
Egyptian bean will protect completely, such as the one from
skink, that from blood, and the Mithridate, which king
Mithridates took every day as a preservative from
deadly
poison ; and being captured by the Romans, he drank twice of
a deadly poison, and not being able to
despatch himself thereby,
he killed himself with his sword. And since are some-
people
times exposed to deleterious things
accidentally in desert places
without design, if they happen to take up their abode under
certain trees, such as pines or firs,
they ought to be on their
 196 TREATMENT. [book v.

guard against deadly animals, whicli fall from them and the
roofs of houses, and keep the vessels in which their wine is

contained, and in which they boil victuals, well covered up, as

has been stated when treating of the preser^^atives from veno-
mous animals.

CoMM. Commentary. Nearly the whole contents of this section

""^^
are taken from Dioscorides. (Prsef.)
The accountof the treatment given by Aetius is somewhat
fuller than our author^ s, but not materially different.
Avicenna makes mention of the same medicines as Diosco-
rides, and says nothing of any other remedies.
Of the substances mentioned by our author, and the others
as preservatives from poisons, some are demulcents, and may
be supposed to act by obtunding the acrimony of poisons, such
as figs, walnuts, and rape-seed ;
some are simple absorbents,
such as Lemnian earth, which probably resembled red ochre,
and was also emetic some are stimulants, such as rue, cala-
:

mint, and Avine ;

and some are refrigerant acids, such as citrons,
which may be supposed to act as analeptics and restoratives.
A irgil mentions this property of the citron :

" Media fert tristes succos tardumque saporem

Felicis raali :
quo non prsesentius ullum,
Pocula si quando sajvae infecere novercas

Miscueruntque herbas, et non innoxia verba,

Auxilium venit, ac membris agit atra venena."
ii.
Georg.

See in particular Simeon Seth (in voce Ktr/oa) ; and Athen.

ii.)
Dr. Paris states that when a narcotic poison has
been ejected from the stomach, citrons or any fruit containing
\(Deip.
a vegetable acid will produce the best effects. (See Pharraa-

cologia i, 254.)

SECT. XXVIII. THE GENERAL TREATMENT OP THOSE WHO HAVE

TAKEN ANY SORT OF DELETERIOUS SUBSTANCE.

If any persons have already taken some deadly poison with

the intention of despatching themselves, such as often happens
in life, or from the wicked design of others, if it be obvious to
SECT. XXVIII.] TREATMENT. 197

us what substance has been taken, we can straightway

apply
the suitable remedy, as will be described in the account of them.
But if the medicine is unknown to us, we must have recourse
immediately to such things as are generally applicable to those
Avho have taken any poison whatever ; for to wait until the

consequent symptoms have come on, is to render the case

hopeless, since owing to the remedies being too long of being

applied such symptoms can hardly be removed wherefore, :

without delay, we must give warm oil by itself or with water,

and force them to vomit, or if oil is not at hand, butter with
hot water may be given, or a decoction of mallows, or of linseed,
or of spelt, or of fenugreek, or of nettle seed. For these things
will not only evacuate by vomiting, but will loosen the
belly
and counteract the bad effects of the poisons, by blunting their
acrimony; and more especially oil will do this, as you may
ascertain clearly from the following consideration. For if you
Avish to produce ulceration of the skin by means of cantharides,
quicklime, or some such acrid substance, and the body has
been previously rubbed with oil, no ulcers will take place, and
neither also can you astringe the body if previously rubbed
with oil. Besides, vomiting is not only useful by evacuating
the oS'ending matter, but by showing the poison which had
been taken from its smell, particles, or colour. For by its
smell and bitterness poppy-juice is known; by their colour, ceruse
and gj^sum ; by their coagula, milk and fresh blood ; by their
heavy smell and quality, the sea-hare and toad so that by :

these means we are enabled to have recourse to the remedies

which are suitable to each. With the oil may be mixed the
decoction of mallows, or the grease of geese, or broth prepared
from fat flesh or fowls, or the cinders of wood. Natron also
triturated with hydromel, much old wine, and those things
which are prepared from fat or butter are efficacious. Having
evacuated the contents of the stomach by emetics, we must
bring away whatever had passed into the intestines by a sti-
mulant clyster. After these things, we are to give milk to
drink, for whatever is noxious and deleterious will be readily
changed by it. We must also give those medicines which are

generally applicable to all such cases, among which are the

Lemnian vermilion, southernwood, agaric, hedge-mustard, the
root of eryngo, the seed of parsnip or of calamint, the Celtic
 198 TREATMENT. [book v.

uard, castor, the inner part of green fennel-giant, the flowers

of nerium (called also rhododendron and rhododaphon), the

juice of leeks, laserwort or

the juice thereof, sagapene, opo-

ponax, the juice and root of hog's fennel, the long birthwort,
the seed of Avild rue, the leaves of that species of oestrum,
called of each of these a drachm may be taken in
betony;
wine. The decoction of poley and liquid pitch in a linctus
is efficacious, and the aforesaid antidotes are excellent
also

remedies, especially the theriac from vipers. But they have

not the same power when taken after as before the poisonous
substances, for a dose which would have been sufficient, if
administered beforehand, to prevent any bad consequences,
must be given in a fourfold or fivefold quantity, in order to
prove eff'ectual when administered afterwards, and that too
not once, but twice a day. For such is the opinion of the
celebrated Galen.

the last two sentences the whole of

"
—"— thisCommentary.
CoMM.
'

section
Except
copied from Dioscorides.
is Celsus' dii'ections, so
" Commodissimum est
far as they go, are excellent :
tamen,
ubi primum sensit aliquis, protinus oleo multo epoto vomere:
deinde, ubi prsecordia exhausit, bibere antidotum ; si id non
est, vel merum vinum." The directions given by Aetius are
to the same purpose as our author's, but somewhat fuller. He
is particularly to be commended for the precision with which
he lays down the rules of treatment, when any organ happens
to be affected in an especial manner. Thus, if the poison
attack the bladder, he du'ects us to put the patient into a hip-
bath of oil or water, in which fenugreek, linseed, mallows, or
some such emollient herbs have been, boiled and to give him
to di'ink the decoction of some vegetable diuretic, such as

parsley, fennel, or spikenard. If the bladder be corroded he

directs us to give the seed of cucumber in diluted sweet wine.
In the same manner when the intestines are corroded the same
seed is to be given, and all heating articles are to be abstained
from. When the poison is determined to the skin, he recom-
mends the hip-bath of oil or water, friction with warm oil,
and the like, evidently Avitli the intention of evacuating it from
the pores of the skin. Food of easy digestion, soups with
honey, tender fishes, and the like are to be given. When the
SECT. XXVIII.] TREATMENT. ] 99

head is particularly affected lie directs us to evacuate the Comm.

bowels with a clyster of linseed, marshm allows, and a decoc-
^
tion of the root of the wild cucumbei", after which sternu-
tatories and odoriferous things are to be applied to the nose.
Like our author, he strongly commends Lemnian earth with
wine as an excellent and speedy emetic. This remedy is also
mentioned by Avicenna. Galen assures us that he found it
an excellent emetic in various cases of poisoning. (Simpl. ix.)
It consists principally of silica, alumina, and oxyde of iron.
Avicenna directs us to give immediately as an emetic, oil of
sesame or olive oil, impregnated if possible with the vu'tues of

dill, and afterwards to use demulcents, such as the decoction

of linseed, melted butter and milk. These emetics are to be
followed by clysters, provided the mischief has spread down-
wards. If the disorder continue, another emetic is to be given,
and draughts of milk repeated. AYheu, after the emetic,
inflammation supervenes, he directs us to give snow-water,
or of roses, and to promote vomiting with them.
oil When
the poison is ascertained to be of an inflammatory nature the
parts affected are to be cooled with camphor, rose-water, or
that of coriander ; or these things are to be congealed in snow
and applied over the vital organs. If the poison is ascertained
to be of a penetrating nature, medicines ai*e to be given
sliai'p
to blunt its acrimony, such as milk, almond oil, melted butter,
&c. Bloodletting, if indicated, is to be performed. When the
poison is known to be of a stupefying nature, garlic is to be

given, or the theriac and assafcetida in undiluted wine. When

it is particularly deleterious, the to be effected by
cure is

means of the mithridate, theriac, musk, and other aromatics.

He inculcates the necessity of preventing sleep and of rousing
by every possible means. The patient is to be covered with
aromatic cloths, the pit of his stomach is to be rubbed, his
face is to be fanned, his hair pulled, and in short, everything
is to be done to prevent him from sinking into a state of

stupor.
Haly Abbas recommends the same plan of treatment. When
the poison is discharged he recommends citrons, plums, and
the like, as restoratives. Rhases gives the following directions :

First, says, produce vomiting with oil and Avater

he then give ;

food of a nauseating nature to continue this operation ; if the

bowels are inflamed give snow-water and rose- oil, and after-
 200 DELETERIOUS SUBSTANCES. [book v.

CoMM. wards provoke vomiting once more administer the tlieriac, :

' '
'
rub the hands and feet, and when the poison appears to have
descended to the intestines give clysters. (Contin. 1.
c.) Rhases
and other of the Arabian authorities recommend the bezoar
stone as an antidote for poisons.

SECT. XXIX. A CATALOGUE OF SIMPLE DELETERIOUS SUBSTANCES.

Of deleterious substances, the following animals are destruc-

tive cantharis, buprestis, salamander, pine-caterpillar, the
:

sea-hare, the toad, the mute marsh frog, and leeches when swal-
lowed; and, of seeds, the henbane, coriander, fieawort, hem-
lock, and gith ; of juices, meconium, opocarpasum, thapsia,
elaterium, and maudragora; of roots, chamseleon, wolfsbane,
thapsia, ixia, hellebore, black agaric, ephemeron, which some
call colchicum, because it grows in Colchis ; of trees and pot-

herbs, smilax, which thymium, but the Romans called

some call

taxus, the strychnus furiosa, which is called dorycnium, the

Sardoan herb, which is a species of ranunculus, horned poppy,
pharicum, toxicum, wild rue, and mushrooms of animal pro- ;

ductions, fresh bull's blood, coagulated milk, Heraclean honey ;

of metals, g^^sum, ceruse, lime, arsenic, sandarach, litharge,
adarce, lead, and that which is called mercury; and of domestic
articles, much wine taken at a draught after the bath, or must,
or cold water in like manner.

CoMM. Commentary. Nicander, in his Alexiphai'mics, treats of

*
•
'

the following deleterious substances :

— 1, Aconitum, or wolfs-
bane ; Argenti spuma, or litharge ; 3, Buprestis ; 4, Cantha-
2,
rides; 5, Ceruse, or whitelead; 6, Conium, or hemlock; 7, Co-
riander ; 8, Dorycnium (see below) ; 9, Ephemeron, or meadow
saffron; 10, Fungi, or poisonous mushrooms; 11, Hirudines,
or leeches; 12, Hyoscyamus, or henbane; 13, Ixias, probably a

species of chamseleon ; 14, Coagulated milk ; 15, The sea-hare;

16, Papaver, or poppy; 17, Pharicum, probably a composition
from figaric (see Schneider's note); 18, the red toad and marsh
frog; 19, the salamander; 20, Bulls' blood; 21, Taxus, or the
yew-tree ; 22, Toxicum, not ascertained. See Aricenua.
The lists of poisonous substances treated of by Dioscorides,
x\etius, and Actuarius are nearlv the same as our author's.
SECT. XXX.] CANTHARIDES. 201

Those of Nonnus and Scribonius Largus are less numerous. Comm.

"
'
The Arabians treat of several substances, the nature of which
it is now difficult to determine. The catalogues of A-sdcenna
and Rhases are the fullest those of Haly Abbas and Alsalia-
;

ra^dus scarcely contain so many articles ; all of them, however,

contain several substances which are not treated of by the
Greek -^Titers on toxicology. Among these we may just men-
tion that they treat of the gall of the viper, of the leopard, of
an animal called leunza (lesena?), of the shark, and also of
the extremity of the stages tail, and bad castor. The sweat of
different animals is also included in their lists.

SECT. XXX. ON CANTHARIDES.

The most grievous symptoms follow the administration of

cantharides, for almost from the mouth to the bladder the parts
are tormented with a gnawing pain. The taste resembles pitch
or cedar rosin, and the patients have inflammation of the right

hypochondiium, with dysuria, and frequently they pass blood

by urine, and sometimes it is discharged by the intestines, as
in dysentery they fall into deliquium animi, nausea, and ver-
:

tigo, and at last they become delirious. The proper remedies

are vomiting with water and oil, di-inking milk, taking four
drachms of Cimolian earth with honied water, pine kernels, the
seeds of cucumber, fat beef soup, or soup of geese or of mutton ;
the flesh of fowls, lambs, sheep, or pigs, being tender and fat,
when boiled with linseed ; much must ; dr. iv of the bark of
rosemaiy ; and after the food inject by clyster the juice of rice,
or of chondrus, or of spelt, or of ptisan, or of mallows, or of
linseed, or of marshmallows, or of fenugreek. And sometimes
ha^^ng cleared out the intestine with honied water and nitre,
we may then inject these things, and afterwards allay the in-
flammation with cataplasms of linseed and barley ; for at first
these things are pernicious. Then we may have recourse to
baths of sweet water, and give the ointments of iris and of
roses in a draught.

Commentary. The symptoms occasioned by taking can- Comm.

tharides, according to Nicander, are erosion of the whole intcs-
^^ '
 202 CANTHARIDES. [book v.

CoMM. tinal canal^ ulceration of tlie bladder^ affection of tlie cliest, and
'
wild delirium. His remedies are emetics^ such as fat^ the oil
of iiis with rue, or Samian aster, laxatives, milk in clysters or
taken bv the mouth, and the decoction of vine-shoots with
honey. Dioscorides describes the symptoms in the same terms
as our author, and like him recommends emetics of oil and
emollient clvsters, such as the decoction of linseed or of mal-
lows. Like our author, he disapproves of warm applications,
such as cataplasms and the hot bath at the commencement,
because by their heat they promote the distribution of the poison
over the system ; but after a time they are useful, he says, by
allaying the pains and promoting the discharge of the poison
by tlie cutaneous perspiration. His other remedies being the
same as oiu' author's, we need not enumerate them. Galen
states that the wings and feet of cantharides prove useful for

removing the deleterious effects occasioned by taking their

bodies. His treatment otherwise, which is borrowed from
Asclepiades, is very similar to that of Dioscorides. He in par-
ticular recommends the Lemnian earth, or terra sigillata, as an
emetic in this case. (De simpl. ix.) He also speaks favorably
of milk. (lb. and de antidot. ii.) He approves veiy much of
animal and vegetable oils given in sweet wine or tepid water to
produce vomiting. Galen states decidedly that the viscus upon
which the action of cantharides is exerted is the bladder. (Ad
Pison.) The treatment recommended by Scribonius Largus is
Httle diffei'ent. Aetius, Oribasius, and Actuarius only copy
from Dioscorides, without suggesting any improvement. A^i-
cenna and Rhases mention that cantharides occasion inflamma-
tion of the penis and erections. They agree with the Greeks
in recommending oily emetics, clysters of the same, and, what
we believe is an improvement which we owe to the Arabians,
injections of rose-oil into the bladder by means of a waxen tube
(flexible catheter). Rhases approves of bleeding, provided it be
long since the patient was bled, and violent pain be felt in the
region of the thighs, that is to say, if the urinary organs are
much Haly Abbas mentions ardor urinse, strangiuy,
affected.
and bloody urine among the symptoms, and recommends oil by
the mouth as an emetic and purgative, and by injection.
Alsaharavius mentions swelling of the penis, bloody urine, and
suppression thereof, and remarks that the same eft'ects have
SECT. XXXI.] BUPRESTIS. 203

been sometimes brought on by tbe external application of can- Comm.

in which case he recommends the tepid bath and """^
'

tbarideSj
emollient fomentations. His treatment is like that of his other
countiymen ; for example^ he joins them in approving of inject-
ing rose-oil into the bladder.
It would appear that cautharides were sometimes used by
the ancients for the purpose of committing suicide. Accord-
ing to Cicero, it was by this means that C. Carbo destroyed him-
self. (Ad Familiar, ix, 21.)
Ambrose Pare, ]Matthiolus, and all the earlier modern writers
on toxicology, follow the treatment laid down by the ancients.
Notwithstanding the concurrent testimonies of all these autho-
'
rities. Professor Orfila, in the last edition of his Toxicologic,'
and Dr. Cluistison, in his late work on ' Poisons,' affirm " that
oil is the reverse of an antidote.''Yet, in a case lately pub-
lished, the free administration of olive-oil was followed by
copious discharges, both upwards and downwards, of cautha-
rides mixed with the oil. (Edinb. Med. and Surg. Jom-n.
No. 104, p. 214.) And siu'ely, if laxatives are to be adminis-
tered at all, oily ones are to be preferred, as producing least
irritation, and not being likely to be absorbed.
It can scai'cely admit of dispute, that the mylabris cichorei
is the same as the ancient cantharis. It is still used in Turkey
and India for the composition of blistering plasters, being pos-
sessed of much the same properties as the Spanish fly.

SECT. XXXI. ON THE BUPRESTIS.

Those who have drunk of the buprestis experience a taste

resembling fetid natron, which is followed by violent pain of
the stomach and bowels ; there is swelling of the abdomen, re-
sembling dropsy, and the skin of the whole body is distended,
the urine also being suppressed. They are relieved by the
same remedies as are given to those who have taken cautha-
rides; but they derive benefit in particular after evacuations by
vomiting and by the bowels, from taking dried figs, and drink-
ing the decoction of them with wine or milk, or a mixture of
wine and honey, and they may eat all kinds of pears, and take
 204 SALAMANDER. [book v.

a woman^s milk. When the violence of the disease has sub-

sided they may eat with advantage Theban palm-nuts boiled
in Avine.

CoMM. Commentary. Isidorus says of the buprestis, " animal est

' '
*
in Italia parvura, simillimum scarabseo longipedi." (Oi'ig- xii.

8.) See also ^Han (H. A. ri, 35); Pliny (H. N. xxx. 10.) The
symptoms and treatment^ as described by the other authorities,
are nearly the same as in our authoi*^s description.
Among the remedies recommended by Kicander, the most
efficacious are milk and emetics of tepid oil. (Alex. 360.) The
Arabians do not treat of this article separately from cantha-
rides, unless it be the stuphe of Alsaharavius. (Pract. xxx, 2, 8.)
We can have no hesitation in holding that the buprestis of
the ancients was the h/tfa vesicatoria, or Spanish fly. See
Sprengel (Comment, in Dioscor.) and Schneider (ad Nicand.)

SECT. XXXII. ON THE SALAMANDER.

When a person has taken of salamander, inflammation of"

the tongue supervenes, with difliculty of speech, trembling,
torpor, and ulceration. Certain parts of the body all around
become livid, so that often, if the medicine remain, they mor-

tify and drop ofl". In this case we should do the same things
as for cantharides ; but more particularly we must administer
to them pine-rosin, or that of the pitch tree, or galbanum with
honey, or pine-kernels with a decoction of ground-pine, or
nettle-leaves boiled along with liHes in oil, the boiled eggs of
land or sea tortoise, soup of frogs, having the root of eryngo
boiled with them.

CoMM. Commentary. The principal symptoms, as detailed by

'~^'
Nicander, are inflammation of the tongue, torpor, tremblings,
aberration of mind, vibices, &c. He treats it like narcotic
poisons, with stimulants and attenuants, such as pine-rosin, the
leaves of ground-pine, nettle-seed mixed with the flour of tares,
&c. Dioscorides, A^dcenna, and most of the authorities direct
us to treat this case of poisoning like that of cantharides ;
SECT. XXXIV.] SEA-HARE. 205

Alsaharavius recommends emetics, draughts containing pine- Comm.

seed, honey, vinegar, wine, &c., with fat flesh. Oil and milk
" ——
•>
'

are recommended by most of the authorities.

Avicenna says the salamander is a species of lizard. Aristotle
mentions the fabulous story of its being proof against fire as a
circumstance which was related. Pliny (H. N. x, 67), iElian
(H. A. ii, 31), and Phile (c. 17) repeat it confidently. On
the other hand, Dioscorides affirms that the story is entirely
without foundation (ii, 56.)
It is the ftalamandra terrestris. Sprengel says it emits a
cold mucus, which may extinguish a small fire. (Notae in Dios.
1.
c.)

SECT. XXXIII. ON THE PITYOCAMPA, OR PINE-CATERPILLAR.

When pine-caterpillar is drunk, there is straightway pain of

the mouth and palate, strong inflammation of the tongue, pain of
the stomach and intestines, with a prurient sensation of ten-
sion and there is a fiery heat of the whole body, and anxiety.
;

Such cases are to be relieved in like manner as those w'ho have

drunk cantharides but in their case, instead of plain oil we
;

may substitute the ointment of apples.

Commentary. Our author, and indeed all the others, only Comm.
"

copy from Dioscorides.

'

Sprengel mentions several species of erucse which infest

pine-trees, such as the leparis monacha, lasiocampa pini, &c.
(Notse in Dioscor.) Virey remarks, that among the Romans
there was an express law forbidding the administration of the
hairy caterpillar of the pine, as it produces the most serious
symptoms, and even loss of life, by its hairs. (Hist, des Mceurs
des Anim.)

XXXIV. ON THE SEA-HARE.

When the sea-hare has been drunk an ill-savoured taste, like

that of a fetid fish, supervenes, and after a time the bowels are

pained and the urine becomes obstructed, or if any is discharged

 206 RED TOAD. [book v.

it is of a purple colour.They loathe and detest all kinds of

fishes^ and have fetid perspirations
mixed with blood. We
must give them therefore asses' milk or must frequently, or a
decoction of the root and leaves of mallows, or the root of hogs-
fennel triturated with wine, or di'. j. of black hellebore, or of
the juice of scammony in honied water, and the warm blood of
a newly-killed goose, and river-crabs alone, if they can be borne,
may be given. It is a symptom of recovery when they can eat
fish.

CoMM. Commentary. Nicander's description of the symptoms is

" '

•
like our autlioi-^s, and his remedies are hellebore, and scammony,
asses' milk, &c. Haly Abbas recommends only emetics at first,
and afterwards milk. When there is continued oppression of
breathing he directs us to bleed and give the syrup of poppies.

(Pract. iv. 49.) Alsaharavius, like Nicander, depends princi-

pally upon drastic purgatives, such as scammony and hellebore.
(See also Nonnus, 279.) Galen says it produces ulceration of
the lungs. (See Ther. ad Pison. and de ^led. sec. gen. i.)
For an account of the lepus marinus, see ^Elian (H. A. ii, 45 ;
ix, 51j xvi, 19); Pliny (H. N. ix, 48; xxxii, 1); Dioscorides

(ii, 20; vi, 34,); Philostratus (vi, 32); Phile (93). Ac-
cording to Schneider, it is called marin in France.
chat
Gorreeus says it is a species of lizard, and resembles the land
hare only in colour. Sprengel inclines to think that it is
the ajjlysia depUans. See also Paris and Fonblanque (]Med.
Jurisprud. ii, 141.) Rondelet refers it to the class mollusca,
and gives a drawing of it. (De Piscibus, xvii.) BeUonius and
Gesner give the same account of it, and all agree respecting its
describe it as being a mass of neai-ly
poisonous quahties. They
unorganized flesh.
Virey says it has long appendages like the
ears of the hare, but which are its eyes.

SECT. XXXV. ON THE RED TOAD OR MARSH FROG.

Whenthe red toad or marsh frog is taken, it brings on

swelling of the body, \vith intense paleness resembling the
colour of the box-ti'ce ; and dyspnoea supervenes with foetor of
the mouth, hiccough, and sometimes an involuntaiy emission
sKCT. xxxvT.] LEECHES. 207

of semen. Thej^ are easily remedied, however, after vomiting, by

taking a large draught of undiluted wine^ and two drachms of
the root of sweet cane, or the same dose of cyperus. We
must also compel them to exercise themselves strenuously in
Avalking and running, on account of the torpor
which is upon
them and they ought to take the bath every day.
;

Commentary. Nicander says the bufo apricans super- Comm. '

induces upon the body difficulty of breathing, fetid breath, and

colour like that of the thapsus ; he means probably jaundice.
His remedies are, the flesh of frogs boiled or roasted, pitch
mixed with sweet wine and the spleen of a marsh frog. Pliny
is an effectual
says a decoction of marsh frogs in vinegar
remedy in this case and against salamanders. (H. N. xxxii, 5.)
Dioscorides recommends emetics, wine, and active exercise.
Avicenna, Rhases, and Haly Abbas recommend nearly the
same treatment. Haly approves of friction, especially over the
stomach. (Pract. iv. 49.) See a learned dissertation on the Poi-
sonous Uanse in Schneider's Notes on Nicander (Alexipharm.) ;

see also Gorrseus' Commentarv on the same. Schneider

inclines to think that it must have been the bnfo cornutus.
^lian states that when the blood of the phrynus is given
with wine, it proves a veiy fatal poison. (H. A. xvii, 12.) It
would appear from two passages in the Satires of Juvenal that
in his time ciiminal acts of poisoning were generally performed
by means of this substance. (See Sat. i, 510, and vi, 659.)
Paris and Ponblanque, however, deny that any species of toad
ispoisonous. See also Pennant, (B. Z. iii, 17.) He calls the
E,ana rubeta the natter-jack.

SECT. XXXVI. ON LEECHES.

If leeches have been swallowed with water, and have stuck

to a part in deglutition, you may ascertain that this has happened
from the mouth of the stomach being, as it were, sucked and
bitten, which is a symptom of the leeches having been swallowed.
Sometimes florid blood is spit up by hawking when the leeches
have fixed to the -udndpipe. They may be rejected by swallowing
brine, or the leaves of beet with vinegar, or by drinking snow
 208 CHAMELEON. [book v.

with oxycrate. Let gargles of nitre (soda) with water be used,

and of copperas with vinegar. When they have stuck to the

throat, put the patient into a warm hip-bath and give him cold
water to hold in his mouth, and they will readily come to the
cold. Some give bugs to those who have swallowed leeches.
I, says Galen, by using garlic in such cases, have not stood in
need of bugs.

CoMM. Commentary. Nicander judiciously recommends when

'
'
leeches have been swallowed to drink vinegar, to take ice or
snow, sea- water, fossil salt (sal gemmse?), or salt prepared
from sea-water. Dioscorides treats the case like our author.
Celsus merely says, " acetum cum sale bibendum est." Bugs
are recommended by Anatolius. (Geopon. xiii 17.)
Aaron, one of the authorities quoted by Rhases, directs us
to lay the patient in the sunshine and examine his throat care-
fully; and if the leech can be detected to extract it with a

forceps. If this cannot be effected he recommends him to gargle

the throat with some bitter decoction or to swallow the same, if
the leech has descended to the stomach. He also directs him to
hold snow in the mouth. (Contin. vii.)
Avicenna recommends nearly the same plan of treatment,
and, like our author, mentions the following device in order to
get a leech extracted that is fixed in the gullet. The patient
isto go into a hot bath and hold cold water in his mouth, which
will have the effect of attracting the leech towards it. (iii, 9, 5.)
"When a leech has fastened in the throat of a beast of burden
and cannot be got at by the hand. Columella directs hot oil to
be poured in by means of a pipe, or if it has passed into the
stomach, it is to be killed with hot vinegar, (vi, 18.) The va-
pour from pounded bugs was also a popular remedy in such
cases. (Ibid, and Geopon. xiii, 17.)

SECT. XXXVII. ON THE CHAM^ELEON.

When one has taken the black chamaeleon intense gnawing

and pain supervene, and tremors with disturbance of the whole
body then convulsions attack, with pituitous and frothy vomit-
;

ing, and in some cases hiccough with loss of speech, and distortion
SECT. XXXVIII.] HENBANE. 209

of the countenance. A wheat taken hot

fatty decoction of
will be applicable in such and a sweet watery wine also
cases^
hot, vomits, drinking of milk, emollient clysters, and fomenta-
tions by cataplasms. To that kind which occasions sufibcation
and lividity, a draught of wormwood or of natron with
oxymel
or of radishes will be
proper, and also fomentations to the
hypochondrium.

Commentary. Dioscorides and Aetius give a similar account Comm.

'

of the treatment and symptoms. On the '

chamseleon, see Apuleius

(de Herb. 109.) The black chamseleon treated of in this section
is the carthamus It is quite a different plant from
corymbosus.
the white chamseleon which is treated of in the 46th section.

SECT. XXXVIII. ON HENBANE.

Hyoscyamos when drunk or eaten brings on disorder of mind

like that of persons in intoxication but is
; easily cm^ed, being
remedied by copious draughts of honied water and milk, es-

pecially that of asses or, if not, of that of goats or cows, and

of the decoction of dried figs. Pine kernels are also serviceable
in such cases, and the seed of cucumber taken with must, and
salt wine with fresh axunge and must, and nettle-seed in like
manner, or natron with water will be proper, also succory, mus-
tard, cresses, radishes, onions, and garlic, each of these being
taken with wine. They must then be made to remain in a
state of rest in order that, like those who have drunk
wine,
they may digest what they have taken.

Commentary. The description of the symptoms in Nicander^s Comm. ' '

Alexipharmics is imperfect owing to an hiatus in the text.

"
His
remedies are milk, fenugreek, nettle-seed,
succory, cresses,
mustard, the heads of garlic, &c.
This section is taken from Dioscorides. Celsus recommends
hot water and milk, especially that of asses.
The description of the symptoms, as given by Aetius, is
somewhat fuller than our author^ s, but not otherwise different.
He and Scribonius Largus mention lividity of the members.
Alsaharavius says, it induces
sleep, stupor, and coldness of the
II. 14
 CORIANDER. v.
210 [book

CoMM. extremities. Avicenna and Haly Ahhas recommend the tlieriac

^-^— and '

antidote of Mitliridates. Rliases speaks liiglily of milk.

(Contin. ult.)
The general remedies which they all recommend are emetics,
vinegar, milk, sweet wine,
and at last, vegetable stimulants,
such as mustard and onions, and the theriac.
See an account of the different varieties of henbane known
to the ancients in Dioscor. (iv, 64.);
Galen (Med. Simpl. viii) ;

and in Schulze (Toxicol, vet. 20.) See

Pliny (H. N. xxv, 4) ;

also the Seventh Book of this work.

The Arabians, in this place, treat of another narcotic to which
See Avicenna
they give the name of Derufitum
or Dai'fion.

(iv, 6, 1, 4) ;
Ehases (xxxix.)

SECT. XXXIX. ON CORIANDER.

Coriander from its smell cannot be mistaken. When drunk

it renders the voice thick, and brings on madness
like that

from intoxication. Wherefore those who have taken it talk

obscenely, and the smell of the coriander is perceptible from

the whole body. They are relieved after the removal of the
iris (as mentioned above), by
poison by common oil or that of
undiluted wine with wormwood and drank by itself; by eggs
emptied into one vessel and triturated with brine and
swallowed ;
and brine also be drunk,
may and salt broth from a hen or a
goose, and sweet wine taken with lye.

CoMM. Commentary. According to Nicander, the symptoms are

' — — violent delirium,
^
'

and great derangement of the mind, as in in-

toxication. His remedies are principally emetics and wine,
the intention of gi\^ng which is quite obvious. Dioscorides

gives nearly the same account of the symptoms and treatment.

Galen (de Simp. Med. viii) attacks Dioscorides in the most
unmeasured terms for saying that the action of coriander is
frigorific, while, on the contrary, he
maintains that it is calefacient.
Avicenna combats the reasoning of Galen and agrees with
Dioscorides ; as do Apuleius among the Latins, and Alsaharavius
and Uhases among the Arabians. Pseudo-Macer calls it a cold
austere medicine.
SECT. XLi.] HEMLOCK. 211

With regard to the treatment, the Arabians recommend

oily Comm.
emetics, with soda, pepper, salt, strong wine, &c. Avicenna (iii,
——
'

6, 2, 8) ; Ehases (Cont. xxi) ; Alsaharavius (Pract. xxx. 2.)

Schulze is satisfied that the corion or coriandrum of the
ancients was the same as our coriander. He appears, however,
to have rather overrated its deleterions It is only
properties.
in particular states of the body that it proves at all
injurious.
(Toxicol, vet. vii.) Sprengel also is satisfied as to the identity
of the ancient and modern coriander. (Comment, in Dios.)

SECT. XL. ON PSYLLIUM OR FLEAWORT,

Fleawort when drunk occasions coldness of the whole

body
and torpor, with relaxation and lowness of spirits, which are re-
by the same remedies
lieved as those given to persons who have
drunk coriander.

Commentary. All the authorities agree in representing its Comm.

' '
"
effects asbeing similar to those produced by coriander. They
treat the case then upon general principles with wine,
pepper,
and other such stimulants.
Schulze finds some difficulty in acknowledging that the

plantago psyllium, L. is the true psyllium of the ancients, and

yet he admits that no other plant has so good a claim to be
identified with it. We see no grounds for scepticism on this point.

sect. XLI. ON CONIUM OR HEMLOCK.

Hemlock, when drunk, brings on vertigo and dimness of

vision, so that the person can no longer see even to a small
distance ;there is hiccough, disorder of the mind, and cold-
ness of the extremities, and at last he is suffocated in convul-
sions, the breath in the arteria aspera being stopped. At first,
therefore, as in other cases of poisoning, we must bring it up
by vomiting, and afterwards, by means of an injection, evacuate
whatever part had passed into the intestines ; and then, as our

great remedy, we have recourse to undiluted wine, giving it at

intervals, diu'ing which we must administer the milk of cows
 212 HEMLOCK. [book v.

or of asses, orwormwood with pepper, wine, and castor ; and

rue and mint, with wine, and a dram of cardamom or of storax;
or of pepper, Avith nettle-seeds in wine ; or the tender leaves of
bay tree ;
and in like manner laserwort^ or the juice thereof,
with common wine or must and sweet Avine drunk alone
;

answers well.

CoMM. Commentary. Theophrastus seems to have been acquainted

with the sedative properties of hemlock, for he recommends
pepper and rosemary as antidotes to it. (H. P. ix, 24) ;
and Athen. (Deip, ii, 73.) The operation of this poison in
'
the case of Socrates is well described by Plato in his Phsedo.'
Socrates, after swallowing the poisoned cup, walked about
for a short time as he was directed by the executioner : when
he felt a sense of heaviness in his limbs he lay down on his
back ; his feet and legs first lost their sensibility, and became
stifli' and cold and this state gradually extended upwards to the
;

heart, when he died convulsed.

The symptoms, according to Nicander, are dimness of sight,
vertigo, a sense of suffocation, coldness of the extremities, im-
peded respiration, and death. His remedies are emetics of oil,
or undiluted wine, clysters of the same, and undiluted wine
taken b}^ the mouth, with pepper, nettle, assafoetida, and the
like. Dioscorides, and all the other authorities, recommend
much the same treatment. Pliny and Aetius mention lividitv,
after death, as a sjonptom of poisoning by cicuta.

Theophi-astus (H. P. vi, 2) and Pbny (H. N. xxv, 95) have

described the conium. Schulze is satisfied that it is the conium
macuJatum, L., and in this opinion we fully agree with him.
He adds, that the ancients have made no mention of the
cicuta A-irosa.

Dioscorides and most of the others enumerate couATilsions

among the symptoms. It will be remarked, that in the ab-
stract given above of the symptoms of poisoning by hemlock
in the case of Socrates, we have stated that the great philosopher
died convulsed. This we think the true interpretation of the
term used by Plato (f/cd-rj^/;), although it has not been so un-
derstood by most of Dioscorides, in another
his interpreters.

place, states somnolency, coma, stertor, lividity, torpor, cold-

ness, stupor, insensibility, and pruritus of the whole body.
SECT. XLii.] JUICE OF THE POPPY. 213

as tlie common symptoms of poisouing by opium, mandragora, Comm.

or conium. ——
'

Scliulze ranks,
amongancient mistakes, tlie assertion of Galen,
that narcotic substances may, in some instances, become di-
gested and prove nutritive. But Dr. Christison says, that both
vegetable and animal poisons may become digested, of which
he gives an interesting example Avith regard to opium (On
Poisons, p. 52.)

SECT. XLII. ON THE JUICE OF THE POPPY.

When one has drunk of the juice of the poppy drowsiness

comes on, with coldness and intense itching, so that often
when the medicine takes effect such an itching comes on that
the person is roused from sleep The smell of the
thereby.
medicine too is emitted from the whole body. The remedies
in such cases, after rejecting the substance taken
by vomiting
with and evacuating downwards by a stimulant clyster, are
oil,

oxymel drank with salts, or honey with warm rose-oil, and

much undiluted wine with wormwood and cinnamon, and warm
vinegar by itself, and natron with water, and marjoram with
lye, the seed of rue and pepper given with castor, and oxymel,
savory, orthe decoction of marjoram with wine. must We
also rouse aromatics, put the person into a hot bath, and
by
foment on account of the pruritus which supervenes ; and after
the bath we may use fat broths, with wine or must. Marrow
also drunk with oil is useful.

CoM-AiENTARY. According to Nicander, the symptoms of poi- Comm.

' '

'
soning by poppy-juice are coldness of the extremities, eyes fixed,
heaviness of the eyelids, profuse and fetid perspiration,
pale-
ness, swelling of the lip, relaxation of the under jaw, slow re-
spiration, cold lireath, and the usual precursors of dissolution,
namely, distortion of the nostrils, lividity of the nails, and hol-
low eyes. His remedies are emetics, such as the oil of iris or
of roses, wine and honey ; hot drink and rousing the patient
by cries, striking his body in different places, and wrapping it
in cloths smeared Avith oil and hot wine, and the hot bath as
a restorative.
 214 JUICE OF THE POPPY. [book v.

CoMM.
' '
Tlie symptoms mentioned by Dioscorides are lethargy, violent
*
pruritus, and tlie perspiration smelling of opium. His remedies
are the same as those of our author, namely, emetics at first,
then clysters, and afterwards wine and vinegar, with various
stimulant and strong-scented things such as pepper, cinnamon,
;

castor, marjoram, &c. The patient is to be roused as directed

by Nicander ;
and baths and fomentations are to be used to
relieve the pruritus.
Galen relates the case of a person reduced to the last stage
of coldness, whom he saved by administering freely a strong,
light-coloured, and fragrant wine. Yet, he remarks correctly,
a small quantity of weak wine operates unfavorably by pro-
moting the distribution of the poison over the system. He,
in particular, recommends vomiting at first with wine and oil,

and afterwards strong clysters.

among the symptoms, violent pruritus and
Aetius mentions,
convulsions. None of the other Greek writers mention con-
vulsions, but among the Arabians, Avicenna, Rhases, and
,

Alsaharavius, have mentioned them. Modern experience has

determined that they are an occasional, but not a frequent
symptom produced by the immoderate administration of opium.
Scribonius Largus directs us, after repeated vomiting, to
apply embrocations of vinegar and roses to the head, to rub
the feet, and to put sinapisms to them and the thighs. Simeon
Seth strongly recommends vinegar.
Haly Abbas and Alsahara\dus, and, in short, all the Arabians
recommend nearly the same treatment namely, emetics of oil
;

and water, or oil and wine, hot clysters, acrid and strong-
scented things, such as castor, assafoetida, savin, &c., and the
warm bath, friction, sternutatories, and every means calcu-
lated to arouse, and to prevent sleep.

Serapion, Rhases, Avicenna, Haly Abbas, and Alsaharavius,

agree in stating that the smallest dose of opium which will
prove destructive to human life is two drachms. Modern au-
thors are not agreed as to the smallest quantity which may
prove fatal, but surely, as Dr. Christison remarks. Dr. Paris
has fixed the minimum dose too low, when he affirms that
four grains may be sufficient to produce this efi*ect. On the
other hand, wc should think that a smaller dose than that
mentioned by the Arabians might be sufficient to destroy life.
SECT. XLii.] JUICE OF THE POPPY. 215

Perhaps tlie ancient opium may have been weaker than that Comm.
" '

now in use. •

It worthy of remark, that most of the ancient authorities

is

recommend vinegar in cases of poisoning by opium, but we are

inclined to think that none of them administered it at the
commencement, nor until the poison had been removed from the
bowels. This practice agrees very well with the rule of treat-
ment down by Orfila, Paris, and Christison, who state
laid
that vinegar is prejudicial, if given at first, by favouring the
solution of the poison, but proves useful afterwards by acting
as a restorative to the system.
None of the ancient authorities recommend venesection.
In another work we have thus explained the ancient theory
of the action of opium upon the human frame.
'^
In order to
understand properly the ideas entertained by the ancients re-
specting the modus operandi of opium, it will be necessary to
say a few words in explanation of their opinions upon certain
points of physiology. Aristotle taught that the prime cause of
all the operations of life is mind, and that the prime instrument

by Avhich it performs them is heat, Avhich, therefore, he deno-

minates the co-cause (aui-cuTtoi-). He illustrates his meaning by
comparing the mind to the artificer, and heat to the wimble or
saw by which he performs his work. Having remarked, no
doubt, that the heart is the warmest part of the body, he appears
to have considered it as the spring which turns the whole ma-

chinery of the animal frame, the brain and nerves deriving their
origin and influence from it. (I need scarcely mention how
well these ideas accord with the ingenious hypothesis lately ad-
vanced by M. Serres.) Many facts, indeed, seem to point out
the supreme importance of the heart. It is, as the ancients

remarked, the pj-imum movens et ultimmn moriens ; and, along

with its accessory organ, the lungs, it is evidently the part
which, in the higher classes of animals, renders them indepen-
dent of the many variations of heat and cold to which they are
subjected. It is this wonderful organ which, under the guid-
ance of the principle of life, preserves the heat of the body
unaltered in all the different gradations of temperature, from
more than 100 degrees above the boiling, to as many below the
freezing point of the thermometer. It seems, in fact, a real
Prometheus that steals the fire from heaven. The connexion
 216 JUICE OF THE POPPY. [book v.

CoMM. between heat and tlie vital actionsvery apparent also in the
is
" '
''

inferior animals^ who are not provided with such an apparatus

for preserving an equability of temperature. Thus the zoophyta^
insecta, et vermes, Avith the loss of heat, lose also sensibility and
muscular energy, which they recover again when their heat is
restored. In this case it is evident that heat is the cause (or
at least the co-cause) of the vital actions, and not the vital
actions of heat. It has always appeared to me
a striking fact,
illustrative of the great influence of heat over the vital actions,
that the strength of all animals is, bulk to bulk, proportionate
to the degree of their animal heat.
" This doctrine of the
supreme authority of the heart, as being
the focus of heat, thus maintained by Aristotle, was eagerly
defended by the great Arabian commentator, Aven-hoes, and
bv his countryman, Avenzoar, who keenly attacked Galen for
having questioned its truth, and taught, as they represent, that
the brain is the leading organ in the animal frame. After
hanng, however, carefully ransacked every part of Galen's works,
in which I could suppose it likely to meet with any allusion to
this doctrine, I am led to believe that these Ai'abians, in the
heat of controversy, have misrepresented the real opinion of
their master's rival. .Galen appears decidedly to have main-
tained with Hippocrates '—that there is in the body no one
beginning, but that all parts are alike, beginning and end for :

a circle has no beginning.' Agreeably to this idea, Galen re-

marks, that the brain cannot properly be said to derive its powers
from the heart, since an animal will run, breathe, and cry after
its heart has been taken out nor can the heart be said pro-
;

perly to derive its powers from the brain, since it will palpitate
and contract, after all commimication with the brain is cut off,
nay, after it has been removed from the body. In so far, then,
the functions of the brain and the heart are independent of
one another. But the brain is dependent upon the heart
and its appendages for vital heat, without which it would be
unable to continue its functions and the heart, on the other
;

hand, dependent upon the brain for imparting nervous in-

is

fluence to the respiratory organs, without which it could not

preserve its vital heat unaltered. Hence the mutual con-

nexion and sympathy of important organs —
a doctrine much
insisted upon by ancient authors, and which bears some resem-
SECT. XLiT.] JUICE OF THE POPPY. 217

blance to the theory lately advanced by Mr. Morgan and Dr. Comm.
' '
"
Addison.
" We now have no
shall difficulty in understanding the ideas
of the ancients regarding the operation of opium. Galen and
Avicenna believed that the poison exerts its primary influence
upon the and impairs its vital heat. Of course they con-
heart,
sidered operation on the brain as secondar}^
its
They called
the action of narcotics frigorific or congealing, no doubt because
they remarked that it was attended Avith a diminution of vital

heat, and
to this they attributed the loss of sensibility and
muscular energy. I leave it to the reader to judge whether
this theory or the modification of it lately proposed by Messrs.
IMorgan and Addison be the more plausible." (Edinburgh
Medical and Surgical Journal, No. 103.)
But although the ancient physiologists maintained that the
prime organs of the animal frame suffer sjonpathetically in cases
of poisoning, they did not hold, it will be remarked, that all
poisons exert their primary action on the nervous system. This
is the
hypothesis lately advocated by IMessrs. Morgan and
Addison, but which is, in fact, only a revival of that maintained
Toxicologia Veterum.^ He thus states his
'
by Schulze in his

theory of the action of poisons,

" Omnia —
sj^mptomata et le-
thales venenorum effectus hoc unum quam luculentissime demon-

strant, ab omnibus veyienis nervos ipsos graviter affligi. Nervea

igitur vis sen Adtalis, a veneni stimulis commota, aut majori
impetu agit, aut prsevalente veneni vehementia prorsus silet,
nexusque omnes sensorii communis cum reliquis nervis tur-
bantur, vita animali aut gra^dter perichtante, aut prorsus
interitura." (Toxic. Vet. vii.) Dr. Mead also, in his last
edition of his work on Poisons, advocates this hypothesis.
It appears to us, however, that this theory, although very
simple and plausible, is somewhat too exclusive. And that there
are other modes by which poisons operate than through the brain
and nerves appears to be demonstrated by the now clearly
fact

established, that poisons act upon vegetables as well as upon

animals. (V. Annales de Chimie, t. Now xxix.) as vegetables
are possessed of neither sensibility nor motion, it seems pre-

posterous to suppose that they have any nervous system.

Perhaps, then, we cannot do better than revert to the old
doctrine delivered by Alsaharavius. Sometimes, he says, poisons
 218 MANDRAKE. [book v.

'
CoMM. act
'
upon the heart, and thereby prove instantly fatal ; some-
"
times upon the liver, producing jaundice and phthisis ; some-
times upon the brain, when they occasion delirium ; and some-
times their action is local, giving rise to corruption and lividity
of the part. (Pract. xxx. 2, 18.)
That the primary action of narcotics is upon the heart appears
to us, upon the whole, the most probable theory hitherto ad-
vanced upon the subject.

SECT. XLIII ON THE JUICE OF THE CARPESIA.

When is drunk it brings on heavy

the juice of carpesia
sleep and acute These
suffocation. are relieved by the same
remedies as those given to persons who have drunk hemlock.

CoMM. Commentary. This section is taken, almost word for word,

" '
"
from Dioscorides. Matthiolus confesses that he was quite un-
able to determine what substance it was. (Comment, in Dioscor.
vi, 13.) It is doubtful whether the Ka^irriaiov of Galen and the
of Dioscorides be the same substance, and whether
KapTraaoi'
either be the same as the oTroKapTraaov. Sprengel can ai'rive
at no certain conclusion respecting it. Valerius Cordus sup-
posed it to be the j^iper longum.

SECT. XLIV. ON MANDRAGORA OR MANDRAKE.

When mandragora has been drunk, stupor immediately

comes on, with loss of strength, and a strong inclination to
sleep, so that the affection differs in nothing from that which
is called lethargy. Before any of these symptoms come on,
vomiting will be proper in this case ; and afterwards honied
water, or natron and wormwood with must, or taken in a dulci-
fied wine, embrocations to the head with rose-oil and vinegar,

rousing by shaking the body, and by strong-smelling things,

pepper, mustard, castor, and rue pounded with -sinegar, liquid
pitch, and the wicks
of lamps lighted and extinguished, will be

proper. When they are difficult to rouse we may also apply

sternutatories, and have recourse to the general remedies in
such cases.
SECT. XLiv.] MANDRAKE. 219

CoMMENTAKY. OuT author, as usual, follows Dioscorides. Comm.

' '

Matthiolus, by the way, in his commentary, questions the pro-

*

priety of applying rose-oil and vinegar to the head, as these

things are of a cold nature, whereas stimulants and calefacients
are indicated. "Perhaps these things, when poured from a height

upon the head, might prove restorative and stimulant. The

other Greek authorities however, as, for example, Aetius and
Actuarius, approve of the practice. Alsaharavius recommends
emetics, and also directs us to pour vinegar and rose-oil on the
head, and to take vinegar in which hyssop and the like have
been boiled.
Rhases recommends vomiting by means of water, honey, and
fossil salt; after which sweet wine is to be
given, and vinegar
and rose-oil poured upon the head ; castor, pepper, and rue are
to be administered, along with sternutatories. He mentions,
however, that he knew an old medical man who cured a young
woman, who had fallen into a state of syncope, with flushing of
the face, after swallowing the apples of mandragora, by the
aff'usion of snow-water on her head. Avicenna properly directs
everything to be done to prevent sleep.
Schulze is satisfied that it is the atropa mandragora of Lin-
naeus. There seems no doubt, however, that the mandragora
of Theophrastus is the atropa belladonna; while the mandragora
mas of Dioscorides is the mandragor'a vernalis, Bertol. ; and the
M. femina of the same, the ma?idragora autumnalis.
Theophrastus, Dioscorides, Galen, Athenseus, Aetius, Suidas,
Hesychius, Apuleius, Pollux, and Frontinus, have made men-
tion of the hypnotic property of mandragora. It is singular
that it should now have fallen into neglect. It appears to
have been used as a medicine in the days of Shakespeare.
I ago says :

" Not poppy nor mandragora

Nor the drowsy syrups of the world,
all

Shall ever medicine thee to that sweet sleep

Which thou owed'st yesterday."
Othello.

We will have occasion to treat of it in the Seventh Bouk.

 220 WOLFSBANE. [book v.

SECT. XLV. ON ACONITUM OR WOLFSBANE.

Wolfsbane immediately after being drunk occasions a sen-

sation of sweetness on the tongue^ with a little astringency ;

vertigo supervenes, more especially when the person attempts to

rise up, and it brings on a watering of the eyes ; there is
heanness of the chest and abdomen, with eructation of much
flatus. In these cases the medicine must be brought up by
vomits, and the contents of the bowels evacuated by a clyster.
We must also give draughts from marjoram and rue, or from
horehound with wine, or from wormwood, or from rocket, or
from southernwood, or mezereon, or ground-pine. Opobalsam,
too, taken to the amount of one drachm, with wine, will hkewise
answer with them also the rennet of a kid, or of a hare, or of
;

a fawn, with vinegar, and the dross of iron, or iron itself, or

gold, or silver^ may be dissolved in wine, and the liquid taken,
and lye with wine, and the broth of a boiled cock, or the broth
of fat flesh taken with wine. The ground-pine, which is said
to be a specific in Heraclea of Pontus, where wolfsbane grows,
is called holocleron, but ionia in Athens, and sideritis in Euboea.

CoMM. Commentary. The symptoms, as described by Xicander,

" '
•
are astringency of the lips, palate, and gums, gnawing pains at
the stomach, singultus, flatulence, running from the eyes, double
vision, as from intoxication. His remedies seem to have been
principally emetics and calefacients. Thus he recommends a
handful of quickhme to be drunk with a hemina of wine, also
southernwood, spurge, ground-pine, marjoram, opobalsam, the
metallic preparations mentioned by our author, and the like.
The accounts of the treatment given by Dioscorides, Aetius,
and Actuarius agi^ee exactly with our author's. Avicenna,
Rhases, and Haly Abbas, in hke manner, recommend emetics,
clysters, and calefacient medicines internally.
Diogenes Laertius states, upon the authority of Eumelus the
historian, that Aristotle the philosopher despatched himself
with a draught of aconite. (Yita Aristot.) Pliny relates that
this poison proves fatal when applied to the genital organs of
women. (H. N. xxvii, 2.)
The ancients have described several varieties of aconite.
SECT. XLVI.] IXIA. 221

See Theophrastus (H. P. ix, 19); Pliny (H. N. xxv, 75); Schulze Comm.
' '

(Toxicol, vet.); Schneider (in Nicand. Alexiphar.); and Sprengel

'

(Rei. Herb. Hist.) These modern authors in general are dis-

it was the iris tuber osa.
posed to think that Sprengel^ how-
ever^ the
innotes to his edition of Dioscorides^ is decided
that the second species of Dioscorides (Mat. Med. iv^ 78) is the
aconitum napellus ; but respecting the first species, he is in
great doubts. All agree that the aconitum of Theophrastus is
diflferent from the A. of Dioscorides and the other toxicologists.

We may be permitted to add, that the symptoms of poisoning

by aconitum, as given by Nicander, agree so well with those

reported lately of cases of poisoning by the aconitum napellus,

that we cannot doubt their identity.

SECT. XLVI. ON IXIA.

Ixia, which is also called ulophonon, when drunk has some

resemblance both in taste and smell to basil-royal. It brings
on strong inflammation of the tongue, and disorder of the mind;
it suppresses all the secretions, occasioning borborygmi and
rumbhng, with dehquium animi ;
but there are no alvine eva-
cuations. After the greater part of the poison has been
brought up by vomiting, or evacuated by the bowels, they will
experience relief from drinking the decoction of wormwood,
with much "\rine, vinegar, or oxymel, or the seed of wild me,
or the root of laserwort, and in the like manner the decoction of
tragoriganum with some of the aforementioned, or with milk ;
or of turpentine, of nard, of castor, of laserwort, of each an obolus
in wine. The fruit also of the walnut triturated with wine will
be proper or of rosin, of castor, and of rue, of each dr. j ;
;

and in likemanner of mezereon, dr. ij ; of the juice of thapsia,

dr. ij,
with honied water ; and hot vinegar may be drunk by
itself.

Commentary. Nicander's description of the symptoms is Comm.

very similar to that given by our aiithor, and his treatment
seems to have been conducted upon the same principles ;
namely, by administering emetics and purgatives at first, and,
afterwards, discutient and detergent medicines, to overcome
 222 MEADOW SAFFRON. [book v.

CoMM. the viscid nature of the poison. Our author's plan of treat-
"— — ment
^
'

differs in no material respect from that recommended by

Dioscorides, Aetius, Actuarius, Avicenna, and Alsaharavius.

A"\dcenna described it by the name of aldabach ; Alsaharavius^
by those of alfos, alclolia, i. e. arbor risi.
Apuleius make ixias^ ulophonon^ chamseleon, ocymoides^ and
various cardui synonymes (109.) The ixias, according to
Gorrseus, is a species of chameeleon, but what species cannot be
determined. (See, also, Schneider's note on Nicander.) Mat-
thiolus calls it a glutinous substance, found in the root of the
chameeleon, or carline thistle. Schulze is decided that it was
a species of carlina (Toxicol, vet., 22.) See Harduin's note
on Pliny (H. N. xxii, 21.) After mature consideration, we
have no difficulty in referring it to the carlina acaulis, or car-
line thistle.

SECT. XLVII. ON EPHEMERON, OR MEADOW SAFFRON.

When one swallows ephemeron (which some call colchicum,

because grows in Colchis, or bulbus silvestris), pruritus takes
it

place over the whole body, as if stung by nettle or squill ; there

is a gnawing pain within, and great heat of the stomach, with

considerable heaviness ; but when the affection gains strength,

blood is discharged from the bowels, mixed with the scrapings
thereof. The same remedies are to be appUed as to those who
have dnink salamander, in vomits and clysters. But before
the medicine gain ground we must give a decoction of oak-
leaves, or of acorns, or of the rind of pomegranate, or of wild
thyme with milk, or the juice of bloodwort, or of vine-
tops, or of brambles, or of the medulla of fennel-giant,
or of myrtle berries, with wine; and when levigated myrtles
themselves are pounded and macerated in water, the liquor
thereof may be taken mth advantage. And, in like manner,
the middle pellicle of the chesnuts, called Sai'dian, may be
taken with the aforesaid juices, and marjoram may be drunk
with lye. Those affected are manifestly relieved by drinking
hot cow's milk, and retaining it in the mouth, so that they
who have plenty of it do not stand in need of any other
remedy.
SECT. xLviii.] THE YEW. 223

Commentary. Our author's detail of the symptoms is taken Comm.

' '

entirely from Nicander, and his treatment also is mostly derived *

from the same source. They seem to have depended principally

upon vegetable astringents^ such as oak-bark, pomegranate-
rind, and chesnuts, for checking the hypercatharsis. Pliny,
like oiu' author, strongly commends milk (H. N. xxvii, 33.)
Dioscoiides recommends emetics, clysters, vegetable astringents,
and demulcents. Alsahara^dus says, that hermodactylus occa-
sions pruritus of the whole body, swelling of the palate, pains
of the stomach, and the like. He recommends emetics, clys-
ters, cows' milk, and vegetable astringents, such as acorns with
wine. This, it will be remarked, is similar to the account
Avhiclithe Greeks give of the symptoms and treatment of
ephemeron, which is undoubtedly the colchicum autumnale ;
and this cii'cumstance tends strongly to prove the identity of
the ephemeron and the hei*modactylus. We agree with Schulze,
Prosper Alpinus, and Humelbergius, that they were unques-
tionably the same plant, notwithstanding that Sprengel, Mat-
thiolus, and Dr. IMurray are of a different opinion. Dr. Paris
considers that there is no doubt of their identity. (See a
learned dissertation on the Ephemeron in a note by Schneider,
on Nicander's Alexipharmics.) We shall only further add, in
this place, that the learned Ardoyn, in his elaborate work on

Poisons, contends, that there is no doubt of the identity of the

colchicum and the hermodactylus. We, in fact, are surprised
that this should have been ever questioned.

SECT. XLVIII.^ ON THE SMTLAX OR YEW.

The tree called smilax is named thymium by some, and taxus

by the Romans. When brings on coldness of the whole
drunk it

body, suffocation, and speedy death ; the remedies for which

are all those things which are given to those who have drunk
of hemlock.

Commentary. The description of the symptoms and the Comm.

plan of treatment are borrowed from Nicander, or, rather,

copied direct from Dioscorides.

Different opinions have been entertained respecting the

poisonous nature of the yew. Haller, Bulliard, and others,

deny that it is poisonous ;
while Berkley, Ray, Matthiolus, and
 224 STRYCHNOS FURIOSA. [book v.

CoMM. others, affirm that it is. Orfila holds it to be a narcotic poison

We
"
•

(chap, iv, cl. 4.) haA-e known

its proving instances of
fatal to cattle. The newspapers lately contained a melancholy-
case of a boy poisoned by yew-berries at Winchester. Mat-
thiolus is not pleased with Dioscoiides for making it to be a

frigorific medicine ;
but Orfila, it appears, gives it the same
character ;
that is to say, he holds it to be narcotic. Yirgil
alludes to its poisonous qualities :

Sic tua Cymteas fugiant examina taxos.

See, also, Theophrastus (H. P, i, 5, and iii, 9) ;

and Schulze
(Tox. vet. 17).

SECT. XLIX. ON THE STRYCHNOS FURIOSA, CALLED DORYCNIUM,

BY SOME.

When one drinks of dorycnium, which some call strj'chnos

it were, of milk to the taste ;
furiosa, there follows a sensation, as
constant hiccough, watering of the tongue, and frequent ejection
of blood ; and there are mucous discharges by the bowels, as
in dysenterical cases. They are to be remedied before any of
these symptoms supervene, by those things which are taken for
ephemeron, I mean emetics and clysters, and whatever else can
evacuate the substance which had been taken. Honied water
isa particularly good remedy or the mUk of asses or of goats
;

and sweet wine, in a tepid state, may be drunk with a small

quantity of anise. Bitter almonds also are proper, the boiled
breasts of fowls, all the shell-fish eaten raw and boiled, crabs
and crawfish, and the broth of them when drunk.

CoMM. Commentary. Our author's detail of symptoms is taken

'
— '
— mostly
'

from Nicander, perhaps, direct from Dioscorides.

or,
The poet's plan of treatment seems to have been much the
same as that of Paulus. He omits, indeed, to make mention
of emetics and purgatives as being general remedies in all cases
of poisoning ; but he recommends milk, must, and the Crusta-
cea, such as the pinna, echinus, &c. The other authorities
supply nothing additional. Avicenna treats of it under the
name of uva vulpis stupefactiva mala; he copies from Dioscorides

(iv,
6 ; i, 7.)
There is considerable difficulty about the nature of the do-
SECT. L.] SARDONIAN HERB. 225

rycnium. Our author, Aetius and Apuleius, make it to be Comm.

the same as the strychnos furiosa, which is generally held to ——
"
'
'

be either the solanum sodomeum, or the atropa belladonna.

On this subject, see Galen (de Med. sec. loc. x, 3)
; Pliny
(H. N. xxi, 105) ; Apuleius (de Herb., 22). Schulze affirms,
that none of the ancient poisons is so little known as the do-
rycnium. He is undecided as to its nature, except that it
belonged to the diadelphous or leguminous plants, and he is
inclined to think that it was an astragalus. (Toxicol. Vetemm,
2.) Sprengel inclines either to the convolvulus cneorus, L.,
or the con. dorycnium, L. But as far as we can see, the most
probable conjecture that can be made regarding it is, that it
was either the solanum sodomeum, or atropa belladonna.

SECT. L. ON THE SARDONIAN HERB.

The herb called the Sardonian is a species of ranunculus,

when drunk, or eaten, it brings on disorder of the intellect, and
convulsions with contraction of the lips, so as to exhibit the ap-
pearance of laughter. From this affection that ill-omened ex-
pression, the Sardonian laugh, took its rise. In these cases,
it wiU be proper to
therefore, after vomiting, give honied water
and milk, with embrocations and lubrications of the whole
body, by calefacient remedies; and to have recourse to hot-
baths of hot on and water, and to anoint properly and rub
them after the baths ; and, upon the whole, to conduct the
treatment as for convulsions.

Commentary. Dioscorides and our author are perfectly comm.

agreed as to the symptoms and treatment. Aetius recom- * •" ——
mends, likewise, castor with sweet wine. Solinus, like om'
author, says that it brings on contractions of the muscles, and
the risus Sardonicus. Avicenna acknowledges his ignorance
of the nature and proper treatment of this herb, but supposes
that it belongs to the class of acute .poisons. There seems,
however, no reason to doubt that it was a species of ranun-
culus. Schulze makes it the ranunculus sceleratus, L., which
bears the English name of celery-leaved crowfoot ; and we are
clearly of the same opinion, although Avicenna seems to make
II. 15
 226 PHARICUM. [book v,

CoMM. a distinction betAveen the Sardonian herb and the kebekenyi,

" '
'
or apinm risus, which is the ^ur^ayiov of Dioscorides. See
Alsaharavins (Pract. xxx, i, 39.)

SECT. LI. ON THE HORNED POPPY.

Seeing that the species of poppy called the horned^ when

eaten or drunk, brings on the same symptoms as the jnice of
poppy, it is to be treated by the same remedies.

CoMM. Commentary. Miller says that the glaucium is called horned

' '
'

poppy because it is a species of poppy having husks resembling

horns. See some account of it in Apuleius (53.) Schulze
remarks that Dioscorides has described several varieties of the

poppy. 1, Papaver hortense ; 2, P. opiiferum ; 3, P. agreste ;

4, P. rhseas ; 5, P. ceratites sive corniculatum ; 6, Hypecoum.

The fifth of these, or horned poppy, is the glaucium luteum.
Scop. Dioscorides gives a distinct description, but treats of it
as a medicine rather than as a poison. (M. M. iv, 66.) None
of the Arabians treat of it separate from opium.

SECT. LII. on PHARICUM.

The substance called pharicum in taste completely resem-

bles nard, and when drunk it brings on paralysis, with dis-
order of the mind and convulsion. After evacuation by vomit-
ing, we must give the patient to drink, along with wine, some
wormwood, cinnamon, myrrh, or Celtic nard (which some call
saliunca), or of spikenard, dr.ij,
or two oboli of myrrh mixed
with must or and the flower of safi^ron with wine.
iris, The
head is to be shaven, and a cataplasm consisting of barley-flom',
with le\ngated rue and vinegar, is to be applied.
ft

CoMM. Commentary. Nicander, like our author, compares its

' '
*
taste to that of spikenard, and says that it proves fatal in
one day, inducing delirium. He recommends the same in-
ternal medicines, and also makes mention of applying a stimu-
lant cataplasm to the head, evidently with a view of relieving
SECT. LiiT.] TOXICUM. 227

the phrenitis. The other authorities recommend similar treat- Comm.

ment.
' ——
«
'

There great disagreement among the ancient writers on

is

toxicology respecting the nature of the pharicum. (See the notes

of Gorrseus and Schneider on Nicander.) The former remarks
that many suppose it a species of nard. Dioscorides (Prfef. vi)
and Galen (Antidot. ii) make it to he a herb. Scribonius
Largus, and Hesychius consider it to have been a compound
medicine. After balancing all the statements Schneider comes
to the conclusion, that most probably it was a composition from

agaric. Schulze is wholly undecided as to its nature. (Toxic.

Vet. 21.) Sprengel, in like manner, can come to no certain
conclusion respecting it. (Notse in Dioscor. 1.
c.)

SECT. LIII. ON TOXICUM.

The toxicum seems to be so called because the barbarians

anointed their darts {ro^evnara) with it. When a person has
drunk of it, inflammation of the lips and tongue comes on, also
irrestrainable madness leading to various fantasies, so that in
the treatment of them they are difficult to cure, and it is rare
that any of those who have drunk of it can be saved. How-
ever, they are to be forcibly bound with ligatures, and com-
pelled to drink sweet wine with rose-oil, and to vomit. Turnip
seed, also, drunk with wine will be proper for them, and the
root of cinquefoil, the blood of a he or she-goat when taken,
oak bark, that of the beech or ilex triturated with milk ; also
quinces when
eaten, or triturated with pennyroyal and drunk
in water and ammomum, and the fruit of balsam with wine.
;

But if any escape the danger they remain for a long time con-
fined to bed, and when they get out of it they spend the rest
of their lives in a state of timidity.

Commentary. The symptoms detailed by Nicander are much Comm. '

the same as those enumerated by our author, namely, swelling '

of the mouth and throat, with violent internal pains. His

remedies likewise are much the same, namely, forcing the patient,
after he iswell secured, to drink wine until he vomit, and mak-
ing him take bruised apples, rose- oil, oil of iris, &c. He says.
 228 MUSHROOMS. [book v.

CoMM. certain savage

tliat nations
upon the Euphrates poisoned their
—
'
*
'

arrows with which rendered

it, theii' wonnds immedicable, occa-

sioning lividity and putrefaction. Dioscorides, Aetius, Actuarius,

and, in short, all the ancient authorities, copy his account.
It is very difficult to determine the natm-e of the toxicum.

Theoplu'astus describes a species of calamus by the name of

toxicus. (H. P. iii, 12.) Avicenna, however, admits that he was
wholly unacquainted with its nature, (iv, 6 ; i, 29.) Some have
supposed, with considerable probability, that it was a prepara-
tion from the rhus toxicodendron. Schulze is only decided
that it was a vegetable poison. (Tox. Yet. 19.) But it even
seems doubtful whether it was a simple or compound medicine,
and whether of an animal or vegetable natui'e. (See Schneider^s
note on Nicander's Alexiph. 248.) Sjirengel inchnes to the
opinion that it was collected fi'om the venom of serpents. (Notse
in Dioscor.) All, however, is mere conjectui'e on this subject.

SECT. LIV. ON MUSHROOMS.

Of mushrooms, some prove deleterious from their general

nature, and some by the quantity taken. They all bring on

suffocation resembling choking. The general remedy which is
to be instantly applied is to compel the persons affected to
vomit by means of oil. They are also wonderfully relieved by
drinking of the lye from A-ine-shoots, or from the wood of the
wild pear with oxycrate, salts, or natron. And wild pears or
their leaA'es, if boiled vrith mushrooms, take away their suffo-
cative quality, and if eaten they prove beneficial. Hen^s dung,
di'unk in oxycrate, proves beneficial to them ; likewise a drachm
of birthwort, or of wormwood with wine, and honey when hcked
or drunk with water ; and baum with natron, or the root and
fruit of all-heal with wine, the burnt lees of wine with water,
and copperas with vinegar, radish, mustard, or cresses when
eaten. And since certain mushrooms having been tasted of
by venomous animals occasion not only suffocation but also
ulceration of the intestines, we must give in such cases plenty
of Avormwood, and the decoction of figs, and of marjoram, and
honied water. Emetics, the hot hip-bath, and raw barley-
flour when appHed to the hypochondi-ia, will also be proper.
SECT. Liv.] MUSHROOMS. 229

Commentary. Nicander mentions suffocation as the com- Comm.

mon effect of taking mushrooms. His remedies are radishes, ' ——
"
'

rue, the flowers of copper, natron, mustard, lixi\ial ashes, &c.

Our author copies from Aetius. Simeon Seth recommends
honey with tepid water, and a moderate quantity of natron.
Ruffus (ap. Oribas. Med. Collect, viii, 24) recommends
clysters
of natron, wormwood, the juice of radish, and the decoction of
rue. Dioscorides recommends emetics of oil, natron, &c., and
afterwards vinegar and stimulant decoctions. Avicenna^s reme-
dies are nearly the same as those of our author. Alsaharavius
directs us to give at first emetics, and then calefacients, such as

pepper, cumin, wine, and, if necessary, the theriac. Haly Abbas,

in like manner, recommends emetics, and then wine with
honey,
the theriac, &c. The symptoms, he says, are cold sweats, faint-
ings, and embaiTassment of breathing. All -the ancient authors
affirm that mushi'ooms act upon the organs of
respiration, and
we remark that a sense of suffocation is e;enerallv mentioned
in the cases reported by modern writers.
For a full report of fungi, or mushrooms, see Dioscor. (iv, 53) .

Pliny (H. N. Schulze (Tox. Vet. 14) ; Sprengel'

xxii, 46) ;

(Comment, in Dioscor.) ; Schweighseuser (in Athen. Deipnos. ii,

59); Schneider (ad Nicand. Alex. 521). Diphilus, as quoted
by Athenseus, states that all mushrooms which are black, hvid,
and hard, or which grow hard after being boiled, are of a dele-
terious nature. He recommends us to give mulse, oxymel,
natron, and \dnegar, so as to produce vomiting.
Dioscorides gives the following characters of poisonous fungi :

Such as grow near rusty nails, or putrid rags of cloth, or near

the lodging-place of reptiles, or by trees which have bad fruits,
are deleterious j such have a glutinous coagulum (membrane
adhering to the cap ?) and when gathered soon become putrid
and melt away. (M. M. iv, 83). According to Sprengel, these
characters are not imiversally applicable (1. c.) ; but
considering
the experience which the ancients had in the use of these arti-
cles, they are no doubt generally so. The amanita muscaria,
the agaricus necator, and many other species,
may be set down
as belonging to the ancient list of poisonous mushrooms. —
Schulze, who appears to have paid great attention to the sub-
enumerates the poisonous mushrooms of the ancients as
ject,
foUows :
1,
—
Agaricus muscarius ; 2, Agaricus piperatus ;
 230 BULLS' BLOOD. [book v.

CoMM. 3, Agaricus emeticus ; 4_, Boletus versicolor; 5, Boletus larieis.

^--^
(Toxic. Vet. xiii, 5.)

SECT. LY. ON BULLS^ BLOOD.

The blood of a newly-killed bull brings on dyspnosa and

suffocation^ obstructing the passages about the tonsils and the
parts concerned in deglutition with violent spasms ; the tongue,
in such cases, is also found red ; the teeth are stained, and there
are clots between them. In this case we must avoid giving a
vomit, because the grumous blood will be more firmly fastened
in the stomach by being raised upwards with the contractions.
We must give those things which are calculated to dissolve the
coagulated blood and loosen the belly; green figs, therefore,
are to be administered when filled with juice, along with oxycrate
and natron. All kinds of rennet are also proper with vinegar,
and the root of laserwort, with its juice in like manner; also

cabbage seed, the lye of figs, and the leaves of fleabane Avith
pepper, and the juice of bramble with vinegar. The bowels
are also to be evacuated. Those who are going to recover have
fetid and bloody discharges by the anus. Cataplasms, made
of barley -flour with honey, are also to be applied to the regions
of the stomach and bowels.

CoMM. Commentary. BuHs^ blood being exceedingly \-iscid and

'

indigestible might prove deleterious by becoming quickly co-

agulated in the stomach : we do not find any mention of it,

however, in modern works on toxicology. Themistocles is said

to have despatched himself with it. Nicander makes no men-
tion of emetics, and Dioscorides, like our author, condemns the
use of them. Nicander recommends almost the same identical
remedies as our author. It will be remarked that they are all
of a penetrating, attenuant, and solvent nature, such as aa^UI
figs, natron, laserwort, the rennets of certain animals, &c.
Galen mentions the pernicious efi'ects of coagulated blood in
the stomach, and recommends hot vinegar for it. (De Al. boni et
mali succi.) Ruffns (ap. Oribas. Med. Collect, viii, 24) recom-
mends clysters composed of natron, vinegar, the decoction of
cabbage, and of its seed, with vinegar.
SECT. Lvi.] COAGULATED MILK. 231

The Arabians treat the case in a similar manner. Alsaha- Comm.

"

ravins directs us to give vinegar, natron, wine, and the like, *

also diuretics, but he forbids the use of emetics.

Sprengel inclines to believe that bulls' blood may prove de-

remain long in the stomach, by evolving
leterious, if allowed to
azotic gas. He therefore approves of the hot vinegar recom-
mended by Galen. (Comment, in Dios. 25.) Ardoyn states
that a large quantity of bulls' blood taken into the stomach

may produce suffocation by stopping the action of the dia-

phragm. (De Venen. iv, 23.)

SECT. LVI. ON COAGULATED MILK.

Those who take a large draught of milk containing rennet,

experience a great feeling of suflFocation from its becoming co-
agulated. In treating them, we may give as an antidote rennet
with vinegar, compelling them often to drink of it ; also the
dried leaves of calamint, and its juice in like manner, or the
roots of laserwort, or its juice with oxy crate, thyme with wine,
and the lye used by bonnet-makers ; but nothing saltish must
be given, for thereby the milk becomes more firmly coagulated
and isconverted into cheese. Neither must we make them
vomit, for thereby the coagula being lodged in the stomach will
produce suffocation.

Commentary. Gorrseus, in his notes on Nicander, remarks Comm.

that milk only proves prejudicial when taken in great quantity,

immediately after the rennet has been added to it, and before
ithas curdled. See also Matthiolus and Ardoyn (de Venenis).
Nicander recommends the same remedies as our author, namely,
such as are of a cutting and attenuant nature, as rennet, vine-
gar, wine, lasewort, &c. Dioscorides forbids all saltish things.
Ruffus (ap. Oribas. Med. Col. viii, 24) recommends a clyster of
vinegar and natron, or asses' milk with much salt. Celsus says,
with his accustomed bre\ity, " Si lac intus coit, aut passum, aut
coagulum, aut cum aceto laser." See also Galen (1. c.) Haly
Abbas, Rhases, Avicenna and Alsaharavius also recommend
rennet with pepper, assafoetida, vinegar, &c. For bad milk
which has spoiled on the stomach, all the Arabian authorities
 232 HERACLEAN HONEY. [book v.

CoMM. concur in recommending first an emetic of hydromel, and after-

' '
"
"wards wine with pepper.
milk
Sprengel accounts for the deleterious effects of curdled
in the same manner as he does for those of buUs^ blood, and re-

marks, that the acid contained in the rennet of certain animals

especiallyof hares, is well calculated for dissolving and evacu-

ating the coagulum (Comment, in Dioscor. 1. c.)
The Arabian authorities treat, among the deleterious sub-
stances, of flesh and fish which have been cooked and hung up
in a wet place until they have become unwholesome. When
eaten in this state, Khases says they bring on violent vomiting
and pm^ging, and may prove fatal unless the proper remedies
are applied. For these symptoms he recommends repeated
emetics and then pm-gatives ; after which wine and pepper is
to be given ; and, in the end, the remedies for poisonous mush-
rooms. (Ad INIansor. viii, 27, 28.) See also Alsaharavius (Pract.
XXX, 2, 15) Haly Abbas (Pract. iv.) Haly Abbas recommends
;

vomiting by means of tepid water, oxymel, and salt.

They treat, in like manner, of rancid fruits; which they

state act as poisons when eaten in large quantity. For the
cure of these they recommend emetics, the rob of bitter grapes,
and medicines to whet the appetite. Rhases (ad Mansor. viii,
30) Avicenna
; (iv. 6 i,;30.)
Avenzoar relates, at considerable length, the history of a case
in which dehrium and other bad symptoms had been brought
on and kept up by drinking out of a cup which had been poi-
soned with some putrid meat, (i, 9, 9.)

SECT. LVII. ON HERACLEAN HONEY.

Those who eat or drink the honey formed in Heraclea, of

Pontus, experience the same symptoms as they who have drunk
of wolfsbane, and the same remedies will be applicable. They
are readily relieved by drinking frequently of mulse, having
the leaves of rue mixed with it.

Commentary, This section is taken from Dioscorides.

Avicenna makes mention of a poisonous kind of honey pro-
duced in Arabia, for which he applies much the same remedies
as those recommended by our author, (iv, 6; i, 32.J
SECT. Lviii.] GYPSUM, 233

The Pontic honey in occasioning madness is men- Comm.

effects of
tioned in the '
Anabasis^ of Xenophon (iv, 8.) The same cha- ——
'
'
'

racter of it is given by Aristotle, Pliny, Diodorus Siculus, and

iElian. Toui'nefort confirms the ancient accounts of its inebri-
ating effects. See Sprengel (ad Dioscor. ii, 103.)

SECT. LVIII. ON GYPSUM.

Gypsum, when drunk, produces suffocation, bybeing converted

into stone hence we must transfer the remedies applicable to
;

those who have taken mushrooms, giving them in this case, and
substituting the decoction of maUows for oil; for being of a
fatty nature it lubricates the
parts, and prevents them from
being injm^ed by the stony hardness of the gypsum. Oil, also,
in honied water is proper ; and the decoction of
figs, and the
lye of figs, or of the ashes of vine-shoots with much wine, and
marjoram, or thyme with lye or vinegar. Clysters are also
to be administered, consisting of must and the decoction of
mallows.

Commentary. Our author copies closely from Dioscorides. Comm.

Rhases and A\icenna treat this case upon much the same' —— '
'

principles as the Greeks,

only they give scammony freely at
first, and dysentery supervene they recommend the remedies
if

suitable for it. Aetius, Dioscorides, and the other Greek au-
thors, although they approve of clysters, say nothing about
drastic purgatives. A\'icenna says, gypsum in its action resem-
bles ceruse, but is even more powerful than it in
inducing
strangulation. Haly Abbas says, gypsum occasions colic and
ileuswith dryness of the mouth, suffocation,
difficulty of making
urine, and so forth. He directs clysters at first, and afterwards
an electuary of pepper and mustard to be given. Alsaharavius
forbids emetics, recommends water mixed with
honey, and ohve-
oil for drink, also emollient
clysters, and sweet wine.
For an account of gypsum, see PHny (H. N. xxxvi, 59) and
Theophi-astus (de Lapidibus.) Isidorus gives the following de-
scription of it
" —
Gypsi plura genera
:
omnium autem opti-
:

mum, lapis specularis est enim signis sedificiorum, et coronis

:

gratissimus.'' (Orig. xvi, 3.) The gypsum speculare was evi-

 234 CERUSE. [book v.

CoMM. dently sclenite^ or crystallized sulj)liate of lime. See Matthi-

" '
'
olus (Com. in Dioscor.)
Dr. Kidd gives the following account of the varieties of the
ancient g}^sum
" It
:
—
was^ by the general description of it^
an earthy compound of lime ; but the ancient naturalists seem
to apply it to sulphate of lime, the
gypsum of the present day^
and sometimes to a calcined carbonate of lime, or quicklime,
which they called calx." (Mineral, b. i, p. 70).
Sir John Hill gives a full account of the ancient gypsums
in his notes on Theophrastus (de Lapidibus.) "
G^^^Dsum," he
" is
says, nothing more than a selenite less elegant than the
rhomboidal or plated kinds." There can be no doubt that the
yvdiOQ S^o(^o'l'TJc of Philoponus (Com. in Aristot. de Anima. ii)
was pure selenite. It is singular that our recent authorities on

toxicolog}^ have not included gypsum in the list of poisonous

substances which they treat of, although there is good reason
to believe that the powder, if given in any great quantity, is

highly deleterious. We
know for certain that gypsum, or stucco,
is often used for
poisoning rats and mice. It is further deserving
of remark that all the earlier modern authorities on medicine,
down at least to the middle of the 16th century, treat of gyp-
sum as an active poison. All the ancient authorities, it will
be seen, represent it in this light. Pliny makes mention of a
case of suicide committed by means of gypsum (H.N. xxxvi, 24.)

SECT. LIX. ON CERUSE.

Ceruse, owing to its colour, cannot be mistaken, and when

taken voluntarily it whitens the palate, tongue, and the intervals
betAveen the teeth. It also brings on hiccup and cough, dry-
ness of the tongue, and coldness of the extremities, with dis-
order of the intellect and difficulty of moving. In this case it
wiU be proper to give honied water or the decoction of figs, or
of mallows, or hot milk, or sesame triturated with wine, or the
lye of Aine-shoots, or the oil of marjoram, or of iris ; also the
bones of peaches, with a decoction of barley or frankincense,
or the gum of prunes, or the juice of the elm which is contained
in its follicles, along with tepid water but let them immedi-
;

ately vomit. The juice of thapsia will also be proper for them,
SECT. LX.] ARSENIC. 23.1

or three oboli of tlie juice of scammony, when drunk with

honied water.

Commentary. Nicander compares the colour of ceruse to Comm.

' '

frothy milk. The symptoms of poisoning by it are constriction '

of the palate and gums, asperity of the tongue, singultus, a dry

cough, nausea, heaviness of the head, unnatural vision, and

torpor. His remedies are emetics of oil, thin milk, decoctions
of mallows, sesame triturated with wine, prunes or elms, which
are to be given partly as emetics, and partly with the intention
of their being digested ; for which piu'pose the patient is to be
put into the warm bath. See the Paraphrase of Eutecnius ;

also Dioscorides, Aetius, Avicenna, and Rhases, who recommend

similar treatment. Aetius, like our author, directs us to give
scammony, evidently to counteract its astringency. Alsahara-
vius recommends emetics of the decoction of figs with mead or
common oil, the infusion of wormwood as a diuretic, scammony
with hydromel^ and hot milk. Rhases recommends emetics of
the decoctions of figs and oil, with drastic purgatives and diu-
retics. (Ad Mansor. ^nii, and Contin. xx, 2.) A^dcenna's prin-
ciples oftreatment are quite similar, that is to say, he trusts to
emetics, diuretics, and clysters, and prevents the patient from
sleeping, (iv, 6, 1.) Haly Abbas recommends an
emetic consisting
of honey with hot water, vinegar and salt ; he also gives diu-
retics, such as the infusion of parsley, fennel, anise, and southern-
wood. (Pract. iv.)
Dr. Alston says, " our white lead is certainly the ipi/nvOiov of
Dioscorides and the cerussa of Pliny .^' It was prepared by

exposing the carbonate of lead to the vapours of vinegar. See

Milligan (Ad Cels. p. 112.)

SECT. LX. ON LIME, SANDARACH, AND ARSENIC,

Lime, sandarach, and arsenic, when taken in a di-aught, bring

on pains of the stomach and bowels, with violent corrosion.
Wherefore we must administer all things of a diluent and solvent
nature, such things as will produce ready vomiting and lubricate
the bowels, as the juice of the marsh or common mallows, and
a decoction of linseed, or of spelt, or of rice, copious draughts
 236 LITHARGE. [book v.

of milk and honied water, broths -uliicli are fatty and contain
wholesome juices.

CoMM. Commentary. Nicander has not treated of poisoning by these

" '

Dioscorides, Aetius, and Actuarius give almost the

*
substances.
same account of the symptoms and treatment as our author.
Their remedies are emetics, lubricants, and laxatives. The
Arabians copy their descriptions and follow theu' treatment.
Thus Alsaharavius directs these cases to be treated by giving
emetics of oily and fatty things, emollient clysters, and unctuous
articles, to prevent ulceration of the intestines. Avicenna
orders, in the first place, an emetic of warm water and oil, then
emollient decoctions, such as those of linseed and mallows, and
fat broths and milk. The cough is to be soothed by demul-
cents, (iv, 6, 1.) Rhases states that quicklime and arsenic
occasion putrefaction of the intestines. (Cont. xxxvii. tr. 1.)
Galen, however, has stated that arsenic is not, properly speak-
ing, a septic, but a strong caustic. (De Simp. 1.)
However meagre this account of these
important medicines
may appear, it be seen, upon reference to the standard
will
works on toxicology, that the treatment at the present day
scarcely differs, in any one point, from the ancient mode of
practice. Emetics, demulcents, consisting of decoctions of
emollient herbs, or copious draughts of milk, laxatives and
clysters, form the present practice.
The ancient arsenicum, or auripigmentum, was orpiment ;
the sandarach was realgar, or the orange-red Our
sulphuret.
oxide of arsenic is a factitious substance, prepared by sublimation
from cobalt : it is much more deleterious than auripigmentum
or orpiment. Servitor and Avicenna have described the facti-
tious arsenic, or oxide of arsenic of the moderns. The Ara-
bian chemist Geber treats largely and
ingeniously of orpiment,
which he holds to be closely alhed to sulphur. He also speaks
of sublimed arsenic, (iii. 29.)

SECT. LXI. ON LITHARGE.

Litharge, when di-unk, brings on heaviness of the stomach

and bowels, with intense tormina ; sometimes by its
weight it
SECT. LXii.] LEAD. 237

Avounds tlie intestines^ occasions retention of urine and swelling

of the hodj, wliicli becomes of a leaden luie^ and assumes an

unseemly appearance. In such cases it will be proper^ after

vomiting, to give the seed of the wild clary (horminum) to drink
witli wine, three oboli of myrrh, wormwood, parsley-seed, pepper,
the flower of privet with wine, and the dried dung of wild pi-
geons, with nard and wine.

Commentary. The symptoms which Nicander mentions as Comm.

" '

being superinduced by litharge are borborygmi, pains resem-

•

bling those of ileus, retention of urine, and discoloration of

the skin. His remedies are carminatives, warm stimulants,
and such as myrrh, clary, St. Jolm^s-wort, hyssop,
diuretics,
pepper, hedge mustard taken in wine, the green shoots of
privet, and the fruit of pomegranate.
Scribonius Largus re-
commends emetics and calefacient medicines, such as pepper,
myrrh, parsley. The Arabians, namely, Rhases, Avicenna, and
Alsaharavius, concur in recommending emetics, drastic purga-
tives, and calefacient medicines.
The ancient litharge was prepared like the modern. It is a
semi- vitrified peroxide of lead.

SECT. LXII. ON LEAD.

Whena person has drunk the shavings of lead or its soil,

he experiences the same symptoms as those from litharge, and
is to be treated in the same manner.

Commentary. We
need scarcely say that litharge is now ascer- comj
tained to be a preparation of lead. (See the preceding section.)
—^
'

Most of the ancient authorities state, like our author, that the
symptoms and treatment of poisoning by lead and litharge are ex-
actly the same. It appears singular that it should be asserted in
some modern works on the materia medica that the ancients Avere
unacquainted with the deleterious properties of lead. Galen
even mentions that water conveyed in leaden pipes sometimes
proves deleterious by occasioning dysentery. (Med. sec. loc. vii.)
Aetius makes the same observation, (xi, 45.) Palladius, the
writer on agricultm'c, speaks of it in the following terms :
 238 MERCURY. [book v.

CoMM. " Ultima ratio est, plumbeis fistulis ducere, qufe aquas noxias
' '
"
reddunt ; nam cerusa plumbo creatur attrito, quae corporibus
nocet liumanis." (ix, 11.) Vitruvius also mentions that water
impregnated with lead is deleterious. (Arch, viii.) Pliny notices
the deleterioiis effects of the exhalations from lead mines.

(H. N. xxxiv, 50.)

The Greek on toxicology do not treat of copper
writers
as a poison ; but the Arabians have done so in brief terms,
all agreeing in recommending the same treatment as in cases

of poisoning with arsenic. (See A^dcenna, Rhases, Haly

Abbas, and Alsahara^ius.) These authorities, likewise, lay
down in very succinct terms the treatment of poisoning by
iron, which they direct to be conducted upon general prin-
ciples. They in particular recommend laxative and demul-
cent medicines. (See Avicenna iv, 6, 18.) As a slight novelty
in their practice we may mention that he recommends the
affusion of vinegar with oil of roses, violets, &c., upon the
head. Averrhoes recommends from - to 1 dr. of balsam.
(Coll. V.)

SECT. LXIIT. ON MERCURY.

Mercury, when swallowed, brings on the same symptoms as

litharge,and the same remedies are to be used in this case.
A copious draught of milk seems to be beneficial, and vomiting
ought to be produced.

CoMM. Commentary. Dioscorides, Galen, and Aetius give the

same imperfect account of this important medicine and poison
as our author gives, and supply no additional information of any

importance. The Arabians were better acquainted with its

properties, having ascertained that it might be taken in its
metallic state with impunity. Rhases says, " I do not think
that any great harm will result from diinking mercury when it
is pure, unless it be pains in the stomach and intestines. It
afterwards passes out in its natural state, especially if the per-
son who swallowed it moves about. I gave a draught of it to
an ape, nor did I perceive any inconvenience arise from it, ex-
cept, as I have mentioned, that it appeared to be pained in its
SECT. Lxiv.] HELLEBORE, ETC. 239

belly, for it often bit it with its mouth, and grasped it with Comm.
hands." (Ad Mansor. 42.)
viii,
its
—
'
— ^
'

Haly Abbas gives a similar account. Mercurj'^, he says, in

its natural state, is not poisonous, and merely occasions some
tormina in the belly ; but when killed (oxydised ?) it is dele-
terious, and is to be remedied by giving emetics of oil and dill,
and afterwards oily clysters, &c. (Pract. iv, 53.) See a similar
account in Avicenna (iv, 6, 1, 2.) Mercury that has been killed,
or sublimed, that is to say attenuated, produces, he says, grave
symptoms, such as pain of the bowels, a bloody flux, reten-
tion of m'ine, and so forth. He recommends, after vomiting,
myrrh in wine, with honied water, &c.
Serapion mentions that fumigations with mercury are very
prejudicial by superinducing nervous affections and paralysis.
(De Simpl. 385.) Alsaharavius
is, we
believe, the only ancient
author who has mentioned that rubbing the bodv with mercury
occasions swelling of the mouth, tongue, and throat, with ero-
sion of those parts. He directs us to wash or gargle with the
decoction of dill, camomile, or mint. (Pract. xxx, 3.) Pliny
mentions milk as a remedy against gypsum, ceruse, sulphur,
and mercmy. (H. N. xxviii.)
Not having access to the unpublished mss. of the ancient
'
Scriptores Chemici,^ we cannot pretend to determine whether
or not they had acquu-ed any considerable skill in analysing
and detecting poisonous substances. See an interesting account
of these mss. in Fabricii ' Bibliotheca Grseca,^ xiii, p. 747.
Consult also Vossius '
De Natura Artium,^ v. 9 ; Sir William
Drummond's Papers in the *
Classical Journal
^
on the Literature
of the Ancient Egyptians and Doutens Dec. de INIodern.^
;
'

p. 176. The only original work on the chemistry of the

ancients which we have read with any attention is the ' Chemia '
of Geber, which contains much curious information regarding
the metals, although nothing that suits our present purpose.

SECT. LXIV. ON WHITE HELLEBORE, THAPSIA, ELATERIUM, BLACK

AGARIC, WILD RUE, GITH, AND THE DOWN OF THE CACTOS.

We must be guarded in the administration of certain medi-

cinal substances, which often occasion as great danger as poisons
 240 HELLEBORE, ETC. [book v.

themselves. Such are the following, namely, white hellebore,

thapsia, elaterium, and the black agaric, for these bring on either
suffocation or hyper catharsis, in which cases we may cure the
suffocation in the way described for mushrooms, and such like
substances, and stop the hypercatharsis by such things are as
calculated to suppress immoderate discharges. Likewise certain
substances which might seem not injurious to any considerable
degree, will sometimes occasion dangerous symptoms, and should
not be neglected. Such are the wild rue, gitli, and the fresh
poppy, which are the flowers of the thorn called cactos. In
such cases the administration of a vomit alone relieves those
who have taken them.

COMM. Commentary. This section is taken from Dioscorides. Of

the pappus Actuarius says, like our author, that it is the Aoat er
of the thorn called cactos, and that vomiting relieves those who
have taken it. (Meth. Med. v, 12.) See Avicenna (iv, 6, I) ;
and Rhases (ad Mansor. viii, 49.) Alsaharavius directs us in
the case of hellebore to clear the stomach by emetics, and to
apply cooling plasters of citrons, apples, and roses. For the
wild rue he recommends emetics of oil, emollient clysters, and
the ashes of vine tops taken with water and vinegar.
In the Seventh Book we shall have occasion to state the
opinions which have been entertained respecting the helleborus
albus of the ancients. Schulze is very undecided. (Toxic,
vet. iv.) The thapsia he makes to be the same as the T.
foetida of Linnaeus. Theophrastus has described it (H. P. ix, 23).

Pliny says it occasions swelling of the body, with erysipelas.

(N. H. xiii, 43.)
We shall treat of the elaterium also in the Seventh Book.

Hippocrates usesthe word as a general term for all drastic

purgatives, but by Dioscorides, and the subsequent writers on
the materia medica, it is applied to the fsecula of the momor-
dica elaterium.
The agaricus muscarius is a well-known poisonous mush-
room. Schulze properly remarks that its eflfects are narcotic ;
and Dr. Cliristison places it in the class of narcotico-acrid
poisons. See sec. liv.
Schulze is much inclined to believe that the trrtyavov aypiov
here treated of is the peganum harmala of Linnseus, a plant
SECT. LXiv.] HELLEBORE, ETC. 241

intermediate between tlie ruta and melanthium. He is also Comm

disposed to think that the melanthium of the ancients was the
——
'

nigella sativa, L. We
are inclined to adopt this opinion from
the text of Avicenna, (iv, 6, 1, 16.) Sprengel agrees with
Anguillara and Dalechampius in opinion that the cactos was the
cynara cardimciilus, Jj., or cardoon artichoke^ a variety of the
C. scolymus. (Comment, in Dioscor.) Schweighaeuser inclines
to the opinion of Villebrun, the French translator of Athenseus,
who makes it to be the C. sylvestris latifolia, which he says
grows commonly in Sicily at the present day. (In Deipnos.
ii, 83.)
Under this head we may notice the treatment of poisoning
by gnm euphorbium, and the spurges, of which no mention is
made by the Greek authorities on toxicology. For the Arabians,
see A^dcenna (iv, 6, 1, 4, 5) ; Rhases (Contin. xx, 2 ; ad Mansor.
viii, 48) ; Alsaharavius (Pract. xxx, 1, 19.) The symptoms
as given by them all are, violent pain and heat in the primae
vise, with bloody discharges, and death, unless timely relief be
given. Their remedies are immediate vomiting with hot water
and oil, then administering demulcents, barley-water, and in
the end, the theriac. G-alen and Haly Abbas, in their treatises
on the Theriac, recommend it in this case of poisoning.
The mezereon is not noticed by the Greeks or Romans
either as a poison nor as a medicinal substance. The Arabians
treat of it under both these heads. See Avicenna (iv, 6, ; 1)
Rhases (ad Mansor. viii, 53.) The symptoms as given by them
are violent vomiting and purging, for which they recommend
sweet milk, butter, juleps, in the first place, and in extreme
cases the theriac and sealed earth. The Arabian authorities
confound their mezereon with the chamseleon of the Greeks,
treated of in the thirty-seventh section of this book. The
dende of Avicenna and Serapion was the strychnos colubrinus,
according to Sprengel. (R. H. H. i, 250.)
Rhases classes the nux vomica along with the articles
treated of in this section. He recommends us in all these
cases to give warm water to promote the vomiting, and
render it easier, and if violent convulsions come on, he directs
the patient to be put into a warm bath, and anointed with hot
oils.(Ad Mansor. viii, 49.) Serapion treats of it in his Materia
Medica (163.) The Arabians also treat of the methel-nut.
II. 16
 242 IIELLE130RE, ETC. [book v.

CoMM. Weare unable to determine satisfactorily the nature of the

' '

condisi, which is treated of by the Arabians, under the pre-

'

sent head. See Rhases (ad Mansor. viii, 49) ; Avicenna (iv,
6, 1, 16.) Alsaharavius calls it cundes. The symptoms, he
says, are dryness of the nose, throat, and palate, sneezing,
muttering delii'ium, pain of the stomach, and, unless speedy
relief be brought, death. (Pract. xxx, 1, 24.) Ardoyn men-
tions that some referred it to the struthium but the above ;

characters do not at all apply to the soapwort [sajjonaria offici-

nalis, L.), which is the arpovOiov of Theophrastus andDioscorides.
See further Sprengel (Comment, in Dioscor. i, 192.)
The sow -bread [cyclamen Europceum) is also treated of by the
Arabians under this head. See Avicenna (iv, 6, 1, 16) ; Rhases
(ad Mansor. viii, 59) ;
Alsaharavius (Pract. xxx, 1, 24.) The
symptoms, according to Alsaharavius, are swelling of the throat,
and strong pain of the bowels. The sow-bread is treated of as
an article of the Materia Medica by Dioscorides (ii, 193.)
Dioscorides (M. M. iv, 82) does not reckon the oleander
(nerium oleander, L.) destructive to man, but the Arabians rank
it among the deleterious substances, of a heating and desiccant

nature; and recommend for it emetics, with the decoction of

fenugreek, figs with honey, and the like. See AAdcenna (iv,
6, 18) ; Alsaharavius (Pract. xxx, 1, 27) Rhases (ad Mansor. ;

viii, 36.)
The anacardium,
or Malacca bean, is treated of as a poison

by Rhases (Contin. xx, 2 ; ad Mansor. viii, 35) ; Avicenna (iv,

6, 1, 9) ;
Alsaharavius (Pract. xxx, 1, 42) ; Haly Abbas (Pract.
iv, 50.) They all describe it as an irritant poison, and recom-
mend emetics of animal and vegetable oils, with demulcents, to
obviate the bad effects of it.
The apocynum, although not treated of by the ancient au-
thorities on toxicology, is described as a deleterious substance
by Dioscorides (Mat. Med. iv, 81) by Galen (De Simpl.) ; ;

and by Pliny (H, N. xxv, 83.) It appears to be the periploca

Graca, L.
Dioscorides and Pliny likewise reckon saffron, or the cro-
cus sativus, a deleterious plant. Its deleterious action is very
weak.
The atramentum sutorium, which was a solution of vitriol,
was used as a poison. See Cicero (ad Familiar, ix, 21.)
SECT. Lxv.] COLD WATER. 243

SBCT. LXV. ON DOMESTIC ARTICLES, SUCH AS WINE AND

COLD WATER.

Cold water when drunk in a great quantity, and mucli

undiluted sweet wine, more especially after the bath, running,
or violent exercises, bring on suffocation and pains. In such
cases, venesection quickly had recourse to, and evacuation by
clysters, remove the impending danger.

Commentary. " Some

Galen says, by taking an immode- Comm. ' '
'
rate draught of cold water have been instantly seized with

dyspnoea, convulsions, and tremors ; in a word, their whole

nervous system has become affected." (Meth. Med. ix, 5.)
Dioscorides, Aetius, and Actuarius concur in recommending
the same mode of treatment as our author. The Arabians,
however, treat those who have taken a draught of cold water
unseasonably in a very different manner from the Greeks.
Thus Rhases and Avicenna recommend undiluted wine inter-
nally, and the application of a plaster over the liver. The dif-
ference between the practice of the Greeks and Arabians may
be thus accounted for. A large draught of cold drink may
either threaten to prove fatal at once by producing a violent im-

pression upon the nerves of the stomach, or it may superinduce

symptoms resembling those of gastritis. In the former case
the practice of the Arabians may seem most proper in order to
support the heat and powers of the system, whereas that of the
Greeks Avill be indicated when inflammatory symptoms have
come on ; and, indeed, even the Arabians bled under these cir-
cumstances. (Avicenna, iv, 61, 31.) For an immoderate draught
of pure wine which has been taken unseasonably, the Arabian
authorities concur with the Greek in recommending immediate
evacuation of the stomach and venesection, to which they add
cold water or whey, with troches of camphor. See in particular
Avicenna (iv, 6, 1, 31.)
 APPENDIX TO BOOK V.

As no better opportunity is likely to occnr, we shall in this

place give a short notice of two subjects connected with medical

practice, which are entirely omitted by oui' author.

ON FEIGNED DISEASES, AND THE DETECTION OF THEM.

Galen, we beheve, is the only ancient author who has treated

professedly of the detection of simulated diseases. He begins

his short treatise on this head with remarking, that persons

feign diseases from various motives, and that it is expected the

physicians should detect such impostures. That, for example,
inflammation, erysipelas, and cedema, when produced artificially,
ought to be distinguished from the same diseases when they ori-
ginate in constitutional causes. He adds, that haemoptysis,
hsematemesis, and bloody discharges from the bowels, are often
simulated. Haemoptysis is simulated by opening a vein in the
gums, and sucking blood from it while one aff'ects to cough.
Others, he says, affect dementia, fatuity, and insanity, all which
cases the vulgar expect that the physician should detect. In-
ward pain, such as that of colic, he had often known to be
simulated, and relates briefly an interesting case in point. He
remarks, that experience and natural sagacity will enable a
man to expose all impositions of this nature. He gives a very
interesting account of the manner in which he detected the
APPENDIX.] PROFESSIONAL IMPOSTORS. 245

nature of a swelling at tlie knee^ that liad been produced inten-

tionally by the juice of tbapsia {thapsia garganica, deadly car-
rot?) Feigned inward pains, lie remarks, may often be dis-
tinguished from the real by the aversion which the malingerer
discovers to swallow medicines, which he would be anxious to
have given him if he w^ere actually in acute pain ; and adds,
that the state of the pulse, and the other symptoms of intes-
tinal diseases, Avill assist in making the detection. (Quomodo
coarg. sint qui fing. se ^grot. t. iii, 388, ed. Basil.)

ON PROFESSIONAL IMPOSTORS.

Rhases has an interesting chapter on this head. The frauds

of impostors, he says, are more numerous than could be con-
tained in his whole work. Some of them, he adds, pretend to
be able to cure epilepsy, and having made a crucial incision in
the back part of the head, they extract from the wound some-
thing which they hold in their hands, and thus impose upon
people. Others, in like manner, cause it to be believed that
they extract a small lizard by the nostrils. Some of these
characters, he says, make it be believed that they remove films
from the eye, by secretly introducing a small membrane into
the eje, and taking it out again. Others manage to create a
belief that they suck water from the ear with a reed. Others
also make it be believed that they extract worms from the ears
or teeth. Others practice a trick by which they obtain the
credit of extracting the ranula below the tongue. Why should
I mention those, he adds, who introduce pieces of bone into
wounds and and afterwards extract them?
ulcers, says, itHe
is not for these impostors to sound a man for the
uncommon
stone, pretend to find one, perform the operation, and exhibit
a calculus which they themselves had introduced secretly into
the incision. Others pretend to cure piles, make incisions
about the anus, and form ulcers there which did not exist before.
Certain of them afli'ect by scarifications and other means to
suck the vitreous humour from the hip-joint, while they exhibit
something of the kind which they themselves have introduced.
There are some who undertake to collect all the infirmities of
246 PROFESSIONAL IMPOSTORS. [book v.

the body into one spot, and then extract tliem ; for this pre-
tended object they raise an itching and violent heat in some
place by means of alkekengi (winter cherry) ; and having accom-
plished this they exact a fee for removing the uneasiness from
the spot, which they do by anointing it with oil. There are
others who will make a man believe that he has swallowed
hairs, glass, or the like ; and then tickUng his throat with a
feather,and making him vomit, they exhibit the substance in
question as if it had been brought up. Thus, he adds, they
often do much mischief, and sometimes are guilty of culpable
homicide. He concludes by warning sensible people to be upon
their guard against such wretches. (Ad Mansor. vii. 27.)

I
 BOOK VL

SECT. I. PREFACE TO THE SURGICAL PART.

Having divided the treatise on the surgical matters into

what relates to manual operations on the flesh, and the account
of fractures and dislocations of bones, we shall begin with what
relates to the flesh, observing there our accustomed brevity.

Beginning therefore, again with the upper parts, we shall first

give an account of the operations on the head, more particu-
larly of the burning of the vertex.

Commentary. This book contains the most complete sys- Comm.

' '

tem of operative surgery which has come down to us from *

ancient times. We shall have occasion also to refer frequently

to Celsus, who, in the last two books of his work, has treated
of surgical operations with considerable accuracy. Our author
appears to have been wholly unacquainted with him ;
but when
did a Greek writer ever acknowledge himself under obligations
to a Roman ? Haly Abbas, in the 9th book of his ' Practica,^
copies almost everything from Paidus. Albucasis gives more
original matter on surgery than any other Arabian author, and
yet, as will be seen from our commentary, he is indebted for
' '
whole chapters to Paulus. In the
Continens of Rhases, that
precious repository of ancient opinions on medical subjects, if
there be any surgical information not to be found in our author,
it is mostly derived from
Antyllus and Archigenes. As to the
other authorities, although we will occasionally have to explain
their opinions upon particular subjects, no one has treated of

surgery in a systematical manner ; for even Avicenna, who treats

so fully of everything else connected with medicine, is defective
 248 OPHTHALMIA, ETC. [book vi.

CoMM. in his account of surgical operations ; and the descriptions which

" '
'
he does give of them are almost all borrowed from our author.
The account of fractures and dislocations given by Hippocrates
and his commentator Galen may be pronounced almost com-
plete but the information which they supply upon most other
;

surgical subjects is scanty.

SECT. TI. ON BURNING OF THE HEAD FOR OPHTHALMIA,

DYSPNCEA, AND ELEPHANTIASIS.

In ophthalmia, occasioned by a defluxion from above, and

in dyspnoea, produced by a redundance of a recrementitious
humour which is sent from the head down to the chest, and by
lodging there proves injurious to the parts contained in it, they
burn the middle of the head in this manner. Having first
shaven the parts about the vertex, they apply cauteries shaped
like olive-kernels and biu-n the skin down to the bone, scraping
the bone after the falling off of the eschar. Some by burning
even the bone itself make a small scale exfoliate from it, in order
to allow thehumours of the head to perspire and be evacuated
the more readily and for this purpose they keep the ulcer open
;

for some time and then allow it to cicatrize. In treating ele-

phantiasis some burn five eschars in the head, one anteriorly
above the part called the bregma another, below this, a little
;

above the forehead, at the extremity of the hairs ; another, at

the part called the occiput ; two others at the parts called the
squamous plates, above the ears, one on the right side and
another on the left and thus, by the removal of several scales,
;

they prociu'e the evaporation and discharge of the collection of

thick humours in the deep-seated parts of the head, and pre-
vent the sight from being injured. They also apply another
cautery on the spleen, in order to remedy the prime organ in
the formation of the melancholic humour by the eschar formed
in the skin.

CoMM. Commentary. See Hippocrates (de Visu) Aretaeus (de

'— — curat.
'
'

Morb. Chron. i, 1) ; Celsus (iii, 23, and

;

vi, 6) ;
Ceelius
Aurelianus (Morb. Acut. i, i, and Morb. Chron. i, 4) ; Aetius
(vi, 50) ; Actuarius (Mcth.
Med. iii, 2); ilhases (Cout. xxvii, 1^
SECT. II.] OPHTHALMIA, ETC. 249

24) ;
Albucasis (Chiriirg. i) ;
Mesue (de iEgr. Capitis) ; Avi- Comm.
cenna (iii, 1) ; Haly Abbas (Pract. ix, 69) ; Avenzoar (I, 9,

17).
Tlie use of the actual cautery in surgical practice is often
alluded to by the classical authors. See a collection of these
passages in Dr. BlomfiekPs edition of the 'Agamemnon' of
^'Eschylus (822.) Consult also Gataker's 'Marcus Antoninus'
'
(v. 193) and Boissonade's
; Anecdota Grseca' (vol. ii, p. 311.)
A very elaborate and sensible account of the use of the cautery
in the practice of surgery is given by Vegetius, (Malomed. i,

28.)
Hippocrates, or whoever was the author of the work referred
to above, applied the cautery to the head very freely in diseases
of the eyes and other complaints.
Aretseus directs us, in cases of cephalsea and epilepsy, to
perforate the bone as far as the diploe, and afterwards to burn
it until the dura mater is separated from the bone. He
admits,
however, that it is a harsh remedy.
Celsus directs us, as an ultimum remedium in epileptic
cases, to form issues with a burning iron upon the occiput and
at the juncture of the first vertebra with the head.
Aetius speaks of burning the head in nearly the same terms
as our author. He directs us to avoid the muscular parts.
Actuarius does the same.
Cselius Aurelianus, however, disapproves of this practice in
cases of cephalsea and epilepsy.
The Arabians were even more partial than the Greeks to
burning the head in these and other complaints. See in par-
ticular Albucasis, whose description is very minute. In cases
of cephalsea he recommends the cautery to be applied to the

occiput, but cautions against touching the bone lest it produce

violent pain. He directs us to be careful to avoid muscles,
nerves, and arteries. Aiicenna, Ehases, Mesue, and Haly Abbas
recommend the operation, in the most unquaUfied terms, as a
poAverful remedy in the cases mentioned by our author. Aven-
zoar, however, condemns the unguarded application of the
burning iron to the head.
Guido de Cauliaco recommends the cautery in cases of hydro-
cephalus (ii, 2, 10). Brunus also applied it for hydrocephalus,
(ii, 17.) But see in particular Lanfrancus (III, iii, 18.)
 250 HYDROCEPHALUS. [book vi.

CoMM. Fabricius ab Aquapendente states that from the most ample

—
'
— experience he
*
'

had ascertained the good effects of applying the

cautery over the sutures of the skull in various complaints^
especially asthma, consumption, and all cold defluxions from
the head to the chest. He gives a full account of the opera-
tion. ((Eu^Tes ChiiTirg. ii, 1.) But see De Haen. (Rat. Med.
t. iii, p. \i, c. 6.)

SECT. III. ON HYDROCEPHALUS.

The hydrocephalic affection is so named from the peculiarity

of the fluid, it being of a watery consistence. It occurs in

infants, owing to their heads being improperly squeezed by

mid^Yives during parturition, or from some other obscure cause ;
or from the rupture of a vessel or vessels, and the extravasated
blood being converted into an inert fluid ; or from rarefaction,
the matter exuding and lodging between the skin and the peri-
cranium. For the formed either between the pericra-
fluid is
nium and the between the pericranium and the bone,
skin, or
or between the bone and the meninx. In those cases, there-
fore, in which the fluid is formed between the skin and the

pericranium, there is a soft tumour, all of one colour, and with-

out pain, accompanied with an elevated swelling, having only a
thin substance intervening between it and the fingers, readily
yielding and again resuming its form. "WTieu it is seated
between the pericranium and the bone, all the other appear-
ances are the same, but the swelling is harder, yields more
slowly, seems to be felt through thicker substances, and is
more painful. When the fluid is seated between the meninx
and the bone, there will still be a swelling, but not of so jdeld-
ing a natui'e, nor so easily felt, only it yields to the application
of strong pressm'c ; for the bones of infants, being recently
formed, are of a more yielding nature ; and this is more espe-
cially the case when, owing to enlargement of the sutiu'es,
the fluid escapes outwards. This is readily ascertained from
the circumstance, that by pressui'e of the fluid it retreats to
the deep-seated parts. In such cases the pain is greater, the
whole head distended, the forehead projects outwards, the
is

eyes are fixed and shed tears frequently. In these cases we

SECT. III.] HYDROCEPHALUS. 251

reprobate any surgical interference, although some remove a

piece of the bone by trepanning, as will be described in the
section on fractures of the bones of the head. But if the
fluidbe formed between the skin and the pericranium, and
the swelling be small, we may make one transverse incision
through the middle. But if the fluid is seated between the
pericranium and the bone, and the tumour is large, we make
two incisions intersecting one another in the middle ; or if it
is still larger we may make three imitating the form of the

Greek letter H. After the operation, having evacuated the

fluid and applied suitable compresses, we bind it up, and soak
it with wine and oil until the third day ; after which, having

loosed the band- ages, we may cure it by the application of

pledgets ; or, if the bone is long of incarnating we may scrape
it Hghtly.

Commentary. See Hippocrates (de Morbis, ii, 15) ; Celsus Comm.

(iv, 3) ; Aetius
(vi, 1) ;
Galeni (ut aiunt) Isagoge ; Antyllus ^^~'
(apud Nicetam) ; Avicenna (iii, 1 ; iv, 2) ; Avenzoar (I, 9, 17);
Albucasis (Chirurg. ii, 1) ; Haly Abbas (Pract. ix, 16) Rhases ;

(Contin. xxvii; and ad Mansor. ii, 25.)

Hippocrates gives an interesting account of water
in the

brain, the symptoms of which, as described by him, are pain

in the opening of the head and temples, rigor, fever, double
vision, impatience of sounds, vomiting of phlegm, &c. He
recommends emetics, caputpurgia, and afterwards purgatives.
He also makes mention of hellebore and sternutatories, and
even directs us to perforate the skull, or, in other words, to

trephine it.

Celsus describes only the hydrocephalus extemus. He re-

commends us to use stimulant applications to the head, such
as sinapisms, and if this treatment does not succeed, he directs
us to use the scalpel. The case, otherwise, is to be treated
like dropsy, with sudorifics, exercise, friction, and diuretics.
Our author^s description is mostly abridged from Aetius, who
gives an extract from Leonidas. Even when the fluid is col-
lected within the skull he directs us to let it out, provided it is

in such quantity as to occasion a separation of the suture.

The account of the disease, given by Antyllus, in the Collec-
tion of Nicetas is nearly the same as our author's. He speaks
 252 HYDROCEPHALUS. [book vi.

CoMM. favorably of the

operation only in cases in which the water is
' — — collected externally
"
'

to the bone.
'
In the Isagoge/ generally ascribed to Galen^ it is directed,,
when the water is collected below the skin on the pericranium,
to evacuateit by making two or three straight incisions and ;

when immediately below the bone, to perforate it but the case

;

in which the fluid is seated between the membrane and the

brain is pronounced to be utterly incurable.

Rhases borrows his account mostly from Autyllus and om-

author. Upon his own authority, however, he recommends
bandages with compresses. He also approves of applying the
actual cautery over the sutures. He further recommends fi'ic-

tion and burning the temporal veins.

Avicenna boiTows freely from Aetius and our author, and
supplies no new ^iews of practice. A^Tien water is collected in
the anterior ventricles of the brain, Avenzoar, although in
general no advocate for the actual cautery, dii'ects us to apply
it over the sutures.
Albucasis says that he had only known hydrocephalus in-
temus in infancy, and in every case it had proved fatal. How-
ever, he describes the operation of evacuating the collection in
much the same terms as the Greeks. He warns the operator
to avoid wounding an artery, lest the evacuation of blood should
occasion immediate death. Alsahara^dus mentions the frequent
occuiTcnce of the disease in sheep. Haly's treatment is the
same as our author's.
The hydrocephalus externus is now scarcely mentioned, and
the existence of such a case has been even questioned. Van
Swieten allows the reality of it, but says that it is of rare oc-
currence. (Comment. 1217.) "We are disposed to think that
the cases described by our author must have been collections
of lymph, or pus occasioned by external injuries forming be-
tween the integuments and the bone. ]Modern pathologists
admit the reahty of collections of serum and pus between the
bone and the dura mater. We may further mention that the
earliermodern authorities approve of the cautery in the present
case. See Guido de Cauliaco (ii, 2, 10.)
The late Baron Larrey was a decided advocate for the
application of moxa in this complaint. Henricus Regius di-
rects us to evacuate the water slowly by making a small in-
SECT. lY.] ARTERIOTOMY. 253

cision and introducing a silver canula. (Animad. Medic. 13.) Comm.

Tliougli recent experience does not give much encouragement
——
'
•
'

to tlie operation, it sometimes happens that it is attended with

success.
Fabricius gives the same account of these cases as the ancients.
((Euv. Chir. ii. 22.)

SECT. IV. ON ARTERIOTOMY.

In chronic defluxions of the eves, and in the affection of

vertigOj we are in the practice of dinding the arteries behind

the ears. Having, therefore, shaven the hind part of the head,
and marked with the fingers the position of the artery, which
is easily discovered by its pulsation, and then having marked
out the line of an incision two fingers in length with black ink,
we cut down to the bone. When this does not succeed we
must measure a distance of three fingers^ breadth from the ears,
and then operate by making a transverse division of the artery
until blood flow per saltum, and the instrument strike the bone.
After a moderate evacuation of blood, the pericranium is to be
divided, lest it become inflamed from the distension and hav- ;

ing scraped the bone we apply a wedge-like tent of linen to

the wounds, and accompHsh the cure by pledgets. But if, after
ail, the bone remain bare, we must have recourse to scraping
it in like manner.

Commentary. Oui' author's description is mostly abridged Comm,

'

who copies from Severus.

'

from Aetius (vi, 90),

•

This operationminutely described by Albucasis. (Chii'iu'g.

is

ii, 2.) He and rub the parts

directs us to shave the head,
behind the ears with a rough cloth until the arteries become
visible. The com'se of the vessels is to be marked with ink,
and they are to be divided with a sharp scalpel, the incision
penetrating down to the bone. He says, however, that if the
surgeon choose, he may introduce the scalpel below the vessel,
and cut upwards. The length of the incision is to be two fin-
gers' breadth. Blood, he remai'ks, springs from an artery per
saltum. About six ounces, more or less, may be taken.
The operation is likewise mentioned by A^icenna (Cantic. iv,
 254 ANGIOLOGY. [book vi.

CoMM. and Averrhoes (in Cantic.) by Rhases (ad Mansor. vii, 21)
; ;
' '
'
and is described in exactly tbe same terms as our author's by
Haly Abbas. (Pract. ix, 4.)

SECT. V. ON ANGIOLOGY, OR SECTION OF THE TEMPORAL

VESSELS,AND ON BURNING THE SAME.

In liemicrania and in cbronic or acute defluxions, wben the

eyes are affected with a hot and acrid defluxion, so as to occa-
sion heat of the temporal muscles with swelling, every one

approves of angiology for the cure of them. HaA*ing, therefore,

firstshaven the hairs of the temples, and noted the part with
our fingers, we must use warm fomentations, and apply a ban-
dage round the neck ; and, when the vessels become visible,
ha\dng marked their course with ink, we must draw the skin
aside with our left hand or the fingers of an assistant, and make
a superficial incision along the vessel; then cutting quite through,
and stretching the parts with hooks, and exposing the vessel by
means of the instruments used in operations on membranous
parts, we must raise it up when it
is separated all around. If it be

small, having stretched and twisted it with a blind hook, we

may divide it through, so as to be able to seize upon part of it.

But if it be large, we must apply a double hgature under it
with a needle, either a piece of raw flax, or some other strong
thing ; and, in the fh'st place, making a sti'aight opening into
the vessel with a scalpel used in venesection, and taking away
a moderate quantity of blood, we must tie the ligatures at both
extremities of the exposed vessel, and cutting the intermediate

part, we may remove it either immediately, or at the time of

loosing the dressings. Some, without di\dding the vessels at
all, burn them to a sufficient depth with burning-irons shaped
like ohve-kernels. After the operation we must use pledgets
of drv' charpie, and put on an oblong compress {splenium) with
a bandage. After the removal of these dressings, we must ac-
complish the cure by incarnating powders, apphcations on
pledgets,and cicatrizing remedies ; the threads and ligatures
having previously dropped out from putrefaction.

CoMM. Commentary. The author of the Hippocratic treatise

SECT, v.] ANGIOLOGY. 255

(de Morbis in Hominc, c. 49) recommends us to

open the tem- CoMAf.
poral veins for obstinate headaches ; and, if this does not effect
a cure, he directs us to burn them.
Celsus describes both operations very distinctly. He directs
us to apply a ligature round the neck, so as to make the vessels
swell, and then, having marked the course of the vessels with
ink, to remove the ligature, and open the
veins. AYhen a
sufficient quantity of blood is
discharged, the part is to be bm'ut
with slender irons cautiously about the temples, for fear of
wounding the temporal muscles, but more boldly between the
forehead and the vertex, so as to produce exfoliation of a scale
of the bone. He also speaks favorably of cutting the vessels
in the templesand upper part of the head, (vii, 7.)
Aetius gives nearly the same description as our author.
The part which relates to the burning is taken from Leonidas
(vii, 93.)
'
Angiology is briefly described in the Isagoge^ of Galen.
A minute description is given by Albucasis. He recommends
the operation as a remedy for inveterate cases of hemicrania,
catarrh, and cephatea. He directs us to shave the hairs about
the temples, and to continue to do so until the
artery appears.
It is known, he remarks, by
its pulsation. When it does not
readily makeappearance, he recommends us to apply a cloth
its

round the patient's head, and to rub the place with a rough
towel. Then, he and make an incision so
says, take a scalpel,
as to lay bare the artery, which seize with a hook, and separate
from the surrounding parts, and if the vessel is small, cut out a
proper piece of it, and allow from three to six ounces of blood
to flow. But if the vessel is large, bind it in two places with
strong silk threads, or strips of raw cloth [alhohod), so that it
may not drop out before the Avound is consohdated. Then cut
out the part between the two ligatures. He directs us to dress
the wound as recommended by our author. He also mentions
the operation of burning the temporal veins as
being one that
is less serious than
angiology. (Chirurg. ii, 3.)
Jesu Haly's account of the operations of tying and burning
the temporal arteries is very distinct, (iii, 25.)
Haly Abbas describes the operations of cutting out and
burning the temporal vessels in nearly the same terms as our
author. (Pract. ix, 70.)
 256 HYPOSPATHISMUS. [book vi.

CoMM. Rhases mentions that tlie celebrated Arcliigenes recom-

' '
"
mended the temporal veins to be burnt for epilepsy. (Contin. i.)
The veterinary surgeons burnt the temporal veins in diseases
of cattle. See Vegetius (Mulomed. iij 16.)
We are inclined to think that it was the temporal veins and not
the arteries which were cut out and burnt by the Greek surgeons
in this operation. It will be seen, however, that the Arabians
direct us to cut out a portion of the artery; at least this is

sufficiently clear in the description of Albucasis, for he states

decidedly that the vessel to be secured will be recognized by its
pulsation, and he fui'ther recommends us to apply beforehand
a ligature about the head, and not about the neck as du'ected
by our author, whereby it is ob^dous that the arteries and not
the veins woidd become distended ; these observations apply
also to Jesu Haly^s description. As Celsus, like our author,
directs the ligature to be applied round the neck (cervix ante
modice deliganda est), we may suppose that his operation re-
lated to the veins. From his using the word venee indeed no
inference can be drawn, as he applies it indiscriminately to
arteries and veins. We are at a loss what to determine re-

specting the description given by Haly Abbas, for although the

vessel that is secured be called arteria, the Kgatm'e or strip of
cloth is directed to be apphed round the collum. "Where the mis-
take lies in this case we cannot venture to conjectm'c, and leave
it to be found out by some person who has access to the MS. of
the original. For our part we may exclaim with a celebrated
German scholar,
— " Felices
ssepe prsedicavimus Bochartum,
Plempium, Celsium, Hydium, Casirium, quibus usus codicum
Arabicorum concessus erat/^ (Sprengel, Rei Herbarise Historia,
i, 239.)
Fabricius ab Aquapendente describes the operation as relating
to the veins (CEuv. Chir. ii, 3.) Tagliacozzi, however, seems
to refer it to the artei'ies.
It thus appears that there is a good
deal of uncertainty regarding this ancient operation.

SECT. VI. ON HYPOSPATHISMUS.

This surgical operation derived its name from the kind of

instrument used in it. We
have recoui'se to it when a copious
 SECT. VI.] HYPOSPATHISMUS. 257

and hot defluxion is determined to the eyes. The face is

ruddy,
and about the forehead there is a sensation as of worms or
ants passing along it. HaA-iug therefore first shaven the hairs
about the forehead, we must permit the lower jaw to move, and
avoiding the place where the temporal muscles are seen to
act, we are to make three straight and parallel incisions on the

forehead, each having the length of two fingers, and descending

to the bone, and being at the distance of about three
fingers'
breadth from one another. After the incision we apply the instru-
ment called h}^ospathister, and extend the division from the
left temple to the middle incision,
dividing all the intermediate
substance along with the pericranium then we push a ; spatula
from the middle one to the rest, and applying the point of a
sharp-pointed knife to the first di\dsion, so that its sharp side
may be turned to the fiesh within the skin, and the blunt one
to the bone, we push it as far as the middle division,
cutting
through all the vessels which descend from the head to the
eyes, but not comprehending the external skin. And again
we push it from the middle to the last incision, cvitting through
the vessels in like manner. After a moderate evacuation
of blood, having squeezed out the coagula, and made three
twisted tents, we are to put one into each di\'ision, and
apply-
ing a compress soaked in water, we must secure it with a
bandage. Next day we bathe not only the ulcers, but like-
wise the temporal muscles, and the ears with wine and oil, on
account of the inflammation ; and on the third day having
removed the dressings, we must have recourse to copious affii-
sion, and afterwards complete the cure suitably with tents out
of basilicon dissolved in rose-oil.

Commentary. See Aetius (vii, 92) Albucasis (Chirurg. Comm.

ii, 4) Haly Abbas (Pract. ix, 7.)
;
;

This operation is better de-

'
—— '
'

scribed by our author than by any of the others. Celsus,

although he describes several grave operations for the relief of
defluxions on the eyes, makes no mention of it. Aetius barely
alludes to it in general terms. It must have been a very for-
midable operation, and for that reason perhaps, has been en-
tirely abandoned in moderate times. Even Albucasis speaks
of it as being an operation which was
performed by the an-
cients ; from which language we may suppose that ithad been
II. 17
 238 PERISCYPHISMUS. [book vi.

CoMM. given up in his time. His description of it isevidently taken

' '
from our Haly Abbas describes the operation very
'
autlior.
distinctly. Three longitudinal incisions at the distance of

three fingers' breadth from one another are to be made in the

forehead down to the bone, then a knife, or some such instru-
ment, is to be introduced so as to diAdde the parts between the
longitudinal incisions, sparing only the outer skin.

SECT. VII. ON PERISCYPHISMUS.

When many deep-seated vessels send a copious defluxion to

the eyes, we have recourse to the operation called periscyphismus.
These cases are attended with such symptoms as these in the :

firstplace you will find the patient's eyes atrophied and small,
weak of sight, the cantlii corroded, and the eyelids ulcerated,
the bail's falling oflF, with a discharge of very thin, acrid, and
hot tears ; there is a deep-seated pain in the head of an acute
and and there is frequent sneezing.
violent character, Having
firstshaved the head as aforesaid, and avoiding the place where
the temporal muscles play, we make a transverse incision, be-
ginning at the left temple and ending at the other. The in-
cision must have its terminations where there are no muscles,
itsdirection being a little above the forehead, and we must
avoid the coronal suture. Leonidas directs the incision to be
made along the middle of the forehead. When the bone is laid
bare we may keep the parts asunder "^"ith tents and plenty of
pledgets, and bind the extremities of the division and, as we ;

formerly stated, bathe with wine and oil. After loosing them,
if the inflammation is on the decline, we may scrape the bone
until it begin to incarnate, and accomplish the cure by a mode

of practice calculated to promote incarnation, using the incar-

native powders ; among which is that containing of wheaten
flour, p. of colophonian rosin, p. j j and that called the
ij ;

cephalic,and those incarnatives prepared from pumice-stone.

For, when the skin is thickened by a dense cicatrix, and the
mouths of the vessels constricted, the defluxion is prevented
from being determined to the eyes as before.

CoMM. Commentary. See Aetius Pseudo Galen (Isagoge);

(vii, 93) ;

Albucasis (Chirurg. ii, 5) ; Haly Abbas (Pract. ix, 18.)

SECT. VIII.] TRICHIASIS. 259

It is evident that this operation is neither more nor less than Comm.
' '

a complete division of the integuments of the head from temple '

to temple; of com-se it must even have been more dangerous

than the operation treated of in the last section. Aetius^ Haly
Abbas, and Albucasis describe it in the same terms as our au-
thor. The periscj'phismus and hypospathismus are briefly
'
noticed in the Isagoge.'
Fabricius ab Aquapendente treats of these operations among
those of the ancients, qui ne sont plus en usage (CE. C. ii, iv) ;

eveiiTagUacozzi speaks of them as being cruel and dangerous.

However, a surgical operation, similar in principle, called the
"
long issue of the scalp,^^ is still practised in certain hospitals
of Great Britain. See the 'Transactions of the Provincial
Association,^ (vol. xi.)

SECT. VIII. ON SUTURE OF THE UPPER EYELID, AND OTHER

MODES OF OPERATING FOR TRICHIASIS.

Distichiasis is a preternatural growth of hairs, superadded

to the natural order of hairs of the eyelids ;
and derives its
origin from a defluxion, when there happens to be a flow upon
the part of a humour which is not pungent or acrid for that;

which is more acrid, or otherwise pungent, when it

saltish,

lodges in these parts, consumes the natural series of hairs. For

this state then we sometimes have recom'se to the suture of the

upper eyelid, and sometimes also for phalangosis when the eyelid
inclines inward, the phalanx or row of the hairs being inverted ;
and sometimes for relaxation of the eyelid, when the natural
row of hairs hurts the ball of the eye. Having placed the patient
on a seat, either before us or on the left hand, we turn the
upper eyelid outwards, and, if it has long hau's, we take hold
of them between the index-finger and thumb of the left hand ;
but if they are very short we push a needle having a thread,
through the middle of the tarsus from -vvithin outwards ; then
stretching the eyelid with the left hand by means of his thread,
with the point of a scalpel held in the right hand, having folded
out the eyelid and everted it, behind the thread we make the
under-incision within the hairs which irritate the eye, extending
from the larger canthus to the smaller, along the tarsus. After
260 TRICHIASIS. [book vi.

subsection, having extracted the thread,

tliis and putting a small
compress under the thumb of the left hand, we stretch the eye-
broAV upwards. Then arranging other small compresses on the
canthi at the extremities, we direct the assistant who stands
behind to stretch the eyelid by means of them. Then by means
of the scalpel used for sutures we make the first incision, called
the veruted (shaped like a verutum or short dart) a little
above the hairs, which are in their natural state, extending
from canthus to canthus, and penetrating only the depth of the
skin ; and afterwards we perform the incision called the lunated,
beginning at the same place as the former, and carrying it up-
wards to such a height as to comprehend the whole redundant
skin, and ending in like manner as it did. Thus the whole
skin comprehended within the incisions will have the shape of
a myrtle leaf, of which portion, having perforated the angle on
the right hand with a hook (tenaculum), we dissect away the
whole skin then washing away the clots with a sponge, we
:

unite the lips of the incision by three or four sutui'es, beginning

at the middle, and passing the needle itself through the under-
section. The thread should be made of wool ; and having cut

away the superfluity of the thread, not close to the sutures, but
so as to leave a superfluity of three fingers^ breadth, we stretch
this remainder along the forehead and fasten it by means of
any of the agglutinative plasters. But the hairs of the eyelid
are to be freed from the sutures with the point of a needle.
Such is the common and safe mode of performing this sui'gical
operation. Some avoid the dissection of the skin, and there-
fore after the under-incision, having stretched the redundant
skin by means of the forceps used in operations on the eyelids,
they cut it off" with a scalpel, and apply sutures as described
above. But if the irritation from the hairs is produced only
by part of the eyelid, it will be proper to confine the operation
a
to that part. Then soaking the compresses in oxycrate, and
laying them on the part, we secure them with bandages, con-
tinuing to moisten the dressings with diluted oxycrate until the
third day ; after which we remove them, and cutting away the

superfluous parts of the threads, we anoint the eyelids either

with saff"ron, glaucium, or some of the anti-inflammatory collyria,
such as that formed of saff'ron and roses. But if the sutures
inflame, we apply some one of the softening plasters, and soothe
SECT. VIII.] TRICHIASIS. 2(il

the eye by an injection of eggs mixed with milk. When the

ligatures slacken we cut and extract them. I know a certain
person who having made the dissection of the skin of the eye-
lid, mentioned above, did not have recourse to sutures, but
as
effected the cure with a healing ointment. For when the wound
cicatrised, the eyelid being somewhat contracted, forced the
hairs to incline outAvards. In like manner, another person not
practising the dissection of the eyelid, nor the two external in-
cisions, but only making the under-incision, stretched Avith his
fingers or by a hook the fold of the eyehd, two reeds or plates
of the same length as the eyelid, and as broad as for
venesection,
he twisted a hgature round it at both its extremities and thus ;

the whole skin behind not being nourished, and on that account
being deprived of life, fell off Avithin ten, or at most fifteen days
along with the reeds or plates, so as to leave scarcely any scar.

Commentary. On suture of the upper eyelid, and other Comm.

methods of operating for distichiasis, see Hippocrates (de Victu " ——
'

acut. 66) ; Aetius (vii, 71, 72) ;

Celsus (vii, 7); Albucasis (Chir.
ii, 11) ; Rhases (Divis. i, 30; ad Mansor. ix, 26; Contin. ii,
3);
Avicenna (iii, iii, 3, 32) ; Avenzoar (i, 8, 6) ; Serapion (ii, 7) ;
Mesne (ii, 18) Jesu HaH (ii, 10) Canamusali (vi, 26) ; Haly
; ;

Abbas (Pract. ix, 19) Vegetius (Mulom. ii, 15.)

;

The description of the operation given by Aetius fromLeonidas

being nearly the same as that described by our author, we shall
confine ourselves to an abridged account of it, and
merely make
a few remarks to illustrate the In order
description of Paulus.
to facilitate the operation, he recommends the
operator to have
two assistants instead of one, as directed by our author. He
also recommends him, in the first place, to mark Avith ink the
portion of skin which requires to be cut out. He then directs
him to make the under-incision, by which he seems to have
meant an incision within the ciliary hairs along the tarsus, and

extending from canthus to canthus. He recommends it to be

made pretty deep, and even in certain cases suggests the pro-
priety of making two under-incisions, one as above described
within the ciliary hairs, in order to relax the tarsus ; and the
other upon the preternatural hairs. He next directs first a
transverse incision to be made along the eyelid above the ciliary
hairs, and then a lunated one beginning and ending like the
 262 TRICHIASIS. [book vi.

CoMM. other, after wliicli thus separated, is to be dissected

tlie skin,

He recommends
'
•
out. the edges to be united by means of five
sutures, one in the middle and two at each extremity of the in-
cisions. The other steps of the operation are exactly the same
as those described by our author, and cannot be misunder-
stood. Hippocrates describes an operation for trichiasis, which
Heister thought the same as that recommended by Aetius, but
the description is so obscure that we must confess our inability
to explain it.

Celsus describes three methods of ciu-e for trichiasis. 1. By

burning the roots of the hairs. 2. The anabrochismus, which

will be explained in the 13th section. 3. The anarrhaphe or

suture, as described by Aetius and our author. As the steps

of the operation described by him are almost exactly the same
as those of Aetius, we need not dwell upon the explanation of
them. Lest, however, there should be any misapprehension about
the under-incision, we shall give his directions about it in his
own language " prseter hoc, in superiore palpebra sub pilis ipsis
:

incidenda linea est ut ab inferiore parte diducti pili sursum spec-

tant ; idque si levis inclinatio est, solum satis est." Instead of
five sutures, as directed by Aetius, he recommends only three.

Albucasis states that there are four modes of curing trichiasis.

1. By the actual cautery. 2. By the potential cautery. 3. By
incision and the sutiu^e, which operation he describes at great

length. He directs us in the first

place to evert the eyelid,
either by taking hold of the ciliary hairs, or by passing a needle,
armed with a hair, through the tarsus, and raising the eyeUd
with it. He then, like the others, directs us to make the under-
incision within the ciliary hairs, from the greater canthus to the

smaller, to cut out the redundant skin of the eyelid, and unite
the siu'faces with sutures. In short, his operation is
exactly
the same as our author's. He
mentions^ however, another me-
thod of making the incision by elevating the redundant fold of
the skin with hooks or a trident, and cutting it off with a pair
of scissors. 4. The fourth method consists of
making the un-
der-incision, as in the last operation, and then twisting the
redundant skin firmly about reeds or small pieces of wood
until it mortifies after which the wound is to be cured
:
upon
general principles.
Serapion's account of the operation is defective, and need
SECT. VIII.] TRICHIASIS. 263

not be particularly noticed. Canamasuli directs us to cut out Comm.

' '

the hairs and burn the part with a cautery of gold. '

Avicenna merely mentions, in very general terms^ that the

cure may be accomplished by agglutinative apphcations, by the
cauterj^, or by excision.
Mesue briefly describes four modes of cure 1. By means of
:

agglutinants. 2. By passing a needle, armed with a hair,

through the be explained in the 13th section.
tarsus, as will
3. By plucking out the hairs and cauterising the part. 4. By

medicines calculated to prevent the renewal of the

applying
hairs after they have been plucked out.
Jesu Mali's description of these operations is
very circum-
stantial ;
he speaks of cutting out the piece of skin with a fine
pair of scissors.
Ehases states that the cure of trichiasis may be effected by
burning the roots of the hairs with a red-hot needle, or by
making the excision of the superfluous skin of the eyelid. He
also makes mention of the treatment by agglutinants. In his
great work, the Continens,' he briefly notices the four ope-
'

rations described by Albucasis. He appears to have approved

A^ery much of the burning. He also describes the operation

with the reeds or pieces of wood.

Avenzoar mentions four methods of curing inversion of the
1. By everting the upper eyelid and secm'ing it
ciliary hairs.
with agglutinants until the roots of the hairs have been cau-
terised with a rod of gold. This method he does not approve
of. 2. By extirpating the ofl'ending hairs and applying the

blood of a bat to the places from which they were torn. 3. By

making an excision of the superfluous skin of the eyelid, and
afterwards applying sutures. He alludes, we suppose, to the
operation of Aetius. 4. By twisting the skin about small reeds or
tubes, in the manner described by our author and Albucasis.
Haly Abbas accm^ately describes the fom' following operations :

1. By excision and the suture. He directs the under-incision

not to be made deep. 2. By twisting the hairs into the fold
of a silk thread and flattening it to the forehead. 3. By the

actual cautery. 4. By the potential cautery.

We will give the description of the veterinary surgeon,

" Non
Vegetius, in his own words :
longe a pilis ab interiori
parte scalpelio plagam dabis in cute palpebrai, post forficibus
 264 BURNING THE EYELIDS. [book vi.

CoMM. per longiira ad mensiiram fasciolam prsecides, et impositis

ociili
' '

fibiilis consucs palpebram foris versus, ut oculus sine deformitate

'^

recipiat \^suin et gratiam natiiralem."

It is remarked that Albucasis, Jesu Hali, and
to be
Vegetius speak of cutting out the superfluous skin of the eye-
lid with a pair of scissors, as was done by Scarpa.
All the ancient operations for trichiasis are described by
Guido de Cauliaco (vi, 2.) The mode of cure by twisting the
skin about small reeds until the parts slough is still generally
practised in China. The Chinese surgeons grasp the fold
between two shps of bamboo, which being tightly fastened at
their ends perform the office of a ligature.

SECT. IX. ON BURNING OF THE EYELIDS BY MEDICINES.

The burning of the eyelids with caustic medicines was re-

probated, in a word, by all the ancients, lest the acrimony of
the application should prove injurious to the eyes ; and because
when the burning was carried to too great an extent the
aftection called lagophthalmos was produced, in which case the

ej'clidscannot be shut, and the vision is apt to be injured by

everything that comes in the way. But since many who suffer
from the irritation of the ciliaiy hairs are not able to endure
even the name of the operation by suture, we are com-
pelled from necessity, against our will, to have recourse to
biu'uing by medicine. The follo\^'ing is a composition of that
kind of quicklime, p. ij ; of Gallic or common soap, p. ij ;
:

and some add of aphronitrum, p. iv. These things being

pounded with strained ley, or soap ley, or some other ley,
as
that of figs or of oaks, and being mixed with the urine of a

young man not come to maturity, we apply to the eyelid, upon

the knob of a specillum, the pai't touched ha^dng the shape
of a mp-tle leaf; and we burn to the extent comprehended in
the operation by suture. The skin being burnt at the first

application, we remove so much

with a sponge, and apply
of it

the medicine a second time, allowing it to remain until the

part blacken ; and if it does not blacken we apply it a third
time. When the skin is blackened and the eschar also formed,
we must clean away the medicine and have recourse to bathing
SECT. X.] LAGOPHTHALMOS. 265

and washing until the eschar drop off; after which it will be
proper to complete the cure by means of pledgets of charpie
and emollient collvria.

Commentary. None of the other authorities describe this Comj

method of cure so minutely as our author, except Haly Abbas, ^ —
'

who e^adently copies from him. (Pract. ix, 71.) Rhases andAlbu-
casis, however, also mention the operation. They direct us to
burn the part with a preparation of quicklime and soap, with
the addition of some caustic lixivia, or leys. These ancient
leys, or lixi\ian ashes, appear to have been preparations of
potass more or less pure. We need scarcely remark that these
applications must have resembled the caustic paste, now used
for forming issues. The method of treatment here described
is, in principle, much the same as that performed
by Quadri
with sulphuric acid. A caustic paste very similar to that now
used is described by Guy of Caulico. (vii, 1.)
The strained ley, of which mention is made
by Paulus, was
probably the same as the calx colata of Cselius Aurelianus.
(Tard. Pass, v, 1.) It appears to have been an
impure pre-
paration of potass with the addition of some lime. It is the
same, we suppose, as the 7rpwroc7raKrov mentioned in the
Third Book of this work. The calx colata would seem to have
been identical with the Vienna paste now used in the treat-
ment of varix. A
composition for burning the eyelids, men-
tioned by Jesu Hali, contains lime, prepared beans, nitre, and
sal ammoniac, formed into a paste with the water of
soap and
pure myrrh. Jesu, however, does not much approve of this
method of treatment.

SECT. X. ON LAGOPHTHALMOS OR HARE-EYE.

Those persons are said to have hare-eyes who have the

eye-
lids drawn upwards. This complaint arises either
naturally or
from the of a wound, and this may have occuiTcd
cicatrix

spontaneously, or from the operations of the sutui-e or burning

(as just mentioned) having been improperly performed in ;

which case even a moderate relief can only be accomplished

when the eyelid is
sufficiently thick. For we must di\ide the
 266 LAGOPHTHALMOS. [book vi.

cicatrix^ and having separated the with a tent, use bandages

lips
until the cure is completed, avoiding such things as are very
desiccative,and having recourse to those which are fatty and
relaxing, such as the juice of fenugreek poured on the part,
and the ointment prepared with four ingredients called basili-
con, applied on a tent.

CoMM. Commentary. See Celsus (\di, 7) ;

Aetius (vii, 71)
; Albu-
' '

Haly Abbas
'
casis (Chirurg. ii, 13) ;
Avicenna (iii, 3, 3, 12) ;

(Pract. ix, 20) ; Rhases (Cont. ii, 4.)

Celsus directs us to make a lunated incision below the eye-
brows, the horns of the incision being turned downwards, and
care being taken not to wound the muscles. tent or pledget A
of lint is to be put into this incision to prevent the edges of it
from uniting. This simple operation is described in nearly
the same terms by Aetius, Albucasis, Avicenna, Haly Abbas,
and Rhases.
Fabricius ab Aquapendente informs us that the operation
had fallen into disuse in his time. It is now sometimes prac-
tised. See Scultet, (Arsen. de Chirurg. Tab. xxxiv, 8.)

SECT. XI. ON THE SUTURE OF THE UNDER EYELID, AND THE

BURNING OF IT BY MEDICINES.

The under eyehd is subject to the same complaints from

the ciliary hairs as the upper ; for, when larger than natural,
it is everted; and it is subject likewise to phalangosis and
distichiasis. We must, therefore, perform the operation of the
suture in the same manner as for the upper eyelid, but in an
inverted order, beginning with the lunated incision on account
of the obstruction occasioned by the blood, and then making the
veruted. But the under -incision is to be omitted altogether,
because the lower eyelid, by its natural weight, is readily
everted. The rest of the treatment to be completed as in the
suture of the upper eyelid, except that the extremities of the
ligatures are not to be glued to the forehead. If in this case
the patient is averse to an operation, and prefers burning by
medicines, you have ah-eady got a description of this process.

CoMM Commentary. This section requires no commentary.

SECT. XII.] ECTROPION. 267

SECT. Xil. ON ECTROPION, OR EVERSION OF THE LOWER

EYELID.

Ectropion of the under lid is occasioned by the same causes

as lagophthalmos of the upper, only that it does not occur
naturally, but arises sometimes from relaxation produced by
medicines possessed of this property, which have been applied
for inflammation ; and sometimes the eversion is occasioned
by
the suture or burning having been improperly performed.
Taking, therefore, a needle, armed with a double thread, we
perforate the fleshy mass, pushing it through from the left
canthus to the right, and then by means of the thread fastened
to both of its extremities, we stretch the skin with the needle,
and cut down upon it with a scalpel, removing the needle at
the same time. Then, if the eyelid resume its proper shape
and is turned inwards, this operation will be sufiicient. But
ifthe eversion continue after the removal of the flesh, we apply
the back of the specillum to the divided eyelid ; and on the
inside of the eyelid, having made two incisions, beginning at
the two angles of the incision formerly made, and terminating
in an acute point, and meeting together like the Greek A, we
remove this substance, so that its acute point may be below at
the eye, and the broad above at what is called the tarsus.
Afterwards we unite the separated parts with a needle con-
taining a woollen thread, being satisfied with two sutures.
But if the ectropion be occasioned
by the operation of the
suture or burning we make a simple incision along the first
cicatrix below the hairs of the tarsi, and having separated its

lips, we fill
up the wound with pledgets, using the same methods
as for lagophthalmos (except fomentations) until the parts
which have been stitched unite.

Commentary. See Aetius (vii, 74) ; Celsus (vii, 7) ; Albu- Com M.

casis (Chirurg. ii, 14) ; Haly Abbas (Pract. ix, 20.)
Aetius gives a full account of the treatment of ectropion
from Demosthenes and Antyllus. When the disease is occa-
sioned by fungous flesh on the inner membrane of the eyelid,
he recommends us to burn it down with escharotics, such as
misy, chalcitis, &c. (See the Third Book.) He describes the
 268 ECTROPION. [book vi.

CoMM. surgical operation in the foUovring terms when the fleshy

:
—
' '
'
excrescences are very large they are to be dissected out with
a scalpel^ and the part touched with burnt copper or the like.
When the erersion is greater, he directs us to perform an
operation upon the inner part of the eyelid, making two in-
cisions, wliich unite below like the Greek letter A, and after-
wards dissecting out this lambdoid or triangular piece, and
along with it the flesh below, which, he remarks, is not car-
tilaginous like the upper eyelid, but taking care to preserve
the skin untouched. The edges of the incisions are then
to be united bv one sutui'e at the evelids. When the

ectropion occasioned by an external cicatrix,

is we are to

operate upon the inner surface of the eyelid in the manner

just nowdescribed, only avoiding to make deep incisions, and
uniting the edges of the incisions as before directed. Then
stretching the cicatrix with a hook, and pushing a needle
armed with a double thread, under the thickened flesh from
the smaller canthus to the larger, we are to cut down upon the
needle and divide the thickened flesh. A pledget of lint is
then to be put into the external incision, and a compress,
moistened with cold water, applied with a bandage. He
directs us to avoid warm fomentations until the ligatures drop
out. When ectropion arises from the excrescence called encan-
this, he recommends us to dissect it out. When the disease
is occasioned by paralysis, or arises from too large a portion of

the eyehd having been cut out in the operation for entropion,
he pronounces it to be incurable. It is also said to be in-
curable when occasioned by the sloughing of carbuncles.
Celsus says that ectropion arises either from an operation
for inversion improperly performed or from old age. In the
former case he directs us to make an incision like that for
lagophthalmos, only with this difference, that the horns of it
are to be turned to the jaws (maxillas) and not to the eye.
When it arises from old age he recommends us to burn the ex-
crescence with a slender piece of iron, and then to anoint it
with honey.
Albucasis describes the operation in nearly the same terms
as Aetius. Thus, he directs us to pass a needle armed with
a double thread, below the fleshy excrescence from the left
canthus to the right, and stretching it by means of the threads
SECT. XIII.] ANABROCHISMUS. 269

to cut it out with a broad scalpel. If this incision does not Comm.
relieve the eyelid, he directs us to take the specillum
(radius)
"
——
'
'

and applying it to the incision, to evert the eyelid with it, and
then to make two incisions in the inner surface of the eyelid
so that they may meet at an angle below, like the Greek letter
A. Then this
triangular portion be dissected out, and
is to
the edges united by a suture with a woollen thread. When
the disease arises from a cicatrix he directs us to divide it, and
then to keep the lips of the wound separate by the application
of a pledget. He concludes with the remark that, as the
disease puts on various forms, a prudent surgeon will show his
skill by restoring the parts to their natural state.
Haly Abbas evidently borrows his description from Aetius
or our author.
The operation here described is
very similar to the one
practised by the late Sir William Adams. In the days of
Fabricius this operation was condemned as cmel and trouble-
some. It will be remarked that the \
operation of modern
times is a modification of the operation now described.

SECT. XIII. ON ANABROCHISMUS AND BURNING WITH IRON.

When the hairs which irritate the eye are not numerous,
but only one, two, or at most, three, close to one another, we
approve of the operation called anabrochismus. Taking, there-
fore, a we pass through its ear (eye ?) a
very slender needle,
woman^s hair or a fine flaxen thread, and unite the two extre-
mities together in such a manner that the thread or hair which
ispassed through may have a double loop ; and we pass another
such thread or hair through the loop, and pushing the needle
through the tarsus where the preternatural hairs appear, we
introduce the hair or hairs into the loop by means of an ear-
specillum, and di'aw it upwards. And if the hair of the eye-
lash be fixed in it, we draAv up the loop ; but if one or
more,
fall out,we again, by means of the one at fii'st introduced, draw
down the loop, and once more introducing a hair or hairs,
draw them upwards. But if there is only one slender haii-
that iiTitates the eye we draw up another of the
ciliary haii-s
along with it, anointing them with gum or some other gluti-
nous substance, and bending them until thev unite to the skin.
 270 ANABROCHISMUS. [book vi.

Some preferring burning to the operation of anabrocliismus,

tui'n tlie eyelid outwards^ and with a hair-forceps dragging
out the offending hair, if there is but one, or two, or three ;
ifthere be as many, they apply a double-headed specillum, or
an ear-specillum, or some such small instrument heated, to the
place whence the hair or hairs were removed. For the skin
being thus constricted, no other hair is produced.

CoMM. Commentary. We
will give Celsus's description of this
'
" Quidam
operation in his own words
'

aiunt, acu transui

'
:

juxta pilos exteriorem partem palpebrre debere, eamque trans-

mitti duphcem capillum muliebrem ducentem, atque ubi acus
transiit,in ipsius capilli sinum, qua duplicatur, pilum esse

conjiciendum, et per eum in superiorem palpebrse partem

attrahendum, ibique corpori agglutinandum, et imponendum
medicamentum quo foramen glutinetur ; sic enim fore, ut is

pilus in exteriorem partem postea spectet." However, he does

not much approve of the operation. He also describes the
operation of cauterising the roots of the hairs, (vii, 7.)

Albucasis, Haly Abbas, and Rhases describe the operation

in much the same terms as Celsus an.d our author.Most of
the Arabian authorities, likewise, describe the operation of
burning the roots of the hairs by means of a specillum or any
such instmment. Canamusah gives a short account of both
operations, that is to say, the auabrochismus and burning the
roots of the hairs.
This operation is described by the earlier of the modern
wi'iters on surgery. The agglutinative composition recom-
mended for this purpose by Guido de Cauliaco consists of
mastich, frankincense, aloes, sarcocol, and tragacauth, dis-
solved in the white of an egg. (vi, ii.)

SECT. XIV, ON HYDATIDS.

The hydatid is a fatty substance, naturally lodged under the

skin of the eyelid, which, in some persons, more especially in
children of a more humid temperament, increases until it be-
come the cause of disagreeable symptoms by encumbering
the eye, and thereby occasioning defluxions. The eyelids,
therefore, under the brows appear watery and cannot be raised
in a becoming manner; and if, when we press upon them
 SECT. XIV.] HYDATIDS. 271

with our fingers, we separate the fingers, the intermediate space

swells up. They are most troubled Avith defluxions about
day-
break, and cannot look direct against the rays of the sun, but
shed tears and are subject to continued ophthalmies. Where-
fore, having placed the patient in a proper position, we com-
press the eyelid with the index and middle fingers a little
separated from one another, so as to form a collection of the
watery contents between the fingers, and direct the assistant,
who stands behind and holds the head, to stretch the eyelid
moderately at the middle of the brow ; then taking a lancet
.

used for bleeding, we make a transverse incision through the

middle, not longer than that made in venesection, and of such
a depth as to divide the skin or even to touch the hydatid itself;
but this is to be done with due circumspection. For many
plunging the instrument too deep, have either divided the
cornea or wounded some muscle of the eyelid. If the hydatid
immediately appear, we draw it out, or if not, we again make
a slight incision. When comes in sight we seize on it by
it

the fingers, with a soft cloth, and moving it hither and thither
and round about, we draw it out. After the removal of it we
soak a double compress in oxycrate, and- bind it on the part,
. Some apply levigated salts, upon the knob of a specillum, to
the incision, in order that if any part of the hydatid remain
it
may be dissolved. After the removal, should there be no
inflammation, we accomplish the cure with collyria in the form
of liniments, or with lycium, horned poppy, or safi'ron. But
when there is inflammation we treat it with suitable cataplasms
y^ Jind the other remedies.

Commentary. Celsus describes them by the name of vesicse Comm.

pingues gravesque. It is clear that they are difierent

from
——
'
"

the tumours to which modern surgeons apply the name. They

appear to have been encysted tumours, or perhaps enlargements
of the sebaceous glands. Celsus du'ects us to apply pressm-e
with two fingers, and the skin being stretched to make a
transverse incison, taking care not to wound the bladder or

cyst. The tumour is then to be seized with the fingers and

pulled out. He remarks that when the cyst is opened, and
its contents evacuated, it renders the operation more difiicult.
When such a thing happens he recommends us to encourage
suppuration.
 272 ADHESION OF EYELIDS. [book vt.

CoMM. To this class of tumours we may perhaps refer the white

rough bodies resembling chalk-stones^ on the inner surface of
the eyelid, which are described by Aetius. He directs us to
evert the eyehd, and, making an incision along the vertex of
the tumour, to scoop it out Avith an earpick, and apply bui'nt
copper, finely triturated, to the pai't. When extracted out-
wardly he recommends a dressing with tetrapharmacum.
(vii, 82.)
See Albucasis (Chu'urg. ii, 10) ; Avicenna (iii, 3, 3, 18) ;

and Haly Abbas (Pract. ix, 21.) They e^-idently copy from
our author. Rhases professes to borrow his description of
the operation from Antyllus and Paulus. (Cont. ii, 3, 2.)
Pabricius ab Aquapendente, describes under the name of
hvdatid, two kinds of encvsted tumours, the contents of the one
being of a thick and heavy nature, and the other, an atheroma.
He approves of the ancient modes of operating. (O. L. ii, 9.)
Heister incorrectly calls them vesiculse aqua plense. (Ch. ii,
2, 9.) Tumom's similar to those which we have here treated of
are described by Scarpa, in the third chapter of his work on
the Eye, and every practical surgeon must be familiar with them.

SECT. XV. ON ADHESION OF THE EYELIDS.

The upper eyehd undergoes adhesion sometimes to the

lower tarsus, sometimes to the tunica adnata, and sometimes
to the cornea itself. This disease obstructs the motions of the
eye. Wherefore, applying an ear-specillum to the broad mar-
gin of the eyelid, or stretching it with a hook-like instrument,
we free the adhesion with the scalpel used in the operation for
pterygia, taking care that the cornea be not wounded, lest we
give rise to procidentia. After the incision, having bathed the
eye, we separate the eyelids with tents, lest adhesion again take
place, and applving wool, soaked in an egg, after the third day
we have recom'se to attenuant and healing colhTia.

CoMM. Commentary. See Aetius (\ii, 66) ; Celsus (vii, 7) ; Albu-

" '
'
casis (Chirui'g. ii, 15) ; Avenzoar (i, 8, 5) ; Avicenna (iii, 8,
8, 10) ; Haly Abbas (Pract. ix, 22) ; Alsahara\ius (Pract. iv, 5) ;

Rhases (Cont. ii) ;

Jesu Hali (ii, 7.)
The description given by Aetius is
exactly the same as our
author's.
SECT, xvi.] CHALAZIA. 2/3

Celsus correctly remarks that the disease is the consequence Comm.

'

of neglected ulcers. He describes the operation in the foUo^v-

'
'

ing terms
"
:
—
Igitur aversum specillum inserendum deduceu-
daeque eo palpebrcc sunt deinde exigua penicilla interponenda,
:

donee exulceratio ejus loci finiatur.^^ He mentions that

Heraclides of Tarentum directed the evelid to be dissected
from the ^srhite of the eve when there is adhesion between
them ;
but recommends us to do it cautiously with an averted
specillum (dos de la spathule_, Fabr. d^Aquapen.), taking care
to wound the eyelid rather than the ball of the eye. Suitable
ointments are afterwards to be applied. Yet he says that he
never saw a case thus cured; and states, that Meges likewise
thought the disease incurable.
In order to understand the above description of Celsus it
may be useful to givefrom Fabricius some account of the
ancient specillum. "
nous suffit syauvoir que specilliiin (qui
II
est le mot Latin de Celse) est un instrument long et rond, de

cuivre, d'argent, on de plomb, duqucl on sonde les fistules,

ayant un de ses bouts plus large, et 1' autre plus etroit, en vul-
gaire Italien stilo." (CEuv. Chir. ii.)
It was, therefore, a
sort of sound.
Avenzoar directs us to make the separation by means of a
golden rod or probe, and then to apply the white of an egg
broken with oil of roses and oil of almonds. AVTien the eyehd
adheres to the white of the eye he advises us in like manner
to make the separation gently with a golden spatula, and then
to apply the oil of roses and of almonds. But the latter case,
he says, is difficult to cure.
Of the other Arabians, Albucasis and Haly Abbas evidently
copy the description of the operation given by Paulus ; and
Hhases and Avicenna supply no additional information. Jesu
Hali's description is accui-ate, but similar to that of Celsus.

SECT. XVI. CHALAZIA OR TUMOURS RESEMBLING HAIL-STONES.

The chalazion is a concretion of inert fluid in the eyelid.

If occur on the external side of the eyelid, having divided
it

the outer part of the eyelid transversely with a scalpel, we

extract the chalazion with an ear-pick, or some sucli instru-
II. 18
 274 ACROCHORDON. [book vi.

CoMM. ment^ and when the mcision is large and the lips thereof se-
^~^ '

parated, we unite them with a suture, and have recourse to

some plaster. But if it be small we omit the suture and effect
the cm*e in the same manner otherwise. But if the chalazion
be internal, so as to appear through the cartilage, having turned
the eyelid outwards, and divided it transversely within, we ex-
tract it and use an injection of salt water.

Commentary. Aetius says that the contents of the chala-

zia, in some cases, resemble the white of an egg. These he
dii'ects us to open, and, ha\ang evacuated their fluid contents,
to touch the part with a poAvder consisting of verdigris, burnt

copper, and other such escharotics. When

the contents are
harder he recommends complete excision, like our author,
(vii, 83.)
Celsus describes the mode of operating with his usual terse-
ness :
—" Hsec incidi debent, si sub cute sunt, ab exteriore
parte, si sub cartilagine, ab interiore, dein scalpelli manubrio
deducenda ab iutegris partibus sunt/' (vii, 7.)
The descriptions of the operation given by Albucasis and
Haly Abbas, if not literally copied from our author, are al-

together to the same effect.

Rhases and Avicenna approve most of the treatment by me-
dicines. See Book Third. Jesu Hali directs us to avert the eye-
lid and extract the tumoiu". Fabricius ab Aquapendente says
'^
that the fluid contained in the chalazion (gresle) is blanche
et transparente, en quelque fafon comme de la gresle.'^ He
repeats the directions given by Celsus. (CEuv. Chir. ii, 11.)
The chalazion is eridently an encysted tumour of a soft nature,
and is not identical Avith the hordeolum, as Scarpa makes it
to be. The treatment here recommended is such as admits of
no improvement.

SECT. XVII. ON ACROCHORDON AND ENCANTHIS.

Acrochordon of the eyelid and that tumour at the greater

canthus called encanthis we seize with a flesh forceps, and
cutting them out with a scalpel, apply levigated chalcitis.
SECT, xviir.] PTERYGIA. 275

Commentary. The nature of the acrochordon is explained Comm.

in the Fourth Book.
Celsus, like oui* author^ directs us to seize the encanthis with
a hook, and cut it out, taking care not to interfere with the
angle of the eyelid. He then recommends us to apply a
pledget sprinkled with calamine or atramentum sutorium (sul-
phate of copper ?) between the eyelids, (vii, 7.)
Aetius recommends us either to use a forceps, or if the
tumour is large, to transfix it with a needle armed with a thread,
and to tie it at its base, and to twist the thread round it.

Albucasis and Haly Abbas evidently copy from our author.

Avenzoar prefers reducing the fleshy tumourwith septics. Rhases
mentions that some recommend septics in cases of encanthis,
but he prefers excision.After the operation he recommends
squama to the part. (Cont. ii.)
oeris Jesu Hali dii'ects us to
remove with septics. (ii, 33.)
it It will be remarked that our
author's operation is the same as that recommended by modern
authorities.

SECT. XVIII. ON PTERYGIA.

This disease is occasioned by a nervous (tendinous) mem-

brane beginning for the most part at the great canthus, and
gradually spreading inwards. It proves injurious to the eye
both by obstructing the motion of the ball, owing to the con-
tractions it produces, and because when it advances forwards it
covers the pupil. Those therefore which are thin and of a
white colour being easiest to cure, we operate upon in this
manner having separated the eyelids, and seized upon the
:

pterygia with a hook-hke instrument, having a small cui'va-

ture, we stretch it, and taking a needle ha\ing a horse-hair
and a strong flaxen thread in its ear (eye ?), and a little bent
at the extremity, we transfix it through the middle of the ptery-

gium, and with the thread we bind the pterygium and raise
itupwards, while with the hair we separate and saw as it were
the part at the pupil away unto its extremity ; but the remain-
der of it at the great canthus we cut oS" from the base with
the scalpel used for the operation by suture, but lea\dng the
natural flesh of the canthus, lest there be a running of the eye
when it is taken away. Some stretching as aforesaid with a
 276 PTERYGIA. [book vi.

thread, dissect away the whole pterygium with the instrament

called pterygotomos, taking care not to touch the cornea.
After the operation, having applied some levigated salts to the
part, we bind on it some wool dipped in an egg. After the
removal of this we inject into the eye salt water for a long
time. But if inflammation supervene we have recourse to the
remedies described for it.

CoMM. Commentary. Celsus gives an excellent account of the

pterygium. He
coiTectly states that the membrane generally

begins at the inner angle of the eye. His description of the

operation is very precise. The patient being properly seated,
the surgeon is to raise the membrane with a sharp hook some-
what bent at the extremity, and is then to pass below it a
needle armed with a thread, the two ends of which he is to lay
hold of and separate the membranes everywhere from the ball
of the eye. The membrane is then to be cut out with a scal-
pel, care being taken not to hurt the angle of the eye-lid. He
directs us to apply to the part a piece of sponge, or some wool,
or a pledget spread with honey. (Adi, 7.)
Aetius also describes the operation very correctly, but in the
same terms as oui* author ; that is to say, he directs us to use
the needle armed with a flaxen thread and a horse-hair, and
afterwards to cut out the membrane, using the precautions
here mentioned, (^ii, 60.)
recommends the same mode of procedure as
Albucasis
Aetius (Chirurg. ii, 16.) Haly gives similar directions. (Pract.
ix, 25.) Both caution us not to carry the incision too near
the inner canthus. Haly Abbas recommends the use of the scis-
sors, and not of the scalpel (in the translation read forficibns
and not forcipibus.)
Avicenna likewise recommends the scissors, (iii, 3, 2, 23.)
Rliases gives directions for passing a needle below the mem-
brane, and for cutting it off. He speaks of using a pair of
scissors. He mentions that he had seen a sui'geon perform it
with a pen. (DiAds. 25, and Cont. ii, 3.)
Jesu Hali dii-ects us to operate either with a scalpel or pair
of scissors. (De Ocidis ii, 38.)
The modern methods of treatment do not appear to differ in

principle from the ancient. Scarpa operates with a pair of scis-

SECT. XIX.] STAPHYLOMA. 277

sors ; but Beer prefers the scalpel. Scai-pa seems to approve of Comm.
'
'
the direction given by the ancient authors, not to carry the
incision too far towards the inner angle of the eye. See also
Fabricius ab Aquapendente (ffiuv. Chir. ii, 18), and Brunus
(Chii\ Mag. ii, 4.)

SECT. XIX. ON STAPHYLOMA.

Staphyloma an incurvation of the cornea, and of the tu-

is

nica choroides, arising from debility, and being produced some-

times bv a defluxion, and sometimes by ulceration. We operate
upon not in order to restore the eyesight, for that is impos-
it

sible, but to moderate the patient's deformity.

Wherefore
having passed a needle from below upwards through the base
of the staphyloma, we are to push another needle, having a
double thread, from the canthus next the hand to the other,
through the base of the staphyloma ; and the first needle re-
maining, we cut the double of the thread, and tie part of the
staphyloma upwards and part downwards with the threads, and
then removing the needle we apply wool dipped in eggs. After
the removal of the dressings we soothe the eyes with emolUent

injections until the ligatures fall off"along with the staphyloma.

" In
Commentary. Celsus thus describes the disease :
ipso Comm.
autem oculo nonnunquam summa attolitur tunica, sive ruptis
intus membranis aliquibus, sive laxatis et similes figura acino
:

fit:unde id (jTa(j)vX(oiLia Grseci vocant." He describes two me-

thods of cure the first of which is by hgatures, as recom-
:

mended by our author and the other consists in cutting from

;

the apex a circular portion equal in size to a lentil.

Scarpa and Guthrie concur in recommending the latter ope-

rations, the merits of which, as they state, have not been gene-
I
rallyappreciated properly.
Aetius directs us to introduce the cross threads, as recom-
mended by our author, and then to cut out the apex of the
tumour. He is at great pains in directing us to introduce the
threads obliquely, and not at right angles to one another. He
also recommends general bleeding and emollient fomentations,

(vii, 37.)
 278 HYPOPYON. [book vi.

CoMM. The operation with the ligatures is briefly described in the

' '

Isagoge/ generally ascribed to Galen.

' '

Haly Abbas and Albncasis describe the operation with the

cross threads in nearly the same terms as our author. The
however^ makes mention of puncturing the apex of the
latter_,
tumour after the application of the ligatures. Jesu Hali gives
nearly the same account of the operation.
Although Scarpa condemns in strong terms the use of the
needle and ligatures, this method of treatment is sanctioned
by the authority of Mr. Travers. This operation was approved
of by William of Saliceto.
Scultet explains the descriptions given by Celsus and Paulus,
but they are sufficiently plain of themselves. (Arsen. de
Chirurg. tab. 32.)
It will be perceived that the ancients applied the name sta-

phyloma to two
distinct, or at least considerably different dis-
eases, namely, to enlargement with protrusion of the cornea,
and to prolapsus of the iris connected with ulceration of the
cornea. Heister, Wenzel, and other continental writers, use it
in the same sense as the ancients. Scarpa and our English ocu-
lists apply it only to protrusion of the cornea, without ulceration.

SECT. XX. ON HYPOPYON OF THE EYE.

Regarding hypopyon of the eyes it will be sufficient to de-

liver Galenas account, which is to this effect :
— ''
A certain
oculist of our time, named Justus, cured many cases of hypo-

pyon by shaking the head. Placing them, therefore, erect

upon a chair, and grasping their head on both sides obliquely,
he shook them so that we could see clearly the pus descending
downwards and, owing to the weight of the substance, it
;

remained below, although cataracts will not remain unless fixed

" oftentimes we evacuate
carefully." And again, he says below,
the pus freely by dividing the cornea a little above the place
where all the coats of the eye unite. This place is called by
some the iris, and by others the corona." These are the words
of Galen in his Avork,
'
On the Method of Cure.^ After the
discharge of the pus, we clean the ulcer with injections of honied
Avater, or of the juice of fenugreek with the addition of some
honey, and then apply the other treatment conformably.
SECT, xxr.] CATARACTS. 279

Commentary. Galen recommends three methods of treat- Comm.

' '

ment for the cure of hj^opyon namely, by discutients, shak-

;
'

ing, and incision. (Meth. Med. xiv.)

Aetius, Albucasis, and Haly Abbas, like our author, are
advocates for shaking and incision. Neither of these methods
is now much in use, but both have had their advocates in

modern times.

SECT. XXI, ON CATARACTS.

The cataracta collection of inert fluids upon the cornea

is

at the pupil, olistructing vision, or preventing distinct vision.

It arises most commonly from a congelation and weakness of
tlie and on that account the disease rather attacks
visual spirit,
old persons, and those who are debilitated by protracted ill-
ness. It is occasioned also by violent vomiting, a blow, and

many other causes. Those kinds of cataract which are but

commencing, as not being proper objects of surgery, have been
treated of in the Third Book. We shall now give the charac-
fairly formed and have acquired
ters of those which are con-
sistence. All those, therefore, who have cataract see the hght
more or less, and by this we distinguish cataract from amau-
rosis and glaucoma ; for persons affected with these complaints
do not perceive the light at all. Wherefore, again, Galen well
instructs us as to the consistence and difference of cataracts and
which kinds ought to be operated upon. Having shut the eye
affected with the cataract, and with the large finger pressing
the eyelid to the eye, and mo^dng it with pressure to this side
and that, then opening the eyelids and observing the cataract
in the eye; if it has not yet acquii'ed consistence, a certain
flow takes place from the pressure of the finger, and at first it

appears broader, but straightway resumes its

former figure and
magnitude. But in those which have acquired consistence no
change takes place as to breadth or figure from the pressure.
But since this appearance is common to those which are of
moderate consistence, and those which are over-compacted, we
their colour. For
distinguish these cases from one another by
tliose which are of an iron, coerulean, or leaden colour, are of
moderate consistence, and fit for couching; but those which
 280 CATARACTS. [book vi.

resemble gypsum and hailstones are over-compacted. After

ascertaining tliese circumstances^ as directed by Galen^ having
placed the patient opposite the light, but not in the sun, we
bind up carefully the sound eye, and having separated the lids
of the other, at the distance from the part called the iris to-
wards the small canthus, of about the size of the knob of the
specillum, we then with the point of the perforator mark the
place about to be perforated and if it is the left eye we ope-
;

rate with the right hand, or if the right eye with the left ;
and turning round the point of the perforator, which is bent
at its extremity, we push it strongly through the part which
was marked out, until we come to an empty place. The depth
of the perforation should be as great as the distance of the
pupil from the iris. Wherefore, raising the perforator to the
apex of the cataract, (for the copper of it is seen through the

transparency of the cornea,) we push down the cataract to the

parts below, and if it is immediately caiTied downwards, we
rest for a little, but if it reascends we press it back again.
After the depression of the cataract we turn round the perfo-
rator and extract it gently. After this, bathing with water
and injecting into the eye a little Cappadocian salts, we apply
externally some wool soaked in the white of an egg with rose-
oil, and biud it up, and at the same time bind up the sound

eye, that it may not move. Then lodging the patient in an

apartment below greund, we order him to remain in a state of
perfect rest, and upon a spare diet ; and the bandages are to
be kept on, if nothing prevent, until the seventh day, after
which we loose them, and make trial of the sight by presenting
him with some object but this we disapprove of during the
:

operation and immediately after by the intense exertion

it, lest

the cataract reascend. become urgent we

If the inflammation
loose the dressing before the seventh day, and must direct our
attention to it.

CoMM. Commentary. See Celsus (vii, 7) ; Galen (Ars Medica,

' '
'
35 ; Isagoge) ; Aetius (vii, 53) ; Albucasis (Chirurg. ii, 23),
Canamusali (vi) ; Avenzoar (i, 8, 19) ; Mesne (de ^gr. Oculi ;
15) ; Haly Abbas (Pract. ix, 28) ; Jcsu Hali (Tract, de Oculis,
68) ;
Avicenna (iii, 3, 4, 20) llhases (ad Mausor. ix, 27, and
;

Cont. ii) ; Vegetius (Mulom. ii, 17.)

SECT. XXI.] CATARACTS. 281

This disease is called suffusio by tlie Latins, and aqua by the Comm.
'
"
*
Arabians.
We have stated in our commentary on aifections of the eye,
in the Third Book, that the ancients were aware that the crys-
talline lens is the seat of one of the species of cataract. This
opinion is clearly delivered by Galen, Aetius, Oribasins, Haly
Abbas, and some of the others. As a proof that this notion
prevailed generally, we will give the words of Psellus literally
" Glaucoma is a
translated :
grievous and incurable affec-
tion, being a certain change of the crystalline humour, and
transmutation of its colour to a sea-green. The suffusion is a
concretion of the fluid between the cornea and crystalline hu-
mour." (Opus Modicum.) The other species then, as Psellus
states, was held to be a concretion between the crystalline lens
and the cornea. That such a disease, although of compara-
tively rare occurrence, is sometimes met with seems undeni-
able.
Celsus lays it down as a rule, that when the suffusion is

small, immovable, and of the colour of sea- water, or of shin-

ing iron, and if a small degree of light can be perceived at the
side, there is reason to hope well of the case. He forbids us to
operate until the disease has attained a proper consistence. He
directs us to place the patient opposite the operator, who is to
sit on a higher seat, while the patient's head is
firmly held by
an The sound eye is to be previously covered up
assistant.
with wool. If the left eye is affected the operator must use
his right hand, and vice versa. A
needle which is sharp and
not too slender is to be passed direct through the two coats at
a place intermediate between the temporal angle and the black
of the eye, and towards the middle of the cataract. When the
needle has perforated far enough, which is readily known by
the absence of resistance, it is to be gently turned so as gradu-
ally to remove the cataract below the region of the pupil, and
this object being attained it is to be strongly pressed to the
lower part. If it remain there the operation is completed ; but
if it return it is to be cut and torn by the needle into many
pieces, in which state they are easier depressed, and prove less
troublesome. Tlie needle is then to be drawn out direct, and
soft wool smeared with the white of an egg, and other anti-
inflammatory applications are to be used. Quiet, restricted
diet, and soothing treatment will be proper.
 282 CATARACTS. [book vi.

CoMM. '
Ars Medica/ alludes to the operation, but
Galen, in his
does not describe it.

Paulus is the only Greek author who describes the opera-

tion. Sextus Platonicus, however^ just mentions that the dis-
eased part is sometimes to be depressed with a specillum. (De
Medic, ex Animalibus.)
Mesne describes the operation of couching briefly, but nearly
in the same terms as our author. He directs us to put the

patient upon a spare diet, and to bleed him before the opera-
tion. He recommends us to be careful to depress the cataract
(aqua) properly.
Albucasis describes the operation of Paulus very minutely,
and gi^es drawings of the couching-needles, called by him
almagda. The instrument is to be passed down into the eye
to as great a space as the pupil of the eye is distant from the
end of the black part called the corona. He says nothing of
tearing the cataract into pieces when it proves difficult to de-
press. He mentions that he had heard of a certain oculist
who, it was sucked out the cataract through a small tube.
said,
He adds, however, that he had never seen any person who per-
formed this operation, nor had read anything about it in the
works of the ancients.
Avenzoar briefly mentions that when a cataract cannot be
got discussed it must be depressed. He gives directions to press
itwell down, but says nothing about tearing it into pieces. He
recommends retirement, abstinence, and rest afterwards.
Avicenna's description is evidently copied from our author.
He also mentions that some surgeons open the lower part of
the cornea, and extract by it. Howevei*, he does not ajaprove
much of this procedure.
Canamusali briefly mentions that cataract must sometimes
be removed by a sm'gical operation. When con\ailsions come
on after the operation he directs us to apply castor to the nose.
E-hases describes acciu'ately the operations of couching, ex-

tracting, and sucking out the cataract. He is the only ancient

author, except Celsus, who recommends the cataract to be
torn in pieces when it cannot be got properly depressed. He
mentions that the famous surgeon Antyllus practised extrac-
tion by opening the lower part of the cornea. He also speaks
of a certain surgeon who sucked it out through a glass tube.
Haly Abbas describes distinctly the operation of couching,
SECT. XXI.] CATARACTS. 283

but evidently copies from Paulus. He makes no mention^ how- Comm.

ever^ of extraction, as far as we can discover, in any part of his
' '
•

works. The operation of couching the cataract is minutely

described by Jesu Haly, but he makes no mention of extraction.
He was the son of Haly Abbas.
'
Sprengel, in his History of Medicine/ refers to Haly
Abbas one of the ancient authorities who make mention of
as
the operation of extracting the cataract; but if this be the case
the edition from which they quote (Venetiis, 1492) must be
considerably different from the one with which we are acquainted.
(Lyon, 1523.) Haly forbids examinations of the eye after the
operation, to ascertain whether or not the patient has recovered
his sight.
We will give the description of Vegetius in his own language :

" Jumentum
igitur pridie temperabis a cibo vel potu maxime
prohibebis, in loco molli elides caputque ejus et cervicem apte
collocabis ita patentem oculum facies ut claudere non
:
possit :

deinde ab ipsa fronte paracenterium inter tunicas oculares sub-

jicito, ne pupillam tangas, aut aliquid Isedas interius. sed ipsum
album de superiori parte ubi hypochysis posita est, capitello pa-
racenterii deorsum deprimis ad palpebram inferiorem subtiliter.
Quod si
depositum fuerit, non
prius paracenterium eximas, nisi
clausum oculum penicello calido diutissime vaporaveris. solet
enim resilire. Quod si evenerit, reprimito, donee ita compo-
natur ut resilire non possit. Cum itaque intellexeris claritatem
pupillse sine illo obstaculo hypochysis, tunc eximes ferrum, et
invenies animal videre."

Sprengel affirms, but not quite correctly, as will be perceived

from the account of the ancient opinions given above, that it
was towards the beginning of the 18th century that it was first
discovered that the crystalline lens is the seat of the cataract.
Otherwise he gives an admirable history of the operation, in
which he does ample justice to the ingenuity and inventive
genius of the ancients. (Hist, de la Med. xviii. 2.)

Fabricius^s description is altogether borrowed from the an-

cient authors, (ffi. C. ii, 16.) Guy of Cauliac, and the other
surgical writers of that age, describe the operation in the same
terms as the ancients. Guy mentions the operation of sucking
out the cataract through a cannula, but does not approve of it.
(VI, 2.)
 284 FISTULA LACHRYMALIS. [book vi.

SECT. XXII. 'ON ^GILOPS, OR FISTULA LACHRYMALIS,

The an apostematous swelling between the great

segilops is
canthus and the nose and it is an affection difficult to cure,
;

owing to the thinness of the bodies, and the fear of injuring

the eye by sympathy. If, therefore, the abscess burst at the
surface, we remove the whole protruberance as far as the
bone and if the fistulous sore incline towards the cheek, we
;

must lay it all open, and if the bone be sound, we must scrape
it;
but if diseased, we must burn it with cauteries, applying to
the eye a sponge soaked in cold water. Some, after the ex-
cision of the flesh, use a perforator, and make a passage for the
fluid or matter to the nose ; but we are contented with burning

alone, using the cauteries for segilops, and burning down until
a lamina of bone drop ofl" ; and after the burning we have re-
course to lentils and honey, or to the application consisting of
pomegranate-rind with honey, and other such desiccative
remedies. If the segilops incHne to the canthus, and do not
tend at all towards the surface, then, with a lancet for the
operation on ptrygium, or one for bleeding, we may dissect
out the body between the canthus as far as the abscess, and
remove the deep-seated flesh, and have recourse to moderately
desiccative applications. Glass reduced to a fine powder is

wonderfully desiccative, and aloes with manna, in like manner.

The rest of the treatment of fistula lachrymalis we have de-
livered in the Third Book.

CoMM. Commentary. Celsus remarks that the segilops is some-

times of a carcinomatous nature, in which case he recommends
us not to interfere with it. He refers here, no doubt, to lupus,
which is of not uncommon occurrence near the inner angle of
the eye. In recent cases which are not of this kind, he directs
us to proceed in the following manner the whole cavity of the
:

abscess, as in fistulee, is to be laid open down to the bone,

which is to be bui-ned with a red-hot iron, more especially if
the bone be carious. Others, he says, instead of the cautery,
use caustics, such as atramentum sutorium, chalcitis, or verdigris;
but these things, he adds, are more slow in their operation,
and less effectual, (vii, 7.)
When the bone is diseased the celebrated Archigeiies recom-
SECT. xxiT.] FISTULA LACHRYMALIS. 285

mends it to be pierced with a slender perforator, or a hole is to Comm.

He mentions that others
' '

be burnt in it with a red-hot iron.

'

brn-ned by means of a funnel and melted lead. (Apud Galen,

it

sec. loc.v; and Rhases Coutin. ii, 4.)

Aetius gives a full and lengthy accoxint of segilops. He re-
commends us to attempt the cure first with medicines (see
Book Third) and if these do not succeed, he directs us to open
;

the abscess freely, and apply to the fungous flesh medicines

possessed of strong stypticity, such as powdered glass, stone
alum, and the like. A
pledget of lint is to be placed over the
medicines. When this method of practice does not succeed,
he recommends burning, and for this purpose directs us to
make a triangular incision in the flesh, and then to touch the
bone with a heated iron, so as to produce exfoliation. Alum
with turpentine is then to be applied to the bottom of the
sore, (vii, 77.)
When the disease does not yield to medicines, Albucasis
directs us to open the abscess freely, so as to make an outlet
for the matter, and expose the bone. If it is found to be
diseased, he recommends us to scrape it with an iron instru-
ment, and then to apply styptic and desiccative medicines to it.
When this treatment does not succeed, he directs us to perfo-
rate the bone with a triangular instrument of iron. When air
issues from the nose by the opening we know, he says, that the

operation is completed.
For the cure of segilops. Mesne recommends the removal of
all the diseased flesh by means of strong caustics, such as
arsenic, sal ammoniac, chalcitis, alum, &c. When the bone is
carious, he directs us to scrape off the carious part. Some, he
adds, perforate the bone ; but the operation had not succeeded
well in his hands. He makes mention of the cautery in the
same terms as the others. (De ^Egr. Oculi, 12.)
Jesu Hali approves decidedly of perforating the bone with a
specillum, or any suitable instrument. He also speaks favor-
ably of the actual cautery. (De Ocuhs, ii, 32.)
Haly Abbas directs us to lay open the swelling, and apply
the cautery. We
have mentioned in another place that he was
acquainted with the lachrymal duct. (Pract. ix, 29, and ix, 72.)
It will be imnecessary to give a particular accoimt of the
treatment recommended by Avicenna, as it does not differ from
that of Albucasis. According to circumstances he approves of
 286 MEATUS AUDITORIUS. [book vi.

CoMM. perforating the bone, and of applying the actual cautery to it.
' '
'
He also speaks of introducing a thread into the lachrymal
passages and of using injections, (iii, 3, 2, 14.)
Avenzoar recommends compression and injections, but does
not describe the operation. He speaks of the matter passing i

into the nose, from which it may be inferred that he also was
acquainted with the lachrymal duct, (i, 8, 10.)
Ehases likewise makes mention of the lachrymal duct. He
recommends us very particularly to make incisions down to the
bone, to perforate it, or to apply the actual cautery to it. He
makes mention also of escharotic applications containing arsenic,
quicklime, and vitriol. He relates a case of apostema lachry-
male in which he effected a cure by the ligature and friction.
(Contin. ii, 2.)
The practice of perforating the bone as recommended by
Albucasis, was approved of by Pott, and the use of the cautery
is also supported by the high
for this purpose authority of
Scarpa. M. A. Severinus, Hildanus, and Garengoit, were like-
wise advocates for the actual cautery. Fabricius seems to have
understood the disease very well, and treated it in the way re-
commended by the ancients. (CEuv. Chii'urg. ii, 21.)
Guy of Cauliac, Theodoricus, and Lanfrancus describe and
appear to have performed the ancient operations for the cure
of fistula lachrymalis.

SECT. XXIII. ON IMPERFORATE MEATUS AUDITORIUS.

This affection sometimes congenital, being occasioned by

is

a membrane which blocks up the entrance into the ear ; and it

is sometimes superficial and sometimes deep-seated. And it is
formed in after life by a preceding ulceration in the meatus ;
for a growth of fungous taking place blocks up the pas-
flesh

sage. If, therefore, the membrane which

obstructs the open-
ing be deep-seated, the attempt at cure is hazardous and yet ;

we may try with some slender instrument to divide it, but if it

is superficial we divide it with a sharp knife, and if
necessary
cut it out. If there be a fleshy excrescence it may be
dissected out with the scalpel used for the operation in ptery-

gium, or that used for polypus ; then making a twisted tent of

the size of the meatus from a linen rag, we soak it in water,
and sprinkling it with levigated chalcitis^ or some such
powder,
SECT. XXIV.] MEATUS AUDITORIUS. 287

we introduce the meatus to prevent the flesh from

it into

growing again. Should inflammation come on we must soon

take it out. If there be a discharge of blood from the meatus
we may soak a sponge in cold water, and apply it along with
other appropriate remedies.

CoMMENTAKY. Cclsus describcs this case with his usual Comm.

" Solet tamen evenire vel a "

terseness primo natali die proti-

'
:

nus, vel postea facta exulceratione, deinde per cicatricem aure

repleta ut foramen in eo nullum sit, ideoque audiendi sensu
careat.^' He directs us to make an examination with a sound
(specillum) in order to ascertain whether the membrane be super-
ficial or deep-seated, and in the latter case recommends us not to

interfere with it, but in the former, directs us to make an open-

ing by means of caustics, burning iron, or scalpel, (^di, 8.)

Albucasis describes the nature of the case and the operation
in nearly the same terms as Celsus and our author. If the
obstruction is occasioned by a superficial membrane he directs
us to perforate it with a slender instrument. If a fieshy ex-
crescence obstruct the passage he approves of seizing it with a
hook, and dissecting it out. If the obstruction be more deeply
seated he directs the membrane to be opened by means of a
heated iron, taking care not to hurt the nerves. It is to be
kept open with a tent. (Chirurg. ii, 7.)
Avicenna miostly borrows his account of the case from
Paulus. When the obstruction occasioned by a fleshy ex-
is

crescence he directs it to be burnt down with arsenic or some

other escharotic. He also approves of perforating the mem-
brane, (iii, 4, 1, 17.)
The account given by Haly Abbas accords very well with
our author^ s. (Pract. ix, 30.)
Fabricius ab Aquapendente describes correctly the treatment
recommended by the ancients. He admits that he had never
attempted to perforate the membrane when deep-seated. (CEuv.
Chirurg. ii, 41.)

SECT. XXIV. ON SUBSTANCES THAT HAVE FALLEN INTO THE

MEATUS AUDITORIUS.

Not only do stones fall into the meatus, but also glass,
beans, and the stones of carob nuts. Of these the stones and
 288 MEATUS AUDITORIUS. [book vi.

glass retain their original magnitude^ but the beans and stones
of carobs being swelled with the natm-al moisture of the bod}%
occasion very severe pains. They must therefore be extracted
by an earpick^ a hook^ or tweezers, or by using powerful shak-
ing of the head, while the ear is placed upon some circular
board. In like manner we extract bodies frequently by suck-
ing them through a reed ; and do the like with water when it

falls into the ear, covering up the outside of the reed with wax
when it is apphed to the ear in order that there may -be no

outlet to the breath. Stones and such like bodies we extract by

wrapping wool around an earpick, and smearing it with turpen-
tine-rosin, or some glutinous substance and introducing it
genth^ into the meatus auditorius. If it does not yield we in-
troduce a sternutatory into the nose and close the mouth and
nostrils. If it yield to none of these, before inflammation,
convulsions, and dangerous symptoms supervene, we must bring
it away by a surgical operation. Wherefore, having placed
the patient in a proper position with his ear turned upwards,
at the base of the ear, behind what is called the lobe, we
make a small lunated incision, and vrith the circular part of
an earpick we extract the body which is lodged there. After
the extraction the wound is to be sewed up, and the cure
completed by the treatment applicable in cases of recent
wounds.

CoMM. Commentary. See Celsus (vi, 7); Aetius (vi, 87); Alexander
" '
"
Trallianus (iii, 6) ; Oribasins (Loc. Affect, iv, 36, 39) ;
Galen
(de Med. sec. loc. iii) ; Aviceuna (iii, 5, 1, 23) ; Mesne (ii, 7, 8) ;

Serapion (ii, 12) ;

Rhases (ad Mansor. ix, 36 ; Contin. iii);
Haly Abbas (Pract. ix, 31.)
Celsus gives nearly the same directions as our author, re-
commending us to use wool wrapped round a specillum, and
smeared with turpentine-rosin, or a hook slightly bent, or an
ear-syringe, or sternutatories, or shaking the patient's head.
The last -mentioned operation he directs us to execute in the
following manner
^^
Tabula quoque collocatur, media adherens,
:

capitibus utrinque pendentibus, superque eam homo deligatur

in id latus versus, cujus anris eo modo laborat, sic, ut extra
tabulam non emineat tum malleo caput tabulae, quod a
:

pedibus est, feritur :

atque ita concussa aure, id quod inest
excidet."
SECT. XXV.] POLYPUS. 289

The treatment recommended by Aetius is exactly the same Comm.

' '

as our author^s. Alexander and Oiibasius also deliver similar "

directions. However, Aetius, Oribasius, Alexander, and our

author, copy from Galen, who in his turn acknowledges his
obligations to Archigenes and Appollonius. (De Comp. Med.
sec. loc. iii.)

Albucasis^s directions are so judicious that we regret our

limits do not allow of our gi^nng them fully. For the extrac-
tion of a piece of stone he recommends us among other means
to use a slender forceps, of which he gives a di'awing. It re-
sembles the modern dissecting forceps. He also gives a draw-
ing of a hook slightly bent, which he commends ;
and also of
a brazen tube to be used for sucking out bodies. When other
means do not succeed, he directs us to make an incision at
the under part of the ear, having previously let blood in order
to avert inflammation and convulsions. Animals are to be
sucked out with a tube narrow below and wider externallv, or
they are to be extracted with a forceps or hook. When these
means do not succeed, an oil, to which some substance destruc-
tive of these animals has been added, is to be injected with an

instrument, of which he gives a drawing.

The reader may likewise consult Mesne with advantage.
Serapion also recommends the same remedies as the Greeks.
Avicenna supplies no new views. Haly recommends incision
when other means have failed.
Rhases directs us to pour tepid oil into the ear, and to put
the patient into a warm bath in order to lubricate and produce
relaxation. His translator, however, remarks that if the sub-
stance lodged in the ear be a bean or a pea there may be
danger of the water occasioning a swelling of it.

SECT. XXV. ON POLYPUS.

The polypus is a preternaturaltumour fonning in the nose ;

so called from its resemblance to a sea polypus, because it re-
sembles its flesh, and because, as the animal with its fibrils
resists those who would seize on it by catching at theii' hands,

manner, block up the nostrils,

so does this affection, in like

occasioning inconvenience both in breathing and speaking.

II. 19
290 POLYPUS. [book vi.

Wherefore those kinds of polypi which are hard, unyielding,

somewhat livid and malignant, inasmuch as they partake of a
carcinomatous nature, are not to be meddled with but such as ;

are more friable, spongy, insensible, and not malignant, are to

be subjected to a surgical operation. Having placed the person
on a seat exposed to the rays of the sun, and opened the nostrils
with the left hand, and holding in the right hand a polypus
like a myrtle-leaf, we cut
scalpel, having its extremity shaped
around the polypus or sarcomatous tumour, applying the extre-
mity of the instrument to the parts where it adheres to the
nose.

Afterwards, turning round the instrument, we bring out the

separated fleshy body with its concave part. And if we see that
the nasal passage is perfectly cleared, we proceed to the cure ;

but if any part of the polypus be left behind, we take another

instrument for eradicating polypi, and, with the extremity
thereof, we bring away what remains by stretching, twisting,
and scraping it strongly. Malignant polypi we burn with cau-
teries, knob-shaped ; and, after the burning, we
have recourse
to the treatment for burnt parts. After the operation, having
sponged the parts carefully, we inject oxycrate or wine into the
nose, and, if the fluid descend by the roof of the mouth to the
pharynx, the operation will have been rightly done ; but if it
does not descend, it is clear that about the ethmoid bones, or
the upper parts of the nose, there are fleshy bodies which have
not been reached with the polypus instruments. Taking, then,
a thread moderately thick, like a cord, and having tied knots
upon it at the distance of two or three fingers^ breadths, we
introduce into the opening of a double-headed specillum, and
it

we push the other extremity of the specillum upwards to the

ethmoid openings, passing it by the palate and mouth, and then
drawing it with both hands, we saw away, as it were, with the
knots the fleshy bodies. After the operation, we keep the opening
separate by means of a tent resembling the wick of a lamp; and
after the third day we consume whatever is left behind by the
trochisk of Musa or the like, and at the same time use desicca-
tive applications to the part. Afterwards, we have recourse to

epulotic trochisks, and, if necessary, during the whole treat-

ment we keep leaden tubes in the nose.
SECT. XXV.] POLYPUS. 291

Commentary. For an account of the treatment by medi- Comm.

"

cines we refer to section xxiv of tlie Third Book. '

The author of one of the Hippocratic treatises, according to

circumstances, recommends sawing it out, consuming it with
septics, tying it with a hgature, and burning it with a red-hot
iron. (De Morbis, ii.)

Isagoge' of Galen, it is merely recommended to cut

'
In the
out the tumour, and to scrape its roots.
Celsus, like our author, recommends excision with a sharp
instrument of iron, and directs us to apply afterwards to the
part a tent smeared with some styptic. A proper dressing is then
to be applied for cleansing the sore, (vii, 10.)
Oribasius briefly mentions excision as a proper remedy when
medicines fail.
Albucasis describes minutely the operations of excision and
sawing out the tumour. Like our author, he directs us to seize
the tumour with a hook, to pull it down, and cut it out. If

any part remain, he recommends us to scrape it out with a slender

instrument, and then to apply styptics, such as vinegar, water,

or snow. The operation of sawing it out with a thick knotted
thread isminutely described by him. He also speaks of cau-
terizing the part from which the tumour has been removed.
Mesne describes the process of sawing out the tumour, with
some slight differences. He recommends us to use three horse-
hairs, which, being tied together with knots, are to be introduced
into the nose with a leaden needle, and one end conveyed out

by the openings of the palate ; and then, by pulhng at both ends,

the tumour is to be sawed out.

Avicenna, Haly Abbas, and Rhases make mention of excision

and the process of sawing out the tumour. Rhases relates the
history of a case of polypus, imusually large, which he
had seen
extracted in an hospital. He and Albucasis recommend the part
to be dressed with green ointment.
The veterinary surgeons appear to have depended principally
upon the actual cautery. See Vegetius (Mulom. ii, 38.)
The method of curing polypi of the nose, by sawing them out,
seems to have now fallen completely into disuse, whether de-
servedly or not we cannot, from our own experience,
venture to
decide. Fabricius ab Aquapendente disapproved of it; but he was
evidently much prejudiced in favour of the operation with
a new
 292 EPULIS AND PARULIS. [book vi.

CoMM. forceps of his own invention. (CEuv. Chir. ii, 24.) Sprengel in-
' '
'
forms ns that this method was practised by the surgeons of the
middle ages. It is described by Brunus (Chir. Mag. ii.)

Sprengel thus explains the other operation described by our

author " II se servait d^un instrument
:
particulier auquel il
donnait le nom de airaOiov ttoXvitiicov, et qui etait garni k I'une
de ses extremites d^un ciseau, KVK\i(7Kog." (Hist, de la Med.
\iii^ 4.) Why does he substitute KVK\i<rKog for KvaOiaKo^?
That the instrument had a chisel (ciseau) at its extremity is
altogether improbable, and this supposition is unwarranted by
the context. KvaOiaKoq means the cup-like or concave end of
the instrument.

SECT. XXVI. ON MAIMED PARTS.

When the ears or the lips have been mutilated, we restore

them by first dissecting the skin below, and afterwards bringing
together the lips of the wounds ; then remo^dng the callous pai'ts,
and afterwards sewing and glueing them together.

CoMM. Commentary. This section is taken from Galen. (Meth.

" '
•
Med. xiv.) See, also, the
Isagoge.'
'

Celsus's observations are too minute and lengthy for our

limits. to say, that he du'ects the edges to be pared,
Suffice it

and then united with sutures, (vii, 9.)

Hhases' directions for the treatment of mutilated ears and
noses are to the same effect as our author's. (Cont. xiv.) Similar
ones are given by Albucasis. He directs us to make the suture
either with needles, as in gastroraphe, or with a thread. (Chi-

rurg. ii, 26.)

Celsus has been supposed, but, as we think, incorrectly, to
touch on the operation for the hare-lip. (vii, 10, 6.) See Sprengel
(Hist, de la Med.)

SECT. XXVII. ON EPULIS AND PARULIS.

Epulis is a fleshy excrescence which forms upon the gums

beside one of the teeth ; but parulis is an abscess which forms
SECT. XXVII.] EPULIS AND PARULIS. 293

near the gums. The epuhs, then, we raise with a flesh forceps
or a hook, and cut out ; but the parulis we divide circularly
and fill the incision with tents. I am aware that often when
opened only with the common lancet used for venesection and
the matter evacuated, the disease has ceased. After the opera-
tion we give orders to gargle with wine, then with honied
water, and afterwards apply to the wound the Flowery powder,
until the cure is completed. But if mortification attack the
gums, and do not yield to the suitable applications, we must
burn the part with knob-shaped cauteries.

Commentary. Parulis is the gum-boil. Epulis is a soft Comm.

" '

fleshy tumour which forms on the gums. Aetius treats fully

'

of them. To the former he directs us to apply at first such

things as promote suppuration, after which it may either be
allowed to break of itself or may be opened with a lancet. Styptic
applications will then be proper. For the epuHs he recom-
mends us at first to apply alum, verdigris, &c., and if these
have not the desired efiect he directs us to cut it off with a

scalpel. 24, 25.)

(\dii,
Celsus treats of both at considerable length by the name of
parulides. For that species which corresponds to the gum-
among other remedies, he recommends us to hold in the
boil,
mouth a decoction of figs, and directs to open it before it is
ripe, lest the matter should hurt the bone. Larger tumours
are to be cut out entire, (vi, 13.)
Haly Abbas recommends excision for the epulis, and to open
the parulis in due time with a lancet. (Pract. ix, 33.)
It appears to us that of all the ancient authorities Albucasis

lays down the best rules for treating the epulis. He directs us
to cut it out with a forceps and scalpel, and then to apply
to the or if the tumour grow again, the
styptic powders part,
actual cautery. For our own part, we have generally found
that no permanent cure could be effected without the cautery.
See Chirurg. (ii, 28, and i, 22. ^
It is unnecessary to detail the treatment recommended by
the other authorities.
 294 EXTRACTION OF TEETH. [book vi.

\i

SECT. XXVIII. ON THE EXTRACTION OF TEETH.

Having scarified around the tooth down to the socket, we

must by degrees shake the teeth with a tooth-extractor, and
draw it out. But if it is carious we must first plug up the hole
with a small tent, that it may not break when compressed by
the instrument. After the extraction we may consume the
by sprinkling it with finely levigated salts, and
flesh that is left
afterwards gargles of wine or oxycrate may be used until the
completion of the cure. And since sometimes supernumerary
teeth are formed, those that are fixed in the socket we must

scrape down with a gra\ing-tool, but those that are not so

fixed we must extract with a tooth-extractor. If any tooth
grow an
to unnatural size, or is broken, we may scrape away
the projecting or redundant part of it with a file. The laminae
which unite to them we may remove as may appear proper,
with the concave part of a specillum, a raspatoiy, or a file.

CoMM. Commentary. Cselius Aurelianus disapproves of extracting

' '

Herophilus and
*
teeth, except in cases of extreme necessity.
Heraclides Ponticus, he says, have related cases in which the
operation had proved fatal ; and in modern times we hear some-
times of such occurrences. (Pass. Tard. ii, 4.)
Celsus directs us, when the pains of toothache cannot be
got othei-wise alleviated, to separate the gums from the tooth
by free scarifications, and then to shake it until it is loosened,
and forbids us to proceed rashly to perform extraction, for fear
of occasioning dislocation of the jaw-bone, or, if the tooth
belong to the upper jaw, of hurting the temples or eyes. If
loose, it is to be taken out with the hand, but otherwise Avith
a forceps, and, if eaten, the hole is to be filled with a tent, or
with lead, to prevent it from breaking dming extraction. The
instrument is to be pulled direct, lest the spongy bone to which
the tooth is be broken.
fixed sliould Of this accident occm*-
ring there is, he adds, considerable danger; and not unfre-
quently when the tooth is short and its roots long, the instru-
ment takes hold of a piece of bone and breaks it in which
;

case he directs us to extract the broken piece with a pincers.

When the teeth are carious he directs us to scrape them, and
 SECT. xxTX.] CONSTRICTION OF TONGUE. 295

apply to them a mixture of the flowers of roses, galls, and Comm.

When the
' '

myrrh, and to hold undiluted wine in the mouth.

'

teeth are slackened by any accident, he directs us to fasten

them to the surrounding ones with a golden tliread, and then
to hold some stringent decoction in the mouth. ^^Tien in
young persons a second tooth appears before the first has fallen
out, he recommends us to scarify around the latter and pull it
out, and to endeavoui' to force the other gradually into its

proper place. Stumps of teeth are to be taken out with a

stump-extractor, (vii, 12.)
Scribonius Largus makes some ingenious observations on the
extraction of teeth, but disapproves of the operation, except
in extreme cases. (De Comp. Med. i, 10.)
Galen, and the medical authorities subsequent to him, direct
Tis to file down teeth when they are diseased and project, but

disapprove in general of extraction.

Albucasis is particularly full in treating of the operations on
the teeth. Like our author, he recommends us to perform
extraction by first making free scarifications, and then pulHng
the tooth direct with a forceps, the patient's head being held
between the knees of the operator. When the tooth is hollow
he directs us to stuft' it beforehand with a tent of cloth. When
a piece of the alveolar process has been broken, he properly
recommends that it be taken out. He gives suitable dii'ections
for fiHng down the teeth,and for fastening them with gold
threads. He gives drawings of instruments for extracting
roots. (Chir. ii, 30.)
The other Arabians describe the operation, but less precisely
than Albucasis. Haly's directions are judicious. He recom-
mends the operator to use a forceps, and to stuff the tooth
when it is hollow. (Pract. ix, 31.)

SECT. XXIX. ON CONSTRICTION OF THE TONGUE, OR

TONGUE-TIED PERSONS.

The aff'ection called ancyloglossus is sometimes congenital,

the membrane which fastens the tongue being originally harder
and more constricted than ordinary but sometimes is acquired
;

from some hard cicatrix formed under it by ulceration. Those

 296 CONSTRICTION OF TONGUE. [book vi.

thereforewho have this affection naturally are distinguished by-

being slow in beginning to speak^ and by having the frsenum

linguae larger than its moderate size, and that without any
previous ulceration. When the complaint
is occasioned
by a
cicatrix it is
easily recognised. Wherefore the patient is to be
placed on a proper seat, the tongue raised to the roof of the
mouth, and the membranous frsenum cut transversely. But
if the curvature is occasioned by a cicatrix, we transfix the
callus with a upwards, and making a cross
hook and draw it

incision free the bent part, taking care not to make deep inci-
sions of the parts ; for hemorrhages which have been found
difficult to stop have thereby been occasioned. After the ope-
ration the part is to be washed with cold water or oxycrate ;
and after all these things the cure is to be completed with
relaxing and incarnative applications.

CoMM. Commentary. Celsus thus describes the treatment in con-

'
*
'
" Horum extrema lingua vulsella prehen-
genital affections :

denda est, sub eaque membrana incidenda, magna cura habita, ne

venae quae juxta sunt, violentur et profusione sanguinis noceant."
(vii, 12, 4.)
Aetius's plan of treatment is quite similar to our author^s.
(viii, 38.)
Albucasis gives a similar account of the operation. He
cautions against opening the artery below the tongue, for fear
of hemorrhage. Should this accident occur he directs the
surgeon to use the actual cautery. (Chirurg. ii, 34.)
Rhases recommends when the frsenum extends to the tip of
the tongue that it be divided, so as to allow freedom of motion.
However, one of the authorities quoted by him directs us to
pass tlu'ough the frsenum a needle armed Avith a thread, which
is to be tightened so as to divide the intermediate
space. He
recommends this method in order to obAaate the fear of he-
morrhage from the incision. Rhases himself states that a
dangerous hemorrhage will result from opening the green veins
below the tongue. (Cont. vii, 1.)
Avicenna also recommends the operation with the ligature,
(iii, vi, 11.)

Haly Abbas describes very distinctly the operation of divi-

ding the fraenum. (Pract. ix, 35 )

SECT. XXX.] ANTIADES. 297

Alsaliara\ius mentions tliat the operation is sometimes ne- Comm.

* '
'

cessary. (Pract. ix, 35.)

SECT. XXX. ON ANTIADES^ OR INDURATED TONSILS.

As indurated glands are called strumee, so the almonds of

the ears when inflamed, SAvelled, and as it were, dried^ occa-
sioning difficulty of deglutition and of breathing, are called
antiades, from theii' being placed opposite one another. "When
therefore they are inflamed we must not meddle with them ;

but when the inflammation is considerably abated, we may

operate, more especially upon such as are white, contracted,

and have a narrow base. But those which are spongy, red,
and haA'e a broad base, are apt to bleed. Wherefore, seating
the person in the light of the sun, and directing him to open
his mouth, while one assistant holds his head, and another

presses down the tongue to the lower jaw with a tongue spatula,
we take a hook (tenaculum) and perforate the tonsil with it,

and drag it outwards as much as we can without drawing its

membranes along with it ; and then we cut it out by the root

with the scalpel suited to that hand, called ancylotomus, for
there are two such instruments, ha\ing opposite curvatures.
After the incision of one we may operate upon the other in-
versely in the same manner. After the operation the patient
must gargle with cold Avater or oxycrate and if any hemor-
;

rhage come on he may use a tepid decoction of brambles, roses,

and myrtle-leaves or if the blood floAvs copiously we must
;

give for a gargle the juice of plantain and comfrey, and the
trochisk from amber and the Lemnian earth, dissolved in oxy-
crate. When the hemorrhage stops, the parts on the next day
may be anointed with the flower of roses, safi'ron, and starch
A\ ith milk, or with water, the white of an egg, or hydrorosatum.
When sordes about the ulcers,
collect we may use injections
and linctuses made from honey.

Commentary. Celsus directs us Avhen the tonsils are indu- Comm.

" '

rated to scrape the membrane with the finger, and tear it out ;
"

or, if this does not succeed, to seize the tumour Avith a hook
or tenaculum, and cut it out tlien the Avound is to be washed
;

with vinegar, and a styptic medicine applied to it. (vii, 12.)

 298 UVA. [book vi.

Co^f^^. Aetius directs us to seize the tonsil with a hook and cut it
'
out at the middle. When cut out at the base, he remarks
there is danger of hemorrhage, (viii, 57.)
Albucasis directs us to make
the patient sit with his head
on the operator's bosom, and, while an assistant presses down
his tongue, the operator is to seize the indurated tonsil with a

hook, and drawing it out, to cut it off with a sharp instrument

resembling a forceps, or, in other words, with a pair of scissors.

He likeAvise gives a drawing of another instrument which con-
sists of a lunated piece of iron fixed to a handle. He relates
an interesting casein which he performed the operation, (ii, 36.)
Rhases, upon the authority of a surgeon called Ancilisius,
in the barbarous translation of his works, which probably is a

corruption of Antyllus, briefly describes this operation. He

directs us to open the mouth and take hold of the tonsils, the
foui'th part of which may be cut off. He recommends us to
make the patient gargle with vinegar. He forbids the opera-
tion when the tonsils are enlarged and red. (Contin. vii, 2.)

Haly Abbas (Pract. ix, 36,) and Mesne (de ^Egr. Gutturis,
4,) describe the operation, but not so minutely as Albucasis.
Guido de Cauliaco copies the descriptions of Albucasis and
Haly Abbas, (c. vi, 2.)

SECT. XXXI. ON THE UVA.

The UAT^ila being, as it were, the quill or plectrum of the organ

of speech is often the seat of defluxion from the head, and becom-
ing preternaturally enlarged, of a lengthened form and slender
shape, it is called columella ; but when thick below and round it
is nameduva, from its resemblance to a grape, as the other is so
called from its resemblance to a column. If, therefore, it
cannot be made to yield to general treatment, —
I mean evacua-
tions by bleeding and pm-ging, —
nor to topical, such as astrin-
gents, repellents, and discutients,
—
we must proceed to the
operation, lest, by its constant irritation, it bring on coughs,
sleeplessness, and even suffocation. Such, therefore, as are
contracted, round, not of a lengthened shape, bloody, or some-
what black, we must decline operating upon but those that ;

are slender, long, small at the extremity, loose, not very bloody.
SECT. XXXI.] UVA. 299

but whitish, we must operate upon ; for the inflammation of

them soon subsides. We must only take away as much of
the uva as exceeded its natural size ; for the complete ex-
tirpation of it proves greatly injurious
to the parts about the

chest, and occasions the loss of voice. Wherefore, having

placed the patient on a seat in the rays of the sun,
and directed
him to gape wide, we seize with the forceps adapted for this
purpose, or a common tenaculum, upon the redundant part
and
drag it downward, and cut it out Avith the instrument called
for the
staphylotomus, or the scalpel used in the operation
suture of the upper eyelid. After the operation the same
things are to be done as are recommended for angiology. But
since often, from the timidity of the patient, or the fear of the

hemorrhage, or the success attending the treatment by medicines,

he declines the operation by instruments, we may rather con-
sume it by means of a caustic medicine. Wherefore, taking
the caustic used for burning the eyelids, or some such, we are
to fill with it the hollows of the instrument called staphylo-
caustos, and directing the patient to gape wide, and getting
the tongue pressed down with a tongue spatula, we open the
instrument sufficiently and grasp Avith it as much of the uva
as we cut off" in the other operation. The medicine must
neither be of too liquid a consistence, lest it run down from
the uva improperly, and burn the adjoining parts (and, there-
fore, we direct the patient not to
swallow during the whole
of nor hard, that it may soon act upon
operation burning), very
the uva. And if from one application the extremity of the
uva become black, this will be sufficient, but if not we must
use it again. Dm-ing the whole time of its action the patient
must sit with his head bent forwards, in order that the saliva
which is melted down with the portions of the medicine may
flow from the mouth. The part becomes dead in one hour,
and falls off" about the third or fourth day. After the burning,
soft wool or tow,
having wrapped the index-finger round with
we wipe the parts about the uvula, or direct the patient to
gargle with water. But after this operation, and also that on
the tonsils, soothing fomentations from the oil of camomile are
to be applied around the neck, and in like manner we may use

gargles and liniments.

 300 PHARYNX. [book vi.

CoMM. Commentary. It appears from the Hippocratic treatises that

' '
•
excision of the uvula was sometimes performed in early times.

(Prognost. de Morbis, ii; De afiect.)

Celsus recommends us not to meddle with the operation
when the uvula is red and enlarged, for fear of hemorrhage ;
but when it is slender, sharp, and white, or when it is pale

and thick below, but slender above, it may be extirpated with-

out danger. For this purpose he merely directs us to seize
upon it with a forceps and cut it out. (^di, 12.)
Galen describes fully the operation by medicines, but says
nothing of excision. (De Med. sec. loc. vi.) Aetius describes
the operation in nearly the same terms as our author. He
directs us to grasp the enlarged uvula with a forceps and cut
it off,
using afterwards some astringent gargle, (viii, 44.)
Oribasius briefly mentions the operation, which he directs to
be performed with extreme circumspection. (Med. Collect,
xxiv, 10.)
Albucasis describes the operation similarly to the Greeks.
He directs the operator to get the patient^s tongue pressed
down by an assistant ; when the operator is to seize upon the
uvula and cut off as much as is proper of it. He gives a
drawing of an instrument for the operation with caustic medi-
cines. (Chirurg, ii, 37.)
Avicenna's description is to the same effect, but not so cir-
cumstantial, (iii, 9, 15.) Mesne directs us to
perform the
operation with a heated scalpel of gold. (De ^gr. Guttm-is, 3.)
Rhases states that when the uvula is enlarged, but is not
red, the operation may be performed without danger. He men-
tions that some preferred the actual or potential cautery, but
that he preferred excision. He describes, but not distinctly,
an instniment for applying the caustic medicines. He states
that loss of the entire uvula impairs the voice and exposes the

lungs to danger from cold. (Contin. vii; and Divis. i, 49.)

SECT. XXXII. ON THORNY SUBSTANCES FIXED IN THE PHARYNX.

Thorns, or the bones of fishes, or other substances, are often

swallowed in eating, and fix in different places. Wherefore,
such as can be seen we are to extract with the forceps for that
SECT. XXXIII.] LARYNGOTOMY. 301

pm'pose; but those which are lower down

in the gullet we
must manage differently. Some are of opinion that the patient
ought to be made to swallow large morsels, such as the stalk
of lettuces, or pieces of bread ; but others direct us to bind a
thread about a small piece of clean soft sponge and give it to
the patient to swallow, and then taking hold of the thread to
draw it up, and to do this frequently in order that the thorn
may get fixed in the sponge and be brought up. Leonidas
orders suppurative cataplasms to be applied, such as those
from raw barley-flour, in order that the part may be converted
into pus and the thorn fall out of its own accord. If we see
the patient at the time of swallowing, before digestion has
taken place in the stomach, and cannot perceive the substance
which is fixed, we may order him to vomit by pushing the
fingers or feathers down the throat, for sometimes
the thing
which is fixed will be brought up with the matters that are
vomited.

Commentary. Our author^s directions are mostly taken Comm.

from Aetius. (viii, 50.)
Albucasis repeats our author's directions, and further re-
commends us, when they fail, to introduce an instrument
made of lead, which he gives a drawing of, and either to ex-
tract the substance or push it downwards. (Chirurg. ii, 38.)
A similar plan of treatment is recommended by Mesne (de

^gr. Gutturis) ; by Avicenna (iii, 9, 43) ; and by Alsaharavius

(Pract. xii.) When a morsel of food sticks to the oesophagus,
Alsaharamis directs that the person should be struck on the
back, which will facihtate the descent of it. (6.)

SECT. XXXIII. ON LARYNGOTOMY.

The most famous surgeons have also described this operation.

" In cases of
Antyllus, therefore, says, cynanche (as we will
explain under the head of Dietetics) we entirely disapprove of
this operation, because the incision is utterly unavailing when
allthe arteries (the whole of the trachea ?) and the lungs are
affected;
but in inflammations about the mouth and palate,
and in cases of indurated tonsils which obstruct the mouth of
 302 LARYNGOTOMY. [book vi.

the windpipe as the trachea is unaffected, it will be proper to

hav^e recourse to pliaryngotomy, in order to avoid tlie risk of suf-
focation. "When, therefore, we engage in the operation we slit

open a part of the arteria aspera (for it is dangerous to di-vide the

whole) below the top of the windpipe, about the third or fourth
ring. For this is a convenient situation, as being free of flesh, and
because the vessels are placed at a distance from the part which
is divided. Wherefore, bending the patient^s head backwards,
so as to bring the windpipe better into view, we are to make
a transverse incision between two of the
rings, so as that it
may not be the cartilage which is divided, but the membrane
connecting the cartilages. If one be more timid in operating, one
may first stretch the skin with a hook and divide it, and then,
remoAdng the vessels aside, if they come in the way, make the
incision.'^ These are the words of Antyllus. We
judge that
the windpipe has been opened from the air rushing
through it
with a whizzing noise, and from the voice being lost. After
the urgency of the suffocation has passed over, we pare the
lips
of the incision so as to make them raw
surfaces again, and
then have recourse to sutures, but sew the skin only, without the
cartilage. Then we use the applications proper for bloody or
fresh wounds, but if it does not unite we must treat it with
incarnants. We must follow the same plan of treatment if
we should meet with the case of a person who had cut his own
throat from a wish to commit suicide.

CoMM. Commentary. Aretseus makes mention of this operation

in such terms as proves that it must have been
practised oc-
casionally in his time. He, however, does not approve of it,
at least in cases of angina. (De Curat. Morb. Acut.
i, 7.)

Cselius Aurelianus says that Asclepiades performed the

operation in cases of cynanche ; but he himself disapproves of
it. (De Morb. Acut. i,
7.)
We
may mention further in this
place that Avicenna, Avenzoar, Haly Abbas, Mesne, and Rhases
express themselves rather favorably of the operation in urgent
cases of cynanche. From the circumstance mentioned by Pollux
of cynanche, that it
mostly attacks children, we are inclined to
think that the ancients meant the crouji
by it.
None of the Greek authorities, except om* author, have left
a description of the operation. Psellus, however, mentions it
SECT. XXXIV.] ABSCESS. 303

in such a manner as would lead us to infer tliat the operation Comm.

" '

'
had not been lost sight of in his time, i. e. Laryngotomy is a
certain surgical operation.^'
Avicenna and Albucasis merely copy our author's descrip-
tion, and appear to have never seen the operation performed.
To show, however, that the windpipe may be opened without
occasioning death, Albucasis relates the case of a female who
cut her trachea while attempting to commit suicide ; in which
case, by sewing up the wound, he effected a cure without diffi-
culty. (Chirurg. ii, 13.)
Rhases mentions that, in cases of cynanche which threaten
instant death, a certain physician, Ancilisius (Antyllus ?) re-
commends the surgeon to open the windpipe. His description of
the operation is as follows The patient's head being kept back
:

the skin is to be divided, and the sides of it separated by means

of threads, so as to expose the windpipe, which is to be opened
by making an incision in the membrane which connects two
of the rings together. After the abcess bursts the wound is

to be sewed up. (Cont. vii, 2.)

Haly Abbas likewise describes the operation accurately.

He directs us to make an incision in the skin, and to separate
the edges with hooks so as to expose the windpipe^ which is to
be opened between two cartilages. (Pract. ix, 38.)
The modern history of the operation is given in Van
Sweiten's Comment. (814) Memoires de TAcad. Royale (ii)
; ;

and Cooper's Surgical Dictionary. See a complete history of

the operation by Sprengel. (Hist, de la Med. 18, 6.) He says,
thatAnthony Benivieni, a surgeon of Florence, is the first after
Antyllus who is known for certain to have performed the
operation.

SECT. XXXIV. ON ABSCESS.

That the abscess is a corruption and transmutation of the

flesh or fleshy parts, and what are its modes of formation, and

how many kinds of abcesses there are, we have sufficiently ex-

plained in the Fourth Book. Now we have only to treat of

the operation upon it. If it be completely changed to pus,
which we ascertain from the pains, fever (if any was formerly
304 ABSCESS. [book yi.

present), redness, pulsation, and the other symptoms of in-

flammation being diminished, from the swelKng assuming a

sharp point, and from pus being felt under the fingers upon
abscess be superficial, in that
pressure, more especially if the
case we may proceed to the operation. But if it is not felt to
the touch, nor is elevated to a point, owing to its being deep-

seated, we must attend to the other symptoms before operating.

It is to be understood, however, that before the conversion to

pus is completed, we sometimes open abscesses when they are

unripe, on account of their being near joints

or ^ital parts,

lest, by their continued putrefaction, a ligament

or some neces-
saiy part should be corrupted by it. And Hippocrates directs
us to open abscesses about the anus before they are completely
intestine. In opening
ripened, for fear of their perforating the
them we must in all cases, make the incisions in the same

manner, but
not,
observe the natural lines as —on the face; and the
growth of the hairs
—
as on the head, and taking as much care
as possible not to occasion deformity. Straight incisions are
to be made in the legs, as in the muscles and tendons ; and
nerves, arteries, \atal parts are to be avoided, taking care
and
of their safetyby sometimes making a straight incision and
sometimes a transverse one into the abscess, according to the
circumstances of each case. "UTien the abscesses are small we
make one incision, but when they are larger we make more,
always di\dding the thinner parts, and those which are most
convenient for the escape of the matter. When the swelling
is much raised up to a point, unconcocted, thin, and devoid of
vitality, we must cut out
a piece either like a triangle, or like
a mp'tle leaf, or of some other angular figm-e, because the
circular is unfavorable to cicatrization. Those which ai'e

not pointed we open by a simple incision, and when we find a

sinus, if the part is fleshy and the skin proper for uniting, we
only make such incisions into the part as
will allow the mat-

ter to be discharged ; but if it be thin and veiy devoid of flesh

we make a simple incision along its whole length ; and after
this simple incision, if the parts on each side appear thin and
not fleshy we must pare them off. After the operation, ha\dng
first sponged the part, if the abscess be small, and if only one

incision has been made, we may use a simple pledget, but if it

be large, and there be many incisions, we draw through them
SECT. XXXIV.] ABSCESS. 305

a fillet which cau be easily extracted and when the part has
;

been cut out we fill it in like manner with lint. If a hemor-

rhage take place we must use cold water or oxrcrate, and if
the bleeding continue we may sprinkle upon the part finely
powdered which we may also have recoiu'se to often
clialcitis,
when the part is gangrenous and flaccid. In winter, and when
the parts are nervous, we may soak oblong pledgets in wine
and oil and apply them and in summer, when the parts are
;

fleshy, we may soak these appUcations in water and oil, or in

the same cold wine and oil, and binding them, on the following
day we may bathe with the same fluids but on the third day,
;

having loosed the dressings and sponged the parts, we may use
the application called tetrapharmacon on a pledget, and if
there be no inflammation present we may apply the same
wash for the preservation of the pledget but if there be in-
;

flammation, we must apply a digestive cataplasm, having first

pom-ed water on the parts. "When the inflammation abates
we may eff'ect the cure by promoting suppuration and incar-
nation. Sinuses are to be cured by agglutinative remedies, as
has been said, in the Fom'th Book, on sinuses.

Commentary. All the authors quoted under this head in Comm.

the Fourth Book may be consulted.
Celsus is more than usually prolix in laying down the rules
for the surgical treatment of abcesses. Before the abscess
harden, he du'ects us to make incisions in the skin, and apply
a cupping instniment, in order to remove any symptoms of in-
flammation which may have been present, or, in other words,
to procure resolution. Sometimes, however, as he explains,
the matter is collected in a cyst (tunica), in which case it is
not to be supposed that the contents of the abscess can be re-
moved by a cupping instrument. When the pus ripens it is
seldom proper to let it out if seated in the armpits, or groins ;
nor when the collection is superficial, or in the flesh ; and it is
better, as he prudently directs, to apply cataplasms until the
pus make an opening for itself. When it is judged necessary
to open an abscess, he recommends us, if not seated in a
nervous part, to perform the operation with a red-hot iroii,
because a small opening made in this manner will remain
longer open. Abscesses in nervous parts are to be opened
II. 20
 306 ABSCESS. [book vi.

CoMM. with a scalpel. In making an incision, the form and size of

" '
"
it are to be considered. In general the openings ai*e to be
made as small as possible ; biit large sinuses require larger
incisions,and sometimes two or three are necessary' when the :

skin or diseased it sometimes must be cut off to further

is livid

the cure. In this case an opening is to be made of the shape

of a myrtle-leaf. AVhen the pus is evacuatedj if in the arm-
pit or groins, no pledget is to be used, but a sponge out of
wine is to be applied. In other places, a little honey is first
to be used then aggUitinative medicines and above these
; ;

necessary, a sponge squeezed out of wine. {\i\, 2.)

likewise, if
The treatment of abscesses is fully explained by Galen.
(Therap. ad Glauc. ii.) He dii'ects us, when an abscess is slow
of ripening, to make superficial scarifications in it, and after-
wards to apply a cataplasm of barley-meal.
Aetius^s directions are, upon the whole, similar to our
author^s, but not quite so minute and precise. Like our
author, he directs us to make the incision long and naiTow,
like a myrtle-leaf. The ancients were well aware that cir-
cular sores are slow of healing ; and the causes of this fact are

fully explained by Cassius and Alexander Aphrodisiensis.

Little additional infomiation is to be obtained from the
other authorities. Albucasis directs us, when the abscess is
large, not to evacuate all its contents at once, lest it produce

dangerous prostration, especially if the patient be weak ; for,

he remarks, the animal spirits will escape along with the pus.
Like our author, he forbids us to open abscesses until they are
ripe, unless seated near the anus, or some A-ital part. (Chirurg.
ii, 40.)
Haly Abbas justly remarks that if an abscess be opened
prematm-ely, the lips of it remain in an indurated state, and
prevent the sore from heahng. But when seated near nerves
or ligaments, he advises not to wait until it is ripe. His
treatment upon the whole does not difier from our author's.
(Pract. Lx, 8.)
The method of opening abscesses, by means of caustic ap-
plications, is described in the Fourth Book, 18.
SECT. XXXV.] STRUMA. 30/

SECT. XXXV. ON STRUMA, OR SCROFULOUS GLANDS.

The choeraSj or scrofula, is an indm'ated gland, mostly form-

ing in the neck, armpits, and groins, deriving its name either
from a Greek word, signifying a species of rock, or from swine,
because they are fruitful animals, or because swine have swell-
ings of the neck. The strumse are formed either on the anterior
part of the neck, or on either side of it, or on both, and they
consist of one, two, or more, all contained in their proper mem-

branes, like the steatoma, atheroma, and meliceris. Those, there-

fore,which are painful to the touch, and on the application of
medicine, are of a malignant nature, are to be considered as
carcinomatous and it is obvious that they do not readily yield
to a surgical operation. But such as are mild to the touch
and the seasonable application of medicines, may be operated
upon in this manner. To such as are superficial and incline to-
wards the skin we use a simple section, and free them from the
surrounding bodies, and stretching the skin with hooks we flay
the lips of the incision, as we said in describing the operation
of angiology, and by degrees remove them entirely. But such
as are larger, having transfixed them with hooks, we raise up,
and dissecting away the skin from them in like manner, we must
free them entirely from the surrounding bodies, avoiding in

particular the carotid arteries and recurrent nerves. If any

divided vessel obscure the operation, we may include it in a
ligature, or cut it asunder, if not large. And when the base
of the scrofulous tumour runs out into a narrow point, we
may cut it away readily, and introducing the index finger search
if there be any other strumse lying there, and remove them in

the same manner. But if we suspect that a large vessel or

vessels are situated at the bottom of the scrofulous tumour, we
need not cut it out from the base, but include it in a ligature,
so that it may fall off spontaneously in pieces without danger,
when we may effect the cure by the application of lint ; but
if cut away at once we may unite the lips of the incisions. The
incisions are to be made direct, and if there be nothing re-
dundant we may immediately sew them up. But, if owing to
the size of the scrofulous swelling there be a redundancy of
skin, having cut away a part of it like a myrtle-leaf, we may
 308 STRUMA. [book vr.

have recourse to sutures, and use the applications for recent

wounds.

CoMM. Commentary. See all the authors referred to in the 34th

" '
'
section of the Fourth Book.
Galen briefly recommends incision or septic applications.
He relates an unfortunate case in which an ignorant surgeon,

by cutting the recurrent nerve, occasioned loss of speech. (See

Meth. Med. xvi; and Loc. Affect, i, 6.)
Aetius gives a long extract from Leonidas on the treatment
of scrofula. His directions for dissecting out the tumours in
the neck are such as experience alone covild have dictated. In
operating on the neck, he cautions us to avoid the jugular
veins, carotid arteries, and the nerves of speech, and with this
intention he recommends us rather to make the incisions lon-
gitudinal than transverse. When the tumour is small a simple
incision, he says, will be sufficient but if large, the skin is to
;

be cut in the form of a myrtle-leaf, and the lips of the incision

being stretched with hooks, the skin is to be separated from
the struma with the fingers and a scalpel ; but the base of the
tumour is to be cut with great caution. He does not, like our
author, make any mention of the ligature. When there is a
discharge of blood he recommends styptics, (xv, 5.)
Celsus says nothing of the treatment by a surgical operation,
(v, 28.)
Haly Abbas, Avicenna, and most of the Arabian authorities
approve of excision, and describe the operation in much the same
terms as our author. Albucasis directs us when there is a
large vein at the bottom of the tumour to apply a ligature round
its root,and allow it to drop out by putrefaction. When the
contents of the tumour are fluid, he recommends us to open
it,and apply an ointment to consume the corrupted flesh ; after
which incarnants and detergents are to be used. W^hen scro-
fulous tumours resist, the ordinary treatment, he directs us to
burn them with a red-hot iron.
SECT. XXXVI.] STEATOMA, ETC. 309

SECT. XXXVI. ON STEATOMA, ATHEROMA, AND MELICERIS.

These also belong to tlie class of abscesses, but differ from

them in this respect, that those which are properly called ab-
scesses are of an inflammatory nature, painful, and contain an
acrid and corroding fluid; neither are they surrounded a by
proper membrane or tunic. They differ from one another, in
as much as that which is contained in the steatoma is, as its
name implies, like suet ; that which is in the atheroma is like
pap made from corn; while the fluid in the meliceris is like
honey. You may distinguish them from one another thus.
The steatoma is harder than the others, is unyielding to the
touch, and has a narrower base. The meliceris conveys to the
touch the sensation of a soft body, is slowly diffused, and soon
returns again to its shape. We
operate upon them as upon
scrofulous tumours, by incision, dissection, sutures, and the rest
of the treatment, only avoiding to wound the membrane, lest
its fluid contents be poured out and obstruct the operation, and
lest a part of it should be left behind, which often occasions a
renewal of the complaint at the wrists, ankles, and the move-
able parts about joints, as a scrofulous tumour does in like
manner, if the whole or a part of it be left behind. If any
such thing be left it will be better not to sew up the wound,
but to consume the remainder with septic appHcations.

Commentary. We
have given an explanation of the nature Comm.
of these tumours in the Fourth Book.
'

•
— '

Galen states that the indications of cure in all these cases

are to discuss their contents, produce putrefaction of them,
or to cut them out. The steatoma, he remarks, being of a solid
nature, can be remedied onh^ by an operation. (Meth. Med. xiv.)
Celsus directs us, in extirpating steatomatous tumours, to
open the cyst and evacuate its ;
but recommends not
contents
to wound the Should the whole or part of
cyst of the others.
the cyst be unavoidably left behind, he directs suppurative ap-
plications to be used. After the operation he directs us to
unite the lips of the wound by a
clasp (fibula) and an agglu-
tinative medicine, (vii, 6.)
The surgical treatment of these tumours is very fully laid
 310 ANEURISM. [book vi.

CoMM. down by Aetius, in an extract from Leonidas ;

but Ms descrip-
" '

•
tion is so long that we cannot do
justice to it within our narrow
limits. Like Celsus^ he directs us to avoid wounding the tunics
which suiTOund the atheroma and mehceris hut states that ;

this may be done in the case of the steatoma. He judiciously

directs the skin to be cut in the form of a myrtle-leaf, (xv, 7, 8.)
Albucasis directs us, in the fii'st
place, to prick the tumour,
in order to ascertain the nature of its contents. "VMien they
are found to be fatty, he recommends us to cut it out by
making a crucial incision, and removing it with its cyst if
possible. When the cyst is wounded he directs us to dissect
it out in pieces, and to endeavom* to leave no part of it behind.

He gives di'awings of various instruments, namely, scalpels,

tenacula, and perforators, for dissecting out these tumours,
(ii,45, 46.)
E/hases and Avicenna give very judicious dii'ections for the
treatment of these tumours, but thev scarcelv differ at all from
those of Aetius and our author. They recommend us to avoid

opening the cysts of the atheroma and meliceris, if possible ;

but if any part remain they direct us to destroy it by septics.
(Contin. xx"vii.)

SECT. XXXVII. ON ANEURISM.

Aneurism is a tumour soft to the touch and yielding to the

fingers, baring its origin from blood and spirits. Galen says
" an
artery having become anastomosed (i. e. dilated) the affec-
tion is called an aneurism; it arises also from a wound of the same,
when the skin that lies over it is cicatrized, but the wound in
the remains, and neither unites nor is blocked up by
artery
flesh. Such
affections are recognised by the pulsation of arte-
ries ; but, if compressed, the tumour disappears in so far, the
substance which forms it returning back into the arteries."
Thus Galen. —
But we distinguish them from one another in this
way That
: formed fi'om anastomosis of an arteiy appears longer,
is deep seated, and when pressed upon by the fingers, a sort of

sound is heard ; whereas no noise is heard in the cases arising

from rupture, and these, moreover, are more rounded, and feel
superficial. Those therefore which form in the ai'mpits, groin.
SECT. XXXVII.] ANEURISM. 311

and neck, aud tliose in otlier parts of the body, wliicli are very-
large, we must decline operating upon, on account of tlie large-
ness of tlie vessels. But those which occur in the extremities,
the limbs, or the head, we operate upon thus. We make a
straight longitudinal incision in the skin, and then liaAing se-
parated the lips with hooks, as we mentioned in the operation
of angiology, and ha\ing dissected away the skin, and sepa-
rated it with the instruments used for operations on membranes,
we lay bare the artery, and passing a needle under it, and tying
itwith two ligatures, and having first divided the intermediate
part of the artery with a lancet used for bleeding, and evacuated
its contents, we have recourse to the suppurative treatment until

the falling off of the ligatures. If the aneurism be occasioned

by rupture of the artery, we must seize in the fingers along with

the skin as much as possible of the aneurism, and then below
what we hold in our hand we push a needle having a double
thread, and after it has passed through we cut the double, and
thus with the two threads we bind the tumour on this side
and on that, as we mentioned for staphyloma. If any appre-
hension be entertained from the falling off of the Hgatui'es,
Ave must push another needle entirely through, in the course
of the first, liaA^ng in like manner a double thread, and, cutting
the noose into four pieces, we may bind the tumour. Or,
having opened the tumour in the middle, after the evacuation
of contents, we cut away what is redundant of the skin,
its

lea^dng Avhat is secured with the ligatures, and applying an

oblong compress soaked in wine and oil, we have recourse to
the treatment by lint.

Commentary. Galen, we believe, is the first author who Comm.

He
'

he had known cases in

'

treats of aneiu'ism. states that '

which an aneurism had been occasioned by a wound of the

artery at the bend of the arm in performing venesection. He
relates the case of a cure having been accomplished by the ap-

plication of a sponge with bandages. (Meth. Med. v, 7.) The pas-

sage quoted by our author is from his work De Tumoribus (11.)
Aetius gives a most interesting account of anevirism. He
states that it arises most frequently in women during labour,
owing to the breath being violently retained, but that it may
take place in any part of the body from a wound, as when an
 312 ANEURISM. [book vi.

CoMM. unskilful surgeon in opening a vein at the bend of the arm,

' '

''

opens an artery at the same time. It proceeds, he says, either

from rupture or dilatation, and its contents are blood and spirits.
The sj^mptoms of an aneurism are a swelling of a smaller or

larger size, without change of colour, free fr'om pain, of a spongy

softness, disappearing upon the pressure with the fingers, and
returning again when they are removed; this last symptom
being particularly characteristic of aneurism from dilatation. But
when it arises from a wound the tumour is not equally soft, as
the blood becomes coagulated. With regard to the treatment,
he declares that aneurisms in the neck and head ought not to
be interfered with ; but when the disease arises at the bend of
the arm he directs us to proceed in the following manner. In
the first place having marked the course of the artery from the
armpit to the fore-arm, we are to make a simple incision, three
or four fingers' breadth below the armpit along the inside of
the arm, Avhere the artery is most superficial ; and having laid
itbare and separated it from the surrounding parts, to seize
the artery with a blunt hook and bind it with two ligatm'es ;
after which it is to be divided between them, and the Avouud
filled with fine frankincense, and a suitable pledget of hut

bound over it. The swelling at the bend of the arm may then
be opened without any fear of hemorrhage. When the coagula
have been cleared away the arter}^ from which the blood was
discharged is to be seized with a hook, secured and divided
like the former ; after which the wound is to be filled with fine

frankincense, and suppuration promoted, (xv, 10,)

Albucasis treats of aneurism in the following terms. When
an artery dinded, and the skin heals over it, a tumour fre-
is

quently is the consequence, and the same thing sometimes

happens from the wound of a vein. Aneurism of an artery is
characterized by a deep-seated tumoiu' in the situation of an
artery, the swelling subsidingwhen pressed upon by the fingers,
and being attended with a hissing sound. When it arises from
the Avound of a vein it is round and exposed. He adds, to
open such tumours, especially if seated in the armpits, groins,
and neck would be a fatal mistake. When the aneurism arises
from dilatation of the artery, we are to make a longitudinal in-
cision, and having dissected a^ay the artery from the sur-

rounding parts, to pass below it a needle armed with a double

SECT, xxxvii.] ANEURISM. 313

and to tie the threads iu two places as recommended Comm.

tliread,
in angiology. The part between the two ligatures is then to "
——
'
'

be divided and the blood evacuated. Suppurative applications

are then to be made^ until the ligatures fall out ; after which
suitable ointments are to be applied. If the disease arise from
the opening of a vein, we are to grasp as much as possible of the
tumour in the hand, to push a needle through it armed with
a double thread, when the aneurism is to be firmly bound with
the threads in the manner described in the operation for sta-
phyloma. When danger is apprehended from the falling out
of the threads, we are to introduce another needle armed with
another thread under the whole tumour at the opening made
by the first needle, and to tie the threads in four places. The
aneurism is then to be cut in its middle, and its contents evacu-
ated, when the superfluous skin is to be removed, and a com-
press dipped in mne and oil applied.
(Chirurg. ii, 49.) The
threads which he speaks of are meant to decussate one another
like the letter X. This pai-t of his description is somewhat
obscure.
We need scarcely remark that the operation of Albucasis is
exactly the same as our author^s.
Ilhases borrows his account of aneurism from Antj'llus and
Paulus. The operation of Antyllus consisted of tying the artery
above and below the tumour, and then evacuating its contents,
(xiii, 7.) He states that when the disease occurs in the hams,
groins, or neck, it is dangerous to meddle with it, but that
when seated in the extremities it is easily cured. All the cases
in which he had known the artery to be opened during the
performance of venesection had terminated in aneurism, except
one in which a cure was effected by compression. (Cont. xxviii.)
Haly Abbas directs us when an artery has been Avounded in
lileeding, to dissect away the parts about it, and having applied
a silk thread on each side of the wound, to diAdde the artery
in the middle. When an aneurism takes place he recommends
a plan of treatment similar to that recommended
by Albucasis.
(Pract. ix, 45.)
Avicenna and Alsaharavius do not describe the operation.
Alsahara\dus directs us w^hen an artery has been opened in
bleeding at the arm, to attempt a cure by means of compresses
and tight bandages. (Pract. xxix, 11.)
 314 BRONCHOCELE. [book vi.

CoMM. be perceived from the foregoing account of the prac-

It will
'

Aetius^ that the ancient surgeons were

'
"
tice recommended by
aware of the advantages of securing the artery above the
seat aneurism, as practised by the late Mr. John
of the
Hunter, and that they actually had recourse to two ligatm-es
in the manner directed by Mr. Abernethy; but that they
afterwards opened the tumour and evacuated its contents, not
having yet learned from experience to trust to the absorbent
powers of the system. It will likewise be remarked that ca-

rotid, axillary, and inguinal anem-isms were in ancient times

abandoned as incurable so that modern surgery may undoubt-
;

edly boast of ha\ing so far improved upon the practice of the

Greeks and Arabians.
Sprengel gives an interesting history of the operation for
aneurism. (Hist, de la Med. xviii, 3=) According to him,
John de Vigo was the first who conceived the idea of curing
aneui'ismby compresses and styptics. This, however, is not
exactly true, for, as mentioned above, Galen, Rhases, and
Alsaharavius recommended compresses and bandages to prevent
aneurism after the accident which most commonly gives rise
to it.

SECT. XXXVIII. ON BRONCHOCELE.

A large round tumour forms on the neck from the inner

parts, whenceobtains the appellation of bronchocele, of
it

which there are two varieties, the steatomatous and the aneuris-
matical. The aneurismatical we judge
of from the symptoms of

aneurism, and abandon as hopeless, like all other aneurisms

which it is dangerous to meddle with, as is the case most espe-

ciallywith those of the neck, owing to the size of the arteries.
The steatomatous we operate upon
like steatomes in general,

distinguishing and avoiding the vessels, in the same manner

as we described for strumse,

CoMM. Commentary. The surgical operation for bronchocele is

'

He says that its contents may be evacu-

"
"
described by Celsus.
ated by caustics, but that the knife is a more expeditious process
of cure. For this purpose he dii'ects us to make a single inci-
SECT, XXXIX.] GANGLION. 315

sion doAvn to the cyst, and to dissect it from the

surrounding Comm.
parts with the jfingers. When its cyst cannot be removed he "^"^ — '

recommends us to destroy it with caustic medicines, (vii, 13.)

Aetius and Albucasis gi^^e exactly the same account of bron-
chocele as our author.
The poet Juvenal alludes to the prevalence of bronchocele

among the people at the foot of the Alps. (Sat. xiii, 162.)
it to the
Pliny attributes corruption of the water, {xi, 37.)
Rolandus_, Guy of Cauliac, and other of the earlier modern
authorities, direct us to remove the tumour bv means of two
cross setons.

SECT. XXXIX. ON GANGLION.

A ganglion is a round tumour of a tendon, arising from a

blow or violent exercise, being formed most frequently about
the wi"ists, ankles, and. the parts about a joint which are much
moved, but likewise in the other parts. It is attended with a

swelling, which is free from discoloration, unyielding, and

without pain, but if strongly pressed upon it has a dull feeling.
It is not deep-seated, but takes its origin under the skin, and

may be moved laterally, but cannot by any means be forced

forwards or backwards. Those then which form in the legs,
arms, and extremities not safe to cut out, for there is
it is

danger lest the part be mutilated. But those about the head
or forehead we operate upon by dividing the skin with a scal-

pel, and if the tumours be small, seizing them with a flesh

forceps and cutting them out by the roots. But if they are
larger, we transfix them with hooks, and remove them by dis-
secting them from the skin, and uniting the lips with sutui'es,
complete the cure by the treatment applicable to fresh wounds.

Commentary. We have treated of ganglion in the Fourth Comm.

' '
"^

Book, and mentioned the principal authorities on the subject.

Hippocrates and most of the others forbid ganglia to be opened.
The hard tumour on the head, to Avhicli likewise he applies the
name, may safely be removed in the manner described by our
author. Albucasis repeats his directions. (Chirurg. ii, 50.)
Haly Abbas recommends discutients at first, and if these
 316 VENESECTION. [book vi.

CoMM. have not the desired effect we are to strike the tumour with a
' '

'
hard body so as to break its cyst, (ix, 10.)
Rhases recommends striking the tumour with a hammer,
binding a piece of lead on it, and excision. When excision is
practised he directs us to take pains to extirpate the cyst or
tunic which surrounds it. (Cont. xxviii.)

SECT. XL. ON VENESECTION.

Although the mode of performing venesection be known to

everybody, yet, in order that no part of surgery may be
omitted, and for the sake of its technical distinctions, it must
not be overlooked by us. The first object then in venesection
is the evacuation of a fulness of blood. It has been shown
that fulness of blood is of a twofold nature :
first, with regard
to the strength, although the veins do not appear full, in which
case those affected soon become weak and enervated, nature
not being able to support, as it were, the load; and second,
with regard to the containing vessels, as is seen in the paren-
chymatous parts, in which case, although the strength seems
able to support the fulness without stress, the vessels some-
times burst, and a spitting of blood or some other discharge
takes place. Plethora then as regards the strength may be
ascertained from the heaviness upon the body ; and plethora
of the veins from their distension and from their appearing
full. In both cases evacuation is indicated; and, therefore,
if necessity require, you must bleed on the first attack of the
disease, waiting only for the digestion of the food in the
stomach, or the complete sanguification thereof in the liver.
But if on any account venesection has not been had recourse
to in the beginning, and has been postponed until after the
seventh day, there will be no impropriety of bleeding even
then when necessity requires it, and the strength does not
coutra-indicate. But when about to let blood it is
necessary
to ascertain that there be not a great obstruction of faeces in
the intestines, and, if there be, the bowels ought first to be
evacuated by an emollient clyster, lest the veins of the intes-
tines suck in the putrid matter of the excrements. Those re-
quiring the abstraction of blood from the presence of a disease
SECT. XL.] VENESECTION. 31 7

we may bleed at any season^ avoiding only the acme of

par-
ticularparoxysms in fevers. But if it be a continual fever,
the morning is by all means the fittest season for the
operation.
Those who require the evacnation of blood, not from the pre-
sence of any disease, but as a preventive, will find the
spring
the fittest season of the year. With regard to age, bleeding
must not be practised before the fourteenth, nor after the
seventieth year, unless some urgent necessity compel us.
And upon the whole we must avoid bleeding those persons
whose strength is reduced. In recent inflammations we must
make the evacuation from the opposite parts, but in chronic
from the adjoining. We abstract blood from many parts of the
body, but more especially from the inner part of the elbow. But
it is to be recollected that in general the artery lies below the
inner vein called the alar ; that below the middle one (median)

there is a nerve
; whereas the upper one, called also the humeral,
is free from all risk. In diseases of the head we open the
humeral, but in those below the neck, the alar. The median
is applicable in both cases. Wherefore we must tie a narrow
band around some muscular part of the arm, and having by
friction of thehands upon one another produced the necessary
fulness of the vein, we divide it transversel}^ but only along
itsbreadth for larger incisions than this are difficult to heal,
whilst those which are very narrow occasion inflammations by

obstructing the passage of the thicker fluids. When we expect

to have to abstract blood again on the second, third, and some-
times the fourth day, we must divide the vein more obliquely,
in order that by bending the arm the incision may be kept
open and not heal speedily. Such is the opinion of Antyllus.
The quantity of the evacuation must be determined by the
strength of the patient and the magnitude of the disease.
When, therefore, there is a humeral plethora, and the matter
is in a state of inflammation, we are to make our evacuations
to deliquium animi, provided the strength be firm, and the
patient does not swoon from an overflow of the humour upon the
stomach. Wherefore many at the commencement fall into
deliquium animi before a sufficient evacuation has taken place,
and, therefore, the deliquium must be judged of from the mea-
sure of the evacuation. If there is a necessity for much evacu-
ation, and the strength is weak, we must husband the evacua-
318 VENESECTION. [book vi.

tion^ and making the first abstraction in small quantity, bleed

again, or even a third time, if required. We have recourse to
general evacuation not only when the body is in a plethoric
state (as Galen says), but on account of the
magnitude of the
affection, when the general system is in a moderate state with
regard to the humours, as we do also in hemorrhage from the
nose or elsewhere, when although the discharge do not pro-
ceed from plethora, we bleed from the opposite parts in order
to produce revulsion ; and so also in violent inflammations, as
in colics and affections of the
kidneys from calculi, ophthalmies,
and other such acute and m-gent attacks ; for the heat and
pain of the inflamed parts occasion a defluxion upon it, al-
though the general system be free from superfluities. In such
cases we must bleed more sparingly,
proportioning the evacu-
ation particularly to the age and constitution of the
patient,
and also taking into account the season, country, and habits of
the person affected. When there is a strong inflammation
near the vein which is opened, as in pleui-isy and
hepatitis, it
will be most proper to wait the
change of the blood in colour
and consistence. Blood in inflammation is different from the
natm-al, since being excessively heated, if it was formerly crude,
it becomes mddier and
brighter ; or if it was such before, it turns
black from being over-heated. Yet we must not in every case
wait for the change, but sometimes give over before this takes
place; for two reasons, either from the weakness of the patient^s
powers, which you may ascertain to have sunk by feeling the
will find either unequal as to
pulse (for you it
strength and
magnitude, or indistinct, the stream of the blood failing also
indicates that the strength is sunk), or from the
mahgnity of
the infiammation ; for sometimes it will not remit, but the con-
striction continues strong. But if none of these circumstances
contra-iudicate, and if the patient be in the vigom' of age, we may
wait until a change takes place,
especially if the atmosphere be
mild. But if the flow of blood stop before a sufiicient evacua-
tion has taken place (this happens from fear,
deliquium animi,
and coagulum, or too tight an appHcation of the
bandage), we
must attend to each of these causes, rousing from
deliquium
with strong- scented things, slackening the
bandage when too
tight, and a coagulum may be dissolved by pouring in oil, or
by rubbing it with the fingers. The rest of the apparatus for
SECT. XL.] VENESECTION. 319

phlebotomy is known to everybody. But these things apply

to venesection at the bend of the arm. When we would ab-
stract blood from the forehead as for headache, having first
used fomentations, we apply a bandage round the neck, placing
a finger over the windpipe to prevent suffocation, and when the
frontal vein is properly filled we divide it with the point of a
lancet or scalpel. In the same manner we may open the
external jugulars for chronic ophthalmy, producing a discharge
of blood with the concave part of the scalpel. The vessels also
below the tongue we open transversely for angina, but without
the application of any bandage. Some also open in like man-
ner the veins which appear in the great canthi, as for chronic
affections of the head or eyes, in which cases they also some-
times rupture the vessels within the nostrils either by rubbing
them with the extremity of a specillum, or by tickling them
with rough substances. They also open those behind the ears
for the affections about the head ; and those about the top of
the thighs, as in affections of the kidneys ; and those in the
extremities they also open, after by the application of the liga-
tures to the parts above, by friction in the case of the hands,
and walking in that of the feet, the vessels having become dis-
tended with blood j in affections of the spleen opening the ves-
sel in particular between the small and middle finger of the
left hand, and in affections of the liver those of the right
hand ; for the evacuation of the extremities, being from a

distance, occasions a more powerful re\Tilsion. In ischiatic

diseases, and those of the uterus, they open the vein in the foot
above the inner toe.

Commentary. We have to regret that our limits prevent Comm.

us from doing more ample justice to the sound and enlarged
views of the ancient physicians on this subject, and we must be
content with making a few desultory observations and giving a
few extracts.
We have had occasion frequently to remark that Hippocrates
practised venesection freely in various diseases. He has left
no treatise, however, expressly on the subject.
Celsus says, that to let blood was no new discover}- in his
day ;
but that blood might be let with advantage in almost
every disease was a discovery. He states it also as a recent
 320 VENESECTION. [book vi.

CoMM. discovery that men, and pregnant women might

old
'— — be safely bled, the
"
'
cliilclren,

operation having been anciently proscribed

in all these cases. Yet, notwithstanding the authority of Celsus,

the prejudice against bleeding young and old persons seems to

have generall}^ prevailed, for it will be perceived, that our
author, copying from Galen, forbids persons to be bled before
fourteen and after seventy, except in urgent cases. However,
Averrhoes mentions that his countryman Avenzoar had bled
a child only three years old with great success ; and relates
further that he had known certain persons who had been bled
at the age of eighty. Celsus properly directs us to judge of a
patient's ability to endure venesection from his strength, and
not from his tender or advanced age. He also acutely remarks
that there is a difierence between a strong body and a fat, and

between a lean and a weak for that a lean body contains most
;

blood, and a fat most flesh. (See also Arist. H. A. iii, 19.) Those,
therefore, who are lean bear depletion best, and the corpulent
suffer most from it. The strength of the body, therefore, is to be
estimated from the veins rather than from the general appear-
ance. When the nature of the disease indicates evacuation,
and the strength appears ill fitted to bear it, he advises us first
to give warning of the danger, and then to abstract blood ; for,
he adds, " satins est remedium anceps experiri quam nullum.'"
In general he forbids venesection when the stomach is loaded
with impm'ities and upon this rule of practice all the ancient
;

authorities, we believe, agree with him. Thus, to give an ex-

ample from the Arabians, Averrhoes says, our famous physician,
Abumeron Avenzoar, states that venesection ought not to be
had recourse to until the body is pui^ged, for the veins being
emptied of blood attract the crude superfluities. (CoUig. vii, 1.)
This rule of practice is now too little attended to. In general
Celsus holds that the second or thii'd day of a disease is the
time for abstracting blood.
fittest He forbids bleeding upon
the very onset of a fever, which he says is enough to kill a
man outright. Upon the whole he approves of letting blood
as near as possible to the affected part. He admits, however,
that venesection may sometimes act by producing revulsion.
The operation, he remarks, although easy to a skilful person
may prove dangerous when performed by an unskilful one, as
a nerve or artery may be wounded. In securing the arm after
SECT. XL.] VENESECTION. 321

tlie operation he directs us to bind on the wound a compress Comm.

' '

soaked in cold water, (ii^ 10.)

'

Galen wrote three treatises on venesection, to which opera-

tion he was very partial. They are De venesectione adversus
:

Erasistratum ; de venesectione adversus Erasistrateos in Roma ;

and de curatione per venae sectionem. These works are deserving
of great attention as containing many judicious observations and
rules of practice, but which are delivered at so great length
that we can scarcely venture even upon an abstract of them.
His principles of treatment, however, are nearly the same
as those of our author. He appears to have abstracted blood
in great quantities. Thus he mentions haAdng seen six lib.
taken away in the course of a fever, and six heminse at once
in a case of haemoptysis. Now the hemina being somewhat
more than a half a pint, the quantity abstracted must have ex-
ceeded three pints. He strenuously inculcates that venesection
proves useful by occasioning revulsion, and as a proof of this
he instances the beneficial effects produced by opening a vein
of the armin cases of epistaxis. He practised bloodletting
occasionally in cases of dropsy, aswe have mentioned under
that head. Bleeding from the arm he thinks prejudicial in
cases of amenorrhcEa, as it causes a determination of blood to
the upper parts of the body, and, therefore, he directs us
rather to bleed at the ankle. He agrees with Celsus that lean
persons bear depletion better than such as are fat j and that
venesection is not to be performed when there are undigested
matters in the stomach. He states that persons in extreme
heat or cold do not bear bleeding. He
mentions that in bleed-
ing from the basilic vein there danger of wounding the
is

artery, that a nerve lies under the median; but that the
cephalic may be opened without danger.
Oribasius gives an interesting dissertation on venesection,
principally condensed from the works of Herodotus, Antyllus,
and Galen. (Med. Collect, vii.) Antyllus directs us when
going to bleed at the elbow to apply a ligature two fingers
broad round the arm, so as to produce a swelling of the veins ;
and remarks that they are mistaken who affirm that the same
efi'ect may be produced by
applying the ligature below, for that
the veins will not then swell, even when the arm is fomented.
When going to bleed at the ankle he directs us to apply the
II. 31
 322 VENESECTION. [book vi.

CoMM. ligature aljove the knee ; to put tlie limb into hot water^ and
make the person walk about. When the blood does not flow
readily, he ad\dses us to slacken the bandage if too tight ; or if
the opening in the vein be covered with the skin, to turn the
arm into all positions until the opening of the vein and of the
skin correspond ; and if it be too small, to enlarge it. When
fear retards the flow of the blood it will be of advantage, he

says, not to allow the patient

to hear the sound of it. When
it stops from deliquium animi he ad^dses us to lay the patient

in a recHning posture on a couch ; to promote vomiting, and to

rouse by tight ligatures to the extremities, and by aromatics.
When a clot of blood obstructs the vein he directs us to squeeze
it out, or to dissolve it with oil or vinegar. When coldness of
the body, occasioned whether by the temperature of the air, or
the nature of the disease, prevents the flow of blood, he recom-
mends fomentations and frictions. When a piece of fat or
flesh blocks up the opening of the vein, he says there is no

remedy for it but to cut it out or push it aside. When the ob-
ject is to produce a sudden depletion he directs us to make a
large incision in the vein, but a small one when it is intended
to procure re\Tilsion.

According to Drs. Freind and Milward, Alexander Trallian

is the first authority who recommends bleeding by opening the
jugulars. As far as we know this statement is correct.
Aetius's account of this subject is similar to our author's, but
less copious, 10.)
(iii,

Actuarius in likemanner has many judicious remarks on

venesection, which our limits prevent us from giving to the
reader. He forbids venesection when any natural secretion is
increased, and this is in general a very proper rule, although,
as Galen and Avicenna remark, profuse sweatings are some-
times remedied by bleeding. Bloodletting, he says, is contra-
indicated by crudities in the stomach, and a loose state of the
bowels. (Meth. Med. iii, 1.)
Little additional information is to be gleaned from the
Ai'abians. We
have mentioned, however, that Averrhoes and
Avenzoar approved of venesection at a later and earlier period
of life than the Greeks permitted it.
Avicenna with his customary accuracy collects everything of
importance which had previously been written on the subject.
SECT. LX.] VENESECTION. 323

but makes hardly any addition to the ancient stock of infor- Comm.
mation. We can scarcely venture upon an abstract of his im- '
'
'

portant chapter on phlebotomy. We

may just mention that as
a general rule he approves of bleeding after any accident. He

disapproves of bleeding both at the onset and the crisis of

a disease. In constitutions requiring bloodletting he holds
that spring is the best season for it. Even in cases in which
there is a deficiency of bloody but there is congestion in some
particular part, he permits blood to be abstracted, in order to
produce revulsion, the patient's strength being recruited after-
wards by a nourishing diet. When the colour of the blood is
dark, and it is thick in consistence, a larger amount is to be
abstracted than when it is thin and of a light colour. He makes
the important remark, that bleeding sometimes kindles up a
fever. He forbids the bath immediately before the operation,
and food or exercise immediately afterwards. When a piece of
fat obstructs the flow of blood, he directs that it should be gently
pushed aside, but not cut out. (i, 4, 20.)
Noauthor, ancient or modern, has described the modes of
performing venesection in all parts of the body more accurately
than Albucasis. Bleeding from the jugular vein he describes
in much way that it is now practised by veterinary
the same
sm-geons, namely, by placing a sort of scalpel, benr at the point,
which he calls fossorium, upon the vein, and striking the instru-
ment Avith a hammer, or some such body. He gives drawings
of variously-shaped lancets for opening the veins of the arm.

(Chirurg. ii, 97.)

The reader is also referred to Haly Abbas for a copious ac-
count of the operation, and the cii'cumstances under which it
may be performed. It is contra-indicated, he says, when the
bowels are loaded with vitiated faeces. He allows it to be per-
formed even after seventy years of age, provided the patient be
of a vigorous constitution. (Pract. ix, 2.)
Hhases, with admirable judgment, condenses all the informa-
tion supplied by preceding authorities, and mixes it up with his
own personal observations. He forbids us to give food imme-
diately after bleeding, as the empty veins will absorb the chyle
before it is properly digested, which will prove a pabulum of
disease. For the same reason, he, like the others, forbids bleed-

ing when the stomach is loaded with crudities, lest they should
 324 CUPPING. [BOOK vi.

CoMM. be absorbed, and carried over the

system. In retention of the
'— — menses directs us to open the saphena,
"
'

lie or to apply a cupping

instrument to the ankle. When the disease is an acute attack
of inflammation^ he recommends us to abstract blood fully from
an part, so as to procure
opposite
revulsion but when it is a ;

clrronic affection, he advises to take it from the part affected.

(Coutin. xx^dii.) He
enjoins, as a prudent precaution
in bleeding
a person who is intoxicated, to apply two bandages about the
arm, and to have proper attendants to restrain the bleeding,
which is often difiicult to stop in such cases. (Ad Mansor.
vii, 21.)
The veterinary surgeons practised bleeding freely in the treat-
ment of the diseases of cattle. Vegetius, the great authority
on this subject, mentions that many persons bled their cattle
every year, in the spring. He
adds, however, that the ancient
and more prudent authorities disapproved of indiscriminate
depletion. (Mulom. i, 22.)

SECT. XLI. ON CUPPING.

We must not have recourse to cupping at the commence-

ment of complaints, nor when the body is in a plethoric state,
but when the general system has been evacuated, and when
there is no defluxion any longer to the part, and especially
when there is a necessity of removing, dislodging, and deter-
mining something outwardly. Dry cupping then dissipates
flatulence, stops defluxions to the stomach, attracts blood to a
part, and stops it again, when determined to a part, if applied
to the opposite parts ; and it also occasions a translation from
.

the deep-seated parts to the surface, and on the whole produces

a metastasis of the fluids, and an evacuation of the spirits.
But cupping with scarifications facilitates the evacuation of
the ofi'ending causes, which it manifestly brings from the deep-
seated parts ; for it produces the discharge not only of blood
but of the other humom*s, and especially if applied with much
heat. And if we wish to make the abstraction from parts that
are fleshy, we must and then apply the cupping
first scarify
instrument ;
but if not fleshy, we must first have
the part is

recourse to dry cupping, and when the parts becomes swelled

SECT. XLi.] CUPPINa. 325

up,we scarify and apply the cupping instrument again. If we

wish to make but a small evacuation we must be satisfied with
one incision, but if we wish much we must make several. And
if we apprehend that the contained blood is of a thinner con-
sistence we will make superficial scarifications, but if of a
thicker, deep-seated. When we wish to evacuate coagulated
blood, occasioned by a blow, we must be regulated as to the
depth of the incisions by the thickness of the skin above. Some
have devised an instrument for this purpose, by joining three
equal lancets together, so that by one application it may pro-
duce three incisions, but we consider it inconvenient, and use
a simple lancet. Others have used cupping instruments of
glass, in order that the quantity of blood which is evacuated
may be seen ; but those made of copper have a more powerful
attraction, as being able to endure a stronger fire, whereas
those of glass are apt to break. But such as draw out the
blood by sucking with the mouth through horns, evacuate less,
but do not dry, like those applied with fire. If necessary,
when we are about to apply the cupping instrument, having
placed the limb in an erect posture, we fasten it to the side ;
for if we apply the lamp above when lying, the wick falling
upon the skin with the flame burns in a painful manner,
whereas there is no necessity for this. Sometimes the size
of the instrument is proportioned to the part on which it is
applied ; and on that account there is a great variety of cup-
ping instruments with regard to smallness and greatness of
size. For the same reason, those which are made with longer
necks and broader bellies are possessed of a stronger power of
attraction. We must avoid applying the cupping instrument
near the breasts, for sometimes they fall into it, and swelling
greatly, render the removal difficult, and in that case sponges
out of hot water are to be applied round the cupping instru-
ment, which make it relax. But if even with this it do not
fall off we must it.
perforate

Commentary. On mode of abstracting blood, and of Comm.

this

altering its
determination, the records of ancient surgery are
so full of information that our only difficulty lies in selection.
It appears that the father of medicine and his successors
practised cupping. (De Articulis, 49, and de Medico, 6.)
 32(i CUPPING. [book vi.

CoMM. Celsus mentions t\YO kinds of cupping instruments^ tlie one

being made of horn, and the otli<5r of copper. Those of copper
were open at one end and shut at tlie other. Those of horn had
a larger opening at one end and a smaller at the other. piece A
of cloth was set on fire and thrown into the copper one^ and its
mouth was then fitted to the body and pressed on until it fast-
ened. In applying the one made of horn, the air was exhausted
by sucking at the smaller end, which was then covered up with
wax, and in this state it would fasten to the part. He remarks
that when the part to which the instrument is applied had been
previously scarified, blood is discharged, but otherwise nothing
but spirits. He states th.at the principal use of the cupping
instrument is to remove any local affection when the general
constitution is sound. Upon the whole, he considers it to be
a safer but less efiicacious remedy than venesection. Cupping,
he adds, is to be had recourse to in chronic diseases, in order
to remove any corrupted matter which may be seated in a part ;
and in acute, when the strength will not allow of venesection,
(ii, 11.)
According to Galen, cupping is useful after evacuation, but
does not answer when there is plethora. In inflammation of
the brain and its membranes, therefore, he forbids cupping at
the commencement, and also in inflammation of other parts,
until the defluxion is stopped and the general system has been
evacuated ; and states that the object of cupping in such dis-
eases is to move and determine the inflammatory particles out-
wards. In general, he advises us not to apply the instrument
to the part aflected, but to the adjacent part, with the view of

producing revulsion, de hirud. revids. cucurb., &c. He like-

wise gives an interesting account of leeches. He recommends
their tails to be clipped off when it is wished to abstract much
blood by means of a few leeches. (Ibid.)
Oribasius is the ancient author who discusses this subject at
the greatest length, and to him Paulus is principally indebted.
He mentions that cupping instruments are made of glass, horn,
or copper. Those of silver, he says, are to be rejected; those
of copper are in most general use ; those of glass answer best
when we wish to see the quantity of blood that flows into the
instrument and those of horn are to be applied to the head
;

because copper ones are diflicidt to remove ; and besides, timid

SECT. XLi.] CUPPING. 327

persons are afraid of the flame in such cases. Those -vrliicli are Comm.
' '

made deep attract more strongly than such as are shallow ; in- *
struments of the latter description are to be applied to the
head. Before using them he recommends us to warm the part
with fomentations and cataplasms. Upon the authority of
Herodotus he enumerates the beneficial efiFects which may be
derived from cupping ; such as evacuating the matters fixed in
the part, diminishing inflammation, recalling the appetite,
strengthening the stomach, detemiining to the surface, provok-
ing menstruation, and so forth. (]Med. Coll. vii.)
Aetius gives a similar but less copious account of tliis sub-

ject, (iii.)

Actuarius forbids us to apply cupping instruments until after

general evacuation, when, he says, they will be useful by pro-
ducing revulsion of the noxious humours. He also approves of
cupping for strengthening the stomach when it has lost its tone,
and to discuss flatulence in the bowels. (INIeth. Med. iii, 4.)
Albucasis gives a most circumstantial and interesting account
of the methods of cupping every part of the body. He parti-
cularly recommends cupping the nape of the neck in affections
of the brain and eyes. He gives a full account of dry cupping.
He recommends it to be applied when the disease is seated in

places which do not bear cupping with scarifications, such as

the region of the liver and spleen, the kidneys, the bowels, and
the joints afi'ected with gout. In applying the instrument he
du-ects us either to create a flame in it, or to fill it with hot water.
He gives drawings of various instruments for cupping. (Chirui'g.
ii, 98.) He also treats fully of leeching, w^hich, however, he
recommends only in cases in which the cupping instrument
cannot be applied. When
the bleeding continues longer than
is desired, he directs a piece of cloth soaked in cold water to

be applied to the place, or if that does not prove efi'ectual,

styptics, beans without their skins, and the like.
such as galls,
W hen the leeches will not take, the place is to be smeared
with fresh blood. "When it is desii'ed to make them drop off,
powdered aloes, salts, or ashes are to be sprinkled upon them,
(ii. 99.)
in
Haly Abbasgives an ample enumeration of the cases
which cupping is apphcable. He recommends it particularly
in such cases as do not admit of general bleeding, for ophthal-
 323 BURNING THE ARMPIT. [book vi.

CoMM. mies^ cynanclie, and in an especial manner for amenorrhoea,

' '
•
when it is applied to the breasts.
The other Arabians, although some of them treat fully of
Avicenna and Rhases, yet give little ad-
this subject, especially
ditional information. Rhases speaks of apphdng a glass or a
cupping instrument to draw off the blood after leeching. He
gives a full account of the different kinds of leeches. Before
applying them, some, he says, smear the part with blood and
some with milk. When they are too long of falling off he
directs us to sprinkle salt upon their mouths. He recommends
them to be kept in a vessel containing water herbs. (Cont.

xxviii.) When
it is wished to abstract more blood after the

leeches have fallen off, Albucasis directs us to foment the part

with hot water, to rub and apply a cupping instrument to it.
it,

W^hen, on the contrary, it is wished to stop the discharge,

Avicenna recommends us to apply galls, lime, or other astrin-

gents, to the part. For this purpose Albucasis likewise directs
us to apply a mass of beans deprived of their skins.

SECT. XLll. ON BURNING THE ARMPIT.

In dislocation at the joint of the shoulder, it sometimes hap-

pens that the head of the arm falls out over and over again,
either from the prevalence of too much humidity, or because
the Avay is paved to it by its frequent occurrence. In this case
then we have recourse to burning. Wherefore, the patient
being laid on his back, or on the sound side, the skin at the
inner part of the armpit, where the dislocation mostly takes
place, is to be stretched between two fingers of the left hand,
or with hooks, and burnt with heated cauteries, of a slender
and oblong shape, until the cautery, being pushed through to
the other side, occasion the formation of two eschars at one
application. And if the distance between them is considerable,
having passed the head of a specillum through them, we make
another eschar in the middle by burning down until the cau-
tery reach the specillum. And Hippocrates wishes two other
eschars to be formed on each side of the middle one at the same
distance as they, so as to form a quadrangular figui'e. We must
not burn deeper than the skin, because nerves, glands, and other
SECT. XLiii.] PRETERNATURAL FINGERS. 329

substances, which may give rise to inflammation and dis-

turbance, lie below. The treatment may be conducted by
means of leeks applied with pounded salts, and the rest of
the treatment of eschars. Afterwards we mav use the hand
cautiously.

CoMMExTARY. Hippocratcs (as stated by our author) re- Comm.

' '

commends this operation for preventing the recurrence of dis- "

location at the shoulder-joint it is minutely described

:
by him.
(De Artie, xi.) Albucasis describes the operation, but it will
be readily understood from our author^s account of it. (Chirurg.
i.
27.) It is described in Hke manner by Haly Abbas. (Pract.
ix. 73.)

SECT. XLIII. ON PRETERNATURAL FINGERS, AND ON PERSONS

HAVING SIX FINGERS.

Preternatural fingers are formed in the hand sometimes

near the thumbs, and sometimes near the little finger, but
rarely beside any of the others. Of preternatural fingers,
some are wholly fleshy, and others have bones in them, and
sometimes they have likewise nails. Of those ha^-ing bones,
some derive theii* origin from a joint, ha^^ng a common articu-
lation with some other finger ; and some arise from the phalanx,
and these have no motion. The others sometimes have
motion. Now the excision of those which are fleshy is easy,
for we cut with a scalpel the preternatural finger all through.
But on those which have their origin from a joint the attempt
is more difficult. Of those which arise from the phalanx we
must first cut away the flesh all around to the bone, and as
to the bone itself we either chop it through with a chisel, or
remove it by salving and in the treatment we scrape and
;

cicatrize them as mentioned by us with regard to the wounds

of bones.

Commentary. Galen (de Difi*. Morb. 4,) and Avicenna Comm.

(Cant, i, 2,) allude to the preternatiu'al growth of fingers.

Haly Abbas describes the operation in the same terms as

our author. (Pract. ix, 39.) Rhases repeats our autlior^s de-
 330 EMPYEMA. [book vi.

CoMM, scription of tlie metliod of treatment, and also mentions that of

' '
'

Antyllus, which, however, is little or nothing different from

our author^s. Thus, he directs us to make an incision of
first

the soft parts down to the bone, which is to be sawn across ;

the skin is then to be united, and the part treated with agglu-
tinants. When the supernumerary finger grows from a joint
he directs us to make the separation cautiously and if it grows ;

between two fingers, or contains a bone, he forbids it to be

amputated. (Cent, xxiv.)
Albucasis's account of preternatural fingers is evidently
taken from our author. (Chirurg. ii, 91.) When there is a
preternatural adhesion of two fingers to one another, he du'ects
us to divide it with a scalpel, and introduce a pledget wetted in

the oil of roses, or a thin plate of lead between them, until the

parts heal. (Ibid.)

I
SECT. XLIV. ON THE OPERATION OF BURNING FOR EMPYEMA.

The most effectual remedy which has been discovered for

empyema burning. Wherefore, the parts are to be burnt by

is

applying the root of the long birthwort soaked in oil, so as to

form eschars, one of which we must make between the junction
of the clavicles, having stretched the skin upwards ; and two
small ones a little distance from the chin and remote from the
carotids two of considerable size below the mammse, between
;

the third and fourth ribs two others between the fifth and
;

sixth, inclining a little backwards another at the middle

;

of the sternum, and another above the mouth of the stomach,

and three behind, one at the middle of the back, and two
on each side of the spine, higher up than the eschar in the
back, and not very superficial. Others, as Leonidas says,
having passed a knobbed cautery, heated in the fire, through
the interstice between the ribs to the abscess, have carried
the burning down to the pus. Some have dared to operate
upon them by making a transverse incision, or one a little
obliquely in the skin, between the fifth and sixth ribs, then
perforating with a knife the membrane lining the ribs, and
thus evacuating the pus but they and those who burn with
;

iron to a considerable depth either occasion immediate death.

SECT. XLiv.] EMPYEMA. 331

tlie vital spirit being evacuated witli the pus, or occasion in-
curable fistulce.

Commentary. Galen mentions tbe operation of burning Comm.

the chest for phthisis. (De Morb. Vulg.)
'

«
— '

In phthisical complaints, which do not yield to ordinary

treatment, Celsus recommends the cautery to be applied in this
manner One eschar is to be burnt with a redhot iron under
:

the chin, another on the throat, two upon each breast, and two
under the scapulae. They are to be kept open until the cough
is removed, (iii, 22.)

Aetius directs us to burn the chest and neck much in the

same manner recommended by our author, (viii, 73.)
as
This operation is described by Albucasis, who gives a draw-
ing of an instrument for performing it
expeditiously. (Chirurg.
i, 26.) See also Rhases (Cont. ix.)
Haly Abbas recommends such an operation as that described
by Celsus and our author. He directs us to do it, not with
iron, but with the root of the long birthwort smeared with oil.
(Pract. ix, 74.) The use of the root of the birthwort (aristo-
lochia) as a cautery is also mentioned by Aetius. (xii, 3.)
Cor-
narius,by the way, seems not to have been aware of this cir-
cumstance, which has led him into a mistake in translating the
sentence where it is mentioned.
The practice of burning the chest in chronic diseases of the
lungs is strongly advocated by Caillot. (Elemens de Phy-
siologic, i.)
It was tried by Dr. Mudge in his own person
with great success. (See Dr. M. Good's '
Study of Medicine,'
ii, 786.)
Our author, it will be remarked, disapproves of
paracentesis
thoracis. This operation is recommended and described in
one of the Hippocratic treatises. (De Morbis, i, and ii.) It is
'
also mentioned in the Isagoge' of Galen. Rhases likewise
mentions it in brief terms. (Cont. iv, 3, and x.) Rhases
directs us to open the chest by a small orifice, that the matter
may be slowly evacuated. He mentions that Galen recom-
mends burning the chest, and also the operation of paracen-
tesis in such cases.
 332 CANCER. [book vi.

SECT. XLV. ON CANCER.

Cancer is an uneven swelling, rough, unseemly, darkish,

painful, and sometimes without ulceration (which Hippocrates
called also concealed cancer), and if operated upon, it becomes

worse, and sometimes with ulceration, for it derives its origin

from black bile, and spreads by erosion ; forming in most
parts of the body, but more especially in the female uterus and
breasts. It has the veins stretched on all sides as the animal
the crab (cancer) has its feet, whence it derives its name.
Wherefore, the treatment of it bv medicine has been suffici-
ently delivered by us in the Fourth Book ; and cancer of the
womb has been treated of in the Third. But since putrid
parts and such as are simply altered from their natural state
require amputation, cancers in the womb, indeed, it is neither
possible nor expedient to operate upon ; but of those of the
external parts, and especially of the breasts, we have now to

explain the surgical treatment. Some, then, have consumed

the whole redundant matter by cauteries ; but others first make
an excision of the whole breast, and then burn the place. But
Galen approves only of the excision, writing thus of the oper-
" If ever
ation :
you attempt to cure cancer by an operation,
])egin your evacuations by purging the melancholic humour,
and having cut away the whole affected part, so that not a root
of it be left, permit the blood to be discharged, and do not
speedily restrain it, but squeeze the surrounding veins so as to
force out the thick part of the lilood, and then cure the wound
^^
like other ulcers. Such are the words of Galen. And other
malignant and putrid ulcers, such as phagedtena, gangrene,
and the like, must be treated in the same manner.

CoMM, Commentary. Hippocrates forbids the surgeon from inter-

fering with occult cancers, that is to say, with such as have not
ulcerated, remarking that if healed the patient soon dies,
whereas, if let alone, he may live a long time. (Aph. vi, 38.)
Upon this his commentator, Theophilus, remarks that even if
the disease is eradicated by cutting or burning, many untoward
symptoms follow, and the strength of the patient does not
stand out. (Ed. Dietz. ii^ 506.)
SECT. XLV.] CANCER. 333

Celsus describes, we fear but too truly, the general result Comm.
of every known method of treating cancer. He says, some " '

use corrosive applications, some burning ii'ons, and others

cut it out with the scalpel; but medicines are of no avail,

burning only exasperates the disease, and excision only re-

moves the part affected, for the disease immediately returns,
(v, 28.)
Galen's sentiments are partly explained by our author. He
states, that the disease is curable only at its commencement.
When it has attained any considerable magnitude, he says, it

admits of no remedy without a surgical operation ; and when

the tumour is cut out all around there is danger of hemorrhage,
which, if restrained by ligatures, may give rise to the disease
in the neighbouring parts, whereas, if cauteries be used to
burn the roots of the vessels no inconsiderable danger may
result from their application so near to the \ital parts.
(Therap. ad Glauc. ii ; Meth. Med. xiv (Isagoge.)
;

Aetius gives from Leonidas the following description of the

operation on cancerous mammae. Laying the patient in a
supine position, he says, I make an incision into the mammse
above the cancer, and immediately apply a cautery until an
eschar be produced to stop the bleeding. I then make another
incision deep into the substance of the mamma, and again
—
burn the parts, and so proceed first cutting and then burn-
ing alternately, in order to restrain the bleeding. In this way
there is no danger of hemorrhage. After the amputation is

completed I again burn the parts until they are quite dry.
The first burnings are for the sake of the bleedings, and the
last with the intention of eradicating the disease, (xvi, 45.)
This operation, described in nearly the same words, occurs in
Soranus. (61.) He says, when the disease is scrofulous the
burning may be omitted. (Ibid.)
Avicenna mentions that after the excision of a cancerous
part the actual cautery may be required. And yet, he adds,
there may be danger from the burning provided the part
affected be nearany vital organ, (iv, 3, 2.)
Rhases says, that they who make an incision into a cance-
rous part merely produce ulceration thereof, unless it be so
seated that the disease can be completely removed and the
parts aftei-wards burned. (Ad Mansor. vii, 9.) In another
 334 MALE BREASTS. [book vi.

CoMM. work he expresses himself rather favorably of excision and

" '
'

burning. (Contiu. xiii.)

Haly Abbas approves of the operation when the cancer is

seated in the raammse or extremities. He recommends us to
allow the part to bleed until all the melancholic humour is
evacuated^ and says nothing of the cautery or ligatui-e. (Pract.
ix, 13.)
Albucasis says that he never saw a case of cancer cured
unless the tumour was small and recently formed. He directs
us,when the operation is attempted, to cut out the tumour by
the roots, and if the hemorrhage from any vein be profuse to
stop it by the cautery. (Chirurg. ii, 53.)
Serapion expresses himself rather diffidently of excision,

(v, 24.)
Soranus gives a full account of scirrhous breast distinct
from the cancerous. He states that when the whole breast is

scirrhous and adheres to the chest, the excision of the sound

parts from the diseased ought not tobe attempted ; but when
only the extremity of the breast, or only the half of it is
hardened, he approves of amputation without burning, there
being no danger of bleeding in this case as in cancer. {66.)

SECT. XLVI. ON MALE BREASTS RESEMBLING THE FEMALE.

As at the season of puberty the breasts of females swell up,

so in like manner those of the males also swell to a certain
extent but for the most part they subside again.
;
In some
cases, however, having acquired a beginning they go on in-
creasing, owing to the formation of fat below. Wherefore, as
this deformity has the reproach of effeminacy, it is proper to

operate upon it. Having, therefore, made a lunated incision

below the breast, and dissected away the skin, we unite the
parts by sutures. But if, as in women, the breast incline

downward, owing perhaps to its magnitude, we make in it two

lunated incisions, meeting together at the extremities, so that
the smaller may be comprehended by the larger, and dissecting
away the intermediate skin, and remo\dng the fat, we use
sutures in like manner. But if, through mistake, we should
cut away too little, we must again remove what is redundant,
and apply the remedies for fresh wounds.
SECT. XLVii.] BURNING OVER THE LIVER. 335

Commentary. The description given by Albucasis is so Comm.

' '

like our author's that there can be no doubt of its being •

borrowed from him. When there is a great redundance of fat

and he directs us to make two lunated incisions, the
flesh,

larger comprehending the smaller, and having dissected away

the intermediate skin to unite the edges by sutures. (Chirurg.
ii, 47.)
Haly Abbas repeats the same description in almost the same
words. (Pract. ix, 40.)
Rhases recommends the operation upon the authority of
Antyllus and our author. (Contin. xiv.)

SECT, XLVII. ON BURNING OVER THE LIVER.

If the pain be attended with weight in those who have

abscess in the liver, it is an indication that the fleshy part of
the liver is aff'ected ; but if the pain be acute the matter is
rather in the coats, and we must burn the part thus Having :
—
strongly heated slender, knobbed cauteries, we apply them
a little above the loins at the extremity of the liver, making
an eschar. But having burnt the whole skin and reached the
coat we must evacuate the pus after the discharge of which,
:

having used lentils and honey, with the applications from honied
water, and things of an incarnative nature, we have afterwards
recourse to epulotics.

Commentary. In cases of hepatitis, which do not yield to Comm.

' '
'
the usualremedies, the author of one of the Hippocratic
treatises advises us to burn the side "uith spindles of boxwood

dipped in oil, or with fungi. (De Morbis Internis.)

Aretseus directs us to open abscesses of the liver with
red-hot irons. (Morb. Chron. i, 13.) Celsus mentions that some
open abscesses of the liver with a scalpel, and some burn the
vomica, (iv, 8.) disapproves of
Cselius Aurelianus, however,
this practice.(Pass.
Tard. iii, 4.)

Albucasis describes the operation like our author, and gives

a drawing of a spear-shaped instrument for opening the vomica.
(Chirurg. ii, 30.) Haly's description is quite similar. (Pract.
ix, 75.)
 330 BURNING OVER THE STOMACH. [book vi.

SECT. XLVIIl. ON BURNIXG OVER THE SPLEEN.

Having stretched tlie skin wliicli lies over the spleen with
hooks, we burn it through by one application of a long ignited
cautery so as to form two eschars ; and this we do three
times
so that there may be six eschars formed altogether. Eut
Marcellus by using a trident or trident-shaped cautery formed
one apphcation.
six eschars at

CoMM. Commentary. In Coan surgeons

cases of diseased spleen the
" '
•
bui'ned eschars on the side affected. (Hippocr. de Afiect. intern,
and de Affect. 5.)
Aetius directs us to burn the eschar either with the actual
cautery or with caustics, (x, 12.) The ancients used an issue
paste, very like the modern, prepared from potass. See above

Avicenna recommends the same practice as the Greeks (iii,

15, 1) and so in like manner Haly Abbas (Pract. ix, 76) ;
;

Albucasis (Chii-urg. i, 32) ; and Rhases (Contin. xx.)

Guido de Cauliaco repeats Albucasis's description of the
process of burning the side in cases of scirrhous spleen, (ii, 2.)

XLIX. ON BURNING OVER THE STOMACH.

In chronic defluxions of the stomach the moderns have re-

course to burning, —
some with knobbed cauteries, forming
three eschars, one at the ensiform cartilage, and the other two
below, so as to make a triangle, the depth of the burning
being the thickness of the skin. Some fonn only one large
eschar at the mouth of the stomach. But others do not burn
with iron but with the substances called iscse. The iscse are
spongy bodies forming on oaks and walnuts, being mostly in
use with the barbarians. They allow the ulcers to I'emain
for some time without cicatrizing, and rather stimulate them
in order that by the great diaphoresis thereby occasioned, the
mouth of the stomach may be freed from the defluxions.

CoMM. Commentary. Hippocrates, Galen, and Celsus say nothing

SECT. L.] DROPSIES. 337

about burning over the stomach in affections of it. Aetius^s Comm.

account is similar to our author's. He calls the iscee the
——
'

*
'

medullary part of the wood of walnuts, (vii^ 91.) They are

mentioned likewise by Haly Abbas^ who says they are called
ducanum in the Persian language. (Pract. ix, 77.) Albucasis
directs ua to burn with iron. (Chirurg. i^ 28.)

SECT. L. ON DROPSIES.

The formation of dropsical swellings, their varieties and

causes, how they are to be distinguished from one another, and
their treatment by medicine, having been explained in the Third

Book, and it having been there shown that ascites alone falls
under the province of surgery, we are now going to give an
account of it. Wherefore we must make the patient stand
erect or if that cannot be done, we must cause him to be seated ;
;

or if he be so weak that this cannot be done, we must abandon

the operation entirely. If then the man be standing erect we
give orders to the assistants standing behind to press with their
hands and push downwards the swelling to the pubes. Then
taking a sharp-pointed knife or lancet, if the dropsy is among
the intestines, in the perpendicular line of the navel, and about
three fingers^ breadth distance from it we divide the hypogas-
trium as far as the peritoneum. But if the liver be primarily
affected we must make our incision on the left side of the navel ;
or if the spleen, on the right, for we must not make an in-
cision in that part on which the patient is disposed to lie. And
having dissected with the point of the instrument the skin that
lies over it, we divide the peritoneum a little above the first in-
cision until the instrument comes to an empty space. After
tliis we introduce through the incision of the abdomen and pe-

ritoneum a copper tube, having an opening like those of writing-

pens, and by this we must abstract the fluid in proportion to
the strength ; feeling the pulse, and then removing the tube,
we stop the flow of the fluid, (for it will stop immediately from
the alteration of the incision,) and, for the sake of security, we
introduce a twisted tent into the incision of the abdominal pa-
rietes alone and having placed the man in a recumbent posture
;

and recruited him, we may next day again evacuate through the
II. 22
 338 DROPSIES. [book vi.

tube a small quantity of fluid proportionate to his strength ; and

thus, in like manner, until very little be left, avoiding, by all
means, a sudden evacuation. For some ignorant persons having
evacuated the vital spirit with the fluid have immediately killed
the patient. Some for the sake of greater security ha^dng
evacuated a small quantity of the fluid by the operation so as
to relieve the powers of the system from its great load, procure
the discharge of the remainder by hydi-agogue medicines, by
burying the patient in heated sand, by insolation, abstinence
from liquids, giving desiccative food; and they have recourse
likewise to bm-ning over the stomach, liver, spleen, and hypo-
gastrium ; and make five eschars about the navel, some by slender
and others by those substances called iscse, or
cauteries of iron^
some other such like material. And many have been rather
cured by this method alone, sometimes without paracentesis
having been had recourse to at all.

CoMM. Commentary. Hippocrates declares in one of his Aphorisms,

' '

"

that the sudden evacuation of the matter in empyema, or of the

water in dropsy, proves fatal. He speaks of evacuating the
fluid with an instrument called rpuTraiTpwyXrjTr/piov, which

Camper thinks must have been a kind of trochar.

Galen, in his Commentary on the Aphorisms of Hippocrates,
(vi, 7) remarks, that in his time the operation of paracentesis
was in general use, instead of burning. He states, however,
that he had seldom seen recovery take place after the operation.

(See in particular Meth. Med. xiv.)

Aristotle alludes to paracentesis near the conclusion of his
'
work on the Generation of Animals.'
mentions that Erasistratus, Evenor, and
Cselius Aurelianus
Thessalus were advocates for paracentesis, but that Asclepiades,
Themison, and Soranus disapproved of it. He himself approves
very much of the operation, and answers all the objections
which had been made to it. He says, it relieves the fulness
and difficulty of breathing, and prepares the parts for the action
of the remedies. He agrees, however, with the other autho-
rities, that a sudden evacuation of the water is attended with
danger. (Pass. Tard. iii, 8.)
Celsus gives a good description of the operation. Some, he
it at a spot four fingers' breadth below the navel
says, perform
SECT. L.] DROPSIES. 339

in the left side ; some do it at the navel ;

and some burn the Comm.
'

He
"

skin and then perforate the abdominal parietes. directs

"

the operator to be careful not to wound a vessel. The size of

the point of the perforator, he says, should be the third part
of a finger^s breadth. After the perforation has been made, a
tube (canula) of lead or copper is to be introduced and the
water drawn off gradually. The whole is not to be removed

at one time, but a tent is to be introduced into the opening,

unless it was made with fire, to
prevent it from healing too
soon. He speaks favorably of the operation, unless the patient
be much debilitated, (vii, 15 ; also ii, 10.)
Aetius and most of the medical authors subsequent to Galen,
mention the operation of paracentesis, and approve of it.
Vegetius, the veterinary surgeon, recommends paracentesis
for the dropsy of cattle, when the swelling is not removed by
purging. (Mulom. iii, 25.)
Avicenna expresses himself rather unfavorably of paracentesis.
He says, it ought never to be attempted until every other re-
medy has proved ineffectual, and unless the strength of the
patient be good, and he can endure exercise, abstinence from
drink, and restricted diet. His description of the operation is
taken from Paulus. (iii, 14; iv, 13.)
Serapion mentions the operation in very brief terms, (iv, 7.)
Albucasis^s description is very minute but, upon the whole,
;

little different from our author's as to the place of the incision

or the instruments with which it is to be performed. After

the perforation has been made in the manner directed by our
author, he recommends the introduction of a canula made of
silver, copper, or brass, and having a small hole at the bottom
and three in its sides he advises us to evacuate onlv half the
:

water at first. He adds, that when the canula is removed the

skin will cover the opening in the abdominal muscles, and
thereby stop the discharge. The remaining part of the water
is to be removed afterwards, according to the strength of the
patient. (Chirurg. ii, 54.)
Haly Abbas does not in general approve of the operation.
He mentions, that he never saw it performed but once, and then
it did not save the patient. He adds, that Galen relates that
he only knew of one case in which it had proved successful.
He directs the incision to be made three fingers' breadth, straight
 340 EXOMPIIALOS. [book vi.

CoMM. beloTT the navel, that is to say, in the linea alba ; but if the
"
V
——
'

liver is diseased he recommends it to be made in the left side,

or if the spleen, in the right. (Pract. ix^ 41.
Rhases gives Antyllus's description of the operation_, -ohich,
however, is scai'celv at all different from that of onr author.
He directs us to make the assistants stand behind and compress
the sides of the abdomen, and, if possible, recommends to make
the patient sit on a bench. He directs us to make the incision
with a large needle below the navel, when the collection is con-
nected with disease of the intestines ; but if from the liver, on
the left side ;
or if from the spleen, on the right. Like the
other authorities noticed above, he directs us to make the
opening of the peritoneum higher up than that of the skin. A
canula, made of copper, is then to be introduced into the open-
ing. If the pulse sink during the operation he adnses us to

stop the discharge of the water. (Cent, xix.)

We have mentioned in our notes on Book Third, section 48,
that Hippocrates and Aetius approved of scarifications at the
ankles. It appears that Archigenes also was an advocate for
this practice in dropsical cases.

Dropsy of the womb and hydatids thereof are correctly de-

scribed by Soranus. It seems to be now agreed that the dropsy
in this case is a species of large hydatid. (120.)

SECT. LI. ON EXOMPHALOS, OR PROLAPSUS OF THE NAVEL.

Protrusion of the navel takes placewhen the peritoneum

there raptured and prolapsed; or from the omentum, intestine,
is

and sometimes an inert fluid falling down upon the navel, some-
times from hypertrophy of the flesh, and sometimes from a col-
lection of blood there, proceeding from the rupture of a vein or

ai-tery, as in aneurisms ;
and sometimes the collection consists
not of blood, but of spirits only. If, then, the omentum be

protruded, there appears a swelling at the navel, which is free

from discoloration, soft to the touch, without pain, and uneven ;
but if it is intestine inaddition to the afore-mentioncd symptoms,
there is gi'eater inequality,
—
the tumoui*, when pressed by the
fingers, disappears, sometimes Avith borborygmi ; and it is

increased by baths and straining. If its contents be a fluid.

SECT. LI.] EXOMPHALOS. 341

the tumour is equally soft, not yielding to pressure, and is neither

diminished nor increased hy it. If it consist of blood, in ad-
dition to the afore-mentioned symptoms, the swelling is more
livid ; but from hypertrophy of flesh, the tumour will
if it arise

be harder, and will continue of the same size. Those occa-

elastic,
sioned by flatulence are attended with softness, a certain sound
when tapped, and disappearance upon pressure. We must
operate then in this manner. Having placed the man in an
erect posture, we order him to press down at the same time that
he retains his breath then, having marked the whole promi-
;

nence of the navel with black ink, we are to lay him on his back,
and around the tumour with a scalpel, agreeably to the
dissect

marking; then, stretching the middle with a hook, we must

apply a thread or string around the part which is dissected, for
thus it Avill be prevented from falling down, when secured with
a knot. Then, at the top, having opened the constricted tumour,
we must introduce the index-finger, and search carefully lest
any fold of the intestine, or part of the omentum, be included
in the ligature ; and if intestine be included, we must loosen the
fold of the thread, and push it inwards, but if it is omentum we
may draw out, and
it cut off" what is redundant of it, securing,
as is proper, with a thread, any vessel that may come in the way;
and then taking two needles, containing a plam thread, we
pass them through the scarified part in the form of the Greek
letter X, and cutting the doubles of the threads, as we mentioned
for aneurism, we make constriction with the four heads. After
the bodies secured by the ligatures have become putrid and
dropped ofi*, we complete the cure by dressing the part with
pledgets, and strive to make the cicatrix particularly hollow.
Such is the operation when the part concerned is the intestine
or omentum. But if flesh, or fluid, or blood occasions the com-
plaint, having divided the middle of the tumour circularly,
and
then removed whatever lies external to the peritoneum at the
navel, we perform the cure by incarnative applications. But
exomphalos arising from aneurism, or the presence of flatus, we
must abandon as hopeless, like other cases of aneurism.

Commentary. Celsus gives an interesting abstract of the Comm.

ancient opinions upon this subject, but as it difl'ers but little
from our author's description, we shall not dwell very particidarly
 342 GASTRORAPHE. [book vi.

CoMM. upon it. He

directs us to cure tlie disease either by passing
' '
*
through the tumour a needle armed with two threads, in the
manner described for staphyloma, or to produce mortification of
the part by pressure between two rules. Some, he says, first
make an incision in the tumour, so as to be enabled to remove
with the greater facilitj^ whatever is protruded, but this he thinks
unnecessary, as it will be sufficient merely to return the pro-
lapsed substance, and apply a ligature round its base ; after
which the outer part is to be destroyed by medicines or the
cautery. This operation, he adds, will be sufficient, whether
the contents of the hernial tumour be intestine, omentum, or
water. He intimates, hoAvever, that the operation is attended
with some danger, and that it is only to be performed between
the ages of seven and fourteen, and when the bodj^ is in a healthy
state. He forbids to interfere with scirrhous tumours, (vii, 14.)
The
description of the operation given by Albucasis is very
minute, but is to the same effect as our author^s. (Chirurg. ii, 53.)
Rhases, in like manner, recommends us to pass a needle, armed
with two threads, through the tumour, and to secure it by a
crucial knot. He, Avicenna, and Haly Abbas evidently copy
our author's description.
The operation with the ligature, as first described by Celsus,
was revived, with very slight modifications, by the celebrated
Desault, of Paris, but is now seldom practised.

SECT. LII. ON WOUNDS OF THE PERITONEUM, AND ON FALLING

DOWN OF THE INTESTINE OR OMENTUM, WHERE GASTRORAPHE
ALSO IS DESCRIBED FROM THE WORKS OF GALEN.
:

How wounds of the peritoneum are to be treated is next to

be considered. If then the wound be small, so that the pro- I
lapsed intestine being distended with air, cannot be restored to
its place, it will be necessary either to evacuate the flatus or
enlarge the wound. The former measure is the better, pro-
Aided one can accomplish it. But how may this be most pro-
bably done ? By removing the cause which occasions the
inflation of the intestine. But what is this ? Congelation of
the surrounding air; so that the cure is to be performed by

heating. Wherefore, having soaked a soft sponge in hot

 SECT. Lii.] GASTRORAPH^. 343

water^ and then squeezed it out^ foment the intestine there-

with. In the meantime let hot austere wine be prepared^ for
it is more heating than water^ and communicates strength to

the intestine. If, after having had recourse to all these things,
the intestine remain inflated, we must divide as much of the
peritoneum as the prolapsed intestine requires. The straight
instruments called sp'ingotoma, used for operating upon fistulse,
are very proper for this incision. A recumbent position of the
patient is the best when the wound is in the lower part ; and
when in the right side, he may lie on the left, and when in the

left,on the right and this is common both to great and small
;

wounds. But the replacement of the intestine into its proper

place when the wound is large, requires a skilful assistant. For
he must take hold of the wound externally with his hands, and
contract and compress it a little, so as to expose always a small
portion to the sewer, and also must compress moderately what
is sewed until the whole is sewed. What is the most proper
mode of performing the operation called gastroraphe, we must
next explain. Since the abdomen must be united with the
peritoneum, we have to begin by passing a needle through the
skin from without inwards ; but when it has transfixed the skin
and the whole rectus muscle, passing by the adjacent perito-
neum, we must push the needle from within through the other
part of the peritoneum, and so hence from within outwards,
through the rest of the abdomen ; and when it has passed out
we must push the needle again from without inwards through
this part of theabdomen, and, passing b}^ the adjacent portion
of the peritoneum, and beginning again from the opposite side
of this membrane, perforate it from within outwards, and at the
same time all the other parts of the abdomen then beginning
;

again from this, sew it with the opposite membrane, and after-
wards transmit it from the neighbouring skin outwards and ;

do this repeatedly until the v>^hole wound be sewed up. The

space between the sutures required to keep the under parts
together must be very small, but the interval between those
required to keep the skin from falling asunder need not be so
small. Excess in either respects must be avoided, and a me-
dium chosen between the two extremes. And a medium is
likewise to be observed as to the consistence of the thread, for
that which is too hard breaks the soft skin, and what is too
344 GASTRORAPHfe. [book vi.

soft is itself first In the same manner, passing the

broken.
needle too near the
lips of the wound, occasions often a rupture
of the remainder which is too narrow. But if too much is
taken in, much of the skin remains ununited. These obser-
vations apply to the treatment of all ulcers, but are more

especially to be observed in gastroraphe ; and, as aforesaid,

we
must act, forming a conjecture as to the adhesion of the peri-
toneum with the abdomen, from the circumstance that the latter
being membraneous seldom adheres or, as some do, by bringing
;

together the parts of the same kind ; that is to say, peritoneum

to peritoneum, and abdomen to abdomen. Or, it may be done
thus :in the as above, we must pass a needle
same manner
from the side of the abdomen nearest us, from without inwards,
and through it above ; then passing both lips of the perito-
neum, we must again turn the needle from without inwards
through both lips of the peritoneum, and again turning it from
within outwards, pass it through the opposite part of the abdo-
men. This mode differs from the common and vulgar one,
inasmuch through the four lips at one
as the needle is passed

perforation, and exactly conceals the peritoneum within the

abdomen. The proper applications are those formed of the
same materials as the applications for recent wounds ; but in
order that no vital part may be affected sympathetically, some
tender wool be dipped in moderately hot oil, and the whole
is to

space between the groins and armpits wrapped in it. It will

be better, also, to evacuate the bowels by a clyster of warm oil.
But if any of the intestines be wounded, dark austere wine, in
a tepid state, should be injected, more especially if it be per-
forated quite through. The large intestines are easily cured,
but the small ones with difficulty, and the jejunum is utterly
incurable, fi'om the multitude of its convolutions and the mag-
nitude of its vessels, and owing to its and
coats being thin
nervous ; besides, it an undiluted state,
receives all the bile in
and is nearest to the liver. The under and fleshy parts of the
stomach we may attempt to cure, for we may succeed, not only
because these parts are thicker, but because curative medicines
are more readily applied to them, OAving to their situation. The

parts, however, about the mouth of the stomach and oesophagus

are affected by the medicines only in passing down ; and the
exquisite sensibility of the mouth of the stomach is an obstacle
SECT. Lii.] GASTRORAPHE. 345

to the cure of wounds of it. Wlien^ from a rupture of the

peritoneum, the omentum is prolapsed, and either becomes livid
or black, the part anterior to the black portion may be included
in a hgature, for fear of hemorrhage, and then the part behind
the ligature is to be cut off, and the extremities of the ligature
allowed to hang from the under part of the sewed wound of the
abdomen, in order that they may readily escape when cast off
by the suppuration of the wound.

Commentary. The description of gastroraphe here given will Comm.

'

be sufficiently intelligible upon an attentive perusal. It is taken

'

'

from Galen. (Meth. Med. vi, 4.) By abdomen, in this place,

is to be understood the abdominal parietes,
namely, the skin
and muscles. Galen explains that eTriydarpiov is used in this
sense.
Celsus gives a long description of a somewhat different method
of performing gastroraphe. He uses two needles, (vii, 16.)
Several modes of performing the operation are minutely de-
scribed by Albucasis. He relates the history of a case in which
he practised gastroraphe, (ii, 87.)
Halv Abbas recommends the warm bath, to facilitate reduc-
tion. The method of performing gastroraphe which he directs,
is similar to the suture now practised upon dead bodies after
dissections. (Pract. ix, 43.)
K/hases describes various modes of gastroraphe. He speaks
of performing the operation with the string of a harp. (Cont.
xxviii.) That the strings of the ancient harp were made of the
guts of a sheep is clearly proved from the following passage
in theOdyssey of Homer :

i)q OT avtjp ipopfiiyyog iTTiffTd/iivos Kai aoiSijg

pijidicog tTcivvffCfs vkoj
Inl koWotti xopSiji',

u\l/ag a.[i(poTepa)^fi' ivcFrps(piQ tvTipov oiog.

OSvc. <f.

The modes of gastroraphe described by Galen and Celsus are

explained and commented upon by Van Swieten (Comment,

cccxi), and by Fabricius ab Aquapendente. (CEuv. Chir. ii, 53.)
A complete history of the operation is given by Sprengcl. (Hist,
de la Med. xviii, 21.) Ambrose Pare performed the operation
exactly like Galen.
 346 DEFICIENCY OF PREPUCE. [book vr.

SECT. LIII. ON DEFICIENCY OF THE PREPUCE.

TV hen there is a small deficiency in tlie skin of the penis,

some, in order to repair the deformity, have attempted a double
surgical operation sometimes cutting the skin all round above
;

at the commencement of the penis, in order that by this solu-

tion of continuity the skin may be drawn downwards until the

glans (as it is called) be covered ; and sometimes with a scalpel

dissecting its inner surface from the root of the glans, and then
drawing it downwards, and surrounding the glans with a soft
ligature ; but a piece of cloth must be interposed at the inci-
sion, in order to prevent an adhesion of the prepuce to the
glans. Antyllus approves most of this method, of which he
gives a full description, but we have been content with a brief
outline, because it is rare that this surgical operation is required,
as the complaint neither occasions any defect of the functional
nor such deformity that one would choose to submit to
office,
the hazard of an operation on account of it.

CoMM. Commentary. Celsus describes the operation as follows :

''
Cutis circa glandem prehenditur et extenditur, donee illam
ipsam condat ; ibique deligatur deinde, juxta pubem, in orbem
:

tergus inciditur, donee coles nudatur ; magnaque cura cavetur,

ne vel urinse iter, vel venae quse ibi sunt, incidantur. Eo facto,
cutis ad vinculum inclinatur, nudaturque circa pubem velut
circulus; eoque linamenta dantur, ut caro increscat, et id im-
pleat satisque veiamenti supra latitudo plagae prsestat.
:
Sed,
donee cicatrix sit, cinctum esse id debet in medio tantum re-
:

lictoexiguo urinse itinere.^' (vii, 25.)

Rhases directs us to put a proper piece of lead upon the glans,
then to draw the prepuce over it, and seciu'c it with a ligature,
having previously dissected it from the parts below, if necessary.
(Cont. xiv.) This is much the same as our author^s operation
for phimosis. See section Iv.
The reader will find the ancient operation described by
Fabricius ab Aquapendente. (ffiuv. Chirurg. ii, 61.)
SECT. LV.] PHIMOSIS. 347

SECT. LIV. ON HYPOSPADIjEUM, OR IMPERFORATE GLANS

PENIS.

In many children the glans is not perforated at birth^ but

the meatvis is situated under the part called canis^ at the ter-
mination of the glans. Hence they can neither make water
forwards unless they draw up the member to the pubes^ nor
procreate^ as the semen cannot be injected direct into the
uterus. In addition to these defects, the complaint occasions
no ordinary deformity. Wherefore, the simplest and least
dangerous mode of operation is that by amputation. Having
then placed the patient in a supine posture, we have to stretch
the glans forcibly with the fingers of the left hand, and then
with the point of a scalpel we are to amputate the glans at
the corona, not making the amputation obliquely, but caning
it, as it were, all round, so that an eminence may appear in
the middle resembling the glans. And since a hemorrhage
frequently takes place, we may stop it by styptics if possible,
but if not, we must have recourse to burning with slender
cauteries.

Commentary. Galen makes mention of this deformity. (De Comm.

" '

'
usu Partium.) See also Theophilus. (De Fab. Hom. v, 22.)
Albucasis evidently transcribes our author^s description. The
part named canis (kvwv) by our author
is called finis capitis

virga in the translation of Albucasis, and finis coronce in the

translation of Haly Abbas. (Pract. ix. 44.) We
do not remem-
ber to have seen the term kvwv applied by any other medical
author to a part of membrum virile. Perhaps the proper word
is 'Iq gent, [voq, which is applied by Galen to a part of the

genital member. (Meth. Med. xiv. 16.)

Guido de Cauliaco directs us to make an opening with a
suitable instrument and introduce a canula of lead or wood.

(iv, 2.)

sect. LV. ON PHIMUS, OR PHIMOSIS.

There are two causes of phimosis for sometimes the prepuce

;

SO covers the glans that it cannot be retracted; and some-

 348 PHIMOSIS. [book vi.

times when drawn behind, it cannot be brought forward^ which

properly called paraphimosis.

last species is The first variety
is occasioned either from a cicatrix formed in the
prepuce, or
from an adhesion by flesh. Eut the second variety takes
place in inflammations of the genital organs when the skin
being brought back, the glans swells, and it cannot longer
allow of being drawn forward. If it is the first species of phi-
mosis we may operate upon it in this manner. After having
placed the patient properly, and drawn the prepuce forwards,
and having fastened three or four hooks into its extremity and
giAdngthem to assistants to hold, we direct them to stretch
and open it ; and then if the external adhesion be from a
cicatrix, wedivide the prepuce from the internal parts with
a lancet or sharp knife in three or four places, making the
divisions at the inner parts direct and equally distant from one
another. The prepuce at the glans is double, wherefore we
divide the mouth of the inner part
; having thus opened
for
the contraction formed by the cicatrix, we are enabled to re-
tract the prepuce. But if a preternatural adhesion of the
flesh of the internal parts occasion the
phimosis we may make
scarifications in all the flesh, drawing back the prepuce and
scraping away the fleshy prominences between the incisions,
and afterwards apply a tube of lead to the whole glans, having
wrapped it in dried paper (papyrus), the tube having its open-
ing the same everywhere ; for thus, by the application of the
tube, the prepuce, when brought forwards again, is prevented
from forming adhesions, being kept separate by the lead and
the paper wrapped round it ; for by getting swelled Avith the
moisture it separates the skin still more. This we may do
whether we operate upon a phimosis occasioned by a cicatrix,
or one from a preternatural adhesion of flesh. But if the com-
plaint called paraphimosis take place, and become chronic, ad-
hesions take place, and the complaint is incurable, unless one
choose to submit to the operation for
deficiency of prepuce.
But if it has not yet formed adhesions, we may make three, four,
or more direct incisions circularly, and having bathed with much
tepid oil, draw the prepuce outwards.

CoMM. Commentary, Celsus describes the operation as follows :

' " Subtcr a summa ora, cutis inciditur recta linea usque ad
SECT. LVii.] CIRCUMCISION. 349

frsenum ; atque ita superius relaxatum, cedere retro Comm.

tergiis
"

potest. Quod parum

si profectum est, aut propter angustias,
sic '

aut propter duritiem tergoris, protinus triangula forma cutis ab

inferiore parte excidenda est, sic ut vertex ejus ad fraenum, basis
in tergo extremo sit. Turn superdanda linamenta sunt alia
que medicamenta quse ad sanitatem perducant. Necessarium
autem est, donee cicatrix sit, conquiescere nam ambulatio, :

atterendo ulcus sordidum reddit." (vii, 25.)

Our author^s description of the operation for keeping the pre-

puce separated from the glans, by means of a leaden tube, is

mostly taken from Galen. (Meth. Med. xiv, 16.)

SECT. LVI. ON ADHESION OF THE PREPUCE TO THE GLANS.

When there has been a previous ulceration about the glans,

or prepuce, an adhesion of the one part to the other takes place.
We must, therefore, dissect around, as far as may be, en-
deavouring to separate the adhesion with the point of a scalpel,
or of a polypus knife, and more especially to free the glans com-
pletely from the prepuce, to which it adheres ; but, if this be
found difficult, we must rather add of the glans to the prepuce
with which it is united, than contrariwise ; for the prepuce,

being thin, is
readily perforated. After the disengagement of
the adhesion, a thin cloth, dipped in cold water, is to be placed
between the glans and the prepuce, that no adhesion may again
take place, and the parts are to be healed with some astringent
wine.

Commentary. Albucasis describes the operation in exactly Comm.

'

the same terms.

''

(Chirurg. ii, 56.)

SECT. LVII. ON CIRCUMCISION.

We do not treat at present of those who are circumcised in

conformity to a heathen rite, but of those in whom the prepuce
has become black from some affection of the privy part. In
such cases, it becomes necessary to cut off the blackened portion
all around ; and afterwards we must have recourse to the squama
 350 THYMI. [book vi.

seriSj with honey, or to pomegranate-rind and tare, in the form

of those applications which are made upon a pledget. And if
there be a hemorrhage, we must use lunated cauteries, which
contribute to two good purposes I mean the stoppage of the
:

bleeding and of the spreading sore. But if the whole glans be

consumed, having introduced a leaden tube into the urethra,
we direct the patients to make water through it.

CoMM. Commentary. See a similar description in Albucasis.

'

mode
'
•
57.) Albucasis describes the of performing
(Chirurg. ii,

the operation on boys, as a rite of the Jewish religion. He

directs the prepuce to be cut with a pair of scissors, and the part
allowed to bleed freely. From the manner in which he ex-
presses himself respecting the operation, there can be no doubt
that he was a Jew, and it is equally clear that our author was
a Pagan.
Fabricius ab Aquapendente describes a similar operation,
(CEuv. Chirurg. Guido de Cauliaco directs us to draw
ii, 64.)
the prepuce forwards, and cut it off; after which the bleeding
is to be stopped with powders, or the cautery, (vi, 2.)

SECT. LVIII. OF THYMI ON THE PENIS.

Thymiare fleshy excrescences, forming sometimes upon the

glans, and sometimes upon the prepuce and some of them are ;

malignant, and some are not. Those which are of a mild nature
it will be proper to pare away with the edge of a scalpel, and

sprinkle the part with chalcitis ; but when malignant,

the part
must be burned after they are removed. If there be thymi on
both sides of the prepuce, some internal and others external, we
must not attempt all at the same time, lest by mistake we should
cut off the prepuce, which is thin but we must first cut off the
;

internal, and, when they are healed, we may next attempt the
external. Some of the moderns effect a cure by cutting them
off with a pair of scissors, and by binding them with a horse-
hair ; as, in like manner, some bm'n them with the cold cautery.

CoMM. Commentary. Albucasis copies our author's description.

' '

"

(Chirurg. ii, 56.) Wlien the tumour is of a malignant nature,

SECT. Lix.] CATHETERISM. 351

lie particularly approves of using the actual cautery. These Comm.

" '

intractable tumours on the genital member are now frequently

"

met with.

SECT. LIX. ON CATHETERISM, AND INJECTION OF THE BLADDER.

"When the urineis suppressed in the bladder, owing to some

obstruction, such as a coagulum, or stones, or from any other

cause, we have recourse to catheterism for the removal of it.

Wherefore, taking a catheter proportionate to the age and sex we

prepare the instrument for use. The mode of preparation is
this having
: bound a little wool round with a thread, and in-
troduced the thread with a sharp rush into the pipe of the
catheter, we adapt the wool to the opening at the head of the
catheter, and having cut off the projecting parts of the avooI
with a pair of scissors, we put the catheter into oil. Having
then placed the patient on a convenient seat, and used fomen-
tations, if nothing prohibit, we take the catheter and introduce
it at first direct down to the base of the penis, then we must
draw the privy parts upwards to the umbilicus, (for at this
place there is a curvature of the passage,) and thus push the
instrument forwards. When in the perineum it approaches the

anus, we must bend the member with the instrument in it down

to its natural position, for from the perineum to the bladder the

passage is upwards ; and we must push the instrument forwards

until it reach the ca^aty of the bladder. We afterwards take
out the thread fastened into the opening of the catheter, in order
that the urine being attracted by the wool may foUoAv, as hap-
pens in syphons. Such is the method of introducing the ca-
theter. But since we have often occasion to wash an ulcerated
bladder, if an ear-syringe be sufficient to throw in the injection
it
may be used, and is to be introduced in the manner described
above. But if we cannot succeed with it we may fix a skin or
the bladder of an ox to the catheter, and throw in the injection
through its opening.

Commentary. Although we have treated succinctly of stran- Comm.

gury and retention of urine in the Third Book, it may be

proper, before explaining the ancient methods of introducing
 352 CATITETERISM. [book vi.

CoMM. the catheter, to give some further account of the causes of these
" '

complaints, and the opinions entertained by the physiologists

*

with regard to the functional offices of the urinary organs.

Galen states that the bladder is possessed of two faculties, a
retentive and an expulsive, both of which arise from muscular
power ;
that the retentive resides in the neck of the bladder,
and is of the voluntary kind of powers ; but that the expulsive
belongs to the class of natural or involuntary powers, being of
the same kind as the peristaltic faculty of the intestines. When
a person, then, makes water voluntarily, it is by suspending the

voluntary action of the sphincter vesicae, that is to say, of the

retentive faculty of the bladder, whereby the expulsive or peri-
staltic powers are brought into action, and the contents of the
bladder are thereby evacuated. He properly adds, however,
that this involuntary or expulsive faculty may be assisted by the
action of the voluntary muscles which surround the bladder,

especially the recti muscles of the abdomen. Retention of urine,

therefore, mav arise from the loss of either of these faculties.
The expulsive faculty is most commonly lost, either from over-
distension of the bladder, as when its contents have been allowed
to accumulate too far, or from injury of the spinal marrow which

supplies it with nerves. Rhases remarks that when retention

of urine proceeds from debihty of the expulsive faculty, the
bladder may be evacuated by merely making pressure above the
pubes.
According to E-hases, retention of urine arising from derange-
ment of the retentive faculty, that is to say, from its no longer

being under the control of the will, may be occasioned by in-

flammation, by some SAvelling, such as a fleshy tumour forming in
the meatus urinarius, or by the presence of some foreign body,
such as a stone, a clot of blood, or the like. He alludes several
times to this fleshy tumour in the passage, by which he probably
means either an enlargement of the prostate gland, or stricture
of the urethra. He calls it a very intractable case. For a
fuller exposition of the ingenious speculations and opinions
stated above, see Galen (De Locis Afi'ectis, iv, 4) ; Rhases
(Contin. i and xxiii.)
Celsus describes very accurately the operation of catheterism.
The tube or catheter, he says, should be made of copper, and the
male catheter ought to be somewhat bent, smooth, and neither too
 SECT. Lix.] CATHETERISM. 353

large nor too small for the passage. The length of the largest Comm.
male catheter should be 15 inches^ of the middle-sized 12, and^ '

of the smallest 9 ; the largest female catheter should be 9, and

the smallest 6 inches.The patient is to be laid on his back,
and the surgeon standing by his right side, and holding the
penis in his left hand, is to introduce with his right the catheter
into the urinary passage ; and when it reaches the neck of the
bladder, the instrument along with the penis is to be bent
downwards and introduced into the bladder. When the water is
evacuated the catheter is to be extracted. The female passage,
he remarks, is shorter, and is discovered by a sort of mammary
protuberance above the vagina, by which he evidently means
to describe the clitoris. The operation, he adds, in this case is

less difficult, (vii, 26.)

The operation is mentioned by Aetius and other of the Greek
authorities, but none of them describe it fully but Paulus.
Albucasis recommends a catheter made of silver. His ac-
count of the operation is evidently borrowed from our author.

He and gives a drawing of an instrument for throw-

describes

ing injections of oil and water into the bladder when inflamed.
It is a tube of silver or copper having the bladder of a ram
attached to it.
(Chirurg. ii, 59.)
Avicenna and Serapion mention the operation but do not
describe it minutely. Haly Abbas directs us to make the pa-
tient sit and to pour warm water and oil upon the penis. This
isevidently recommended with a view of producing relaxation.
The ordinary steps of the operation are very properly described
by him. (Pract. ix, 45.)
E-hases gives a fuller account of catheterism, and all the cir-
cumstances connected therewith, than any other ancient author.
He very properly forbids the catheter to be introduced when the
retention arises from inflammation at the neck of the bladder.

I {Ad Mansor. He first gives Antyllus's description of the

ix, 73.)

operation, which very accurate, but similar to our author^s.

is

He recommends us, before attempting the introduction of the

instrument, to put the patient into a warm bath, or to apply
hot fomentations to the parts. He then directs us to lubricate
the instrument with oil or thick mucilage, and to introduce it

into the passage until it arrives at the under extremity of the

penis, when it is to be gently pushed upwards in the direction

II. 23
 3J4 CALCULUS. [book vi.

CoMM. of the navel^ turning it to one side or another according as it

'

He states that it is best to have the

'
"
encounters obstruction.
openings of the catheter in its sides as they are less likely to be
obstructed by clots than ^hen in the extremity. He also men-
tions that he was sometimes in the practice of using a ductile
instrument of lead which accommodated itself to the passage.
Both Serapion and Rhases mention the operation of punc-
turing; the bladder. Rhases says that when there is retention
of the urine and the bladder inflamed, the case be urgent,
is if

and there be reason to apprehend that the introduction of the

catheter would aggravate the spnptoms, it -may be proper to
make an incision in the perineum into the side of the bladder,
*ind to draw ofl^ Both add, however,
the urine with a canula.
that there is danger of the wound not closing. (Cont. xxiii, 2.)
The ancients seem to have fancied that it was necessary to
fill
up the internal ca\-ity of the catheter with wool, or some
such substance, in order to produce a vacuum when drawn out,
belie^^ing that the catheter in this case acted upon the princi-
ple of the syphon. See Alexander Aphrodisiensis (Prob. ii, 59.)
It is singular that they should have fallen into this mistake,
when Galen, as we have mentioned
above, had so clearly ex-
plained that the evacuation of the bladder is accomplished by

the action of its expulsive powers whenever its retentive faculty

is suspended or overcome. The earlier writers on surgery like-
wise adopt the notion that the cavity of the instrument requires
to be filled up with wool. See Guido de Cauliaco [xi, 2.) They
describe stricture of the urethra under the names of hypersur-
cosisand caruncula in meatu urinario. See Henricus Regius
(An. Med. 44.)

SECT. LX. ON CALCULUS.

The cause of the formation of stones, and tliat in children

they are formed most readily in the bladder, and in adults in

the kidneys, —
all this haA'ing been explained in another place,

we now proceed to the method of performing lithotomy, but

shall first give the symptoms of stones lodged in the bladder.
The patients then void mine of a watery consistence with a

sandy sediment; and from constant itching the member is now

SECT. Lx.] CALCULUS. 3.55

relaxed and again stretched in an uncommon degree, because,

owing to the irritation, thej are perpetually handling it, more
especially in the case of children. When the stone falls into
the neck of the bladder a sudden retention of urine takes place.
Of those cut for the stone, children to the age of fourteen are
the best subjects for the operation, on account of the softness
of their bodies old men are difficult to cure because ulcers
:

of their bodies do not readily heal ; and the intermediate ages

have an intermediate chance of recovery. And again, those
who have larger stones recover best because thev have become
habituated to the inflammation, whereas those who have smaller
recover with difficulty for the opposite cause. These things
being so, when we proceed to the operation, we first have re-
course to shaking the patient, sometimes by means of assist-
ants, and sometimes by making him jump from a height, in
order that the stone may be forced down to the neck of the
bladder. We have then to place him sitting in an erect pos-
ture^ with his hands under his thighs, in order that the bladder
may be forced down into a small space. If then we ascertain
bv feelino- externallv that the stone with the shaking has fallen
down to the perineum, Ave proceed immediately to the opera-
tion ; but if it has not descended, we must introduce the index
finger of the left hand well oiled, or, if an adidt, the middle
also, into the anus, and with the fingers in a supine direction
we search with them for the stone, and, bnnging it down gra-
dually to the neck of the bladder, we fix it there, pushing it
out with the finger or fingers when so fixed ; and having given
du'ections to the assistant to press down the bladder with his
hands, and ordering another assistant to raise the testicles in
his right hand, and with the other to stretch the perineum to
the other side from that upon which the incision is to be made,
we take the instrument called a lithotome, and between the
anus and the testicles, not, however, in the middle of the peri-
neum, but on one side, towards the left buttock, we make an
oblique incision, cutting down dii'ect upon the stone where it
protrudes, so that the external incision may be wider, but the
internal not larger than just to allow the stone to fall through
it. Sometimes, from the pressure of the finger or fingers at
the anus, the stone starts out readilv at the same time that the
incision is made, without requiring extraction ; but if it does
 356 CALCULUS. [book vi.

not start out of itself we must extract it with the forceps called the
stone-extractor. After the removal of the stone, having stopped
the bleeding by manna of frankincense and aloes, comfrey, misy,
and such like styptic powders, and having dipped wool or com-
presses in wine and oil, we apply them ; and also apply the ban-
dages for calculous diseases, namely, that having six legs. But if
there be any apprehension of hemorrhage we must apply a com-
press which had been soaked in oxycrate, or water and rose-
oil, and placing the patient in a reclining posture, bathe the
parts frequently. After the third day, having loosed the ban-
dages, and poured much water and oil into the wound, we may
dress it with the ointment called tetrapharmacon (basilicon) on
a pledget, removing them and dressing often on account of the
acrimony of the urine. If inflammation come on, we must
have recourse to the cataplasms and fomentations proper for it.
And we may also inject into the bladder oil of roses, oil of ca-

momile, or butter, unless some inflammation prevent. In like

manner, if the sore become spreading, or otherwise malignant,
we must suit the applications to the state of it. When the
ulcer is freed from inflammation we loose the dressings,
may
and use diachylon plaster to the groins and bottom of the belly.
During the Avhole time of the treatment, the thighs must be
bound together, which contributes to the cure with the other
remedies. If the stone, being small, fall into the penis, and
cannot be voided with the urine, we may draw the prepuce
strongly forwards, and bind it at the extremity of the glans.
We must next apply another ligatui-e round the penis behind
the member, making the constriction at its extremity next
the bladder, and then make an incision down upon the stone,
and bending the penis we eject the stone, and undoing the
ligatures Ave clear away the coagula from the wound. The pos-
terior ligature is applied lest the calculus should retreat back-

wards, and the anterior, in order that, Avhen untied, after the
extraction of the stone, the skin of the prepuce may slide back-
wards and cover the incision.

CoMM. Commentary. We will now attempt to explain all the an-

'
cient descrijations of lithotomy.

Hippocrates in his Oath binds his pupils not to perform this

operation, but to leave it to those who made it their business.
SECT. Lx.J CALCULUS. 357

It appears then that in his days lithotomy was a separate branch Comm.
" '

Celsus is the earliest author who describes

'
of the profession.
lithotomy^ although it is probable that he merely explained
the method of operating in Alexandria, the surgeons of which
city had acquired great celebrity in performing this operation.
He forbids the operation, except after every other remedy had
failed ; and in children between the ages of nine and fourteen,
and in the season of spring. The patient is to be kept upon
a spare diet beforehand ;
and when the operation is about to be
to bring down
performed, he is to be directed to walk, so as
the stone to the neck of the bladder, which is to be ascertained
by introducing a finger into the anus. Then a strong and
on a is to take the
experienced person, sitting high seat,

patient and hold him secure, his buttocks being placed

upon the assistant's knee, and his legs being drawn in and
his hands placed on them and held there. But if the patient
be strong he is to be held by two assistants, one on each side,
placed beside one another, and they are
to be
upon two seats
directed to press upon his shoulders with their breasts, so as to

force down the bladder. Two other assistants are to be at

hand, to prevent any risk of the former two losing their hold.
The surgeon having pared his nails, is to introduce gently first
the index and then the middle finger into the anus, whilst with
the right he makes pressure upon the abdomen, and in this way
the stone is to be secured at the neck of the bladder, Tlie

shape of the stone is be considered, and it is to be pressed

to
down so as to favour its These matters being properly
exit.

•arranged, a lunated incision is to be made over the neck of the

bladder near the anus down to the neck of the bladder, the
horns of the incision inclining a little towards the (left ?) but-
tock ; then at that where the incision is bent round (at
part
the curvature of the incision ?) even
under the skin, another
transverse incision is be made, by which the neck is to be
to
the opening being some-
opened, and the urinary passage dilated,
what larger than the stone. When the stone is small it may
be propelled and drawn out by the fingers ; but if large, it is
tobe extracted by a hook or crotchet made for that purpose.
This hook is of a semi-circular form, smooth externally, and

rough on the inside. By the help of it the stone is to be

taken out dexterously, attention being paid to the shape of it.
 358 CALCULUS. [book vi.

CoMM.
^ '
He mentions that Ammonius tlie litliotomistwas in the practice
"
of breaking down the stone into pieces when it was so large

that it could not be extracted without tearing the neck of the

bladder. He states that the operation is seldom required in
the case of females_, but that if the stone be large it
may some-
times be necessaiy. The fingers are to be introduced into the

vagina, as they, are into the rectum of males, and then, if the
patient be a girl, an incision is to be made under the left edge

(of the labia pudendi ?) ; but if in an adult female, a transverse

incision is to be made on both sides between the urethra and
OS pubis.
The above is but an abridgment of the Celsian description,
which, it must be admitted, is attended with considerable diffi-
culties. AVe shall give the passage in Avhich he describes the
" Incidi
form and place of the incisions. super vesicae cervi-
cem juxta anum cutis plaga lunata usque ad cervicem vesicae
debet, cornibus ad coxas spectantibus paulum deinde ea parte,
:

qua resima plaga est, etiamnum sub cute altera transversa

plaga facienda est, qua cervix aperiatur; donee urinse iter pateat,
sic, ut plaga paulo major, quam calculus sit." Sprengel
"
renders the words " cornibus ad coxas spectantibus paulum
" dont
les angles regardant les aines •/' but cox(B signifies
by
properly not the groins, but the nates, A-iz., the buttocks, or
perhaps the hips. (Celsus viii, 1.) In the English translation
of M.
Foubert^s paper on Lithotomy, in the Memoirs of the
'

French Academy of Surgery,^ these words are more coiTcctly

" the extremities of which incision must be in some
rendered,
measure directed towards the thighs." Dr. Milligan, however,
in his edition of Celsus, proposes to read coxam, by which he

supposes that Celsus understood the coxa sinistra. He adds :

" hinc
liquet, cornua plagse Celsianse, ut hodiernse, coxam sinis-
tram respexisse." "We are inchned to adopt this conjecture, as
it makes the Celsian description agree with that of our author

and his Arabian copyists, all of whom direct the first incision
to be made towards the left nates. The words " qua resima
plaga est," must signify, we suppose, the curvature in the
middle of the incision where the two horns unite. M. Foubert
reads '' qua strictior ima plaga est," but we suspect without
any proper authority from MSS.
We may be permitted to remark that the advantages of the
SECT. Lx.] CALCULUS. 359

semi -lunar iiicisiou are pointed out by Bromfield, and the Ccl- Comm. '

*
sian ojjeration was generally practised by the late Baron Dupuv-
treu of Paris.
Aetius and other of the Greek authorities allude frequently
to the operation, but none of them describe it minutely except
Paulus. Our author's statement, that there is less danger from
the extraction of large than of small stones, is at variance, we
believe, with modern experience. Aretaeus states that small
stones are most easily extracted. He was, however, no advo-
cate for the operation at all, except in extreme cases. He speaks
of cutting " the neck of the bladder." (Morb. Acut. Curat, ii, 9.)
Does he not allude to attempts at lithotrity in the following pas-

sage ? 6i»r£
jueyof,') OpvirTeTm, ij woai, i] cpaoiiiaKw,
-yap {\iOoQ
a/LKpiO^vTrToiTO,
t] uvre acru'Ewg Ti/iivirat. (Morb. Chron. ii, 4.)
Which passage may be thus translated " when the stone is
:

large neither lithotrity, or lithotripsy, nor lithotomy, can be

'
practised safely.'' Theophilus, in his Commentary on the
Aphorisms of Hippocrates,' states that in lithotomy it is not
the bladder, properly speaking, but the neck of the bladder,
which is muscular, that is cut.
WenoAv proceed to the Arabians. Albucasis, after detailing
the symptoms in much the same terms as our author, goes on
to describe the operation as follows. Having cleared out the
bowels with a clyster, the patient is to be shaken so as to make
the stone descend, and he is then to be secured in the arms of
an assistant, with his hands under his nates. The surgeon is
then to press upon the perineum, and, if the stone be felt, the
operation is to be proceeded with ; but otherwise, the index
finger of the left hand, if the patient be a child, and the
middle if an adult, is to be introduced into the anus,and the
stone is thereby to be gradually brought down to the neck of
the bladder. Having pushed it outwards to the place where
you mean to make your incision, an assistant is to be directed
to press down the bladder from above the pubes, while another
draAvs up the testicles with the one hand, and with the other
stretches the skin under them. Then with a proper scalpel the
operator is to make an between the anus and the tes-
incision

ticles, not in the middle, but towards the left nates, straight
upon the stone which is to be pressed out by the finger. Let
the incision be transverse (oblique ?), large externally, but ,in-
 360 CALCULUS. [book vi.

CoMM. ternallj of the size of the stone. If the stone does not then
' '

start out, the operator must seize upon it with a forceps, or a

'

hook having a lunated extremity. If there be more than one

stone, the largest is to be extracted first, and then the others

may be easily removed. When the stone is large he directs

us to break it down with a forceps. His directions respecting
the treatment afterwards are similar to those of Paulus. When
the stone sticks in the urethra he recommends us to cut down
upon it. His description of the operation on women is like-
wise similar to our author's, but more circumstantial. Having
got a dexterous midwife, or some proper person to introduce
her finger into the rectum or vagina, and press the stone down
to the left hip, the operator is to make first a small incision
over it, and afterwards, by the help of a sound or specillum, it
is to be enlarged so as to allow a passage for the stone. (Chirm-g.

ii, 60, 61.)

Avicenna's description is nearly the same as that of Albucasis,
but not so minute. He directs the surgeon to introduce a
finger into the anus, if the patient be a male, but into the va-
gina if a woman who is not a virgin, and to push the stone
outwards, so as to make it protrude. He is then to cut down
upon it, making an incision proportionate to the size of the
stone ;
but if the stone be very large, the incision must not be
made of the same size, but it is to be grasped in a forceps and
broken into pieces. If inflammation come on after the opera-
tion,he recommends him to have recourse to clysters, the warm
bath, and venesection, and a piece of cloth dipped in oil of
roses and some vinegar is to be apphed to the part. The bad
symptoms after the operation are said to be violent pain in the
part and under the navel, coldness of the extremities, prostra-
tion of strength, loss of appetite, and, at last, singultus and
involuntary discharges from the bowels, (iii, xix, 1, 7.)
The description given by Haly Abbas being nearly the same
as that of Albucasis, need not be noticed here but very briefly.
He prefers performing the operation in infancy, but permits it
to be done at all ages. For the reason assigned by our author
he states that recovery is most likely to take place when the
stone is large. Like the others, he directs the surgeon to in-
troduce either the fore-finger alone, or it and the middle finger
into the anus, behind the stone, and to push it outwards, and
SECT. Lx.] CALCULUS. 361

then the operator is to cut down upon it^ making the incision Comm.
' '

between the testes and the anus^ yet not in the middle, but "

towards the left side. When the incision is carried down to

the stone itsometimes start out from the pressure of the
will

fingers in the anus; but otherwise, it is to be seized upon with

a forceps and extracted. If inflammation come on he recom-
mends us to apply a cataplasm, and to throw into the bladder
an injection consisting of oil of roses and of camomile, or of
melted butter. (Practic. ix, 46.)
Rhases gives from preceding authors several descriptions of
lithotomy, but as they closely resemble our author's, we shall
treat of them only in a cursory manner. In his first description
he directs the surgeon to place the patient with his hands
fastened to his ankles so as to press down the bladder. When
the stone does not descend properly, so as to be felt externally,
he recommends him to introduce one or more fingers into the
rectum and push it outwards ; and then while an assistant
draws up the testicles the operator is to make a transverse
(oblique ?) incision, larger externally, but internally only of
such a size as to allow the stone to pass out. If the stone
does not come out readily it is to be extracted with an instru-
ment, and the hemorrhage checked Avith a composition of aloes,
frankincense, ana vitriol. When the patient is a child he re-
commends the operator to place him upon the knees of an
assistant, and to make pressure on the abdomen so as to force
down the bladder. He forbids the operation when the stone
cannot be brought down to the neck of the bladder. When
the stone is large he directs it to be broken into pieces before
extraction. taken from the celebrated
His next description is

Antyllus, but as it
scarcely from the preceding
diff'ers at all

one, we shall merely select a few remarks. When the stone

is smooth, round, and small, he directs the
surgeon to push it
down to the neck of the bladder by means of a finger intro-
duced into the rectum, and to make an incision down upon it ;
after which the stone is to be forced out. When pain super-
venes after the operation, he recommends him to place the
patient in a bath medicated with camomile, linseed, mallows,
&c. j or if it be summer, and there be any disposition to
hemorrhage, to place him in a vessel filled with strong vinegar.
When it is ascertained that there are clots of blood in the
 362 CALCULUS. [nooK vr.

CoMM. bladder obstructing the urine, he directs the surgeon to intro-

* '
*
duce a finger by the incision, and extract them gradually.
His next description is from an author named Sarad, whom
he frequently quotes in other parts of his works. He directs
the operator to introduce a finger into the rectum and push
the stone outwards to the of the perineum, removed
left side

about the from the raphe (daramj, and

size of a grain of barley
then to make an incision into the neck of the bladder. He
afterwards gives a very circumstantial account of the operation
from another author called Athuriscus. He particularly directs
the operator to make an incision in the left side of the perineum
and to open the neck of the bladder, as a wound of the body of
the bladder seldom unites. When the stone is large he recom-
mends liim to seize it with strong pincers and break it into
pieces. When a stone sticks in the urethra he directs him to
tie one ligature behind it and to secure the prepuce before the

glans with another, and then to cut down upon the stone.
He gives very minute directions about the after treatment, re-
commending especially the removal of any clots which obstruct
the passage. (Cont. xxiii.)
The practice of lithotomy appears to have been reckoned a
disreputable occupation among the Arabians, for Avenzoar
mentions it as an operation which an upright" and respectable
man would not witness, far less perform, (ii, 2, 7.)
As there are some doubts regarding the form of the incisions
in the ancient methods of performing lithotomy, we will now
give the words of some of the Arabian translators. Stephanus
Antiochensis, the translator of Haly Abbas, has the following-
" Inter testes
words :
anumque finde et non in medifi via sed in
sinistri lateris parte ab intestinis, sitque peralhla fissura, et ab
exterioribus larga, ab interioribus non.^^ The translator of Albu-
casis expresses himself thus
" Finde in eo
:
quod est inter
anura non in medio, ad latus natis sinistrse fiat
et testiculos et :

sectio transversa." The following are the words of Avicenna^s

" Cave ne
translator : scindas super commissuram quum sit
malum, commissura enim secundum veritatem est locus mor-
talis. Amplius fac super ipsum (lapidem ?) scissuram tenden-
tem ad transversum, studendo ut cadat scissura in collo vesicaj.^'
The translator of llhases expresses himself in the following
terms " Scinde cum instrumento
:
super lapidem cainadun ; et
SECT. Lxi.] TESTICLES. 363

scissura debet fieri transversa, et sit exterior caro larga et in Comm.

' '
'
interiori vesicae stricta."
Yet notwithstanding all this we are inclined to think that
the incision was oblique and not transverse ; for our author,
whom they all follow, directs us to make the incision oblique
[Xo^oq), and it is further clear that a transverse one would not
answer the purpose so well. No dependence can be put in
the accuracy of these barbarous translations. The language of
Stephanus Antiochensis is particularly obscure. Casiri justly
characterizes the translations of the Arabian authors «as being
"
perversiones potius quam versiones." (Bibl. Hisp. Arab, i, 266.)
The ancient operation, with scarcely any alterations, is de-
scribed by the earlier writers on surgery.
modern See Brunus
(Chu'urg. INIagna. ii, 17) and ;
Guido de Cauhaco (Chir. vi, 2.)
They direct us to introduce a finger into the rectum and push
the stone outwards then to make an incision down upon it
;

on the left side of the raphe. Brunus recommends a longi-

tudinal incision.
appears that the ancient operation of lithotomy is still
It

practised with great success by the native doctors of Ilindostan.

See ' Transactions of the Medical and Physical Society of
Calcutta,^ vol. iv. An interesting case in point, related in the
*
Medical Gazette' for Feb. 7,1845, forms a valuable commentary
on the Celsian description of lithotomy. In the year 1827
Mr. Madden the traveller saw it performed in Tyre by an old
pilot on a boy of thirteen years of age.
The case did well.

SECT. LXI. ON THE PARTS ABOUT THE TESTICLES.

As contributing to the understanding of the operations on

herniee, we shall premise a description of the parts about the
testicles. The testicle itself is a glandular and friable sub-
stance, formed for the production of semen. The substances
called parastatse and cremasteres, are processes from the mem-
brane of the spinal marrow, descending along with the arterial
vessels in the testicles, by which the semen is injected into the

pudendum ; the spermatic vessels are veins from the vena cava
passing to the testicles in a convoluted manner, and by
them
the testicles are nourished. The tunica vaginalis (erythroides or
elytroides ?) is of a nervous nature j
at the convex and anterior
 364 TESTICLES. [book vi.

part not adhering, but at the concave and posterior parts united
to the testicle, deriving its origin from the peritoneal coat.
This part, where it is united to the testicle, they call the posterior
adhesion. The darti are membranes connecting the external
skin to the tunica vaginalis, being united to it at the part where
it is united behind to the testicle. But that wrinkled skin
which forms an external covering to the testicles is called the

scrotum.

CoMM. CoMM-ENTAKY. Cclsus givcs a similar description of the

' '

'

parts connected with the testicles. The testicles themselves,

he says, consist of medullary matter and possess no sensibility
of their own, but experience violent pains and inflammations
from the membrane which surrounds them. They hang from
the groins by nerves called cremasters by the Greeks, A^dth
each of which descend two veins and arteries. These are
covered by a thin nervous white coat, without blood, called
elytroides by the Greeks. (This must be the tunica vaginalis
of modern anatomists.) Above it is a stronger tunic which
adheres strongly to the inner at its lower part, and is called
dartosby the Greeks. (This appears to be the cremaster muscle
of modern anatomists.) The veins, arteries, and nerves are sur-
rounded by many small membranes. (By these he seems to
have meant the fascise from the aponeurosis of the external
oblique muscle.) All these parts are covered by an external
investment called the scrotum, (vii, 18.)
Buffus Ephesius says that the scrotum is a loose substance
in which the testicles are placed, being in particular fleshy ex-

ternally ; that it consists of two tunics, the external being

corrugated and called dartos, and the internal being called
erythroides (elytroides ?). The dartos and scrotum connect the
testicles to the parts above, but the erythroides (vaginalis ?) is
united to and surrounds the testicle itself. (De Corporis
Humani partium appellationibus, ii.)

Oribasius describes the cremasters as being two muscles

which descend from the groins and surround the tunica vagi-
nalis. (Anatomica ex Galeno.) (This is
very similar to

Cloquet^s description of them.)

Theophilus's description imfortunately has come down to us
very incomplete. (De Fabrica Hominis, v, ad finem.)
SECT. Lxii.] HYDROCELE. 365

SECT. LXII. ON HYDROCELE.

An inert fluids collected about the parts which are enveloped

by the scrotum, and occasioning a marked swelling there, has

obtained this appellation. The fluid is, for the most part, col-
lected in the tunica vaginalis around the testicle, at its anterior

part ; but the affection is sometimes, though rarely, formed ex-

ternally to the tunica vaginalis. Often, however, it is collected
in the proper tunic of the testicles, and surgeons call this affection

hydrocele of the tunica adnata. If the complaint is formed

from some preceding cause, such as weakness of the parts, the
blood brought there for the purpose of nourishment is converted
into an inert watery or serous substance. But if it is occasioned
by a blow, a sanguineous or feculent substance constitutes its
contents. The common symptom is a permanent swelling with-
out pain about the scrotum, not disappearing under any cir-
cumstances, yet somewhat compressible when the collection is
small, but not at all compressible when it is large. When the
fluid is collected in the tunica vaginalis the swelling is globular,
but somewhat oblong like an egg ; and in these cases the testicle
is not to be felt as being evervwhere surrounded with the fluid.

But that which is collected externally to the tunica vaginalis,

is felt through a small intervening substance.
as When it is
formed in the adnata, being everywhere circumscribed and
globular, the swelling has the appearance of another testicle.
If the fluid be watery, the swelling is of one colour and trans-

parent ; but if it be feculent and bloody, it appears red or livid ;

and if these symptoms appear in both parts of the scrotum,
you may be sure that there is a double hernia. We operate
upon it in this manner. Having shaven the pubes and scrotum,
unless the patient be a boy, we lay him in a supine posture

upon a bench, and apply to his buttocks a cloth several times

folded, and to the scrotum a sponge of considerable magnitude,
and sitting at the left side of the patient, we give directions to
an assistant sitting at his right side to draw the genital organs
to the other side, and to draw up the skin of the scrotum to
the abdomen. Then taking a scalpel we divide the scrotum
longitudinally from its middle to near the pubes, making the

incision straight and parallel to the raphe which divides the

366 HYDROCELE. [book vr.

scrotum into two parts, and extending the incision down to the
vaginalis. When
the fluid is in the adnata, we make the in-
cision where the apex of the tunica adnata makes its appear-

ance, and separating the lips of the incision with a hook, and
having dissected the darti with a knife for hydrocele and a
scalpel, and laid bare the tunica vaginalis, we divide it through
the middle with a lancet for bleeding, more especially in that
part where it is separated from the testicle ; and ha^•ing dis-
charged into some vessel the whole or most of the fluid, we cut
away the vaginalis, especially its thinnest parts, with hooks.
Afterwards, Antvllus uses sutures and the treatment for recent
wounds ;
but the moderns have recourse to what is called the
incarnative mode of treatment. If the testicle is found in a
state of putrefaction, or otherwise diseased, the vessels Avhich
pass along with the cremaster are to be separately inclosed in
a ligature, the cremaster cut, and the testicle removed. And
when there are two hernias we may operate in the same manner
twice, directing the incisions on both sides at the parts of the
scrotum about the loins. After these things, haWng introduced
the head of a probe through the incision below at the extremity
of the scrotum, and elevating the scrotum upon it, we make an
incision with a sharp-pointed scalpel in a convenient situation
for the discharge of the coagulated blood and pus. By means
then of the head of the probe we introduce an oblong pledget
into the upper incision, and having sponged away the clotted
blood, we introduce wool dipped in oil through the incision
down and externally we may apply other pieces
to the testicle ;

of wool dipped in wine and oil to the scrotum, hypogastrium,

groins, perineum, and loins and applying a compress three times
;

folded upon them, and binding them with a six-legged bandage,

and other proper bandages, Ave place the man in a reclining
posture, putting wool under the scrotum for the sake of ease,
and spreading the soft skin under him to receive the embro-
cations. We bathe with warm oil until the thii'd day, after
which having loosed the bandages we must use the ointment
tetrapharmacon on a pledget, having changed the oblong one.
Afterwards we may again apply the embrocations proper for in-
flammation until the seventh dav, after which we have recourse
to the medicine called motophylacion. After the ulcer has been
cleaned and moderately incarnated, and the parts have been
SECT. LXTi.] HYDROCELE. 3G7

bathed, we must remove tlie oblong pledget, and have recourse

to the subsequent treatment as formerly described. But if in-
flammation, hemorrhage, or any such disagreeable consequence
come on, we must, in a word, treat each of these in a suitable
manner, that I m:iy not have occasion to make repetitions. But
if we would rather have recourse to the cautery in cases of

hydrocele (as is the practice of the moderns), we must follow

all the directions given as to what is to be done before and after

the operation, and also those given with regard to the operation
itself, omitting only the incision with a scalpel, and the division
for allowing the discharge of its contents. Wherefore having
heated ten or twelve cauteries, shaped like the Greek letter F,
and two sword-shaped ones, we must first burn the scrotum
through the middle with the gamma-shaped, and having dis-
sected away the membranes with a scalpel or blunt hook, we
must burn with the sword-shaped as if cutting. Having laid
bare the tunica vaginalis (which is easily recognized by its
whiteness and density) with the extremity of a gamma-shaped
cautery, we evacuate the fluid. Afterwards, when the whole is
laid bare, we stretch it with hooks and remove it with a sword-

shaped cauteiy.

Commentary. Celsus directs the surgeon, when water is Comm.

'

contained in a hernial tumour, to make an incision in the

'

"

groin, if the patient be a child, unless the largeness of the

collection prevent ;
but in adults, and when the s^Yelling is
great, he recommends him to make it in the scrotum. Then
if the incision be in the groin, the coats are to be di'awn up

there and the water discharged but if in the scrotum, and if

;

the disease be seated there, nothing more is to be done but to

evacuate the fluid, and remove any membranes which may
happen to contain it ; after which the parts are to be washed
with a solution of salt or soda. When the fluid is situated
under the middle or inner coat (the tunica vaginalis and tunica
albuginea ?), all these tunics are to be removed without the
scrotum and cut out. (vii, 21.) Celsus, as well as our author,
describes the haematocele or bloodv tumour, the existence of
which is affirmed by Heister. (ii, 5, 123.)
Galen alludes incidentally to the evacuation of the fluid in
hydrocele. (Meth. Med. xiv.) Sprengel and Guy de Cauliac
 368 HYDROCELE. [book vi.

CoMM. affirm that lie makes mention mode of cure

of the seton as a ;

we have not been able to find

' '
'
but if this assertion be correct
out the passage in which he does so.
Aetius gives a very distinct account of the nature of hydro-
cele, but his description of the operation is by no means so
accurate as our author's. He trusts mostly to astringent and
desiccative applications, (xiv, 22.)
Albucasis describes the operation in nearly the same terms
as Paulus. His operation consisted of making an incision in
the swelling and dissecting out the coats of the testicles. The
dressings which he recommends are similar to those mentioned
by our author. He also describes the operation by the cautery
in nearly the same terms as Paulus. He adds, that if the
patient be timid and do not choose to submit to these operations^
the surgeon may let out the water either with a scalpel or the
instrument used for tapping in dropsy. He states^ however,
that after this operation the water will collect again. (Chirurg.
ii, 62.)
Avicenna briefly describes the operation of opening the
tumour, and applying cauteries or strong medicines to the
membranes, (iii, xxii, i, 6.)
Haly Abbas directs us to open the tumour, and cut out its
tunics, and then to apply incarnative dressings. This treatment,
he. adds, the moderns prefer to the escharotic applications used
by the ancients. (Pract. ix, 47.) He also describes the pro-
cess of burning. (Pract. ix, 79.)
Rhases describes the operation
of punctui'ing the scrotiim
for hydi'ocele. He speaks of burning the part with a
also
slender rod of iron, and of cutting out its tunics. (Cont. xxiv.)
The membrane called tunica adnata in our translation is the
" ima tunica'' of "
Celsus, and the panniculus proprius" of the
Arabian translation of Albucasis, and seems to be the same as
the tunica albuginea of modern anatomists.
Sprengel gives an excellent history of the operation of hy-
drocele. (Hist, de la Med. 18, 8.)
SECT. LXiii.] SARCOCELE. 369

SECT. LXIII. ON SARCOCELE AND TOPHI OP THE TESTICLES.

When flesh is formed in any part of the bodies which arc

connected by the scrotum, it gives rise to the disease called
sarcocele. This arises either from some obscure cause, the
testicle being attacked with a defluxion and becoming indurated,
or from a blow, or from unskilful treatment after the operation
for hernia. Its consequences are, a swelling of the same colour,
with hardness ;
when the swelling is of a scu-rhous nature, it
is devoid of colour and sensibility ;
and when it is malignant
there are sharp pains. When
going to operate we place the
patient as in the former case, and make the incisions in like
manner and if the complaint is occasioned by the growth of
;

a fleshy tumour to the testicle, we divide the dartos and tunica

vaginalis in like manner then stretching
;
the testicle and bring-

ing it to the outside of the vaginalis, we separate the cremaster

from the vessels, tiea ligature round the vessels, and cut the
cremaster ; then we remove the testicle afi'ected with the fleshy
tumour as a foreign body. But if the fleshy tumour be formed
about any of the coats of the testicle or its vessels, having di-
vided the scrotum and the membranes lying under the flesh,
we must dissect out the whole fleshy tumour. Buc if the poste-
rior process {" epididymis^^ ?) be afi'ected with sarcocele, having
dissected all the surrounding parts, we remove the testicle along
with it ; for impossible for the testicle to continue without it.
it is

If tophi be formed about the testicle and the tunica vaginalis,

they distinguished from sarcocele and hydrocele by their
may be
resistance, hardness, and inequality, and are to be operated upon
as sarcocele.

Commentary. Celsus describes and recommends the same Comm.

'

operations. He directs us to divide the nerveby which the

testicle is suspended (the cremaster ?), then to tie the veins
and the groin with a thread, and cut them below
arteries at
the ligature. When a fleshy tumour is formed between the
coats he recommends us to cut it out. (vii, 22, 23.) When the

parts are indurated he forbids us to meddle with them.

Albucasis directs us to separate the cremaster from the ves-
sels, to tie the vessels^ and then remove the testicle
from the
II. 24
 370 CIRSOCELE. [book vi.

CoMM. surrounding parts. When tlie disease consists of a fleshy

" '
•
tumour which adheres to the testicle he directs us to cut it
out. After the operation the wound is to be filled with rose-
oil and wine. (Chirurg. ii, 63.) The other Arabians treat of
the operation less minutely, with the exception of Haly Abbas,
who describes it exactly as Albucasis. (Pract. ix, 48.)

SECT. LXIV. ON CIRSOCELE AND PNEUMATOCELE.

When the vessels about the scrotum or darti are in a varicose

condition, they are called simply varices, but if the nutrient
vessels of the testicles be in a varicose state, the affection is
named cirsocele. The symptoms of it are obvious. There is

a collection attended with swelling, and somewhat cui-ved, of a

botiyoidal shape, and accompanied with relaxation of the testicle.
It also occasions certain inconveniences, especially in running,

exercising, and walking. We

may operate upon it thus. After
putting the patient in a convenient posture, we must lay hold
of the scrotum and push the cremaster to the under part ; it is
easily distinguished from the vessels, being more slender, firmer,
and elastic, as being strong and firm ; the patient also
feels pain

upon pressure, and moreover it is connected with the penis.

Having secured the vessels in the scrotum by our own fingers
and those of our assistant, and stretching them strongly, we
press obliquely the point of a scalpel direct upon the vessels ;
then having transfixed the parts with hooks and dissected what
lie under the skin, and having exposed the vessels, as mentioned

in the operation of angiolog}' and that for aneurism,

and pushing
through them a needle having a double thread, and cutting
the loop of the thread, we tie the ligatures round the vessels
where the varices arise and where they terminate, and make a
straight incision in the intermediate space. Haring evacuated
the blood collected in the tumour, we apply the treatment for
suppurations until the ligatures with the vessels themselves fall
out of their own accord. Leonides says, that when a few of
the vessels which noiunsh the testicles are in a varicose state this
operation shoidd be performed, but that when all are aff'ected,
the testicle should be cut out along with them, lest being de-
prived of its nutrient vessels it should decay. Pneumatocele
SECT. Lxiv.] CIRSOCELE. 371

being a species of aneurism, Leonides forbids us to operate upon

it for fear of a hemorrhage, which cannot be restrained from

taking place at the time ; but, there being two kinds of it, the one
occasioned by the four vessels which nourish the testicle, and
the other by the arteries of the darti and scrotum being af-
moderns refrain from meddling with the latter, but
fected, the
operate upon the former. We
distinguish them from one an-
other, inasmuch as that which arises from the arteries is easily
made to disappear upon pressure with the fingers, whereas that
from the nutrient vessels of the testicles, not at all or with much
trouble. We
operate upon it as for cirsocele, taking up each
of the veins and securing it with a thread.

Commentary. Celsus thus describes the cirsocele :

" Venfe Comm.
intumescunt ; eseque intortse conglomeratseque a superiore
parte, velipsum scrotum implent, vel mediam tunicam vel
imam : interdum etiam sub ima tunica, circa testiculum ner-
vumque ejus, increscunt." (vii, 18.) He describes the operation
at great length afterwards. If the varicose tumour is upon
the scrotum he directs us to burn
with slender and sharp
it

irons, which are to be applied to the veins themselves, but in

such a manner as to burn them alone. Then suitable dressings
are to be applied for producing cicatrization. When the
varicose veins are situated above the middle tunic, an incision
is be made in the groin, the tunic drawn out, and the veins
to

separated from it with a finger or the handle of a scalpel. The

veins are afterwards to be tied with a thread above and below ;
then they are to be cut below, and the testicle restored to its
place. When the disease is situated above the third tunic
(tunica albuginea?) the middle one must be cut out. Then
if only two or three veins are in a varicose state they may be
tied, as above directed, at the groin and where they join the
testicle and cut out. When the disease is situated between
the internal coat and the testicle, he says, there is no other
remedy but the removal of the testicle. For this purpose he
directs us to secure the arteries and veins with a thread, divide

them, and then to cut the nerve by which the testicle is suspended
(the cremaster?). (vii, 19 and 23.) He does not treat of
pneumatocele. It must be obvious that the pneumatocele of
our author was an aneurismal varix or erectile tissue. We see
 372 ENTEROCELE. [book vi.

CoMM. no good reason, therefore, for the animadversions which Heister

' '
'
makes upon his account of it. (See Surgery.)
'
This operation is briefly noticed in the Isagoge' of Galen,
'
and Meth. Med.' (xiv.)
Albucasis considers it a dangerous operation, but says he
will describe it as it was performed by the ancients. He ac-

cordingly gives our author's account of it, directing us to

dis-

sect the congeries of vessels from the surrounding parts, to

pass a needle, armed with a double thread, under them,

and to
tie them above and below ; then to make a longitudinal in-
cision in them, and to evacuate the feculent fluids which they
contain. The wound is afterwards to be di'essed with incar-
nants. If all the vessels are involved in the disease, he directs
us to remove the testicle altogether. (Chirurg. ii, 64.) He
says he never saw the operation performed for pneumatocele ;
but that the ancients operated for it in the same manner as for
cirsocele. (66.)
A^.dcenna and Rliases treat of the pneumatocele, and recom-
mend carminative applications to it ; but they do not describe
the surgical operation.
Haly Abbas borrows the description of Paulus. (Pract.
ix, 49.)

SECT. LXV. ON ENTEROCELE, OR INTESTINAL HERNIA.

Enterocele is a descent of the intestine into the scrotum,

and occasioned either from rupture of the peritoneum which

is

takes place in the groin, or from sti-etching of the peritoneum.

Both these, I mean rupture and stretching, are occasioned by
previous violence, such as a blow, a leap, or loud crying, but
that from stretching in particular is connected with relaxation
and other weaknesses of the body. The common symptoms of
both are a marked swelling in the scrotum, which is increased
by exercise, heat, retention of the breath, and other exertions ;
and its symptoms are, that it goes up slowly upon pressure,
and quickly falls down again, and that while the person afi'ected
with in a recumbent posture it remains in its proper
it lies

he stands again erect.

place until The retention of faeces in the
region of the scrotum often brings on dangerous symptoms ;
SECT. Lxv.] ENTEROCELE. 373

for attended with pain, and sometimes with rumblinfj of

it is

wind upon pressure. The peculiar symptoms of hernia from

distension are, that it does not occur suddenly, but gradually;
that it falls down occasionally from any ordinary causes; that
the swelling appears equable and deep-seated, the protruded
intestine being surrounded by the peritoneum. In those from
rupture the descent at first is sudden, and happens only from
violence ; the swelling very large, and appears seated super-
is

ficially immediately under the skin, owing to the intestines

having burst through the peritoneum. If the omentum alone
falls down to the scrotum in rupture of the peritoneum the affec-

tion is called epiplocele, but if intestine descend along with it,

it is named epiploenterocele ; and if water be contained in the

tunica vaginalis it receives an appellation compounded from all

the three. But neither these nor the intestinal hernia from
rupture of the peritoneum are proper subjects for surgery, but
we operate upon enterocele alone from distension, in the fol-
lowing manner after placing the patient in a recumbent pos-
:

ture, and getting the skin in the groin stretched by an assis-

tant, we make a transverse incision, cutting as in the operation
of angiology (but some make the incision not transverse but
longitudinal), then having transfixed it with hooks we stretch
out the incision to such a degree as to afford room for the
testicle to passthrough then passing through the inner skin
;

a number of hooks proportionate to the size of the wound, and

dissecting the membranes and fat with a blind hook
or scalpel
we cut them across. When
the peritoneum is everywhere
laid bare, introducing the index-finger at the back part of the
scrotum between the darti and peritoneum, we free the posterior
process (epididymis ?) ; and then
with the right hand doubling
its extremity to the inside of the scrotum, and at the same
time stretching the peritoneum in the left hand, we bring the
testicle with the vaginalis tunica to the incision, and give
directions to one assistant to stretch the testicle, whilst we,

having completely cleared the posterior process, ascertain by the

fingers whether a fold of intestine be comprehended in the
tunica vaginalis, and if so we must press it down to the belly ;
then we take a large-sized needle containing a doubled thread
of ten pieces, and we pass it through the middle at the extre-
mity of the peritoneum close to the incision ; and cutting the
 3/4 ENTEROCELE. [book vi.

double we make four pieces of them, and laying them over one
another in the form of the Greek letter X, we bind the perito-
neum securely, and again twisting round the pieces we secure
it none of the nutrient vessels may have a free passage
so that
to it lest any inflammation be occasioned, and we apply another

ligature farther out, less than two fingers' breadth distant from
the former. After making these ligatures we leave about the size
of a finger of the peritoneum, and cut off the whole all round,
removing at the same time the testicle, then making an in-
cision at the lower part of the scrotum to favour the discharge,
we introduce an oblong pledget, and apply embrocations of oil
and bandages as for hydi'ocele. We
must also make the other
applications as there laid down. I have known some not un-
skilful surgeons who after the incision into the tunica vaginalis
bm'ut the extremity of it with heated cauteries for fear of
hemoiThage, as would appear.
These after the operation
straightway bathed their patients in a long wooden trough
containing hot water, until the seventh day, repeating this as
often as times during the period of a day and a night,
five

more especially with children ; and it succeeded wonderfully, for

they remained free from inflammation, and the ligatures fell
out speedily along with the parts. In the intervals between
the bathings the afore-mentioned embrocations were apphed.
Another surgeon, in addition to the means already mentioned,
rubbed into their back at the time pepper tritnrated with oil.

COMM. Commentary. Celsus recommends us, if the patient be a

make an attempt, in the first place, to effect a cure
child, to
with bandages. In more advanced ages, if a large portion of
intestine has fallen do-\vn, and if attended with pain and vomit-
ing, which symptoms generally arise from retention of the fseces,
it is clear, he says, that the knife is not applicable, and that the

case is to be remedied bv other means. He recommends vene-

section in the arm, the tepid bath, warm cataplasms, and spare
diet ; but he disapproves of pui'gatives. This is his treatment
of strangulated hemia. When an operation with the scalpel is
resolved upon, an incision ha^dng been made in the groin down
to the middle tunic (tvmica vaginalis ?), the lips of it are to be

separated with the assistance of hooks, while the sm'geon frees

the tunic from all the small membranes (external fascia?).
SECT. Lxv.] ENTEROOELE. 375

When this tunic is removed, an incision is to be made from the Comm.

' '

groin down to the testicle, which to be carefully cut out.

is
•

This process, however, is only applicable when the patient is of

a tender age, and the mischief is moderate. When the patient
is a strong man and the disease greater, the testicle is not to
be removed, but is to be allowed to remain in its place. It
is accomplished in this manner the groin being opened
:

with a scalpel, in the same manner, down to the middle tunic,

it is to be seized with two hooks, so that an assistant may pre-

vent the testicle from falHng out at the wound ; then that tunic
is to be cut downwards with a scalpel, and under it the index-
finger of the left hand is to be pushed down to the bottom of
the testicle so as to force it up to the wound : then the thumb
and index-finger of the right hand separate the vein, artery,
nerve, and their tunic, from the upper tuuic. But if any small
(fascise ?) come in the way, they are to be cut
membranes out
with a scalpel, until the whole tunic be exposed. Having cut
out what is proper, and replaced the testicle, a somewhat broader
thong of skin is to be removed from the lips of the wound in
the groin, in order to enlarge the wound, and thereby occasion
a greater formation of new flesh. The object of this operation,
it will be remarked, is to produce a firm cicatrix at the external

abdominal ring. In cases of epiplocele, he recommends us

either to replace the omentum, or to cause the death of it by
or to cut it out with
septic medicines, cauteries, or the ligature ;
a pair of scissors, but of this proceeding he does not much ap-
prove, as it occasion dangerous hemorrhage, (vii, 20, 21.)
may
Galen
briefly states that intestinal
and omental hernise are to
be cured by pressing up the intestine or omentum, removing as
much as possible of the spermatic vessels ; or otherwise draw-
ing out the peritoneum, fomenting it, and then cutting it off*.

( Isagoge.) He mentions that it was customary to bleed the

patient before the operation when

he was plethoric. (De Opt.
sec.)
Aetius speaks of the operation as being highly dangerous.
He forbids attempts at reduction while the prolapsed parts are
affected with inflammation, tormina, and flatus, (xiv, 23.)
Albucasis's account of the treatment is quite similar to our
author^s. lie states that the disease is occasioned by the de-
scent of a portion of intestine to the testicle, owing to rupture
 376 ENTEROCELE. [book vi.

CoMM. or distension of the peritoneum.

"
Sometimes, he says, fseces
*
get into the prolapsed bowels, and being retained give rise to
"violentand sometimes fatal symptoms. When going to operate
he directs us, in the first place, to make the patient reduce the
intestine if reducible. Then an incision is to be made along
the whole skin of the testicle, and hooks are to be fixed in the
lips of the wound so as to enlarge it, and allow a passage for
the testicle. The membranes, then, below the skin, are to be
dissected, so as to expose completely the tunica vaginalis {sifac
album.) The index-finger is then to be introduced between
the tunica vaginalis and the second coat (tunica albuginea?)
so as to free the adhesions at the back part of the testicle.
The operator is afterwards to separate the testicle from all its
adhesions and raise it up to the external wound. He must
now examine whether any portion of intestine remain pro-
truded, and if so, it must be replaced. The operator is then
to take a large needle armed with a cord of ten threads,
and ha"ving introduced it behind the tunic under the skin of
the testicle (tunica vaginalis ?) its extremities are to be cut, and
the threads arranged into four pieces. With them the perito-
neum is to be tightly bound in a crucial form, so as that the
nutrient vessels mav it, which will obviate
not be able to reach
inflammation. Another ligature is to be apphed afterwards at
the distance of less than two fingers' breadth from the former.
After applying these two ligatures, about a finger's breadth of
the peritoneum is to be left, and the rest is then to be cut all
around, and the testicle removed along with it. An incision is
then to be made at the lower part so as to allow an outlet for
the blood and matter. Wool dipped in oil is to be applied
afterwards, and bound as formerly described. Sometimes, he
adds, the cautery is applied to the timica vaginalis after the
incision for fear of hemorrhage. (Chirm-g. ii, 65.) He describes
minutely the treatment by burning in another place, (i, 47.)
Avicenna recommends the cauterv, but does not describe the
other operation. Haly's description is evidently taken from our
author. (Pract. ix, 50.)
Rhases states correctly that hernia generally arises from di-
latation of the passage which leads from the cavity of the abdo-
men to the testicle. In ordinary cases, he says, there is no
rupture of the peritoneum. He states that the contents of the
SECT. Lxvi.] BUBONOCELE. 377

hernial tumour are either intestines or omentum. The omen- Comm.

'

commonly found in ruptures.

the intestine most
'

turn, he addsj is
'

He says the peritoneum {sifac) lines the whole intestines and

surrounds the testicles. Antyllus, from whom he gives a sub-
sequent extract, states in like manner that the peritoneum de-
scends to the testicles and forms the tunica elytroides, i. e.
vaginalis. Antyllus also affirms that hernia arises from relax-
ation of the passage between the cavity of the abdomen and
the testicles.This opinion regarding ruptures is maintained
by several of the authorities quoted by Rhases, (Contin. xxiv.)

Sprengel says of Rhases '' Sa theorie des hernies propre-

:

ment dites est infiniment preferable a celle des Grecs." (Hist,

de la Med.) The account which Rhases gives of ruptures is,
no doubt, very correct ; but there is every reason to suppose
that it was entirely taken from the works of the Greek
surgeons.
The operations practised by the ancients for the radical cure of
hernia cannot but appear to us extremely cruel and hazardous ;
and yet the danger attending them must have been less than is
could not have been so fre-
generally supposed, otherwise they
quently performed as they were about two centuries ago. Fa-
bricius ab Aquapendente mentions that a celebrated rupture
doctor of his time informed him that he used to operate upon
200 patients at an average every year. Fabricius, however,
the operation except
prudently recommends us not to perform
in extreme cases, and to be content in general with supporting
the parts by means of a truss.

The ancients never operated to relieve strangulated hernia.

SECT. LXVI. ON BUBONOCELE, OR INGUINAL HERNIA.

Enterocele arising from distension commences as bubono-

cele ; for at first the peritoneum being stretched the relaxed
intestine is protruded as far as the groin, and forms this dis-

ease, which the ancients operated upon in this manner. After

making the incision to the extent of three fingers' breadth

transversely across the tumour in the groin, and removing
the
membranes and fat, and the peritoneum being exposed in the
middle where it is raised up to a point, let the knob of a probe
 378 BUBONOCELE. [book vi.

be applied, by wbich the intestines will be pressed deep down.

The prominences, then, of the peritoneum formed on each side
of the knob of the probe are to be united to one another by-
sutures, and then we extract the probe, neither cutting the peri-
toneum nor removing the testicle, nor anything else, but curing
it with the applications for fresh wounds. But since burning
in cases of bubonocele is preferred by most of the moderns it
will be right for us to give an account of this operation.
After the man has undergone moderate exercise, let him cough
violently and strain to keep in his breath; and when
the

swelling appears at the groin we mark Avith black ink or coUy-

rium the place that is to be burned in a triangular figure,

making itstransverse line above in the situation of the groin,

and we also make a mark in the middle of the triangle.

Having laid the patient in a recumbent posture we first apply to

the mark in the middle nail-shaped cauteries heated in the fire,
afterwards burn the sides of the triangle with gamma-shaped
(F) cauteries, and afterward level the triangle with cauteries
shaped like tiles or lentils, an assistant during the whole pro-
cess of burning wiping away the ichorous discharges with a

rag; and in those who are of a moderate habit of body the

burning should be carried to such a depth as to touch the fat.
But who are lean we must not attend to this mark
in those
lest by mistake we should burn the peritoneum nor again in
;

those who are grosser and fatter, for in them the fat appears

before a sufl&cient burning has taken place. We

must, there-
fore, be rather guided as to its extent by a skilful conjecture.
After the burning, having triturated salts with leeks we apply
them to the eschar, and use the inguinal bandage shaped like
the Greek letter X. On the following days we complete the
cure with the dressings fitting for eschars, such as lentils with
honey, and the like.

CoMM. when the

Commentary. Celsus directs us, inguinal tumour
ismoderate in size, to make one but if larger, he re-
incision ;

commends two lines to be made, so that the middle may be cut

out ; then, without extracting the testicle, as advised in certain
cases of prolapsed intestines, the veins are to be bound together
and tied where they adhere to the tunics, and afterwards cut
below the knots, (vii, 24.)
SECT. Lxviii.] CASTRATION. 379

Avicenna speaks of astringent applications and the actual Comm.

cautery, but disapproves of the incision and suture, (iii, 22, 1 .)
——
'

•
'

The operations of the suture and burning are described by

Albucasis (Chirurg. ii, 67, and i, 47) ; by Rhases (Cont. xxiv) ;
and by Haly Abbas (Pract. ix, 52, and ix, 80.) They all evi-
dently copy from our author.
Garengoit affirms that Paulus has made mention of crural
hernia^ but we agree with Heister that this is a mistake.

SECT. LXVII. ON RHACOSIS, OR RELAXATION OF THE SCROTUM.

When the skin about the scrotum is relaxed without the

bodies within being formed, being a most
aflFected, rhacosis is

unseemly complaint. Wherefore Leonides, having placed the

man in a recumbent posture, cut off the redundant skin with
a scalpel direct upon some board or some hard skin, and united
the lips of the wound with sutures. But Antyllus, having first
transfixed the redundant skin with three or four ligatures, cut
off what was external to them with a sharp-pointed pair of
scissors or scalpel, and having secured the parts with sutures,
effected the cure by the treatment for recent wounds.

Commentary. Our author^s description of the two modes Comm.

" '

"
of perfonning the operation is copied by Albucasis. (Chirurg.

ii, 68) ;
and by Haly Abbas (Pract. ix, 53.)

SECT. LXVIII. ON CASTRATION.

The object of our art being to restore those parts which are
in a preternatural state to their natural, the operation of castra-
tion professes just the reverse. But since we are sometimes
compelled against our will by persons of high rank to perform
the operation, we shall briefly describe the mode of doing it.
There are two ways of performing it, the one by compression,
and the other by excision. That by compression is thus per-
formed :
children, of a tender age, are placed in a vessel of
still

hot Avater, and then when the parts are softened in the bath,
the testicles are to be squeezed with the fingers until they dis-
 380 CASTRATION. [book vi.

appear, and, being dissolved, can no longer be felt. The

method by excision is as follows let tbe person to be castrated
:

be placed upon a bench, and the scrotum with the testicles

grasped by the fingers of the left hand, and stretched ; two
straight incisions are then to be made with a scalpel, one in
each testicle and when the testicles start up they are to be
;

dissected around and cut out, having merely left the very thin
bond of connexion between the vessels in their natural state.
This method is preferred to that by compression for those who ;

have had them squeezed sometimes have venereal desires, a

certain part, as it would appear, of the testicles ha\ing escaped
the compression.

CoMM. Commentary. We
have given Celsus's description of the
" '

operation in the 64th section of this Book. Albucasis describes

•

the operations by compression and by excision. In the former

the testicle is squeezed by the operator while the patient is
seated in hot water. In the other the spermatic cord is to be
first secured with a ligature and then the testicle cut out.
(Chirurg. ii, 69.)
Thev are likewise described in nearlv the same terms bv
Haly Abbas. (Pract. ix, 54.) The castration of the inferior
animals is mentioned by Aristotle (Hist. Animal, ix, 50) ; by
Varro (De Re Rustica, iii, 9) ; by Columella (De R. R. vi, 26) ;
and by Palladius (De R. R. vi, 7.) Varro informs us that it
was customary to make capons by burning the testicles of cocks
with a red-hot iron. It appears from Juvenal that the surgeons
in his time were often called upon to perform castration. (Sat.
vi, 1.
370.) Abulpharagius likewise mentions that the perform-
ance of this operation constituted at one time an important part
of the surgical practice in Bagdad. (Dynast, ix.) But the
Emperor Justinian condemned the operation as being dangerous
and often fatal.
Sprengel gives an interesting histoiy of castration. One of
the most important points in this operation is the mode of
t}dng the cord. Some modern authorities afifinn that no bad
eflPects result from putting a ligatiu'e round the whole cord, but
others condemn this practice as bringing on convulsions and
tetanus. All admit the difficulty of securing the artery sepa-
rately.
SECT. Lxx.] NYMPHA. 381

SECT. LXIX. ON HERMAPHRODITES.

This affection derives its name from a combination of the

names Hermes and Aphrodite (Mercury and Venus,) and occa-
sions great deformity to both sexes. There being four varieties
of it^ according to Leonides ; three of them occur in men and
one in women. In men, sometimes about the perineum and
sometimes about the middle of the scrotum, there is the ap-
pearance of a female pudendum with hair ; and in addition to
these there is a third variety, in which the discharge of urine
takes place at the scrotum as from a female pudendum. In
women there is often found above the pudendum and in the
situation of the pubes the appearance of a man^s privy parts, there

being three bodies projecting there, one like a penis, and two
like testicles. The third of the male varieties in which the
urine is voided through the scrotum is incurable ; but the other
three may be cured by remo\ing the supernumerary bodies and
treating the part like sores.

Commentary. This section of our author is copied by Comm.

Albucasis (Chirurg. ii, 70) ;
and by Haly Abbas (Pract. ix, 55.)
' ——
»
'

Avicenna briefly mentions this monstrosity, (iii, 20, 2, 43.)

Guy of Cauliac and Brunus describe it in the same terms as
the Arabians.

SECT. LXX. ON EXTIRPATION OF THE NYMPHA AND CAUDA

PUDENDI.

In certain women the nympha (clitoris ?) is excessively large

and presents a shameful deformity, insomuch that, as has been
related, some women have had erections of this part like men,
and also venereal desires of a like kind. Wherefore, having
placed the woman in a supine posture, and seizing the redun-
dant portion of the nympha in a forceps we cut it out with a
scalpel, taking care not to cut too deep lest we occasion the

complaint called rhoeas. The cauda is a fleshy excrescence

arising from the mouth of the womb, and filling the female pu-
dendum, sometimes even projecting externally like a tail; and
it
may be removed in the same manner as the nympha.
 382 THYMI, ETC. [book vi.

CoMM. Commentary. That the nympha and clitoris were used

'

synonymous teims is evident from lluflus Ephesius

'

anciently as
(De Partibus Hominis) Soranus (c. 6) ; and Pollux (Onomasti-
;

con, ii.) Martial, in more than one place, makes allusion to

unnatural practices connected with an enlarged clitoris. Aetius
says that it is a small muscular substance situated at the com-
missure of the alse pudendi above the meatus urinarius. He
adds, that when preternaturally enlarged it is to be amputated.
Like our author, he directs us to take hold of the tumour with
a forceps and cut off the protuberance, taking care not to carry
the excision too far. He recommends us to apply a sponge
squeezed out of an astringent wine or cold Avater, with suitable
dressings. He gives the same account of the cauda as our
author, (xvi, 103 and 104.) It was a tumour arising from the
uterus itself. Albucasis merely transcribes our author's ac-
count of these operations. (Chirurg. ii, 71.) Avicenna briefly
recommends us toremove the enlarged nympha by medicines
or the knife, (iii, 22 ; i, 24.) It would appear that this operation,
like circumcision, is still often practised in the East.
The chapters of Soranus, in which these operations were
treated of, are unfortunately wanting.
On extirpation of the enlarged clitoris see Heister^s Sur-
gery (ii, 5, 147). The cauda pudendi was probably the cauli-
flower excrescence of the os uteri described by late authorities
on midwifery.

SECT. LXXI. ON THYMI, CONDYLOMATA, AND HEMORRHOIDS

ABOUT THE FEMALE PARTS OF GENERATION.

The thymus is an excrescence sometimes red, but sometimes

white, for the most part without pain, and resembling the
clusters of thyme. The condylomata are rugose protuberances ;
and the hemorrhoids resemble those about the anus, and, like
them, sometimes pour forth blood. Such excrescences in
women, when brought into view and exposed, are to be seized
with a forceps and cut out with the point of a half-spatula.
And we are then to use pounded galls, or fissile alum. For
the more distinguished sm'geons do not approve of ligatures in
these cases.
SECT. Lxxii.] IMPERFORATE PUDENDUM. 383

Commentary. Aetius gives a fuller account of these tuber- Comm.

cles. He recommends us to seize them with a forceps and cut ' ——
*
'

them out by the roots. He directs us not to interfere with

such hemorrhoids of the womb as are varicose and malignant.
Those which are hard and do not bleed are to be cut out at
once, but such as are disposed to bleed are to be seized with a
forceps and a ligature put round them before they are cut.
Moschion, however, condemns this practice as being highly
dangerous.
Albucasis e\ddently copies from our author. (Chirurg. ii, 73.)
Haly Abbas briefly directs us to seize these tubercles with a
forceps and cut them out with a pair of scissors. (Pract. ix, 65.)
" if there be
Rhases, treating of diseases of the uterus, says,
a red piece of flesh in the mouth of the womb, if situated at
its anterior part, and if it be round, or long, and not attended

with pain, some surgeons cut it ofl", but I prefer tying it.^^
(Cont. xxii.) This description seems to apply to polypus of
the womb.
See a account of the condylomata and hemorrhoids of
full
the womb, by Lodovicus Mercatus (in the Gynsecia, p. 962.)
He remarks that Celsus and Aetius call any tubercle arising
from inflammation by the name of condyloma, whereas Paulus
applies the term only to callous tubercles of the uterus. He
approves of seizing them with a forceps and cutting them out.

SECT. LXXII. ON IMPERFORATE PUDENDUM AND PHIMUS.

Some women have the genital parts imperforate, sometimes

naturally, and sometimes owing to some previous disease. And
sometimes deep-seated, sometimes in the alee pudendi, or in
it is

the intermediate places, and is sometimes occasioned by an adhe-

sion of the parts, and sometimes by obstruction. The obstructing
substance is either flesh or membrane. The disease occasions

great impediment sometimes in coition, sometimes in concep-

tion, or in parturition, and occasionally during the menstrual
purgation, provided the membrane or flesh occasion a complete
obstruction ; for in certain cases there is a perforation in the
middle. Having ascertained the cause, either from its being
obvious to the sight, or by introducing the speculum, if it be
 384 IMPERFORATE PUDENDUM. [book vi.

a simple adhesion only, it may be separated by a straight in-

cision, made with a scalpel, for operating upon fistulse. But
if it is an obstruction, having transfixed the connecting body,

whether it be membrane or flesh, with hooks, we stretch it

and divide with a scalpel for fistulse ;
and having stopped the
hemorrhage with such applications as are desiccative without

being stimulant, we have then recourse

to such medicines as

promote cicatrization, applying a priapus-shaped tent covered

with some epulotic medicine, in those cases especially in which
the operation is performed upon a part not very deep-seated,
in order that the parts may not unite again. And the phiraus
which isformed at the mouth of the uterus is operated upon
in the same manner.

CoMM. Commentary. Aristotle makes mention of imperforate

" '
'

vagina. (De Generat. Animal, iv, 4.) Aetius treats of these

diseases at considerably greater length than our author, but
his practice is nearly the same. Upon the whole the amount
of his directions respecting the treatment is, that when the
obstruction is occasioned by a membrane, it is to be divided

and the lips of the incision prevented from adhering by the

introduction of suitable tents ; or, if it is a fleshy body, it is to
be dissected out, and the parts separated by a piece of sponge
or tents, (xvi, 96.) The same operation is described by Sora-
nus. (219.)
The same method of treatment, however, had been previously
recommended by Celsus. Thus, when the obstruction is oc-
casioned by a simple membrane, he recommends us to divide
it by two transverse incisions hke the letter X, taking great

care not to wound the urinary passage, and then the mem-
brane is to be cut out. When the obstruction is produced by
a fleshy tumour, he directs us to expose it by making a straight
incision ; then, having seized it with a forceps or hook, to dis-
sect it out, and introduce an oblong tent (Xtj^uviWoc) soaked
in vinegar, and apply externally wool moistened with vinegar.
The dressings are to be removed on the third day, and the sore
treated upon general principles. When the wound is lieaUng,
he advises us to introduce a leaden tube smeared with some suit-
able ointment to prevent adhesion, (vii, 28.)
Albucasis makes mention of a singular substitute for the
SECT. LxxiiT.] ABSCESS OF WOMB. SS.i

leaden tube recommended by Celsus " Coeat mulier omni die Comm.
:

'

The same advice is

'

ut non consolidetur locus vice alia !" !

^

gravely given by Rliases (Cont. xxii), and b}^ Alsabaravius, who,

as we have formerly stated, was probably the same person as
Albucasis. (Pract. xxv, 2, 19.) But when the obstruction arises
from a fleshy tumoiu% Albucasis recommends us to make use of
the leaden tube. (Chirurg. ii, 72.) Alsabaravius dii'ccts us to
remove the obstruction by corrosive medicines or with the knife.
Rhases briefly describes the phimus, and directs us to perforate
itwith an instrument of iron, and then to introduce a tent
moistened in some styptic wine.
Haly Abbas states that obstruction of the uterus may arise
either from a natural, that is to say, a congenital impediment,
or from the effiects of ulceration. He recommends us to make
the midwife clear away the obstruction with a scalpel or any
other convenient instniment. The Arabians were very delicate
in allowing male practitioners to perform surgical operations
about the genital organs of Avomen. (Pract. ix, 66.)

SECT. LXXIII. ON ABSCESS OF THE WOMB.

When the abscess is situated at the mouth of the womb, so as

that can be operated upon, we must not be in haste in having
it

recourse to incision, nor until the disease be ripened, and the

inflammation has increased to its utmost, and the vascular
bodies which surround it have become attenuated, owing to the
importance of the uterus in the system. In operating, the
woman should be placed on a seat in a supine posture, having
her legs drawn up to the belly, and her thighs separated from
one another. Let her arms likewise be brought down to her
legs and secured by proper ligatures about the neck. The
operator, sitting on her right side, is to make an examination
with a speculum proportionate to her age. The person using
the speculum should measure with a probe the depth oi the
woman^s vagina, lest the stalk (fistula) of the speculum being
too long it should happen that the uterus should be pressed
upon. If it be ascertained that the stalk is larger than the

vagina, folded compresses are to be laid upon the alse pudendi,

in order that the speculum may be placed upon them. The
II. 25
 386 ABSCESS OF WOMB. [book vi.

be inti'oduced, having a screw at the upper

stalk (fistula) is to

part, and speculum is to be lield by the operator, but the

tlie

screw is to be turned by the assistant, so that the laminse of

the stalk being separated the vagina may be distended. When
the abscess is exposed, if it be soft and thin (which may be
ascertained by touching it with the finger), it is to be divided
at the top b}^ a scalpel or needle, and after the discharge of
the pus, a soft oblong tent well smeared with rose-oil is to be
introduced into the incision, or rather external to the opening
into the woman^s vagina, so as not to produce compression.
And externally to the alse pudendi and the region of the pubes
and loins unwashed wool, or clean wool dipped in oil, is to be
applied. On
the third day she is to be placed in a hip-bath
of warm oil or water, or of a decoction of mallows ; and having
wiped the parts, we introduce the tent gently into the opening,
spread with the ointment tetrapharmacon, either alone or with
clarified honey ;
its strength, however, ought to be reduced
with butter or oil of roses. The external parts are to be
covered with cataplasms until the inflammation subside and the
sore become clean. If it is got cleansed with difficulty, an

injection of the decoction of iris, of birthwort, or of honey,

may be thrown up with an ear-syringe. The healing process
may be promoted by the calamine ointment diluted with wine
and applied upon a pledget. But if the abscess be within the
mouth of the uterus, we must decline operating.

CoMM. Commentary. A
similar description of the method of open-

ing abscesses in the vagina is given by Aetius. (xvi, 85.) The

only difficulty in comprehending his description or our author's
arises from oiu* unacquaintance with the construction of the an-
cient dioptrse or specula. Drawings of several sorts of them are
given in the surgery of Albucasis and by Scultet. (Arsenal de
Chirurg. tab. 18.) One of the simplest of them consists of two
laminae or plates so united that by turning a vice or screw they
separated to the proper distance. Albucasis evidently copies
our author's description. (Chirurg. ii, 71.) The account given
by Haly Abbas is quite similar. (Pract. ix, 57.)
SECT. Lxxiv.] EMBRYULCIA. 387

SECT. LXXIV. ON EMBRYULCIA AND EMBRYOTOMY.

We have described the treatment of difficult labours in the

Third Book. If the process of parturition be not rectified by
the means there laid down^ we must proceed to the surgical
operation^ after having formed a probable conjecture Avhether
the woman will survive or not ; and if she may be saved, then
we are to operate ; but if not, we must decline attempting the
operation. Those in a dying state are aflFected with coma,
lethargy, and loss of muscular motion they are difficult to
;

rouse, or if roused by loud cries, they return a feeble answer,

and again sink into a comatose state. Some have convulsive
contractions, or subsultus tendinum, or insensibility to food.
The pulse is found to be greatly inflated, but obscm'e and

Those who are to recover have none of these symptoms.

feeble.

Having placed the woman in a supine posture, Avith her head

rather depressed, her thighs are to be kept elevated by women
on each side, or by certain assistants ; or if they are not at
hand, her chest is to be first fastened to the bed by ligatures,
so that when the pulled the woman's body may not
foetvis is

follow, and diminish the force of the pulling. Then the ate
pudendi being separated by an assistant, we must introduce the
lefthand lubricated with some unctuous substance, the fingers
being contracted, to the mouth of the uterus, and dilate it,
and having got it relaxed by lubricating it with oil, we seek
for the most convenient place for fastening the hook (embry-
The most convenient places in presentations of the
ulcus)
—
.

head are the eyes, the occiput, the roof of the mouth, the
chin, the clavicles, and the parts about the sides and hypo-
chondrium ; and in feet presentations, the bones of the pubes,
the middle of the ribs, or, again, the clavicles. The hook is to
be held in the right hand, and its curvature grasped with the
fingers, and it is to be gently introduced with the left hand,
and fixed on some of the afore-mentioned places, being pushed
to the cavity of the uterus. And another is to be applied oppo-
site to it in order that the pulling may be straight down and

not to one side. Then we are to pull gently, not only straight-
forward but also from side to side, as in the extraction of teeth ;

and there ought to be no relaxation of the pulling in the in-

3S8 EMBRYULCIA. [book vi.

tervals. Then introducing theindex-finger or more fingers

besmeared with between the mouth of the womb and the
fat

impacted body, we must lubricate it all around. When the

hook comes down properly it must be changed to a part above,
and so on until the foetus is completely extracted. When a
hand presents, and is so impacted that it canuot be returned,
we must wrap a cloth round it so that it may not slip, and
pullit so far, and when it is properly fallen down it should

be cut off at the shoulder. The same thing is to be done

when two hands fall down into the vagina ; and in like manner,
when the feet come down, and the rest of the body does not
come along, we must amputate at the groins, and then en-
deavom? to turn the rest of the body. If the impaction take

place owing to the head being larger than natural, if it be a

hydrocephalous foetus, we must open its skull with a polypus-
scalpel, or a needle, or a sharp-pointed knife concealed between
the fingers, in order that it may collapse when evacuated ; but
if itbe a naturally large head, we must open the skull in like
manner, and break down its bones with a tooth-forceps or a
bone-forceps, and if the bones j)roject they ought to be ex-
tracted. If, after the head lias been delivered, an impediment
should take place at the chest, the parts about the clavicles
should be di\ided down to the cavity of the thorax with the
same instrument, so that the thorax may collapse when its fluid
contents are discharged; but if it do not collapse v,e may
divide the clavicles and extract them, when the thorax will

collapse. If the belly be inflated, owing to the death of the

child, or its being dropsical, we must evacuate its contents with
the intestines in the same way. In presentations by the feet
the wrong direction may be easily rectified at the mouth of the
womb. But if the foetus stick at the chest or belly, we must
wrap a cloth about it and draw it down, and making a division
in the same manner, evacuate its contents. If, after the other

parts are cut off', the head retreat backwards and is retained,
we must introduce the left hand, and if the mouth of the
womb be open, push up the hand to the cavity of the womb,
and having found the head, bring it down with the fingers fixed
in the mouth, and extract by one or two hooks fixed in it but
;

when inflammation at the mouth of the womb we

tliere is

must use no violence, but lubricate the parts with unctuous

SECT. Lxxiv.] EMBRYULCIA. 389

and fatty applications^ and have recourse to liip-baths^ emliro-

cations, and cataplasms, in order that when the mouth is

dilated extraction accomplished in the manner described

may be
above. Cross presentations, if they can be rectified, may be
treated according to the afore-mentioned methods ; but if not,
the whole foetus must be cut asunder within, and extracted in
pieces, taking care that none of the parts of it be left behind.
After the operation we must have recourse to the treatment for
inflammations of the uterus. If liemoiThage come on, you have
ah'eady had the management of it described.

Commentary. There is a curious treatise commonly pub- Comm.

lished along with the works of Hippocrates on the extraction .

of the foetus ; but, as it is not mentioned by Erotian and Galen,

it is now generally admitted not to be genuine. The author
of it directs us, when the arm presents, to pull itdown and
amputate at the shoulder-joint ; after which the head is to be
brought to the proper position and delivery accomplished ac-
cordingly. This is not now the general rule of practice, and
yet we were once compelled by necessity to deliver in this way,
after we and an intelligent assistant had been foiled in all our

attempts to turn the child. We have known of similar cases

happening in the practice of other surgeons ; and, in fact, this
method of procedure was advocated lately by a sensible writer
in the ' Edinburgh Medical and Surgical Journal.^ The author
of the ancient treatise in question recommends us to bring
down the head in its natural state, if possible, but if this be
found impracticable, to break it down. He directs us to give
for drink a white, sweet, undiluted wine.
Celsus gives an interesting account of this subject, and his
practice is deser\ing of much consideration. He I'ecommends
us, when the position is unnatural, to turn the child either to
the head or the feet ; adding, afterwards, that deliveiy may
generally be accomplished easily enough by the feet. In arm
presentations, he approves of turning to the head, that is to

sav, in cases when it is ascertained that the foetus is dead. If

the head is at hand, a smooth hook with a small point is to be

fastened at the eye, the ear, the mouth, or the forehead, and
its body is to be thus dragged down. This, however, must not
be attempted Avhcu the mouth of the womb is not properly
 390 EMBRYULCIA. [book vr.

CoMM. dilated. The right hand is to be employed in dragging down

'
'
'
the foetus, and the left in directing the instiaiment and the
foetus. When the body of the foetus is distended with a fluid,
it isto be let out, and the body brought down with a hook.
If the child lie across and the position cannot be got rectified,

the hook is to be inserted at the armpit, and extraction gi'adu-

ally performed. In extreme cases he recommends us to cut
the neck asunder, and extract the parts separately, beginning
with the head, for fear of its being left in the uterus. Should
such an accident occur, howerer, he directs us to get the belly
compressed so as to force the head down to the os uteri ; after
which it may be extracted with a hook in the manner described
.above. (Smellie relates histories of such cases.) When one
foot presents, and the breech sticks at the os uteri, he recom-
mends us, when the other foot cannot be found, to separate
the one which protrudes after which the body of the child
,•

may be pushed up, and the other leg found and brought down.
It is to be recollected that this practice is only recommended
Avhen the child is dead. He adds, that other difficulties may
give rise to the necessity of performing embryotomy, (vii, 29.)
Aetius has an interesting chapter on the Extraction of the
Dead Foetus, copied from the works of Philumenus. His
description of embryotomy is similar to our author^s. He
directs us to apply two hooks to certain parts of the head,
such as the eye, mouth, and chin, and thus to drag down the
body. If the head is large or hydrocephalic, he advises us to
open it and evacuate its contents ; and if even then it is found to
be too large for the passage, he recommends us to break down
the bones of the skull and remove them with a forceps, after
which the instrument is to be fixed and the foetus dragged down.
If obstruction to the delivery take place at the chest or the

belly,he directs us to evacuate their contents in like manner.

When an arm or both present, he recommends us to amputate
at the shoulder-joint. If the child come down doubled, and
the position cannot be got rectified, he adrises us, if the head
can be reached, to break down its bones, and then extract the
other parts accordingly but if the legs are got at most easily
;

and cannot be brought down, they are to be amputated at the

hip-joint, and then the head will be got delivered. When the
body is so impacted in a doubled state that it cannot be moved.
SECT. Lxxiv.] EMBRYULCIA. 391

he directs us to separate the vertebra at the neck, and then to Comm.

'

drag down the lower part of the body; after which the head
is to be sought for bv the hand introduced into the uterus, and

brought along with two hooks, (xvi, 23.)

No ancient author has described the operation of embry-
otomy so accurately as Soranus ; but as his account of the
process is lengthy and does not differ essentially from that of
Aetius, (indeed the latter e\ddently copies from Soranus,) we
need not seek to give any outline of it. (Op. 51, 52, 53.)
Avicenna takes his chapter on the extraction of the dead
foetus from our author, (iii, 21, 2, 24.) We have mentioned
in the Third Book that he was acquainted with the forceps.

Albucasis, in like manner, takes his account of embryotomy

from Paulus. He relates a singular case that came under his
own knowledge of an extra-uterine conception ; the most re-
markable circumstance about which was, that the bones of the
foetus after a time were discharged at the umbilicus. The work
of Albucasis contains drawings of the instruments used in his
time for obstetrical operations. There are several forcipes among
them, but as they all have teeth, it is to be presumed that
they were used only for delivering the foetus when dead. It

is to be regretted that he has entirely omitted the forceps

mentioned by Avicenna. (See Chirurg. ii, 76 and 77.)
Rhases directs us when the child's head is large and cannot
be brought down with fillets, to open it and deliver with hooks.
When it is ascertained that the child is dead, he recommends
us to break down the bones of the head and evacuate the brain.
In preternatural presentations he recommends us to deliver, if
if this cannot be got accom-
possible, by the head or feet, but
plished, he directs us to cut off the protruding part. Upon
the whole his rules of practice are much the same as our
author's. (Cont. xxii.)
for the of
Haly Abbas gives ample directions management
these cases. When
the head presents (the child being dead
and delivery found otherwise impracticable), he dii-ects us to
fix hooks in the hollows of the eyes, neck, or jaw-bone ; or if

the feet present, at the tops of the thighs. The body of the
child is then to be dragged along. When a hand presents, he
recommends us to down the arm and amputate at the
pull
shoulder and in like manner he directs us to amputate at the
;
 392 SECUNDINES. [book vi.

CoMM. hip-joint when in footling presentations the delivery cannot be

—
^"^^
'

otherwise accomplished. When the head is preternaturally

large, he directs us to open it
and evacuate its contents ; and
to do so in like manner Avith the chest when any obstruction
takes place at it. He makes no mention of any instrument
resembling the modern forceps. (Pract. ix, 57.)

SECT. LXXV.— ON RETENTION OF THE SECUNDINES.

Often, after the removal of the foetus, the placenta (which is

also called the secundines) is retained in the uterus. When
the mouth of the uterus is dilated and the placenta separated,
and rolled into a ball in some part of the uterus, the extraction
is most easy. The hand warmed and anointed is to be
left

introduced into and the secundines extracted as they

its cavity,

present. But if they adhere to the fundus uteri we must in-

troduce the hand in like manner, and grasp them and pull them
along, not straight down for fear of prolapsus, nor with great
violence, but they are to be moved gently, at first from this side
to that,and afterwards somewhat more strongly, for thus they
and be freed from their adhesion.
will j-ield If the mouth of
the uterus be found shut we must have recourse to the same
treatment. If the strength is not sunk, sternutatories and fu-

migations with aromatics in a pot may be used and if the;

mouth of the womb dilate, the hand is to be introduced and an

attempt made to extract the placenta, as aforesaid. If even
in this way it cannot be extracted, one need not be alarmed,
for after a few days it will putrefy, dissolve into sanies and drop
off. But since the fetid smell affects the head and disorders
the stomach, we must use suitable fumigations, among which
cardamum and dried figs are much approved.

CoMM. Commentary. We
have mentioned in another place that
Hippocrates^ practice in retention of the placenta consisted in
suspending weights from the end of the umbilical cord.
Celsus directs us, when the placenta is not cast off soon after
the dehvery of the child, to draw down the umbilical cord gently
with the left hand, taking care not to break it. The right hand
is then to follow it up to the secundines, and their veins and
SECT. Lxxv.] SECUNDINES. 393

membranes being separated from the womb, the whole are to Comm.
" '
'
be extracted along with whatever coagulated blood may be in
the uterus, (vii, 29.)
Our author merely abridges a fuller account of the subject
given by Aetius from the works of Philumenus. (xvi, 24.)
jNIoschion reprobates the ancient practice of using sternuta-
tories, pessaries, and fumigations, and of suspending scales or

weights from the cord, because these means sometimes occasion

hemorrhage. He recommends the midwife, if the mouth of
the womb be still open, to introduce her left hand, and to take
hold of whatever part of the placenta presents then, if it does
:

not adhere to the fundus uteri it is to be extracted ; but if it

is not separated it is to be moved gently hither and thither
without \aolence. When the mouth of the uterus is con-
tracted, he advises her to use those liquors and injections which
are applicable for inflammations of the womb. (Section Hv.)
His method of securing the umbilical cord after delivery is
nearly the same as that now adopted. After the child has been
allowed to lie on the ground for a few minutes, two ligatures
are to be applied round the cord, the nearest being four fingers
from the belly ;
it is then to be cut with a scalpel or any shai"p
knife. He
disapproves of using instruments of wood, glass, or
reeds, and hard crusts of bread, as practised by the ancients.
(Ixv.) He directs lacerations of tlie perineum to be treated by
applpng ointments composed of wax, oil of roses, litharge,
ceruse, and alum, with suitable bandages. (Ivii.)
The practice of Soranus in these cases is most judicious, and
such as can scarcely be improved upon at the present day. He
disapproves of all Ndolent attempts at extraction, but when the
placenta cannot be got otherwise removed from the womb, he
approves of introducing the hand well lubricated to extract the
secundines eentlv. He directs us when the mouth of the womb
is shut to open it if possible with the fingers in a gentle man-

ner. This is the case now incorrectly called the hour-glass

contraction.
Avicenna repeats the directions given by Paulus and Aetius,
but seems to have considered the introduction of the hand into
the uterus as a painful, and, in general, an unnecessary ope-
ration, (iii, 21, 2, 16.)
Albucasis follows our author^s practice. (Chirurg. ii, 78.)
 394 BURNIING THE HIPS. [book vi.

CoM.M. Haly Abbas directs us to introduce the hand well lubricated

' '

of violets, or the like, into the uterus, and extract the

'
with oil

placenta if it but if it still adhere it is to be

be separated ;

moved from and not pulled straight downwards.

side to side,
He adds, that when not extracted, it becomes putrid. (Pract.
ix, 59.)
Rhases directs us when the secundines do not come away
after delivery to make the woman sneeze, and if they are still
retained, to pare the nails, and having introduced the hand into
the uterus to pull cautiously so as not to give pain. When
they cannot be removed in this way, he recommends us to throw
injections into the Avomb so as to promote putrefaction of the
placenta. In another place he mentions, that when long re-
tained, the placenta putrefies and comes off in pieces, (Cont. xxii.)

SECT. LXXVI. ox BrilMNG THE HIPS.

As in the case of the shoulder, so also the hip-joint getting

dislocated from a collection of humours requires burning. Where-
" AVhen dislocation at the
fore Hippocrates says :
hip-joint takes
place from long-continued ischiatic disease, the leg wastes, and
the patients are lame unless burnt." Biu'uing, therefore, is to
be performed more particularly at the place where the joint is
dislocated, for thus the redundant humour will be dried up, and
the part being condensed by the cicatrix will no longer be able
to receive the bone, wherefore the Inu-ning should be carried
to a considerable depth. The moderns form three eschai's by
burning one
;
behind in the hollow of the buttocks, another a
little above the knee on the outside, and a third on the outside

of the ankle in the fleshy part.

CoMM. Commentary. Hippocrates recommends us to burn the parts

over the hip-joint with crude flax. (De Afiectionibus.) The
author of another of the Hippocratic treatises directs us to
burn the bony parts with fungi and the flesh with a red-hot iron.
(De Affect. Int.)
Aetius, upon the authority of Archigenes, recommends burn-
ing in this case with irons, the roots of fuller^s herb and birth-
wort, or with goat's dung, (xii, 3.)
Cselius Aurclianus, in cases of ischiatic disease, speaks of form-
SECT. Lxxvi.] BURNING THE HIPS. 395

ing issues over the hip-joint by the actual and potential cau- Comm.
"

teries. His potential cauteries, with which he mentions that '

eschars were burnt, appear to have been the ashes of herbs, that
isto say, impure preparations of the caustic alkali, to which quick-
lime was sometimes added. They must, therefore, have been
nearly the same as the calx cum kali of modern use. He states,
that some burned the part Avith the root of fuller^s herb ; others

with pieces of iron shaped like the letter T ; that some raised
the skin in a fold and transfixed it with heated irons ; that some
burned it with fungi, and others with a piece of linen cloth
folded and laid on the part. (Pass. Tard. v, 1.)
But the fullest account which we have of the ancient modes
of burning the hips for diseases of the joint is that which is

given in the book Euporiston,^ ascribed to Dioscorides. Men-

'

tion is there made of the methods of burning with goat^s dung,

and Avith wool smeared Avith oil. Some, it is said, form a ball
of clay, and, having laid it on the place, apply to it a burning
staff as long as it can be borne.
Others, haAdng stretched the
skin over the affected joint, transfix it with a heated style or
writing pen. The Libyans perfonned the operation with shavings
of the lote tree, sulphur, and elaterium. The Marmaridse are
said to have done it with green pieces of the Avood of olive trees.
The Parthians used a leaden tube, the extremity of which they
smeared Avith dough, in order to prevent the oil in the inside
from escaping ; then hot cauteries, to the number of forty or
fifty, Avere introduced,
and the burning continued as long as it
could be well endured. Care in the meantime was taken to
cool the face with cold Avater; and it was attended to, that
the tube was not over-filled with oil, lest it should run over.
(Euporist. i, 242.)
Albucasis describes minutely the process of burning Avitli
red-hot irons. (Chirm'g. i, 43.) Haly Abbas in like manner
directs us to burn an eschar over the joint, and to keep it open
for a considerable time. (Pract. ix, 81.)
Asclepiades (apud Xicetse Collect.) mentions that he had seen .

two cases in Avhicli dislocation had taken place at the hip-joint

without any accident. The editor of this work, Anthony Cocchi,
states that he had met Avith only one such case in the Avhole
course of his practice. We need scarcely remark that such
cases, hoAvever, are by no means of rare occurrence.
396 FISTULiE. [book vi.

SECT. LXXVII. ON FISTULjE AND FAVI.

The present occasion requiring us to treat of fistula in ano,

it will not be improper to give an account in the first place of
fistuhe in general. A fistula then is a callous sinus, attended
with little or no pain, and forming in most parts of the body.
It generally originates in abscesses not properly healed. The
callus is compact and white, the flesh dr}', and therefore insen-

sible, neither vein nor nerve

passing to it. Sometimes the
sinus is dry and sometimes
with a discharge.
filled The dis-
charge is sometimes constant, and sometimes at intervals, the
mouth of it being at one time shut up, and at another time
open. Sometimes the fistula terminates on a bone, sometimes on
a nerve, or some other impoi'tant part ; and it is either straight
or crooked ; has either one orifice or many. Those therefore
tha,t terminate upon large arteries, or nerves, or tendons of
considerable size, or the pleura, or any important part, are
either not to be meddled with at all, or with great and skilful
caution ;
but the others may be operated upon in this manner.
We first examine them if they be straight with a sound (specil-
lum), or if crooked with a double-headed specillum of a very
flexible nature, such as those made of tin, and the smallest of
those made of copper. When there are two or more orifices,
we must not trust to the examination with a specillum, but in-

jecting the sinus by one of its openings we ascertain from the

manner in which the injection comes out whether it be one
fistula with many orifices, or if there be several fistulse. After
the examination, if the sinus be superficial and naiTow, it is to
be distended by the introduction of a specillum, and the callus
is to be cut off" with a properly-shaped scalpel, or pared Avitli

the nails or the point of a scalpel. If it is also broad the re-

dundant parts are to be dissected away. If it is not superficial,
but deep and straight, we must cut off" the callus all around as
far as we can make incisions, and if any part remain, destroy
it with a caustic medicine ; or if the callus be large, and do
not yield to medicine, we must form a slough by burning it
with hot irons. If the fistula. terminate Avith a bone, and if it
is not diseased, we need only scrape it, but if it is carious, or
otherwise corrupted, the whole diseased portion is to be cut
SECT. Lxxvii.] FISTULA. 397

out with counter perforators, and if necessary we may bore a

hole with a wimble (trephine ?) whether the bone be diseased
only to the diploe or as far as the marrow. If a bone project,
as after a transverse fractui'e, we must saw it ofi\ Taking,
therefore, two bandages, v,e apply the middle of the one to the
projecting bone itself, and get it kept stretched by an assistant ;
the other being thicker, or formed of wool, we are to take in
like mann.r, and apply the middle of it to the flesh under the

bone, and taking its ends below, we give directions that the

fleshbelow be retracted by this band lest it be torn by the teeth

of the saw, and in this manner we accomplish the sawing.
When any vital part is situated below, such as the pleura, spinal
marrow, or the Hke, in cutting or sawing the bone, we must use
the instrument called meningophylax for protecting them. If
the bone is not diseased, but is denuded of flesh a]l around, it
is to be sawn in the same manner, for bones which are disen-
gaged from the other parts all around cannot possibly incar-
nate. In like manner, the extremity of a bone near a joint,
if diseased, is to be sawn ofi*; and often, if the whole of a bone,

such as the ulna, radius, tibia, or the like, be diseased, it is to

be taken out entire. But if the head of the thigh-bone, or
pelvis, or a vertebra of the spine be diseased, we must not at-
tempt to operate upon them for fear of the adjoining arteries.
We must proceed in this manner in every particular case, atten-
tion being paid to the situation, proximity, and connexions of
the afi'ected parts, the extent of the disease, the strength and
powers of the patient. The favus being a fistulous sinus with
a milky discharge must be subjected to the same operation and
treatment as fistula.

Commentary. For an account of the practice of Hippo- Comm.

'
^"^
crateswe refer to our notes on the 49th section of the Fom-th
Book.
Celsus states thatif fistulpe spread deep, are crooked, or are

numerous, they are to be cui'cd by an operation rather than by

medicines. Wherefore, if it spread transversely, he recommends
us to introduce a specillum, or sound, and cut down upon it.
But if it is crooked, its bondings are to be followed out and
cut open in the same manner. When the operator has readied
the end of the fistula, all the callus is to be cut out, and the
 398 FISTUL.^. [book vr.

CoMM. lips of the wound secured by clasps and agglutinative applica-

' '
*
tions. "When the fistula terminates Avith a rib he directs us to
saw out a piece of it lest it affect the adjoining parts. Fistu-
lous sores about the abdomen he pronounces to be highly dan-

gerous. He recommends us^ however, to attempt a cure by

making an incision, and uniting the edges of the wound by
sutures, (vii, 4.)
Aetius lavs down nearlv^ the same rules for the treatment of
fistulffi as our author. When the sinus runs transversely along
the skin, he directs us to lay it open. "When it penetrates
downwards he ad\ises us to cut off the callus ; and when the
ulcer terminates with a bone to remove the diseased lamina
of it. (xiv, 55.)
Albucasis delivers the surgical treatment of fistulce at great
length. He is very particular in inculcating the necessity of
making free incisions, and of removing any pieces of diseased
bone which may happen to be found at the bottom of the sore.
He relates a case of fistulous ulcer in the thigh, to cure which
he removed large pieces of bone, sawing it down as far as the
marrow. Some of his saws are very ingeniously constructed,
and one of them is not unlike the saw introduced into the prac-
tice of surgery by the late j\Ir. Hey, of Leeds. He enumerates
nine causes which prevent sores from healing and as they ap- ;

pear to be of some practical utility we shall briefly mention

.
what they are 1, a deficiency of blood in the body
:
2, ca- ;

chexy, or bad coudition thereof; 3, fungous flesh, which pre-

vents the union of the edges of the sore 4, much sordes in the
;

ulcer 5, putridity, or any other bad quality of the fluids

; ;

6, improper applications 7 and 8, the pestilential state of the

;

atmosphere and the insalubrity of the place where the patient

resides 9, a diseased bone.
;
When none of these causes are
present, the restorative principle of nature will of itself effect
the cure of any solution of continuity. (Chirurg. ii, 88.)
Ehases gives extracts from Antyllus, and many other authors,
on this subject, but as their principles of treatment are much
the same as those delivered b}' Paulus, we need not occupy
much room with an abstract of them. Antyllus forbids us to
use the knife when the fistula is situated in the groin or fun-
dament. When it is not judged expedient to have recourse to
an operation, one of his Arabian authorities, Aaron, recora-
SECT. Lxxviii.] FISTULA IN ANO. 399

mends a powder composed of equal parts of quicklime, can- Comm.

'

tliandes, arsenic, sandarach, sal ammoniac, and ginger. (Cont. '

xxviii.)

SECT. LXXVIII. ON FISTULA IN ANO.

Fistulse in ano are discovered, if tliey are blind, from tlieir

being attended Avith pain, altliougli no orifice appears ; from

there being a purulent moisture about the anus, and in most
cases from tlieir being preceded by symptoms of abscess; or,
if they are open, by the introduction of a sound or swine's
bristle ;
for the instrument will pass down into a cavity and
meet the index-finger introduced into the anus if the fistula
has penetrated to the inside but if it has not penetrated, the
;

instrument does not come in contact with the finger but the
intermediate substance between them remains imperforated.
The fistula is known to be crooked and winding from the in-
strument's passing down but a short way, while a great quantity
of pus is discharged in proportion. Those near the intestines
are known by an abdominal worm or fseces sometimes pass-
ing through the mouth of them. In almost all cases some
callus appears about the orifice of the fistula. A fistula is in-
curable that perforates the neck of the bladder, or extends
to the joint of the thigh, or to the rectum. A
fistula is diffi-
cult to cure when it has no orifice, is blind, ends with a bone,
and has many windings. All the rest are, in general, easily
cured. We proceed with them thus :
having placed the
patient in a supine posture, with the legs elevated, so that the
thighs may be bent upon the heMj, as when an injection of
the bowels is administered, if the fistula terminate superficially,
having introduced a sound or ear-specillum through the orifice
of it, we cut the skin which covers it at one incision. But if
the fistula terminate deeply in the anus, having introduced a
specillum into the mouth of it, and if we find that it has per-
forated the gut, by introducing the finger into the anus oppo-
site the aff'ected buttock, we take hold of the head of the

specillum, and bending it, bring it to the outside, and with one
simple division cut asunder the parts wliich lie over the sound.
If the fistula is found not to have as yet perforated the gut.
400 FISTULtE in ANO. [book vi.

and to have terminated only deeply in the fundament, and if

upon examination we find that a scaly or membranous substance

intervenes between the index-finger and the extremity of the
sound, we must perforate it violently Avith the head of the
sound, and forcing the sound through the rectum, we must
again, as formerly described, cut asunder the intervening parts
with a scalpel ; or, having perforated the bottom of the fistula
in ano with the sharp part of a falciform instrument for

operating upon fistulse, we bring the instrument out at the

anus, and so divide all the intermediate space with the edge of
the instrument ; and after the incision, having taken hold of
the surrounding parts, which mostly consist of callus, with a
common forceps, or one called staphylagra, we cut them out all

around, avoiding the sphincter muscle for some cutting deep

;

in an unskilful manner, have wounded it, from which the

patient has had an involuntary discharge of faeces. Those who
from timidity, avoid a surgical operation may be treated Avitli
the ligature, as recommended by Hippocrates. For Hippocrates
directs us to pass a raw thread, consisting of five pieces, through
the fistula by means of a probe having a perforation, or a
double-headed specillum, and to tie the ends of the thread and
tighten it every day until the whole intermediate substance

between the orifice be divided and the ligature fall out. If it

remain long, the thread may be sprinkled with the detergent
powder called psarum, or some such powder, and drawn in.
Some insert a thread into the opening of the falciform instru-
ment for operations on fistulse, and pass it through in the
manner described, which I think ought not to be done. For
by avoiding an operation, in addition they incur the incon-
venience of a slow recovery. With regard to blind fistuhe,
Leonides says " When the fistula is deep, and penetrates the
:

sphincter, whether beginning in the fundament, or arising from

a distance and terminating in the sphincter, after the examina-
tion which has been described,we dilate the anus as we do the
female vagina, with the instrument for that purpose, or the
small specillum. When the orifice of the fistula is discovei'ed,
the end of an ear-specillum is to be passed through it, and
pushed deep into it, and cutting down upon it where it pre-
sents, the whole fistula is to be diAdded with a semispathula or
a spathula for operating upon fistula?." We having met with
SECT. Lxxviii.] FISTUL.E IN ANO. 401

this state of the disease, have found it impossible to practise

this mode
of operating, because we could not discover the
cavity of the fistula. For it was situated between the anus and
sphincter towards the right side, and the dilator rather obscured
the operation. But having dilated the wrinkles about the anus
a certain fissure appeared among them, being as it were the
defluxion of the fistula, for the pus passed out by it we saw to
pass the head of the specillum into the fistula by it, which
served as a director; and having passed the index-finger of the
right hand to the sphincter, and having found a certain thin
substance intervening between the finger and the sound, by
pressing the sound violently to the finger, we perforated the
bottom of the fistula, which was turned upwards ; and passing
with the finger the head of the instrument outwards, the
whole of the substance between the mouths of the fistula,
(I mean the one so situated as to favour the defluxion, and
that now made by us,) we divided with a scalpel and cut out
the sound.

Commentary. Comm.
Hippocrates describes minutely the apoli-
nose, or the cure with the ligature, in his work De Fistulis.'
'

We must mention, however, that Kiihn and Sprengel do not

admit this among the genuine treatises of Hippocraces, although
they allow that it is ancient. Littre also, though with some
hesitation, has rejected it from his list of the genuine works of
Hippocrates. And yet, considering that it was received as
such by Galen and Erotian, it seems bold in any modern critic

to refuse its claims.

Celsus hkewise describes distinctly the method of apphang
the ligature. The process, he says, is slow but free from pain.
It may be expedited by smearing the thread with some escha-
rotic ointment. The same thing, he adds, may be accomplished
by means of a guided upon a specillum (sound). When
scalpel
many sinuses open by one mouth, he directs us to cut open a
straight fistula with a scalpel, and then the others being
thereby exposed are to be tied with a thread. The diet is
to be of a diluent nature, with a liberal allowance of water for
drink, (vii, 4.)
Aetius gives, from Leonides, a full account of fistulse in ano,
as we have explained in another
place. He recommends us to
II. 26
 402 FISTULiE IN ANO. [book vi.

CoMM. iutroduce a specillum, and ha^dng cut open the fistula upon it,
' '
*
to pare away the callous parts of it. (xiv, 11.)
Actuarius approves of the same practice as the others. He
cautions against making large incisions lest the sphincter ani
be wounded. (Meth Med. iv, 6.)
Albucasis delivers nearly the same rules of treatment as our
author. According to circumstances he approves of the knife,
the cautery, or the apolinose. (Chir. ii, 80.)
Haly Abbas describes only the operation by the incision.
He also states that if the sphincter ani be woimded, it will oc-
casion irretention of the faeces.
(Pr. ix, 60.) See also Rhases
(Ad Mansor. ix, 80; Cont. xxviii) and A^-icenna (iii, 18,
;

1, 18.) Avicenna prefers twisted hairs or bristles of a hog, as

they will not putrefy.
Upon the whole no other of the ancient authorities has
treated so efficiently of fistulee in ano as Paulus.
See an excellent account of the operation in SprengeFs
*
History of Medicine.^ John de Vigo trusted to septics, such
as arsenic and the aegyptiacum. Ambrose Pare approved of the

apolinose and incision. Severinus was an advocate for the

Foubert and Camper hkewise practised the apolinose
—
cautery.
the one with a leaden thread, the other with a silk one.
Guido de Cauliaco and Rogerius approve of the ligature.
Brunus and Theodoricus prefer the actual cautery, but describe
the others. The surgeons of this country have now generally
rejected the methods with the ligature and the cautery.
The following account of the ancient specillum by the
learned Harduin will serve to illustrate our author's description
of the operation. We overlooked it in the commentary on the
" Quid sit
fifteenth section. specillum Varro explicat (Lib. 5
de Lingua Lat.) Quo oculos inunguimus quibus specimus (hoc
est, aspicimus), specillum est. Grsecis fxriXr]
dicitur. Aetius
Serm. 8, 14, cum sjjecillo instrumento, quod melam Grceci ap-
pellant. Instrumentum parvum ac teres, quo utuntur ad vul-
nerum aut fistularum ^'iam aut profunditatem pernoscendam.
Une sonde de chirurgien.^^ (Ad Plin. H. N. vii, 54.) If
the KOTTo'ptoi', however, was the same as the ^ujX'/ ^'* the spe-
cillum, it was evidently used for cutting with as well as for
cutting upon.
SECT. Lxxix.l HEMORRHOIDS. 403

SECT. LXXTX. ON HEMORRHOIDS OR PILES.

The is rendered manifest to us

existence of hemorrhoids by the
discharge from them. Before proceeding to the operation we must
use frequent clysters with the Adew of evacuating at the same
time the contents of the intestine, and, by irritating the anus, of
rendering it more disposed to eversion and protrusion of the
gut. Having, therefore, laid the patient on his back in a clear
light, if we are to use the ligature we pass a very thick thread
round the lips and secure each of the hemorrhoids with this
ligature, leaving one as an outlet to the superfluovis blood (for
so Hippocrates directs.) After the application of the ligatui-e,
using a compress that has been dipped in oil and the bandage
adapted for the anus, we order the patient to remain quiet,
and treat the bowels with tepid oil and honied water, and
afterwards we use a cataplasm made of crumbs
of bread and
saffron ; and hemorrhoids the cica-
after the falling off of the
trization is to be promoted by wine. Leonides has not recourse
to the ligature, but having seized the hemorrhoids and held
them for some time with the forceps used for operations on the
uvula he cuts them offwith a scalpel. After the operation we
must use manna and starch with chalcitis, or the plaster of
burnt sponge with pitch, and the trochisk called faustinum, in
order to burn it completely. Others by filling the cavity of
the instrument called staphylocaustes, with caustic medicines,
have Durnt hemorrhoids like a scirrhous uvula.

Commentary. Hippocrates directs us to pass a needle Comm.

'

armed with a very thick thread through the hemorrhoids, and '

tie them with it. Septic applications are afterwards to be

made to them. (De Yictu Acut. 67.) The author of another
of the Hippocratic treatises recommends us to cure them by

burning with red-hot irons. (De Hsemorr.)

Celsus directs us when the base of a hemorrhoid is narrow
to tie it with a thread wherejoins the anus, and to apply
it

over it a sponge squeezed out of hot water until it become

livid, when it is to be scraped off with the nail or a scalpel.

Sometimes, however, he says, the ligature occasions great pain

and retention of urine. If the hemorrhoid be large and its
 404 HEMORRHOIDS. [book vi.

CoMM. base broad, lie directs us to seize it with a hook, and dissect it
' '

out a little above its base the part is to be secured with a

"
:

thread, ^"hen there are many hemorrhoids he ad^ises us not

to operate upon them all at one time. When there is a dis-

charge of blood it is to be stopped by the application of a

sponge. The day after the operation he recommends us to use
the tepid bath and catalapsms. (vii, 30.)
Aetius approves of cutting off hemorrhoids, and describes
the operation minutely. He directs us to seize the pile with a
hook, grasp it firmly, and bind it with a tkread, after which it
is to be raised and cut off. To stop the bleeding a piece of
round is to be introduced into the
sponge bound with a thread
anus. Suitable dressings and bandages are then to be apphed.
(xiv, 6.)
In the 'Isagoge' ascribed to Galen, the method of treating
hemorrhoids by the ligature is particularly commended.
Albucasis prefers excision and burning, but if the patient
will not submit to these methods of cure he approves of having
recourse to the ligature. Excision is performed by seizing the
hemorrhoid with a hook and cutting it at its base, after which
some is to be made.
styptic application The ligature is applied
by transfixing the base of the hemorrhoid with a needle armed
with a thread. (Chirurg. ii, 81.) He gives particular directions
about the process of burning, (p. i, 37.)
When the hemorrhoid is internal Rhases directs us to evert
the anus, and having laid hold of the tumour to cut it out.
He also describes the process of tying them in the same terms
as the other authorities. (Contin. xxiv.) The directions given
by Aricenna are quite similar.
Halv Abbas recommends excision or the ligature. (Pract.
ix, 61.)
Fabricius makes mention of all these methods of treatment,
but speaks of the application of the cauteiy as being dangerous.
Upon the whole he appears to have entertained great appre-
hensions fi'om stopping the discharge of piles. (CEuv. Ch. ii, 94.)
Theodoricus and Brunus recommend excision, the cautery,
and the ligature, according to circumstances. Theodoricus also
makes mention of applications for consuming and drying
them up.
SECT. Lxxx.] CONDYLOMATA. 405

SECT. LXXX. ON CONDYLOMATA OR EXCRESCENCES, AND

FISSURES.

Condyloma on the fundament differs in situation alone

from that on the female parts of generation, being a wrinkled
excrescence of the anus, either from a preceding inflammation
or fissure. At first, then, it is called an excrescence, but when
it becomes callous, condyloma. These also, like the former,
are to be taken hold of with a forceps and cut out, and the
cure completed with escharotics. Fissures are occasioned princi-
pally by hard faeces, and being slow of granulating owing
to
their callosity, must be converted into recent ulcers by paring
them with the nails or a scalpel, when they may be made to

granulate by proper applications.

Commentary. Celsus briefly directs us to seize the condy- Comm.

loma with a forceps and cut itout by the roots. Should any
fungous flesh arise it is to be kept down with the squama seris.
(Adi, 30.)
Aetius gives a fuller account of these affections than our
author. The condyloma, he says, is a tubercle which forms in
the soft wrinkled skin about the anus. When it becomes hard
and callous he recommends us to take hold of it with a forceps
and cut it out by the roots. Old fissures he directs us to treat
by paring their edges and applying suitable dressings, (xiv, 3.)
The same treatment is recommended by the Arabians, See
Haly Abbas (Chirurg. ix, 62) Albucasis (Chirurg. ii, 81, 82)
; ;

Rhases (Contin. xxiv.)

SECT. LXXXI.— ON IMPERFORATE ANUS.

In new-born children the anus is sometimes found imper-

forate,being blocked up by -a membrane. If possible, then,

the membrane is to be ruptured with the fingers, but if not,
we must cut it with the point of a scalpel, and accomplish the
cure with wine. And since often in adults, owing to an
ulcer not properly cured, a stricture takes place at the anus,
we must break it with a convenient instrument, and treat it
 406 EXCISION OF VARICES. [book vi.

properly with a pipe of leadj or some wedge-shaped

tent in-
troduced into the anus until the cure be completed, lest con-
traction should again take place. The Avedge-shaped tent is

to be anointed with some healing ointment.

CoMM. Commentary. Soranus describes this operation in very

distinct terms, (p. 164.)
Albucasis evidently copies our author^s account, recommend-
ing us to break or divide the membrane, and introduce a canula
of lead into the opening to prevent adhesion. (Chirurg. ii, 79.)

Haly Abbas, in like manner, directs us to make an opening

and introduce a leaden tube or a piece of sponge. (Pract. ix_, 63.)

SECT. LXXXTI. ox THE EXCISION OF VARICES.

The varix is a dilatation of a vein occurring sometimes in the

temples, sometimes in the hypogastric region below the navel,
sometimes in the testicles, but more especially in the legs. For
the most part derives its origin from a melancholic humour.
it

The operation for those of the testicle we have already described

Avhen treating of cirsocele, and those in the leg may be operated
upon in a similar manner, making the attempt upon those in
the inner parts of the thighs, where they generally arise ; for
below this, as they are di\dded into many ramifications, they are
more difficult to succeed with. Wherefore, haA'iug washed the
man, and apphed a ligature round the upper part of the thigh,
we are to direct him to walk about, and when the vein becomes
distended we are to mark its situation with writing ink or col-

lyrium, to the extent of three fingers^ breadth or a little more,

and having placed the man in a reclining posture with his leg
extended, we apply another ligature above the knee ; and where
the vein is distended we make an incision upon the mai'k with
a scalpel, but not to a greater depth than the thickness of the
skin, lest we divide the vein ; and ha^^ng separated the lips of
the wound yvith. hooks, and dissected away the membranes with
crooked those used in the operation for hydrocele,
specilla, like
and laid bare the vein,and freed it all around, we loose the
ligatures from the thigh, and having raised the vessel with a
blind hook, and introduced under it a needle having a double
SECT. Lxxxii.] EXCISION OF VARICES. 407

thread we cut the double of it, and opening the vein in the
middle with a lancet, evacuate as much blood as may be re-
quired. Then having tied the upper part of the vessel with one
of the ligatures, and stretched the leg, we evacuate the blood
in the limb by compression with the hands. Then having tied
the lower part of the vein, we may either cut out the portion in-
termediate between the ligatures, or suffer it to remain until it
drop out of its own accord with the ligatures ;
then we have to
put a dry pledget into the wound, and apply over it an oblong
compress soaked in wine and oil, and secure them with a band-
age, and accomplish the cm'e by the treatment applicable
in
cases of suppuration. I am aware that some of the ancients
do not use ligatures, but cut out the vessel immediately after it
islaid bare, whilst others stretch it from below and tear it out

by force. But the mode of operating now described is of all

others the safest. Varices on the hypogastrium may be treated
in like manner, and those on the temples as described in the

operation of angiology.

Hippocrates directs us to make small punc-

Commentary. Comm.
tures in varices of the leg, but forbids to open them freely. (De
'
Ulceribus, 16.) In the Hippocratic treatise entitled Hippi-
atrica,' it is recommended to burn varices in the legs of
horses.
Celsus treats ingeniously of varices on the head (aneurism
by anastamosis) on the belly (cirsocele ?), and on the leg.
With regard to the treatment, he says, in a word, that they are
all either to be burnt or cut out. If the varix be straight, or

if,although transverse, it consist of a single vein of moderate

be better, he says, to burn it. If crooked and con-
size, it will

voluted, and if it consist of a multitude of veins, it will be more

useful to cut them out. He directs us, in burning them, to

make an incision in the skin, and having laid bare the vein to

touch it with a slender blunt piece of iron red-hot, taking care

not to burn the edges of the wound which are to be drawn

aside with hooks. This is to be done at intervals of about
four fingers along the whole extent of the varix, and then the
(bessings for burns are to be applied.
The varix is cut out in
this The vein is to be exposed as above directed, and
way.
dissected with a scalpel from the surrounding parts (care being
 408 EXCISION OF VARICES. [book vi.

CoMM taken not to hurt it) a blunt liook is then to be introduced

;
'
^
below it ; and the same thing is to be done at the same interval
as mentioned above. When this has been performed wherever
there are varices^ the vein is to be cut asunder at one of the
hooks, and drawn towards the next hook^ and then torn out.
The leg being in this way cleared of the varices, the lips of the
wound are to be united, and an agglutinative plaster applied
above, (vii, 31.) It will be remarked that our author makes
mention of this method of treatment but disapproves of it.
Aetius describes the excision of varices in exactly the same
terms as our author. He also makes mention of the treatment
by the actual cautery, (xiv, 84.)
The operation of extracting varicose veins is briefly described
in the'Isagoge^ of Galen.
Albucasis describes accurately
the different modes of operating upon varices. He says there
are two methods of performing the operation with the knife,
that is say, by incision or by extraction.
to The former
method done by applying a piece of fillet round the upper
is

part of the thigh, and at the inferior part near the knee, and
then opening the vein in one, two, or three places, and evacu-
ating the blood in it the limb is then to be bound up.
: In
performing extraction, the veins are first to be made to swell
by putting the limb into hot water, applying fomentations, and
taking strong exercise ; and then a longitudinal incision is to
be made in it, either at the knee or the ankle. The vein is
afterwards to be dissected from the neighbouring parts and sus-
pended with a blunt hook. The vein is to be laid bare in like

manner at the distance of three fipgers' breadth, and in more

places if required. At last, it is to be cut asunder at the ankle
and drawn out. Afterwards wool dipped in wine and rose-oil
is to be applied. When the varix consists of a congeries of
tortuous vessels he recommends us to dissect it out entire.
(Chirurg. ii, 92.)
Haly Abbas briefly inculcates the same treatment as Albu-
casis. (Pract. ix, 64.) Avenzoar considers the complaint nearly
incurable.
lihases directs us, in the first place, to bleed and pru'ge, and
then to expose the vessel or cut it out. He also approves of
compression. (Cont. xxviii.)
It is related that the operation here described was performed
SECT. Lxxxiv.] AMPUTATION. 409

upon tlie celebrated Caius Marius. See Cicero (Tusc. Disput. ii.) C OMM.
Pliny (H. N. xi, 104) and Plutarclius (in Mario.) It seems to
;

have been a very painful operation, since it is mentioned as a

proof of liis fortitude that he submitted to it without being
bound. It would appear that the learned and ingenious Aurelius
Severinus used to perform it. (V. Mangeti Bib. Chir. xvi.)

SECT. LXXXIII. ON THE DUACUNCULI OR GUINEA-WORMS.

The treatment of dracunculi being principally accomplished by

medicines, we have given an account of it in the Fourth Book.

Commentary. We have treated fidly of this subject at the Comm.

'
'
end of the Fourth Book.

SECT. LXXXIV. on AMPUTATION OF THE EXTREMITIES.

Sometimes the extremities, such as a hand or a foot, having

mortified, so thatthe bones themselves are corrupted, either

from having been fractured by some external means, or from
having become putrid owing to some internal cause, it is neces-
sary to saw them off ; before doing which the parts surrounding
the bones must be divided. But since, when this is done first,
as a considerable time is required for the sawing, there is dan-

ger of a hemorrhage taking place, Leonides properly directs us

not to divide all the parts at once unless they are completely
mortified, but first to cut the part Avhere not many nor very
large veins or arteries are known to be situated, down to the
bone quickly ; then to saw the bone as expeditiously as possible,
applying a linen rag to the parts Avhich have been cut lest they
be torn by the sawing and occasion pain, and then having cut
through what remains, to apply red-hot irons to the vessels and
stop the hemorrliage thereby with compresses of lint, and to
apply proper bandages with the dressings suitable to suppu-
rations.
 410 AMPUTATION. [book vi.

CoMM. Commentary. Hippocrates and Galen recommend ampu-

^"''— tatiou
'

to be performed in general at a joint. (De Articulis,

Galeni Comment, t. v, p. 650, ed. Basil.) Hippocrates says com-

plete excision may
be performed at the joints of the hand and
foot, and at those of the wrist and ankle, and generally with

safety, unless the patient

be cut off by fainting, or continual
fever supervene on the fourth day. When gangrene attacks a
fractured limb, his rule of practice is to let the parts drop off",

and he remarks, many persons thus recover, even when the

fracture is seated in the femur. When gangrene comes on
without being preceded by fracture, he directs the soft parts, as
soon as they have lost all sensibility, to be removed at the
nearest joint below, and the surgeon is to wait until the bone
also separates. He says he had seen the bone of the thigh
thus separateon the day ; in that case the limb below
eightieth
had been removed at the knee on the twentieth day. In a
similar case of gangrene of the leg, the bones separated on the
sixtieth day. He
pronounces gangrene of the extremities to
be more formidable in appearance than in reality. He recom-
mends a mild and anti-inflammatory treatment, and that the

limb should be laid in an elevated position as long as there is

any fear of hemorrhage. Violent attacks of dysentery are apt

to come on, but do not generally prove obstinate. (De Artie. 69.)

It would appear from Thucydides and Lucretius that it was not

uncommon to amputate gangrene in the days of
in cases of
their Descriptions of the Plague of Athens.)
Hippocrates. (See
In cases of Celsus
gangrene directs us to make an incision
of the flesh, between the sound and corrupted part, down to
the bone, which is to be sawed across, and after the asperities
have been removed from the end of the bone, the skin is to be
brought over the stump, (vii, 33.) He gives us no particular
de-

scription, however, of amputation of the extremities. We turn,

therefore, to the celebrated fragments of the works of
Archi-
of Nicetas,
genes and Heliodorus, preserved in the collection
Florent. 1756.)
published by Cocchius. (Chirurgici Grseci,
Archigeues begins by stating the circumstances which require
recourse to be had to amputation. They are, the presence of
some intractable disease, such as gangrene, necrosis, putrefac-
tion, cancer, certain callous tumours, and sometimes wounds
inflicted by weapons, and the like. Before attempting the
SECT. Lxxxiv.] AMPUTATION. ,
411

operation he recommends us to consider well if the patient's Comm.

'

strength will enable him to endure it. The operator must then
'

"

tie or sew the vessels which pass to the parts ; in certain cases

a ligature is to be applied round the whole limb, cold water is

to be poiu'ed upon it, and some are to be bled. Amputation
near the joints is not to be attempted. In such as are of a full
habit of body, a circular band is to be put round the limb, to
draw up the skin with, and to direct the incision. After cut-
ting down to the bone, tlie tendons are to be retracted, and
the bone scraped and sawn. When much blood is discharged,
red-hot irons are to be applied, and a double compress laid on
the part from which the blood proceeds. Having loosened the
band, a cataplasm of leeks, bread, and salt is to be applied to
the stump; and the parts about the jaw-bone are to be
anointed with cerate of iris and old oil, doubtless in order to
obviate the danger from tetanus.
Heliodorus states that a limbmay require to be amputated
owing to gangrene or any other cause that occasions the death
of it. In the extremities, then, he remarks, amputation may
be performed with less danger but above the knee or elbow
;

the danger of hemorrhage from the great vessels being wounded

is
very considerable. Some, he says, from too great anxiety for
at one
despatch, cut through all the bodies (the soft parts ?)
incision, and then saw the bones. But this method of remov-
ing the limb is not unattended with danger, as many vessels
"
pour forth blood at the same time. Wherefore," he adds,
" it to me better first to divide those parts of the
appears
limb where there is least flesh, as on the anterior part of the
leg, and then to saw the bone ; and I myself am in the prac-
of the limb
tice of applying a ligature above the part
first

which is to be sawn across, and then of operating in the manner

described. In sawing the bone the plate of the saw ought to
be applied even, in order that the sawing of the bones may be
even. When the bones are sawed the other parts which re-
main undivided are straightway to be cut through with a scal-
pel, and large pledgets applied along
with suitable compresses.
External to these, sponges with suitable bandages are to be
put on. After the third or fourth day, when all fear of
be promoted by suitable
hemorrhage is over, suppuration is to
dressings'."
 412 AMPUTATION. [book vi.

CoMM. In no other of the Greek medical works which have come

*
^~'
down to us is there any description of amputation of the ex-
tremities.
Avicenna mentions the operation of sawing off the bones of
the extremities, but in such general terms as gives us no in-
formation in what manner it was performed, (iv, 4, 4, 10,
11, 12.)
The by Haly Abbas is more complete. A
description given
limb, he says, amputated thus.
is The operation is to com-
mence with first cutting the skin, and then when the bone
of a limb is to be sawn, you must not cut through the whole
flesh at once, lest an immoderate discharge of blood take place
from the veins and arteries so as to occasion the death of the
patient and interrupt the process of sawing the bone except ;

the flesh of the limb be wasted or putrid. But you ought first
to divide that part of the flesh where no great arteries and
veins are situated, cutting them down to the bone, which is to
be sawn across as quickly as possible, the fleshy parts in the
mean time being retracted with a piece of hnen, lest the saw
should tear them and occasion bleeding and pain when the ;

bone is sawn across, whatever portion of the flesh remains un-

divided is to be cut, and then the veins and arteries are to be
burned. When the bleeding is stopped a pledget with suitable
bandages is to be applied. (Pract. ix, 65.)
Albucasis represents amputation as necessary in cases of mor-
tification, as indicated by the smell and discoloration. When
the disease is seated in the hand, he recommends us to ampu-
tate at the fore-arm ;
when in the forearm, at the elbow ; and
ifthe arm itself be affected, he pronounces the case to be hopeless.
In like manner, with regard to the lower extremities, he pro-
nounces all cases incurable in which the disease is seated above
the knee. In performing the operation he directs us to apply
two bandages around the limb, the one above and the other
below the place at which it is to be cut off. These bandages
are to be pulled, the former upwards and the latter downwards,

by two assistants, so as to put the skin upon the stretch the ;

fleshy parts are then to be divided with a large scalpel dqwn to

the bone, which is afterwards to be cut out, or sawed across, and
during this part of the process a piece of linen is to be applied
around all the fleshy parts, to prevent them from being injured
SECT. Lxxxiv.] AMPUTATION. 413

by the sawing. Should any hemorrhage occur during the opera- Comm. ' '

tion, he directs us to apply the cautery^ or a styptic powder

"

and after the operation he recommends us to bandage the limb

in a suitable manner, until the stump is healed. He relates a
case, from which the timidity of his own practice is rendered
very apparent. A
person who had a spreading mortification in
the foot, cut it off at the ankle-joint himself, and was cured for
the time. The disease next attacked the hand, upon which he
applied to Albucasis, requesting that he would cut it off in the
same manner, but this he refused to do, for fear that the man^s
strength might not be able to endure the operation. He after-
wards learned that the man had cut off his whole hand, and had
recovered. (Chirurg, ii, 89.) The history of this case proves
decidedly that the operative surgery of the Arabians, in the
days of Albucasis, must have been very defective ; this he him-
self frankly confesses, for he declares that all knowledge of this
art had been lost, except what vestiges of it had been preserved
in the works of the ancient authors, whose descriptions, he com-

plains, had been mutilated and corrupted. (Prefatio.) We men-

tion this, in order that the ignorance which prevailed in his time

may not be imputed to all preceding ages, nor may be used as

an argument against the genuineness of the extracts from the
works of Heliodorus and Archigenes, given above.
Rhases makes some interesting remarks on the sawing of
bones. He directs us to stretch the flesh upwards and down-
wards, with a piece of cloth, so that it may not come in the way
of the teeth of the saw. When it is necessary to saw a rib or
a bone, near any important membrane or organ, he recommends
us to use a plate (tabella), to protect the soft parts from the saw.
When the bone connected vnth a joint is diseased, he directs
us to extract it at the joint. When the os brachii, or tibia, is

diseased, he recommends us to extract it entire, but forbids to

meddle with the head of the femur or the vertebrae. In another
place he declares it as his opinion that when a joint is swelled,
and the bone diseased, (in cases of white swelling?) it will be
impossible to effect a cure imless the whole diseased portion of
the bone be cut out. (Cont. xxix.) From these passages it is
quite obvious that the ancients practised excision of the bones
of joints. See also what our author says on this subject in
the seventy- seventh section of this book. A Cooper br a
 414 PTERYGIA. [book vi.

CoMM. Listen could not recommend a bolder plan of treatment in

such cases.
Tlieodoricus, Guy of Cauliac, and the other surgical writers
of that age, follow closely in the footsteps
of the ancients,

especially of the Arabians. When

the mortified part is near to
a joint, they recommend amputation at it. In other cases they
direct us to make an incision between the sound and the dead
fine saw, and to stop the bleeding
parts, to saw the bone with a
with a heated iron. Theodoricus recommends stupifying medi-
cines, such as opium, hyoscyamus, mandi'agora, or cicuta, before
the operation. Ambrose Pare has undoubtedly the merit of in-
troducing the use of the hgatm'e into modern practice in ampu-
tations, and, in fact, Archigenes seems to be the only ancient
authority who mentions it in such cases. We have shown, how-
ever, in another place, that the ligature was freely used by the
ancients for stopping bleeding from wounds.

SECT. LXXXV. ON PTERYGIA ABOUT THE NAILS.

The pterygium is a fleshy excrescence about the nails, covering

part of the nail, and being commonly formed in the large fingers
and toes. But those in the feet arise most commonly from an
accident, whereas, those in the hands arise from whitlow, the
inflammation being neglected and turning to pus. For, the .

pus being allowed to remain, corrodes and corrupts the root of

the nail, and often destroys the whole of it, but generally the
one half, while a portion of it uncorroded is left at the root of
the nail, and sometimes the whole root is left uncorroded.
Sometimes, too, it corrupts the bone, when a disagreeable smell
arises from it, and the extremity of the finger becomes swelled
and appears livid. They are to be treated, then, by cutting
and removing all the remaining part of the nail with the point
of a scalpel, and then bui-ning both the ulcerated and cut part
with cauteries. For, the pterygium is a spreading disease, and
does not stop unless burnt, so that, if neglected, it aff'ects the
whole finger. If, while the nail and bone remain sound, the

inner angle of the nail sink down and pierce the adjacent
flesh, it occasions inflammation ; and in this case the irritating

portion is to be raised upon a thin probe, or some such thing

SECT. Lxxxvi.] BRUISED NAIL. 415

put under it, and removed with the point of a scalpel, and the
excrescence eaten down with an escharotic medicine. And
most cases are cured by being treated in this way. But if
larger, it is first to be cut out with a scalpel, and then the
medicine is to be used.

Commentary. "We have given an account of the ancient Comm.

" '

treatment of pterygia by medicines towards the end of the "^

Third Book.
Celsus recommends excision with the knife and the appli-
cation of cauteries or strong caustics afterwards, (vi, 19.)
Aetius and Oribasius trust to septic and caustic applications
without an operation. Antyllus (apud Bhasis Cont. xxx\-i,)
recommended excision and burning when the discharge from
the ulcer is fetid.

Albucasis, like our author, recommends us to cut off the

piece of nail that is attached, and then to apply a burning iron
to the part. The burning, he adds, is of great consequence.
When the bone is diseased he directs us to take it out, which
generally may be done at the joint. (Chirurg. ii, 9.)
Haly Abbas Hkewise directs us to cut off the piece of nail
and apply the cautery. He says, if this be neglected the bone
is apt to become diseased. When pus is seated below the nail,
he recommends us to introduce the head of a probe under it,
and cut upon it with a knife ; after which a caustic medicine
is to be applied to the flesh. (Pract. ix, 66.)

SECT. LXXXVI. ON A BRUISED NAIL.

owing to nails having been bruised by accidents,

Since,
pains supervene, which compel us to operate upon them, it
will be sufficient to give you Galenas account of the matter.
He says, then " When the nails are contused we have found
:

the evacuation of the blood a palpable remedy for soothing the

pain, when it and the throbbings are very violent. But we
must make an oblique incision, not straight from above down-
wards, with a sharp scalpel, so that when the blood is evacuated
the dimled part of the nail may serve as a cover to the parts
under it. But if you make a straight incision fi'om above
 41G CLAVI, ETC. [book vi.

down to the fleshy excrescence, as it is called^ another body is

formed from the flesh below the nail shooting out through the
division of the nail, whence pains again invade, as in the com-

plaint we paronychia, owing to the flesh under the nail

call

being compressed by it. Wherefore, one may see the patients

immediately relieved from pain by this section. On the fol-
lowing days we may gently raise the divided part of the nail,
and press the sanies from under the nail, and then again, as I

said, apply the nail as a cover to the flesh below.

The rest
of the treatment of the finger should be soothing and dis-
cutient.'^

CoMM. Commentary. Avicenna and Rhases approve of the plan of

' '
•
treatment here recommended, upon the authority of Galen.
Rhases, in fact, gives the very words of Galen. (Cont.
xxxvi.)
Albucasis directs us, in the case of a bruised nail, first to
have recourse to venesection, and then to make a transverse
{oblique?) incision through it. (Chiriu'g. ii, 91.)
See our remarks in the sixtieth section of this Book on the
confusion of the terms transverse and oblique by the translators
of the Arabians.
The same treatment is recommended by Haly Abbas. (Pract.
ix, 67.)

SECT. LXXXVII. ON CLAVI, MYRMECIA, AND ACROCHORDONES.

The clavus is a round callus, white, resembling the head of

a nail, and occurring in all parts of the body, but more espe-
cially on the soles of the feet and the toes, occasioning pain
and lameness in walking. AVherefore, having scarified around
the clavus or corn, and taken hold of it with a forceps, we cut
it out by the roots with a
sharp -pointed scalpel or lancet for
bleeding. Some, in order that they may not grow again, use
heated cauteries. The myrmecia is a prominence of the skin,
small, callous, round, thick, spreading deep at the base, and, if
rubbed, occasioning a sensation like the bites of ants, and being
formed in all parts of the body, but more especially in the
hands. Wherefore, some, among whom is Galen, advise us to
SECT. Lxxxvii.] CLAVI, ETC. 417

scarify around the rayrmecia with the stalk of a hard feather,

such as those of okl fowls, of geese, and of eagles, and to push
it down so as to remove the myrmecia from the root. Others
do the same thing with a copper or iron tube. The moderns
are satisfied to scarify around it, and, having seized it with a
forceps, to cut it out like corns with a scalpel. The acro-
chordon is a small rising of the surface, free of pain, callous,
for the most part round, and hanng a narroAv base so as to
appear to hang. It is so called from its resemblance to the
end of a cord. Having stretched out the protuberance then
we may cut it out ; or, otherwise, we may tie a thread or a
hair round it. I have known many who consumed this and
all the afore-mentioned protuberances with what is called the
cold cautery.

Commentary. We have already treated fully of these diseases Comm. ' '

towards the end of the Third Book and in the Fourth, to which
•

we refer the reader for further information on this head.

Celsus recommends us merely to shave the cla\Tis or corn.
The others he remove by caustics, such as the lees
directs us to
of wine (potass ?), or a mixture of alum and sandarach. The
acrochordon, he says, when cut out leaves no roots behind.

{V, 28.)
Albucasis particularly recommends burning for the cure of
clavus and myrmecia. This may be accomplished either with
fire or hot water. If the former method is prefei-red, an iron

proportionate to the size of the corn is to be

heated red-hot
and applied to it, and the burning carried to such an extent
as to occasion suppuration. In the other method a fimiiel of
is to be applied
copper or iron, or else the quill of a ^oilture
to the corn, and then filled with boiling water. By these
means, he says, the corn may be eradicated. (Chirurg. i, 55.)
See also Haly Abbas (Pract. ix, 12) and Rhases (Cont.
xxxvi.) Khases does not state very distinctly the difference
between the myrmecia and acrochordon. He speaks of scraping
them out with a hard pen, and of tying them at the base but ;

upon the whole he approves most of taking hold of them

with
a forceps and dissecting them out.
Avicenna recommends us to cut out the clavus and then
apply a caustic medicine to the part, (iv, 7, 4, 14.)
II. 27
418 WEAPONS. [book vi.

SECT. LXXXVIIl. ON THE EXTRACTION OF "WEAPONS.

That the extraction of weapons is a most important de-

partment of surgery is declared by the Poet Homer, when he
says :

" The man of medicine can in worth with many warriors \ie,
Who knows the weapons to excise, and soothing salves apply."

We must first describe the different kinds of weapons. War-

like instruments, then, differ from one another in material,
figure, size, number, mode, power. and In material, then, as
the shafts are made of wood or of reeds ;
and the heads them-
selves are either made
of iron, copper, tin, lead, horn, glass,

bones, and of reeds, too, or of wood and such differences are

:

found especially among the Egyptians. In figure, inasmuch

assome are round, some angled (as triangular), some pointed
and lance-shaped, as some have three points; some are barbed
and some are without barbs ; and of the barbed, some have
the barbs turned backwards, so that in attempting to extract
them they may fasten in the parts ; and some forwards, so that
when pushed they may do the same thing some have them :

diverging in opposite directions like the forked lightning, in

order that whether pulled or pushed they may fasten in the
parts. Some missiles have their barbs united by a hinge,
which being expanded in the extraction, prevent the weapon
from being drawn out. They differ in size, inasmuch as
some are three fingers^ breadth in size, and some are as small
as one finger, which are called micca in Egypt, and some are
intermediate between them. In number, inasmuch as some
are simple and some compounded. For certain small pieces
of iron are inserted in them, which, in the extraction of the
weapon, remain concealed in deep-seated parts. In mode, as
some have the sharp extremity fixed to a tail and some to a
shaft and some have it carefully inserted in the shaft, and
;

some carelessly, so that in the extraction they may separate

and leave the head behind. In power, as some are not poisoned
and some are poisoned. Such are the differences of weapons.
We now proceed to treat of the extraction, both in cases of
those who have been wounded in war and those not in war.
SECT. LxxxYiii.] WEAPONS. 419

whether voluntarily and involuntarily, under whatever circum-

stances, and of whatever materials they may be composed.
There are two modes of extracting weapons from fleshy parts ;
either by pulling them backwards, or pushing them forwards.
When the weapon is fixed superficially the extraction is made
by pulHng it back, and in like manner Avhen it is lodged deep,
but the opposite parts, if wounded, would occasion danger from
hemorrhage or sympathy. It is to be pushed forwards when

lodged deep, and the intervening substances between it and

the opposite side are of small size, and neither nerve, bone,
nor any such thing is an obstacle to the division. Wlien a
bone is wounded, the mode of extraction is by pulling; if,
therefore, the head of the weapon be in sight, we make the
extraction immediately ; but, if it is hid, we must, says Hip-
pocrates, get the wounded person to put himself in the same
posture as when he received the wound, and thus make the
examination ; or, if this cannot be done, he is to be placed in
the nearest possible to it, and thus it is to be examined with a
sound. If the head of the weapon has fixed in the flesh, it is
to be drawn out with the hands, or by laying hold of the ap-
pendage, which is called the shaft, if it has not fallen off. This
part is mostly made of wood. When it has fallen off", we make the
extraction by means of a tooth-extractor, or a root-extractor, or
an instrument for extracting weapons, or any other convenient
instrument. And sometimes we make an incision in the flesh
around it in the first place, if the wound do not admit the in-
strument. And if the head of the weapon has passed to the
opposite side, and it is found impossible to extract it by the way
in which it entered, having di\aded the parts opposite we extract
itthrough them, either drawing it out in the manner mentioned,
or we make a hole with the weapon itself, pushing it either by
the shaft, or, if it has come away, by an impellent instrument,
taking care not to divide a nerve, vein, artery, or any important
part, for it would be disgraceful if,
in extracting the weapon, we
should do more mischief than the weapon itself had done. If
the weapon has a tail, which is ascertained by examination with
the probe, having introduced the female part of the impellent
instrument and fixing it, we push the weapon forwards, but if
ithas a shaft, the male part. And if the head when extracted
appear to have notches, so that other small pieces of iron might
420 WEAPONS. [bookvt.

he inserted in them, we make an examination again with the

probe, if we find them we exti'act
them in the same manner.
And if the weapon has barbs in opposite dii'ections, which do
not jield to our puUing, we must make an incision in the ad-
jacent parts, if no important vessel or the like lie there,
and when
the weapon is laid bare, we extract it without trouble. Some
apply a tube about the barbs, so that when they draw out the

weapon the flesh may not be torn by the barbs. If the wound
does not become inflamed, we may use sutui'es, and heal it up
Uke a bloody wound ; but if it inflame we may remove the in-
flammation by embrocations, cataplasms, and the like. If the

weapon be poisoned we must, if possible, cut off" all the flesh

which has imbibed the poison, which is known by its being

altered fi'om the sound flesh, for it appears pale, li-^dd, and as

it were dead. They say that the Dacians and Dalmatians touch
the points of their weapons with elecampane, called also ninum,
and that when it thus becomes mixed with the blood of the
wounded animal it proves fatal, although it is eaten by them

with impunity. If, again, the weapon fix in a bone, we make

trial with the instrument, and, if flesh prevent the extraction,

we cut it oft', or separate it ; but if it be lodged deep in the

bone (which we know by its being so firm that it cannot be
shaken with a considerable force) we first remove the remaining
part of the bone with a cutting instrument, or bore it with tre-
phines if it has considerable thickness, and thus disengage the
weapon. If a weapon be lodged in any important part, such
as the brain, heart, throat, lungs, liver, stomach, intestines,
kidneys, womb, or bladder, and fatal symptoms have already
shown themselves, as the extraction would occasion much lacera-
tion we must decline the attempt, lest while we do no good we
expose ourselves to the reprobation of ignorant people. But if the
result be dubious, we must make the attempt, ha^dng first given

warning of the danger. For in many cases, when an abscess

has formed in some vital part, recovery has unexpectedly taken
place and the lobe of the liver, part of the omentum and peri-
;

toneum, and the whole uterus are said to have been taken
away, and yet death was not the consequence. And we often
open the windpipe intentionally, in cases of angina, as we men-
tioned under the head of Laryngotomy. To leave the weapon
then as it is, occasions certain death, and exhibits the art in an
SECT. Lxxxviii.] WEAPONS. 421

inhumane liglit, Avhereas by extracting it we might possibly

save a life. It is not difficult to ascertain when an important
is wounded, this being discovered by the
part peculiarity of the
symptoms, the discharges, and situation of the parts. When,
therefore, the membranes of the brain are wounded, there is
intense pain of the head, the eyes are fiery, the tongue red, and
there is abenration of intellect; but if it is attended with a
wound of the brain, there is prostration of strength, with loss of
speech, distortion of the countenance, A-omiting of bile, a dis-
charge of blood from the nostrils, an evacuation of a white and
pultaceous fluid by the auditory foramen, and of ichor, if it can
find a passage by the wound. If the weapon has penetrated to
the cavity of the chest, and sufficient room is left for it, the
breath passes out. When the heart is wounded, the weapon
appears at the left breast, and feels not as if in a cavity, but
as fixed in another body, and sometimes there
a throbbing is

motion ; there is can

a discharge of black blood
find vent, if it

vnih coldness, sweats, and deliquium animi, and death follows

in a short time. When the lungs are wounded, if the opening
be sufficiently large, a fi'othy blood passes out at it ; but if not,
it is rather A^omited up, the vessels of the neck are swelled, the

tongue changes colour, and there is an urgent desire of cold

things. When the diaphragm is wounded the weapon appears
lodged about the false ribs, there are large inspirations with
pain, sighs, and heavings of the parts about the shoulder-joints.
If the viscera of the abdomen are wounded, the nature of the
injury will be apparent from the discharge, if the wound be
sufficiently large, or if the weapon be extracted,
or if the shaft
be broken internally ; for chyle is evacuated from the stomach,
and fceces from the intestines ;
sometimes the omentum or an
intestine protrudes. When the bladder is wounded urine is

discharged. When the membranes of the brain or the cere-

brum itself is wounded, we extract the weapon by trepanning
the skull, as will be described presently in fractures of the
bones of the head. If the weapon is lodged in the chest, and
does not come out readily, it is to be extracted by means of a
moderate incision in the intercostal space, or by cutting out a
rib with the assistance of the instrument called meningophylax.
In like manner, when the stomach, bladder, and other deep-
seated parts are wounded, if the weapon come out readily it is
 422 WEAPONS. [book vi.

to be extracted without more ado ;

but if not, we must en-
large the wound, and afterwards use the dressings for fresh
wounds. In wounds of the abdomen, gastroraphe as formerly
described may be had recourse to, if necessary. But if the
weapon has lodged in any of the larger vessels, such as the in-
ternal jugulars or carotids, and the large arteries in the arm-

pits or groins, and if the extraction threaten a great hemor-

rhage, they are first to be secured with ligatures on both sides,
and then the extraction is to be made. If parts have been
fastened to one another, such as the arm to the chest, or the
fore-arm to the other parts of the body, or the feet to one
another, if the weapon (as a spear) do not penetrate through
both parts, we are to take hold of the weapon externally and
extract as if only one part were affected, but if it has passed

through both, having sawed the wood through the middle, we

extract each part singly, in the most convenient direction. But
since often stones or the sharp points of rocks, or pieces of
lead, or the like, are lodged in the body, either being impelled
with force from a sling, or happening to be acuminated, they
are to be known by the swelling being hard and
irregu-
lar, and by the solution not being everywhere straight, but

larger than common, and having the skin bruised and livid,
and the pain being attended with a sense of weight. They
are, therefore, to be dislodged by means of suitable instruments,
or scraped out with the concave part of a specillum or of an
ear-specillum adapted for wounds ; or, if they can be apphed,
a tooth-extractor or a root-extractormay be used for pulling
them out. In many instances weapons lodged in the body lie
concealed, and a long time after, when the wounds are healed
up, the part having suppurated bursts, and the weapon drops
out.

CoMM. Commentary. Hippocrates considered the extraction of

weapons to be one of the most important departments of
surgery. It is to be fully learned, he
says, only by attaching
oneself to a foreign army. (De
Medico.) He makes some
interesting remarks on the subject in his treatise De Capitis
'

Vulneribus.'
We must now attempt to give an abstract of Celsus's very
interesting chapteron the Extraction of Weapons. Every
SECT. Lxxxviii.] WEAPONS. 423

weapon is to be extracted either by tlie part at wbich it enters c OMM.

or by that to which it tends. If it is not deep-seated, or if it
has not passed any great vessels or nerves, there is no better
plan than to draw it out as it entered. But if there is a greater
space through which it must return than there would be to
push it out, and has already passed the vessels and nerves,
if it

it will be better to open what remains undivided, and extract

it in this direction. If the weapon is to be drawn backwards,
the opening is to be enlarged by a scalpel, which will occasion
lessinflammation and obstruction of the parts than if they are
torn by the weapon itself. In whichever way it be extracted
great care ought to be taken that no nerve, large vein, or
artery be divided. If any of these parts be detected in the
wound they are to be drawn aside with a blunt hook. These
are his general directions. He then subjoins instructions for
extracting particular kinds of weapons. An arrow being a
slender body, and generally impelled with great force, is often
lodged deep, and is to be extracted for the most part rather
by the opposite side to which it entered, especially as it has
barbs, which tear most if drawn backwards. The flesh about
the weapon is to be separated by means of a suitable instru-
ment, and then if the head (mucro) appear with the shaft
(arundo) fixed to it, the weapon is to be propelled until it can
be laid hold of at the opposite side and extracted ; or if the
shaft has fallen out and only the iron remain lodged within,
the head is to be seized with the fingers or a forceps, and re-
moved, and it is to be extracted by the opening at which it
entered, upon the same principles ; for the wound being en-
larged, the weapon is to be drawn back by the shaft if it
remain, or otherwise by the iron itself. If there appear to be
barbs upon the arrow, and if short and small, they are to be
broken ofl" with a pair of pincers ; or, if larger and stronger,
they are to be covered with split writing-pens (fissis scriptoriis
calamis) to prevent them from tearing the flesh dm*ing
extraction. (And here we may mention, that the com-
mon calamus scriptnrius of the ancients was made from an
Egyptian reed. See Montfau9on (Palseographia Grseca, p. 3.)
When the weapon which is lodged in the body is large it must
not be extracted by the opposite side, as it would make the
wound too large. He directs us to draw it back by means of
 424 WEAPONS. [book vi.

CoMM. an instrument invented by Diocles^ of whicli lie gives a descrip-

" '
*
tion. Another of weapons which must sometimes be
class
extracted are leaden balls, stones, or any such thing which
breaks the skin^ and is buried within. In all such cases the
M'ound^ he says, must be enlarged and the body extracted with
a forceps. A complication which increases the difficulty of
extraction arises from the. weapon being lodged in a bone, or
between two bones at a joint. When lodged in a bone it is
to be moved about until loosened, when it is to be grasped
with a forceps and extracted in the same way that a tooth is
pjilled out. It rarely happens that the weapon cannot be re-
moved in this way; but if it remain fixed in the bone, it is
to be struck Avith some iron instrument until it be shaken from
the place where it is lodged. When other means do not suc-
ceed, the bone is to be perforated with a trephine. When the
body is lodged in a joint between two bones, the two members

about the wound are to be Avrapped round with strips of cloth,

or leathern thongs, and thereby separated by pulling in oppo-
site directions,by which means the space between them will be
slackened, and then the weapon may be removed without diffi-
culty. When the weapon had been poisoned, these things
must be done with all possible despatch, and the remedies ap-
plied which are used when a poison has been swallowed, or a
person has been stung by a serpent. The wound from which
a weapon has been extracted requires no. other treatment than
what is applicable for ordinary injuries, (vii, 5.)
Albucasis borrows mostly from our author the account which
he gives of the construction of weapons and the symptoms oc-
casioned by the wounds which they inflict. He also relates
some interesting cases of recovery from very severe wounds.
An arrow entered at the root of a man's nose and Avas extracted
by Albucasis behind his ear ; and the man recovered without
having sustained any injury to the eye. He extracted another
large arrow which had lodged deep below the eye of a Jew ;
and in this case also the sight was not impaired. He extracted
a barbed arrow Avhich had lodged in the throat of a Christian,
by
enlarging the Avound, and the man recovered. An arrow had
lodged in a man's belly, so that, at first sight, Albucasis con-
sidered the case as hopeless; but, after thirty as no
days,
mortal symptoms had supervened, he enlarged the Avound and
SECT. Lxxxviii.] WEAPONS. 425

extracted the weapon. He saw a mau wLo Lad got an an-ow Comm.
'

lodged in his back ; the wound healed, but after an interval of

'

seven years the weapon came out below his buttocks. He

knew a woman who had an arrow lodged in her belly, and the
wound healed, and the weapon never afterwards occasioned
her any inconvenience. He knew a man who had an arrow
lodged in his face, and the Avound healed up, and never gave
him much trouble. He relates that he extracted an arrow
which had been buried in the nose of a prince, after making
various fruitless attempts for the space of four months. He then
delivers general directions for the extraction of weapons, bor-

rowing, as usual, very freely from our author. When a weapon

cannot readily be got extracted at the time, he recommends us
to let it alone until it become loosened by the putrefaction of the

surrounding parts. When impacted in a bone, he directs us

either tomove it about until it is loosened, or to perforate the
bone with a trephine. When lodged in the cranium, it is to
be removed in like manner with a trephine, provided the dura
mater is not injured, for if it is wounded the case must not
be interfered with. When a weapon is lodged deep in any
part of the body where there are no large nerves, veins, or
bones, he directs us to enlarge the wound and extract the
weapon ; but if it has barbs, the fleshy parts about it must first
be carefully separated to prevent them from being torn. "UTien
a weapon passes through a limb, or attaches one part of the
body to another, he directs us to cut off the part which pro-
jects, and then extraction may easily be accomplished. If
fastened in a bone, he advises us to turn it round so as to
loosen it ; and if that does not sutfice, he recommends us to
leave it for a few days, when it may be extracted without diffi-

culty. If the shaft or Avooden part of a weapon be broken off,

he apply to the head an impellent instrument
directs us to
with a concave extremity, so as to adapt itself to the form of
the body M'hich is to be extracted. When the weapon is
poisoned, he recommends us, if possible, to cut out the flesh
around it. When a
weapon lodges in the breast, belly, bladder,
or side, and can be felt with a probe, he du'ects us to cut
cautiously upon it, taking care not to wound a vein or nerve.
He concludes with giving drawings of forcipes and impellents.
(Chirurg. ii, 96.)
 426 WEAPONS. [book vi.

CoMM. Rliases gives sensible directions for the management of these

cases^ but they are so similar to those of our author that we
need not dwell upon them. If the size of the wound permit,
he directs us to introduce a forceps to the iron head and draw
it out. If the opening be too small, he recommends us to en-

large it. When the weapon has nearly passed through the
limb, he advises us to push it out at the opposite side. Thorns
and such like sharp things are to be removed by the applica-
(Ad- Mans, vii, 25.)
tion of extractive plasters.
Avicenna gives a literal translation of the present chapter
of Paulus, and supplies nothing additional of much interest,
(iv, 4, 2, 10.)
The account given by Haly Abbas is fall, but like that of
Albucasis. He mentions that he had seen cases in which an
arrow had been lodged in the intestines, and although faeces
were discharged by the wound, the patient recovered. He
adds that others relate cases in which recovery took place
although the liver or omentum had been wounded. (Pract.
ix, 15.)
The rules for the extraction of weapons laid down by Theo-
doricus and all the earlier authorities are mostly copied from
the ancient authors, (i, 22.)
It would be naturally expected that we should give some
account in this place of the surgery in the heroic ages, as far
as it can be learned from the poems of Homer and the Com-

mentary of Eustathius. The Commentator remarks that three

methods of extracting Aveapons are mentioned by Homer 1 : .

By evulsion or pulling the weapon backwards, as in the case of

Menelaus. (Iliad, iv, 214.) 2. By protrusion or pushing it

forwards, as in the case of Diomedes. (Iliad, v, 112.) 3.

By enlarging the wound and cutting out the weapon, as prac-

tised by Patroclus in the case of Eiirypylus. (Iliad, xi, 218.) He
further remarks that it appears to have been a common practice
to suck a wound with the mouth; and, he adds, that this method
was still in use among a barbarous people in his days. (IHad,
iv,219.) The weapons used in the Trojan war were swords,
spears or javelins, stones flung by the hand or by a sling,
hatchets or axes, as used by the Trojans on certain occasions
(Iliad, xii, 590), and arrows. Eustathius remarks, however,
that there would appear to have been very few bowmen. In
SECT. Lxxxix.] FRACTURES. 427

his Commentary on the Odyssey he states that poisoned arrows Comm.

were never employed in war, but only for killing wild beasts. ——
'

*
'

(Odyss. i, 260.) We believe that no weapons of iron were

used in the war of Troy, and that they were all made of
copper. (See Jameson's Mineralogy, iii.) Little transpires
from Homer with regard to the internal treatment. In one
place (Iliad, xi_, 638) mention is made of a mixtui'e of wine and
cheese ha\ing been given to a wounded warrior, which practice,
Eustathius says, had given rise to a variety of conjectures.
Some supposed that the wound in the case referred to was so
sHght as not to render the administration of stimulants im-
proper ; others rather believed that the loss of blood had been
so great as to call for the use of wine to support the
strength.
But many, he adds, were of opinion that men in the heroic
ages lived so temperately that their constitutions readily bore
things on extraordinary occasions, which in after ages were
reckoned to be of too inflammatory a nature. This explanation
is advocated by Athenseus. (Deipnos, i.) In the Odyssey,
mention is made of a hemorrhage being stopped by incanta-
tion, which shows, as Eustathius remarks, that amulets and
incantations were as ancient as the heroic ages.

SECT. LXXXIX. ON FRACTURES AND THEIR DIFFERENCES.

Having described the surgical operations on the fleshy parts,

we have next to give an account of those which relate to the
bones, I mean the treatment of fractures and dislocations ; for
these also under the department of surgery. And first, of
fall

fractures, beginning with fractures of the bones of the head,

because they hold an intermediate place between the operations
on the fleshy parts and the bones, and because the cranium
overtops all the other parts. In general terms, then, a fracture
isa division of a bone, or rupture, or excision of it, produced
by external violence. The differences of fractures are many.
A bone, then, is said to be fractured raphanatim, scandulatim,
in unguem, polentatim, and per defr actionem. A
fracture rapha-
natim is a transverse one through the thickness of the bone,
and is called also cucumeratim and caidatim, because cucumbers
and cabbages break in this way. Scandulatim is a longitudinal
 428 FRACTURES. [book vi.

fracture of a bone. is a fracture at one

In unyuem part straight,
and and it is also called arundatim.
at its extremity lunated,
Polentathn is a fracture of a bone into small pieces and it is ;

also called nucatim hj some Defractio or

:
pracisio is when part
of a bone is taken away with tearing of the skin, so that part
is removed and is wanting. These are the differences of fractui'es.

CoMM. Commentary. The following is a list of the ancient authors

who have treated of fractures and dislocations :
Hippocrates
(de Fracturis; de Articuhs; de Yulner. Capit. ; Officina Medici);
Galen (Comment, in eosdem, Meth. Med. vi.) ; Celsus (viii) ;
Oribasius (de Machinamentis, &c.) ;
Nicetse CoUectio ex
Chirurg. Grsec. ; Apollonius Citiensis (Scholia in Hippocrat.
ed. Dietz) ;
Avicenna (iv, 5, 23) ; Rhases (ad Mansor. vii, 26 ;
DiA-is i, 140; Cont. xxix) Averrhoes (CoUig. "\dij 36) ; Avenzoar
;

(ii, Q, \) ; Haly Abbas (Pract. ix, ad finem.)

Hippocrates does not make use of the technical terms explained
by our author in this section, and Galen hints that he thinks
his Master did better in confining himself to words generally un-
derstood. Galen defines only a few of these terms. He calls
that kind of fracture in which the end of a bone at an arti-
culation is entirely taken away, cibruptio {a-n-ayfxa.) trans- A
verse fracture with a complete separation of the broken portions
is called a fracture caulatim (jcovArjSoi'.) A
longitudinal division
not attended with an entire separation of the parts is called
scandulatim ((rytSa/crjSov.) He thinks the later writers on the
subject who had introduced the use of such terms as raphanatim

{pacpain^^dv)
&.nd polentatim (aX^trr^Soi') had refined too much.
All the terms mentioned by our author occur in a fragment
of Soranus, preserved in the collection of Nicetas. They are
also treated of very elaborately in the fragments of Heliodorus,
contained in the same collection.
Celsus, who was studious of perspicuity and elegance, avoids
all technical terms as much as possible. He thus defines the
varieties of fractures. A bone, he says, may be split longitu-
dinally like a piece of wood, or it may be broken transversely
or obliquely, and its ends may be blunt or sharp, which last

variety is the worst of all, as they cannot be easily made to

unite with the other parts, and are apt to wound the muscles
and nerves. Sometimes the bone is broken into fragments, and
SECT. xc.J HEAD. 429

iu certain bones a fragment is occasionally separated entirely Comm.

'

from tlie broken bone. ''

The Arabians^
especially A^acenna^ Haly Abbas, andAlbucasis,
adopt the terms used by our author. Albucasis remarks, that
the fracture of a bone is recognised by the derangement of the
broken pieces, by theii* projection, and the crepitus produced
upon pressure. He says, however, that there may be a fissure

without derangement or crepitus.

SECT. XC. ON FRACTURES OF THE BONES OF THE HEAD.

In head is a division of the

particular, then, a fracture in the
cranium, sometimes simple and sometimes complex, occasioned
by some external violence. The differences of fractures of the
head are these a fissure, an incision, an expression, a depres-
:

sion, an arched fracture, and, in infants, a dent. A fissure,

then, a division of the skull, either superficial or deep, when

is

the inward bone is not removed out of its place. An incision,

or slash, (ey/coTTj)) is a division of the skull with refraction of
the fractured bone (if the injured bone be broken off some call
the affection deasciatio, i. e. as if done by a hatchet) An ex- .

pression is a division of a bone into many parts, Avith a sinking

down of the fractured pieces upon the membrane of the brain.

A depression (ty-yiawjito)
is a division of a bone with a sinking
downwards of the fractured bone from its natural position

towards the meninx. An arched fracture {Ka/uaouyaig), as Galen

says, a division of the skull attended with elevation of the
is

fractured pieces in the middle, and depression around the edges

of the sound parts, like as in expression. Such is his opinion.
Some enumerate also the capillary fracture, but it is a very
narrow which eludes the senses, and therefore, being
fissure
often overlooked owing to the symptoms of it not being obvious,
it occasions death. An indentation is not a division of a bone,
and, therefore, such an injury is not properly called a fracture,
but is, as it were, a protrusion and bending of the sktdl in-
as
wardly, forming a hollow without a solution of continiiity,
when vessels made of copper, or the raw hide of an ox, are
struck on the outside. There are two different kinds of in-
dentation, for either the bone is depressed through its whole
430 FRACTURES. [book ti.

thickness, so that often a separation of the membrane of the

brain takes place, or it is pressed upon by the skull through-
out ; or sometimes the indentation does not aflfect the skull
through its whole thickness but only its outer plate down to
the diploe. To
these differences some also add that by reper-
cussion, which happens, say they, when a fracture of the cra-
nium takes place opposite to the part which received the blow.
But they are in a mistake, for what happens to glass vessels
does not, as they say, happen here; for, this happens to them
from their being empty, but the skull is full and otherwise
strong. But when many other parts of the head have been
struck, as in a fall, and a fissure of the skull takes place with-
out a solution of continuity of the skin, an abscess afterwards
forms in it, and being opened, this fissure is discovered, which
appears to them to have been occasioned by the blow on the
opposite side ;
and this is to be cured like the fissure first

mentioned. If a fracture, then, occur in the head, it is dis-

covered by the sharpness, weight, hardness, or violent force
of the body which struck it, and by the symptoms which
supervene upon the person who has been struck, such as ver-
tigo, loss of speech, and sudden prostration, more particularly
if itbe a fracture with depression, or contusion, or expression,
or the internally-arched fracture, owing to the compression of
the brain. It is also discovered by its appearances to the
senses ;
for if there be a considerable division of the skin we
ascertain the occurrence readily thereby; but if there be no
division, or a very narrow one, and we suspect a fracture, we
make an incision in the skin and ascertain it by the sight, or
by probing it with an instrument. If then it be any of the
other kinds of fracture will readily be apparent, but if it is
it

only a narrow capillary fissure which eludes the sense, having

poured on the part some black liquid medicine, or the common
writing ink, we scrape the bone, for the fissure appears black,
and we must go on scraping until the symptoms of the fissure
disappear but if it extend to the membrane we must desist
;

from the scraping, and endeavour to ascertain whether the

membrane has separated from the bone or remains fixed. For
if it remain, the inflammation of the wound continues mode-
rate, thepatient gets gradually freed from the fever, and the
pus appears concocted. But if the membrane has separated.
SECT, xc] FRACTURES. 431

the pains increase and tlie fever in like manner^ the bone

changes colour, and then unconcocted pus is discharged ; and

if the person who has the charge of it neglect the case, and has

not recourse to perforation^ still more grievous symptoms Avill

come on, vomiting of bile, convulsions, disorder of intellect,
and acute fever, under which circumstances one must decline
operating. But if these are not present, and the membrane
has not separated, and if the fracture be a mere fissure, it may-
be cured by scraping alone, although it be of considerable
depth. If it extend to the diploe only it is to be scraped down
to it, or the broken bone removed, as will be described. If
broken into small pieces, these also are to be extracted with a
convenient instrument. And if the membrane separate, and
you have treated the patient from the commencement, and if
it be winter, endeavom' by all means to effect the removal of

the bone before the fourteenth day but, if in summer, before ;

the seventh, while the afore-mentioned symptoms have not come

on you may operate in this way :

The Operation. —
Having first shaved the head about the
wound, we make two incisions intersecting one another at right
angles like the Greek letter X, one of them being the wound
already existing then dissecting the four angles at the top, so
;

that the bone about to be perforated may be wholly laid bare,

if there be bleeding we apply pledgets moistened in oxycrate,

but if not dry ones ; and then applying a compress out of wine
and oil, we use a proper bandage; and next day, if no new
symptom supervene, we proceed to perforate the afi'ected bone.

Wherefore, having placed the patient on a seat, or in a reclin-

ing posture suitable to the wound, and stuff*ed his ears with
wool in order to avoid the noise of the perforation, we loosen the
bandage from the wound, and having removed all the dressings
and sponged it, we direct two assistants with small twisted
bands to retract the four angles of the parts lying over the
fracture, and if the bone be weak, either naturally or from the
fractiu-e, we cut it out with counter-perforators, beginning first
with the broader ones and changing to the narrower, and then
using those which are of the form of a specillum, striking gently
with the mallet to avoid shaking the head. But if the bone
be strong it is to be first perforated with that kind of perforators
432 FRACTURES. [book vi.

called abaptistie, which have certain eminences projecting a

littleabove the point that prevent them from sinking clown
to the membrane^ and then, by using the chisels, Ave remove
the fractured bone not at once, but by pieces, if possible with
the fingers, or otherwise with a tooth forceps, or bone forceps,
or hair-nippers, or some such instrument. The space between
the perforations should be as great as the breadth of the largest
head of a specillum, and its depth should be until it is near

the inner sm-face of the bone, taking care that the perforator
(trepan ?) do not touch the membrane. Therefore, in order to
suit the thickness of the bone with the size of the perforator,
several ought to be previously prepared for the purpose. But
if the fracture extend only to the diploe the perforation should

be earned no farther. After the removal of the bone, ha^-ing

cleared away any asperity that remained after the cutting of
the bone with a carving instrument, or the extremity of a per-
forator, using the meningo-phylax as a protector, and bringing
away carefully the small bones and spiculse which remain, we
proceed to the application of the dressings. This is the more
common, and at the same time the easiest and least dangerous
mode of operating ;
but the method of performing it with a sort
of incisor called lenticular is
greatly praised by Galen, being
performed without perforation after the part has been scraped
all round with hollow chisels {kvkXlgkoi). Wherefore he says
" If
thus :
you have once laid bare the place, then applying the
incisor, which has a projection at the extremity like a lenticu-
lar, blunt and smooth, but sharp longitudinally, when you apply
the broad part of the lenticular to the meninx, divide the cra-
nium by striking with the small hammer. For we have all that
we require in such operations ; for the membrane, even if the
operator were half asleep, could not be wounded being in con-
tact only with the broad part of the lenticular, and if anything
adhere to the cranium, the round part of the lenticular removes
its adhesion without trouble. And behind it follows the inci-
sor, or knife dividing the skull;
itself, so that is
impossible
to discover another mode of operating more free from danger
or more expeditious." But the mode of operating with saws
and the instruments called chceuicides or modioli (trepans ?)
is condemned by the moderns as a bad one, and the
operation
may be done as we described for fissure. The same mode of
SECT, xc] HEAD. 433

remoAdng bones will be applicable in the other fractures of the

cranium. But regarding the amount of bones requiring ex-
" What
traction Galen informs us, wi'iting thus plainly parts :

of a fractured bone are to be removed I will now explain to

you in order. When it is greatly bruised it is to be taken out

entu'e, but if certain fissures extend fi'om it farther, as some-

times they appear to do, we must not pursue them to their
termination, well knowing that no harm will result from them
if everything else After the operation,
be properly done."
a
having dipped simple linen rag of the size of the wound in oil of

roses, we lay it over the membrane as a cover, and in like

manner, ha\"ing dipped a small ball of wool in oil of roses, we put
it over the aforesaid rag, and then having moistened a doubled

compress in wine and oil, or in the same oil of roses, we apply it

to the whole wound, taking care that they be not too heavy for
the meninx. We then have recoui'se to a broad bandage, which
also must not be made tight, but so as merely to preserve the

pledgets. And the regimen is to be what is called anti-inflam-

matory and such as is applicable for fevers, frequently bathing
the membrane with oil of roses. After the third day loosing them
and sponging the part we pm^sue the treatment applicable for
recent wounds and the anti-inflammatory sprinkling upon the
;

meninx some of the powders called cephalics until it incarnate,

and sometimes scraping the bone, if it require it, on account of
certain projecting spiculse, or for the sake of incarnation itself.
And we may apply medicines of the ingredients recommended
for wounds.

On inflammation of the membrane of the brain. Often after

the operation the membrane is inflamed, so as not only to rise

above the skull but likewise above the skin, and is attended with
hardness, and obstructs the natural pulsatory
motion of the
brain, in which case convulsionsand other severe symptoms, or
most part supervene. It becomes inflamed either
death, for the
from the imtation of some sharp projecting piece of bone, or
from the weight of the dressings, or from cold, or from eating
too much, or from di'inking wine, or some other cause not ap-
If then the cause be obvious it isbe speedily re-
to
parent.
moved, or, if it is not, it will be proper to contend strenuously
against it, either by having recoiu'se to venesection, if nothmg
II. 28
 434 FRACTURES. [book vi.

or to a diet suitable for inflammation. 'We must

prohibit it,

also use topical remedies, sucli as warm embrocations vrith. hot

rose-oil, and bathing the part -^rith the decoction of marsh-

mallows, or of fenngi-eek, of linseed, of camomile, and such like,
and cataplasms of raw barley flour, or of linseed with the afore-
mentioned decoction and the grease of a fowl ; and irrigations
with wool to be poured upon the head and occiput, and some
anti-inflammatory oil is also to be poured into the
meatus
auditorius. The viscera also are not to be neglected, but suit-

able cataplasms are to be applied to them. And care is to be

taken of the whole body, putting the patients into warm baths
and anointing them. If the inflammation continues and nothing
else Hippocrates directs us to purge them with cho-
prohibit,
lagogue medicines.

On blackness of the meninx. When the meninx turns black,

ifthe blackness be superficial, and has been brought on by me-
dicines which have that propei-ty, we may remove it by applying
three parts of honey with rose-oil upon pledgets, along with the
other suitable treatment. But if the blackness has come on

spontaneously, more particularly if deep-seated, and be attended

with other dangerous symptoms, then we must refrain from
using them, for these appearances indicate a dissolution of the
natm'al heat. I knew a person who had his skull trephined a
vear after the accident, and recovered. The fractiu'e was from
a weapon, and was situated on the bregma, and the discharge
having an outlet, the meninx was thereby preserved free from
injurj^

CoMM. Commentary. it doAvn as a

"— — ride that no injuries Hippocrates
'
'
very properly lays
of the head are to be considered as trifling,
since wounds aff'ecting only the integuments will sometimes
prove dangerous if neglected. He treats distinctly of fissures,

contusions, and fractures of the cranium, which is an excellent

arrangement of these accidents. Our limits, however, will not
allow of our entering minutely into an explanation of his modes
of treatment. In fractures of the head he forbids liquid appli-
cations, especially wine. He calls the trephine by the name
of rpv-rravov and makes mention of a raspatory {^varrip)- It
',

would appear that his object in applying the trepan was alto-
SECT, xc] HEAD. 435

getlier preventive ; that is to say, that he had recourse to the Com M.

operation in order to prevent inflammation and sweUing of
the brain, and not to remove the eflPeets of them. He holds
that severe contusions without fracture and fissures are more
dangerous than injuries attended with depression and consider-
able separation of the fractured portions, and it is in the former
class of cases that he recommends trepanning. When the bone
is broken into several
pieces, he says it stands in no need of the
trephine. One of the varieties of fracture, which he describes
with surprising accuracy, is the separation of the bones at a
sutiu'e. It, he adds, seldom requires the use of the trephine.
He remarks, that couM^ilsions often occur in consequence of
injuries of the head, and that the convulsions are in the opposite
side to that in wliich the injury of the brain is seated. He
gives an excellent account of erysipelas of the face supervening
upon injury of the head, and recommends it to be treated with
Altogether, his work On Injuries of the Head'
'
cholagogues.
bespeaks extensive acquaintance with the subject, and we need
have httle hesitation in pronouncing it to be one of the most
valuable relics of antiquity. In one of his aphorisms, he states
that concussion of the brain occasions loss of speech; that is

to say, as Galen explains his meaning, superinduces apoplectic

symptoms.
Galen mentions three sorts of instruments for operating upon
the cranium, namely the cyclisci, the lenticulars, and the nar-
row raspatories. Fractures are classed by him into those which
extend only to the diploe, and those which penetrate to the
inner surface of the bone. He likewise dirides them into sim-
ple fissures, contusions,and depressions inflicted by the body,
which occasioned the injury. When the fissure extends down
only to the diploe, he directs us to scrape down the bone with
raspatories, and then to apply the medicines called cephalics,
consisting of Illyrian iris, the farina of tares, manna, birthwort,
and panacea. Of the fractui'es which extend to the meninx, if
a simple fissure, it may be treated in the same manner by ras-
patories ; but if attended with contusion, by perforating it all
round with an auger (trepan ?), and then using the scalpel,
or by means of the cychsci at once. Some, he says, instead of
these instruments, use the abaptista, which had a circular bor-
der projecting a little above the sharp extremity of the per-
 436 FRACTURES. [book vi.

CoMM. forator. Some, he from timidity, use only the instrament

— called
"""^ '

choenix (modiolus).
says,
Of all modes, however, he prefers
that by the lenticular, as stated by our author. He then de-
fines the engeisoma and camerosis, which we have translated
the depressed and the arched fractures, the former being attended
with depression, and the latter with elevation in the middle of
the fracture. These are to be taken out entire by means of a
lenticular or bone forceps. This, by the way, was the practice
of the celebrated Hehodorus, of whose opinions on this subject
we will give a short abstract below. (Nicetse CoUectio.) Such
is Galenas general treatment of fractm-es of the skull. In a
word, he lays it down as a rule, that parts which are greatly
comminuted, must be entirely removed ; but that fragments,
which extend far, must not be followed to their extremities.
He forbids the use of bandages. He mentions having tre-
panned the head occasionally, but states that he generally left
this task to the Roman surgeons. Sprengel remarks, that Galen
was averse to the use of the trepan, and preferred the two
instruments called by him ^a/cwroc aud KVKX'iaKoc. The latter,
he remarks, was, properly speaking, a hollow chisel (un ciseau
creux), which he drove in with a hammer. The former was a
true lenticular-knife, resembling that described by Petit and
Bell (Hist, de la Med., 18.)
We will now attempt an abstract of Celsus's lengthy account
of these accidents. When the skull has been struck, he recom-
mends us in the first place to inquire whether the person has
vomited has experienced dimness of \ision, with loss of
bile,

speech, or a discharge of blood from the nose and ears ; whether

he fell down at the time, and if he lav in a comatose and sense-
less state. These symptoms, he says, indicate a fractiu'e of the
bone, and the accident is to be looked upon as serious. But if
torpor has come on, with mental aberration, paralysis, or con-
ti'action of the tendons, it is probable that the membrane of
the brain has been injured, and little hopes of recovery need
be entertained. In order to ascertain whether or not the bone
be fractured, nothing answers better, he says, than making an
examination Avith a specillum (sound), that is neither too sharp
nor too blunt. If the bone is felt to be everywhere smooth,
we are certain that it is sound but if roughness is detected,
;

we know that it is occasioned by a fracture. He warns us.

SECT, xc] HEAD. 437

however, not to mistake a suture for a fissure, as was once done Comm.
by Hippocrates,, upon whom he bestows a merited eulogium for
' '
'

this frank confession of his own blunder. When this method

of inspection does not succeed, he advises us to pour writing
ink on the part and to scrape the bone, which will appear black
when there is a fissure. Sometimes, however, he adds, the
blow has been sustained on one part of the skull, and the fissure
occurs in another. This is the case of fractvu'e by repercussion,

of which we will make further mention afterwards. Celsus

says, we ought to suspect the existence of it when symptoms
of fracture have occurred without our being able to detect one
in the part which received the blow. He also recommends us,
if softnessand swelling be detected in any part, to examine it,
as it is likely that a fissure of the bone may be found there.

(By the softness and swelling, of which he speaks, he pro-

bably meant the ptfffy tumour, described by Mr. Pott, in his
work on ' Injuries of the Head.') Sometimes, he adds, but
rarely, although the skull be safe, a vessel in the membrane of
the brain bursts and pours forth much blood, which^ becoming
coagulated, occasions great pain and dimness of sight. In such
a case, he says, the pain will point out the seat of the extrava-
sation, and if an incision be made in the skin, the bone will be
found to be pale —
" eo loco cute
incisa, pallidum on reperitur."
(Heliodorus, in like manner, states that when extravasation has
taken place within the cranium, the bone will be found to be
pale
— Nicetse Collectio.) The fact that in cases of extravasation
below the skull the bone pale, that is to say, does not bleed,
is

ispointed out by Mr. Abernethy as an unerring guide to prac-

tice in such cases. He says, " unless one of the large vessels
of the dura mater be wounded, the quantity of blood poured
out will probably be inconsiderable ; I believe that a bone so
circumstanced will not be found to bleed.'' Celsus then pro-
ceeds to the description of the operation. If the injured por-
tion of the bone is not sufficiently exposed, he directs us in the
first place to enlarge the wound of the integuments. The
periosteum is then to be scraped away with a raspatory. The
form of the incision, if made solely by the operator, is to
consist of two cross lines intersecting one another like the
letter X, from the extremities of which the skin is to be
dissected If there be a discharge of blood it is to
away.
 438 FRACTURES. [book ti.

CoMM. be stopped by a sponge dipped in vinegar, or

' '
by compresses,
*
wLDe the head is elevated. In cases of fracture and fissure
of the cranium, the ancient surgeons, he says, had immediate
recom-se to instruments for cutting out the part ; but he
recommends the surgeon, in the first place, to
tiy the effect of
applications for allaying the in-itation, such as suitable plasters,
with wool soaked in vinegar, proper bandages, and the like.
This treatment is to be continued for five davs, and on the sixth
the part is to be fomented with a sponge soaked in warm
water. If the skin begin to heal, and the fever to
abate, and
ifthe appetite return, with sound sleep, he recommends
perse-
verance in the use of these applications. In this manner, he
adds, fissiu-es will often be filled with callus ; thus, also, bones
more extensively fractured may become united with caUus, which
forms a much
better cover to the brain than the common in-
teguments after a piece of bone has been cut out. But if, on
the other hand, fever set in at the first with disturbed
sleep, a
copious discharge from the wound which shows no appearance
of healing ; if the glands of the neck swell, or if violent
pain
comes on, with loathing of food, the surgeon must
proceed
forthwith to the operation. Dangerous
consequences, he adds,
may arise either from a fissui-e or a depression. A
fissm-e may
allow fluids to descend to the membrane of the brain, and
thereby gi\ e rise to pain and inflammation. Adepression in
like manner may occasion irritation, and spiculae of bones
by
ATOUuding the brain may prove particularly troublesome. As
a general rule, he recommends as little of the bone as
possible
to be removed. If the one edge
overtop the other, it wiU be
sufficient to remove with a
raspatory the prominent part ; for
when taken away there will be a sufficient opening for the
it is

cure. If the edges are firmly compressed

together, a hole is to
be bored with a wimble (terebra) on its side, at the distance
of a finger's breath, and from it two lines are to be cut to the
fissure with a
raspatory (scalpel), in the form of the letter V, so
that its vertex may be at the hole, and its base at the fissure.
If the fracture be long, more of these holes must be cut out.
In cases of depression the whole depressed portion must be re-
moved. In Avhatever way the pieces of bone are cut
they are
all to be removed
by means of a suitable forceps. But we will
not occupy more space in explaining his method of
operatirg.
SECT, xc] HEAD. 439

as we have been already more than usually prolix.

Enough has Comm.
been said to show that the practice of Celsus was sensible, and ——
'
'
'

in many respects not very different from that which is now fol-
lowed in such cases. It will be seen that he was not forward
to perforate the skull, and that many of the rules of treatment
new discoveries are distinctly mentioned by
lateh" laid doAvn as
him. For a description of the instruments used by him,
namely, the modiolus, terebrse, and scalper excisorius, we must
refer the reader to the original Avork. (viii, 3.)
The different kinds of fracture to which the skull is subject, and
the treatment of them, are given very minutely in the Fragments
of Heliodorus, published by Cocclii(Ch.Yet.lOO,&c.); but as the
views of the subject there laid down are nearly the same as our
author's, we shall only give a few specimens of the doctrines he
inculcates. He describes very distinctly the species of fracture
called diastasis, namely, the separation of two bones of the
head at a suture. He directs that the head should be moulded
into former shape, and secured with compresses and tight
its

bandaging. When matter forms he recommends it to be cut

down upon. "When depression of the bone without fracture
not to be much interfered with, if no
occiu's in children, it is
untoward symptoms come on. But if any collection take
place, it is to be evacuated, even if trepanning should be re-

quired for this purpose. He says, in the treatment of simple

injuries of the scalp, that the cure by the first intention is the
quickest, but the suppurative the safest. In the same Collec-
tion there are a few fragments of Archigenes, containing some
curious and important matter. He describes diastasis of the
bones with more minuteness than any other ancient author,
but does not touch upon the treatment. He appears to treat
of hernia cerebri under the name of hypersarcosis, and recom-
mends the excrescence to be removed, with septic medicines
or the sc^pel, down to the membrane {dura mater) ; after
which a light dressing dipped in rose-oil is to be applied, and
the part surrounded with a circular bandage. (Chu'urg. Vet.
p. 119.) Effusion of blood within the cranium is indicated by

fevers coming on with chills, inordinate heat, disturbed sleep,

eyes glossy, muddy, and red, loss of flesh, &c. In such cases,
he remarks, if operated upon speedily, they exhibit promises of

recovery, but generally soon die. (Ibid. 117.)

 440 FRACTURES. [book vi.

CoMM. Albucasis enumerates the same varieties of fracture as our

'

author, and his clescripton of 'the operation is little difierent.

"""^^

The drawings wliich he gives of the surgical instruments used

by the ancients in operations on the head are interesting, as
they tend to illustrate the descriptions of Paulus and the other
authorities. We may remark, by the way, that his abaptista,
which he calls terebru non i^rofundantia, are a sort of spear-
shaped instruments, having a globular ball a short way above
their extremity. They, therefore, had no resemblance to a
modern trephine with a conical crown.
Avicenna gives a very full account of injuries of the head,
but it is taken almost word for word from Galeu and our author.
Nearly the same may be said of Haly Abbas.
Avenzoar states that trepanning the skull will be proper
when there fracture with depression ; but laments that in
is

his time it would be

difficult to find a surgeon capable of per-

forming the operation. Averrhoes likewise intimates that he

did not know a surgeon who could trepan the skull. This is an
additional proof to what we have mentioned in the section on
amputation that the Arabians in general were very timid
operators.
Rhases strongly inculcates the propriety of having recourse
promj)tly to the operation,when the bone is fractured and de-
pressed, before dangerous symptoms have come on. Unless
there be pressure on the brain, however, he does not approve
of haAdng immediate recourse to the operation.
It will be remarked that Celsus affirms, and our author

denies, the occurrence of fracture by repercussion. It is the

same as la fractuTe par contre-coup of the French medical
authors, or the counter -fissure, namely, the fractura per resoni-
tum of the earlier authorities. Soranus, who, like Celsus, be-
lieves in its occurrence, defines it to be a fissure which takes

place in the part of the cranium opposite to that which received

the blow. (Nicetse CoUectio.) Hippocrates himself makes
mention of the counter-fissure, and pronounces it to be in-
curable, as the sm-geon has no certain data to discover its
existence. (Vul. Cap. viii.) Tulpius, Pare, and Van Sweiten
have related cases of the counter-fissure. (See Comment, in
Boerhaav. Aph. 254.) Heister also believed in its occiirrence.

(Chirurg. i, 1, 14.) For cases of it he refers to D. Wagnerus,

SECT. xc.J HEAD. 441

(Dissert, de contra-fissura,) and Le Maire (De resonitu.) He is Comm.

'

mistaken^ however, wlien he quotes ^Egineta as an authority

'

for it, Sabatier relates a case of fracture par contre-coivp in

the sternum occasioned by a fall on the back. (Memoires de
VInstitut Natural^ ii, 120.) See also Sprengel (Hist, de la
Med. 17.) Garengoit further relates various cases of the
contre fissure. Bertaphalia defines it in much the same terms
as Soranus. (v, 5.) Mr. Guthrie treats learnedly of this sub-
ject ; but although he quotes many
instances from the earlier
authorities of fracture on one side of the head from a blow on
the other, he states that in later years there is little proof of
such an occurrence taking place. He admits, however, as in-
the occurrence of fracture at the base of the skull
disputable
from a blow on the vertex or back of the head. (Injuries of the
Head, 65.) He also states that the term airr\yr]i.ia of our
author, and that of ' resonitus,^ as used by Latin authors, was

applied to that species of fracture when

the inner plate of the
skull is knocked in or fractured, without the outer one being

injured. (Ibid.) It does not appear, however, that the ancients

applied the term in this sense. Thus Soranus, as stated above,

defined it to be a fissure produced in the parts of the skull oppo-
site to those which have received the blow. See the learned
note of Cocchi. (Ap. Chirurg. Vet. 47.) Galen's definition is

to the same effect. (Ibid. 107.)

The treatment here recommended for inflammation of the

membranes of the brain is so judicious, that even at the present
be made on it. Our late
day scarcely any improvement could
authorities, have shown the utility of cholagogue piu^gatives in
such cases, and it will be remarked that they are recommended
Vuln.
by our author and Hippocrates. (De Cap. 27.)
Celsus directs us, when the dm-a mater. gets inflamed and
swelled, to pour tepid rose-oil upon it ; and if it rise above the

bone to apply lentil or vine leaves pounded with fresh butter

or the grease of geese. He enjoins us to avoid all kinds of

food requiring mastication, also smoke and sternutatories. When
the brain projects beyond the bone (a case called hernia cere-
briby modern surgeons), he advises us to sprinkle it with
squama seris, and to use cicatrizing applications. A
person
who has sustained a fracture of the skull is advised to avoid
 442 FRACTURES. [book vi.

CoMM. the sun, wind, frequent baths, and the free use of wine until
" '

the wound is healed.

'

Aetius recommends bleeding and laxative clysters, (vi, 47.)

Heliodorus recommends abstinence at first, and afterAvards
spare diet, water for drink, bleeding, when the inflammation is

violent and the patient full, light dressings, cataplasms of

melilot, hnseed, and oil, and fomentations with decoctions of
fenugreek or mallows. Archigenes directs us when there is a

fungous tumour projecting above the bone, to remove it with

septicsor the scalpel, and then to apply pledgets. (Nicetse Collect.)
Avicenna and Albucasis repeat our author^s directions. Haly
Abbas follows in the same strain, recommending us to remove
any cause of irritation, to pour refrigerant oils on the place, and
to have recourse to venesection. (Pract. ix, 85.)
Our author having alluded to the pulsatory motion of the

brain, we will state briefly the opinions of the principal ancient

and modern authorities on this matter. Besides our
author,
Hippocrates, Galen, Oribasius, and Aetius, among the ancients,
mention a certain movement of the brain, namely, a swelling
up during expiration, and a falling down during insjjiration.
Fallopius, Vesalius, Voltherus, Goiter, and Boerhaave main-
tained that this opinion is unfounded. But Columbo, Piccolo-
mini, Dulaurens, Riolan, Littre, and more recently, Schliting,
Lamure, Haller, Lorri, Vic d^Azyr, and Dumas, have reproduced
this ancient truth. We once had an opportunity of observing
the pulsatory motion of the brain in the case of a poor boy who
had lost a considerable piece of the skull by exfoliation.
This would appear to be the most suitable occasion which
we shall have to introduce an account of the osseous tumour,
nearly all the information regarding which is derived from a
fragment of Heliodorus. He describes it as a hard resistent
tumour, immoveable, without pain, or change of colour. He
says it occurs on all parts of the body, but more especially on
the head, about the temj)les, when if one is formed on each
side they are called horns. He directs that the tumour should
be cut out from the very base, and the bone scraped with a
raspatory. The wound is to be healed by glueing (the first in-
tention?), if possible, but otherwise by suppm-ative applica-
tions. (Ch. Vet. 124.)
SECT, xci.] NOSE. 443

SECT. XCI. ON FRACTURE AND CONTUSION OF THE NOSE.

The under part of the nose being cartilaginous does not admit
of fracture^ but it is liable to be crushed^ flattened, and dis-
torted ; but the upper part being of a bony substance is some-
times fractured. In such cases Hippocrates prohibits ban-
daging, which only increases the flatness and distortion, unless
when from a blow the parts about the middle of the nose pro-
trude. For in these cases he applies a suitable bandage Avith

medicines, in order to give the nose its proper shape. When,

therefore, the nose is fractured in its under parts, having in-
troduced the index or little finger into the nostril, push the parts

outwards to their proper position. When the fracture is of the

inner parts this is to be done with the head of a probe imme-
diately, during the course of the first day, or not long after-
wards, because the bones of the nose get consolidated about
the tenth day. But they are to be put into the proper position
with the index-finger and thumb externally. In order to pre-
vent the bones from changing their position, two wedge-like
tents, formed of a twisted linen rag, are to be applied, one to
each nostril, even if but one part of the nose be deranged, and
these are to be allowed to remain until the bone or cartilage
gets consolidated. And some sew the quills of the feathers of
a goose into the rags, and thus introduce them into the nose,
in order that they may preserve the parts in position without

obstructing the respiration ; but this is unnecessary, as respi-

ration is carried on by the mouth. If the nose become in-
flamed we may use some anti-inflammatory appHcation to it,
such as that from juices (diachylon), the one from vinegar and
oil, and such like ; or a cataplasm of
fine wheaten flour boiled

with manna or gum may be applied, both for the sake of the
inflammation and in order to keep the nose in position. When
the nose distorted to either side, Hippocrates directs us, after
is

it has been restored to its proper position, to take a piece of

leather of a finger^s breadth, and having spread one of its ends

with taurocolla or gum, to fasten one extremity of it on that
side of the nose to which it inclines, and after it dries to bring
the thong by the opposite ear to the occiput and forehead, and
to fix the other end of the thong firmly there, so that the nose
 444 FRACTURES. [book vi.

being drawn sideAvays may take the proper position in the

middle. Tliis practice^ however, is not much approved of by
the moderns. If the bones of the nose are broken into small

pieces we must make an incision or enlarge the wound, and

having removed the small bones with a hair forceps, unite the
divided parts with sutures, and use the applications for recent
wounds and those of an agglutinative nature. If there be a
sore within the nose it is to be cured with the pledgets called

lemnisci, spread with suitable ointments. Some also use leaden

tubes until it cicatrize, lest a fleshy excrescence should arise
from the ulcer.

CoMM. Commentary. Some account of Hippocrates's practice is given

' '

by our author. As here mentioned, he strongly disapproves of

•

bandages which, he says, never fail to disappoint the expectations

of both surgeon and patient. He directs us to replace the broken
parts, eitherwith the fore-finger or a specillum. He also describes
the application of the piece of thong ; a distinct account of which
is given by our author. (De Articulis, 30.)
'
Galen, in his Commentary,^ explains the obscurities in the
text,but supplies no additional facts or views of practice. He
greatly disapproved of agglutinative apphcations and bandages.
(Fragmentum ap. Nicetse Collect.)
Celsus gives a full account of fractures of the nose, but as
he follows the plan of treatment recommended by Hippocrates,
it will be unnecessary to dwell long upon it. When the car-
tilages are fractured, the pieces are tobe replaced ^viih a spe-
cillum, or with two fingers pressing on both sides ; then oblong
tents sewed round with a thin soft skin are to be introduced
into the nostrils or a large quill smeared with gum, or arti-
;

ficers'glue may be applied in like manner. He speaks of the

leathern thong, but uses it under somewhat different circum-
stances than those for which our author recommends it. He
directs us to fasten the middle of it to the nose, and the extre-
mities to the temples on either side. When any fragment of
a bone does not coalesce properly with the rest, he recommends
us to extract it with a
forceps. The case, he properly states, is
more dangerous when there is an external wound; but in this
case he recommends us to apply one of the plasters adapted
for recent wounds; like. the others he disapproves of bandages.
SECT, xcii.] LOWER JAW. 445

Rhases, Avicenna, Haly Abbas, and Albucasis lay down ex- Comm.
actly the same rules of practice as Hippocrates and our author. " ——
'

The recent authorities consider the introduction of the tents

into the nostrils unnecessary, and even prejudicial. (See Bell's
Operative Surgery Cooper's Surgical Dictionary.)
; But the
earlier modern writers adopt exactly the practice of the ancients.
Theodoricus recommends us to turn the nose to its proper shape
when distorted, by means of a
strip of linen fastened to its ex-
tremity with ichthyocolla, or the gluten of hides, as directed by
the ancients, (ii, 29.)

SECT. XCII. ON FRACTURE OF THE LOWER JAW, AND CONTUSION

OF THE EAR.

We have treated of contusion of the ear in the Third Book,

as this affection is not of the nature of a fracture. But the
lower jaw is fractured from
many causes. If, be only
then, it

fractured externally, and is not divided into two, as it occasions

a curvature inwardly, the symptoms of it are ob^dous. Where-
having introduced the index and middle fingers of one
fore,
hand — of the right, if the right jaw be fractured, and of the
left, if it is the left
—
we push outwards the internal curvature
of the fracture, which is to be secured with the other hand

externally. The bones of the jaw are ascertained to be set

straight by the equality of the teeth. When the jaw is fractured
completely across, {that is to say, caulatiin,) it is to be set by
making extension and counter-extension, with the aid of an
assistant and the teeth, separated at the broken part, are to
;

be fastened together, as Hippocrates says, and bound with gold,

namely, with a ligature or thread of gold. But since this is
not readily procured by everybody, a strong flaxen thread, a
piece of fine linen, horse-hairs, or the like, may be substituted.
If the fracture be attended with an external wound, we must
examine with a probe and ascertain whether a piece of bone he
broken off, and if this be found to be the case, and the wound
is small, it is to be enlarged and the broken piece or pieces

removed with some suitable instrument, and the lips of tlie

wound united with sutures then dressings suitable to recent
;

wounds with bandages are to be applied. If there be no wound,

 446 FRACTURES. [book vr.

a simple cerate is to be applied to tlie

jaw along with suitable
bandages. In applying the bandage, the middle of it is to be
placed on the occiput, and tlie fold of it
brought along by the
ears on both sides to the chin, and then from the chin to the

occiput again, and then again to the chin, and thence by the
cheeks to the bregma, and then again to below the occiput,
where the bandage must terminate. Upon these again a cover,
that is to say, another bandage, is to be applied to the forehead
and fastened behind the head, in order to secure the afore-
mentioned bandages. Some, also, apply a light splint, or a
piece of leather of proper size, to the jaw, and bandage it as we
have described. Others use the bandage called a muzzle. If
both sides of the jaws are separated at the symphysis, having
removed them a little asunder with both the hands, adapt them
again to one another, and having fastened the teeth together
as aforesaid with a ligature, and applied the
proper bandages,
order the patient to be nourished with thin soups, because mas-
ticationis hurtful in this case. And, if you suspect that it has
been deranged from its position, loose the bandages on the third
daj^, and apply them again, and do in like manner until the
callus be formed. The caUus of the jaw-bone is generally
formed within three weeks at most, because it is spongy and
full of marrow. If any inflammation come on, we must not
neglect the embrocations and cataplasms suitable to it ; which
practice is to be observed in all cases.

CoMM. Commentary. Our author's account of fractures of the lower

"~"^^
'jaw is taken almost word for word from Hippocrates.
(De
Articulis.) He divides them into external fractures, and frac-
tures caulatim (or cauledon), which,
agreeably to the explanation
of this term, given in the 89th section, Galen
interprets to be
a complete separation of the fractured portions. He dii-ects
us to fasten the teeth with a gold thread ; and in other
respects
also his practice is
exactly the same as oiu* author's. His ac-
count of fracture at the symphysis is
very correct.
Soranus gives a veiy sensible account of this subject. A
transverse fracture, he says, often takes
place, but a longitudinal
one seldom, and in certain cases it is not attended with
any
distortion. It to be recognized
is
by examination with the
fingers, when any displacement of the parts and crepitus will
SECT, xciii.] CLAVICLE, 447

be recognized. Fracture in the ramus may be distinguisbed c oMjr.

from dislocation, by tbere being mobiHty in the former case
wbereas there is none in the latter. (Chirurg. Vet. p. 49.)
Celsus says, that in fractures of the jaw-bone the separated
portions are never completely disjoined. When the bone is fairly
broken transveiJse, the tooth at the fractured part protrudes,
and is therefore to be secured to the
adjoining one with a hair.
He then recommends us to apply a double compress, moistened
in wine and oil, with agglutinants ; and afterwards a bandage
or soft piece of leather is to be put on with its middle at the
chin, and its extremities fastened above the head. In this, as
in every other species of fracture, he recommends at first ab-

stinence, and afterwards, liquid food; not allowing a full diet

until the inflammation has subsided. He says, a fractured
jaw-bone gets consolidated between the 14th and the 21st day.
Albucasis evidently copies from our author ; and Avicenna
and Rhases do so avowedly.
Haly Abbas gives a similar account, recommending us to
secure the teeth with a thread ;
and then to apply bandages,
and occasionally a compress, as directed by our author.
By the first variety, described by all the ancient authorities,
was meant, we suppose, a fracture of the condyle.

SECT. XCIII. ON FRACTURE OF THE CLAVICLE.

The clavicle in its natural position is united to the sternum

at its inner extremity, and at its outer it is articulated with the
acromion and, therefore, as it supports the shoulder and the
;

arm undergo a fracture in any part whatever, the

itself, if it

portion of it united to the shoulder sinks down, being dragged

along with the arm. It is better, then, that the fracture be

transverse, and not longitudinal, or partly straight with a lu-

nated extremity, according to the opinion of most surgeons.
For that which is fractured transversely, can, by extension and

compression with the fingers, be readily restored to its proper

position ; but the other kinds of fracture have prominences not
easily arranged. If, therefore, it be broken in any way through
its whole thickness, let one assistant take hold of the arm con-

nected with the fractured clavicle, pulling it at the same time

 443 FRACTURES. [book vt.

outwai'ds and upwards ; and let another pull the opposite

shoulder^ or at least the neck, and let them make counter-ex-
tension. The sui'geon then, with his fingers, is to set the frac-
ture, pushing down what is prominent, and drawing outwards
what situated too deep. If more counter-extension be required,
is

a ball of rags, wool, or something such, may be applied below

the armpit, and the elbow brought to the rib adjoining to it ;
and the other things may be done as described ah'eady. But
if it isfound impossible to raise up the end of the clavicle con-
nected with the shoulder that is lodged down below, ha\dng

laid the man on his back, and placed a moderate cushion under
his back, let an assistant push the shoulders downwards, so that
the bone of the clavicle which is lodged below may be bent up-
wards, and then set the fracture with the fingers. But if part
of the claricle be broken off and unconnected, and if we find
it irritating the parts, we must make a straight incision with

a scalpel and remove the broken portion, and smooth the re-
mainder with chisels, taking care that the instrument called
meningophylax, or another chisel be put under the clavicle to
make it steady ; and if no inflammation is present, we may use
sutures, but otherwise, pledgets. And having prepared various
splenia (compresses), we must apply the larger and thicker to
the projecting part of the bone ; and these, when inflammation
is present, are to be dipped in oil, but otherwise
they are to be
applied dry. And having put a moderate ball of wool under
the nearer armpit, we apply a suitable bandage round by the
armpits, the fractured clavicle and the scapula, bringing the
folds in a proper du'ection ; and if the part of the clavicle con-
nected with the shoulder fall downwards, the middle of a broad
thong be put under the elbow of the same side, and the
is to
whole arm suspended by the neck, and the hand is to be slung
in another bandage as in cases of bleeding at the elbow. But
if, which rarely happens, the outer part be uppermost, we must

not have recom'se to this arrangement of the arm. The patient

must lie in a supine
position, and live upon a spare diet, and
ifnecessary, embrocations and other suitable applications are to
be made until the callus is formed. The callus of the clavicle
is formed in about twenty days at most.

CoMM. CoMMEMTARY. Hippocratcs gives such an account of this

SECT, xciii.] CLAVICLE. 449

accident as clearly bespeaks his intimate acquaintance witli the Comm.

' '

subject. Transverse fractures, he says, are easily healed, whereas '

such 'as are oblique prove more difficidt to manage. He justly

remarks, that the deformity occasioned by this injury appears
at first very great, and annoys both the patient and his phy-

sician, but that it

gradually becomes less, and the patient, feel-
ing little inconvenience fi'om it, grows careless,- and the phy-
sician, seeing no evil consequences result from this neglect,
acquiesces in it,and presently it is found that proper callus is
formed. Hippocrates further exposes the mistake of those who
endeavour to push down the projecting bone, which, he justly
remarks, cannot be effected. The part which projects, as he
states, is almost universally the extremity attached to the ster-
num, the other portion being dragged down by the weight of the
arm and hence the mistake is obvious of those who attempt
;

to push down the upper extremity. He recommends the patient

to lie in bed until adhesion takes place, which generally occurs
between the fourteenth and twentieth day. (De Articulis, 16.)
Galen directs us to apply four splenia or oblong compresses
intersecting one another like the letter X. (Comment, et
Fragment, apud Nicetee Collect.) When the fracture is near
the shoulder, Galen recommends the spica bandage (DeFasciis),
'
for a drawing and description of which, see Heister's Surgery,^
(p. iii, c. 4,
§"1, c. 3.)
Cflsus agrees entirely with the account of the matter given
by Hippocrates. When the bone is broken transverselj', he
says, it willsometimes unite readily without the application of
a bandage. In general, as he explains, the upper end of the
fractured portions is the part attached to the sternum, the other
being attached to the shoulder and dragged down along
with
the arm. He mentions that this is so generally the state of
the parts, that some great masters of the art had declared that
the end attached to the
they had never seen a case in which
shoulder but that Hippocrates, who is rich in informa-
projected,
tion upon these subjects, had affirmed upon his own authority
that such an occurrence is to be met with. In setting the
fracture he properly directs us to raise the shoulder and his
;

mode of bandaging v,'oukl seem to have been little different

from that now generally followed. He directs us to fill the

armpit with wool, and to apply over the fractured portions of
II. 29
 450 FRACTURES. [book vi.

C OMM. the bone a compress three times folded, and moistened in wine
' '
^
and oil or^ if the bone is broken into many fragments, a splint
;

formed of cane (ferula). If the bones incline to the common

position, the arm is to be fixed to the side, but if the outer end
lias a tendency upwards, the arm is to be tied to the neck.

The man is to be Liid on his back. All spiculse of bones are

to be cut out, if it is found that they are wounding the flesh.
Albucasis follows our author closely. He particularly enjoins
the surgeon when there are any projecting spiculse, to make an
incision and cut them out ;
after which, a suture may be used
to heal the integuments, provided the wound is large. com- A
press, soaked in rose-oil, vinegar, and wine, is to be applied to
allay inflammation. He directs the patient to sleep on his back
with a pillow under his armpit.
Rliases, Avicenna, and Haly Abbas give exactly the same
account of the accident as Albucasis and our author.

SECT. XCXIV. ON THE SCAPULA.

The scapula is not fractured in its broad and tabular part,

but a fracture may sometimes take place at its spine. The
fracture being sometimes what is called by expression, some-
times a simple fracture, and sometimes a piece is broken ofi".
The expression^ then, is ascertained by the touch, exhibiting
a hollow, and occasioning torpidity of the adjacent arm and a
throbbing pain. Simple fracture is known by its roughness
and local pain. Both are to be managed according to the

anti-inflammatory plan of treatment. When a piece is

broken off, which also may be ascertained by the touch, if it

gives no disturbance it may be fixed by a convenient bandage,
but when it moves about and produces irritation, it is to be
removed by an incision, and sutures used, as described above.
Bandages like those for the clavicle are to be applied, and the
patient is to be laid on the opposite side.

CoMM. Commentary. Hippocrates has not treated particularly of

"
'
this fracture.
Celsus treats in general terms of the cheek-bone, breast-
bone, the broad bone of the scapula, the spine, os sacrum, &c.
SECT, xcv.] BREAST-BONE. 451

If there be an external wound, it is to be healed with suitable Comm.

' '

dressings ;
after which the fissure or hole in the bone will fill '

up with callus. If the skin be entire, he merely enjoins rest,

a suitable cerate, and gentle bandages.
Albucasis and Avicenna, as usual, copy from our author.
The former states that fractures of the scapula are healed in
twenty or twenty-five days. Haly Abbas, like the others,
directs us to remove any spicules which occasion irritation, to

apply soothing cataplasms, and suitable bandages. Rhases re-

marks that the body of the bone is little subject to fractures-,
but that its extremities may be broken off. A fracture of the
hollow portion of it isascertained by a rising in the part ;
fis-

sures aj:e recognized only by the local pain.

SECT. xcv. ON THE BREAST-BONE.

The middle of the sternum is fractured by simple diA^sion

and by expression, and the extremity of it is broken off". When,
therefore, the fracture is deranged, pain and inequality of the
place follow, and there is crepitus upon pressure with the
fingers. When by expression, there is violent pain, dyspnoea,
and cough, owing to the pleura being irritated and rarely
;

there is vomiting of blood, a hollow in the fractured place, and

yielding thereof. The same treatment is to be applied as that
recommended for the scapula. When the fracture is by ex-
pression, we may practise Hippocrates's mode of setting
which
he recommended for the clavicle when
it inclines inwards,

having recourse to the supine posture, the application of a

cushion upon the back, pressing down the shoulders, and draw-
ing the sides together with the hands. The sides being covered

with wool, we apply a circular bandage, having first put on

two thongs straight from the shoulders, so that afterwards the
two ends may be united in a proper manner, and prevent the
circular bandage from falling off".

Commentary. Hippocrates holds injuries of the sternum Comm,

more dangerous than those of the ribs. He recommends
' '
*
to be
in this case a light diet, rest, silence, bleeding at the arm, and
so forth. (De Artie. 50.)
 452 FRACTURES. [book yi.

CoMM. Celsus directs this fracture to be treated upon general prin-

" '
*

ciples, as explained in the nreceding section.

The Arabians evidently follow our author. Albucasis speaks
of applying thin splints.
The reader will find, upon reference to the ninetieth
section, that a fracture by expression is a comminuted fracture
with depression.

SECT. XCVl. ON THE RIBS,

Of the ribs, called also spathae, those which are long admit
of a fracture in any part, but the false only at the spine, be-
cause there only thev are of a bonv nature for at their an-
:

tenor part they are cartilaginous, and are liable to be crushed,

but not fractured. The diagnosis is not difficult, for an in-
equality presents itself to the fingers of the examiner, and there
is crepitus with derangement at the fractured part. When
the fractured parts incline inwards there is a violent pungent

pain, more severe than that in pleurisy, from the pleiu'a being
wounded as with a sharp instrument there is difficulty of
;

breathing, cough, and often vomiting of blood. The other

modes of displacement, then, may be rectified by the fingers,
but in that inwards cannot be done, owing to the difficulty
this
of appMng Wherefore, some direct us to give
distension.
much flatulent food, in order that by the inflation and disten-
sion occasioned by it the fracture may be propelled outwards.
But this is not necessaiy, for there is no communication be-
tween the chest and the organs of nutrition, and besides, the
inflammation will be augmented by repletion. Others ap-
ply a cupping instrument, which is not amiss, unless a collec-
tion of humours should be occasioned bv the suction, and
the fracture be thereby pushed more Wherefore,
inwardly.
Soranus says, " Let the parts be covered with wool dipped in
hot oil, and let the intercostal
space be filled with compresses,
in order that the circular bandage
applied, as in the case of
the sternum, may He smooth. And let everything be done,
as in pleurisy, according to the
degree of accident. But if any
great necessity compel us, owing to the pleura being irritated,
we must divide the skin and lay bare the broken part of the
 SECT, xcvi.] RIBS. 453

rib ; and then putting tlie instrument for

protecting mem-
brane^ under, to prevent the pleura from being \younded, cut
off properly, and remove the irritating pieces of bone. After
this the parts which are not inflamed are to be united and
cured as recent wounds ; but such as are inflamed are to be
covered with pledgets dipped in oil. The diet and treatment
must be anti-inflammatory^ and the patient is to be laid in the
easiest posture."

Commentary. Hippocrates gives a full and accurate ac- Comm.

"

He remarks that when the broken

'

count of this accident. '

ends of the bone are not pushed inwards, it seldom happens

that fever or any unpleasant symptoms supervene. When fever
is not
present he thinks that abstinence by occasioning an empti-
ness of the belly, proves rather prejudicial by removing what
otherwise tends to support the part aff'ected, which is thereby
made to hang unsupported. In this case a slight bandage
will be sufficient. The ribs, he says, become united in about

twenty days. When the skin about the ribs bruised by a

is

blow or any other such cause, much blood, he says, is often

vomited up. Galen, in his commentary ou this passage, states
that when the vessels of the pleura are wounded and blood
eff'used into its cavity, a spitting of blood may take place
although the lungs themselves have not been injured. The
treatment recommended by Hippocrates consists of bleeding at
the elbow, enjoining silence, applying folded compresses Avith
broad bandages, neither too tight nor too loose. He directs
us to use a double-headed bandage, and to commence at the seat
of the fracture. He approves of gentle aperients and restricted
diet for ten days, after which* period nouiishing food is to be
given. He adds, that Avhen the proper treatment is neglected,
even no other inconvenience should
if result from it,a viscid
collection is sure to form in the part. When, in addition to
this swelling, a chronic pain gets seated in the part, he advises
the actual cauteiy to be applied. (De Articulis.)
Celsus, with his characteristic elegance and terseness, ex-
pounds the rules of practice delivered by Hippocrates. He
directs us to apply a bandage, to bleed from the arm, to open
the belly ; to avoid noise, speaking, tumultuous passions, smoke,

dust, and whatever is calculated to excite coughing and sneez-

 454 FRACTURES. [book vi.

CoMM. ing. Gruels only are to be taken before the seventh day,
" '

'
after bread may be used,
-wliicli ^'ben the pain is violent be
directs us to apply a cataplasm made from darnel, or barley
Avitli fat figs.Should a collection of matter take place it is to
be opened with a red-hot iron. When mucus forms about
the fracture, he recommends the application of the cauter}\
The above is but an imperfect outline of his admirable chapter
on fractures of the ribs.
Avicenna professedly copies from our author. Haly Abbas,
Rhases, and Albucasis give nearly the same account, Avithout
the slightest addition of any importance. They all approve of
making an incision and extracting the pieces of bones which

may happen to be irritating the pleura. Albucasis gives a

drawing of the meningophylax, or instrument for protecting
membranes diu'ing the sawing of bones.

SECT. XCVIl. ON THE BONES OF THE HIPS AND PUBES.

The bones of the ischium or hips are rarely fractured indeed,

but admit of the same varieties as those of the scapula. Their
extremities, then, are sometimes broken off; there may be
fracture along their length, and the middle may be fractured

by expression. They are attended with a local pain, a pungent

and thi'obbing sensation, and toi'por of the leg on that side if
from expression. It is to be set in the same way as that of
the scapula, only it does not admit of the extraction of broken
pieces by an operation on account of the external parts. If
necessary, it is to be set
by the fingers, and afterwards we must
apply the other convenient treatftient, using embrocations, and
filling up the hollows of the loins with compresses, in order
that the circular bandages which are put on may He even.
The same things may be said with respect to the bones of the
pubes, for we have nothing more particular to say of them.

CoMM. CoMMENTARV. The othcr authorities do not treat of these

cases so minutely as our author, whose account of them is

sufficiently accurate.
Celsus merely directs us to treat them upon general prin-
ciples.
SECT, xcviii.] VERTEBRAE, ETC. 455

Albucasis recommends the same plau of treatment as our Comm.

made of wood or leather.
author, with the addition of splints
"
——
"
'

These, however, cannot be very much required. He directs

the patient to lie on his back or on the sound side.
Avicenna does not treat of these cases of fracture. Haly
Abbas and Rhases abridge our author^s account.

SECT. XCVIII. ON THE VERTEBRAE, SPINE OF THE BACK^ AND

OS SACRUM.

The round bodies of the vertebrae may sometimes be cm shed,

but rarely undergo fracture, in which cases the membranes of
the spinal marrow or the marrow itself being compressed,
sympathetic nervous affections take place, and death speedily
follows, more particularly if the vertebra of the neck be affected.
Wherefore, having first given warning of the danger, we must,
attempt to extract by an incision the compressing
if possible,

bone, or if not we must soothe the part by the anti- inflam-

matory treatment. But if any of the processes of the vertebrae,
of which the spine, as it is called, consists, be broken off, it will

readily be upon examination with the finger, the broken

felt

jiiece yielding and retiu^ning again to its position, and, there

fore, we must make an incision of the skin externally and ex-
tract it, and having united the wound with sutures, pursue the
treatment for recent wounds. When the os sacrum is frac-
tured the index-finger of the left hand is to be introduced into
the anus, while with the other we manage as we best can the
fractured bone ; or if we feel any piece broken off, we make
an incision and lay hold of it, and apply bandages and suitable
treatment.

Commentary. Celsus remarks that when a piece of one of Comm.

the vertebrae is broken off a hollow is felt in the place, it is

attended with pain, and the person is compelled to bend in-

wards. The treatment is to be conducted upon general prin-
ciples, asexplained under fractures of the scapula.
Albucasis lays it down as a rule that when a fracture of the
cervical vertebrae produces paralysis and insensibility of the

arms, the case may be abandoned as hopeless. When, after a

 456 FRACTURES. [book vi.

CoMM. fracture of tlie dorsal vertebrae, it is remarked that there is

'

and insensibility of the lower extremities, and that

'

paralysis
the alvine and urinary discharges are passed unconsciously, he,
in like manner, pronounces the case to be desperate. AVhen
a piece of bone is broken off and occasions great in-itation, he
recommends us, like our author, to make an incision and take
it out.

Haly Abbas and Aricenna borrow everything from Paulus.

Rhases gives many cui'ious remarks upon injuries of the
spine, but several of them are borrowed from Galen. (De Locis
Affectis.) Galen relates many cases to show that retention of
the urine and faeces is a common effect of an injmy of the
spine. He also mentions that loss of speech is sometimes the
consequence of the upper part of the spine being injui'ed,
Rhases relates the case of a man who lost the sensibihty of
his arms from an injuiy of the last vertebra of the neck, pro-
duced by a fall from a horse. He states, that when the injury
isbelow the neck the respiration is never affected. He incul-
cates that whenever there is paralysis of the limbs, or of any
part after a fall, it arises from some injury of the spine.
(Cont. i.)

AYhen the sacrum or os coccygis is fractured, he directs us

to replace the parts by introducing the finger per anum. (Cont.
xxix.)

SECT. XCIX. ON THE ARM.

Whenthe arm is broken Hippocrates makes the extension

thus he says, " We must take an oblong piece of wood, such
:

as that which is put into the holes at the end of

spades, and
fastening ropes to its extremities, suspend it transverseh^ from

some beam, and placing the man upon some elevated object
more erect than what is called the erect sleeping posture, we
pass his hand over the above-mentioned piece of Avood, so that
the middle of the wood may be fitted to the ai-mpit, and his
arm beiug bent at a right angle, an assistant stooping do-wn
takes hold of the hand, and then some heavy
object, such as a
stone, a leaden ball, or the like, is to be fastened to the elbow,
and being allowed to hang suspended, in tliis way you must
SECT, xcix,] ARM. 457

set tlie fracture, or instead of a weight an assistant may pull

down the arm, and insteadof the above-mentioned piece of wood
some use the step of a ladder." Soranus, however, proceeds
thus Having placed
: the man in a chair, or, which is better,
as occasions less disturbance, in a supine posture, then having
it

put a ligatui'e round the wrist and suspended it from the neck
so as to preserve its angular figure, we direct two assistants,
the one to apply his fingers below the fracture and the other
above, and thus to make the extension. Or if we require
stronger pulling we apply two equal pieces of thong to the arm,
the one above the fractiire and the other below, and gi^'ing one
of the pieces of tliong to the assistant who stands above the

patient's head, and the other to the one at his feet, we order
them to make counter-extension. If the fi^actm'e be near the
top of the shoulder we apply the middle of the thong to the
armpit and direct the assistant at the head to hold it, and,
while the other pulls in the opposite direction, we make the
counter-extension as above. And when the fracture is at the
elbow, the ligature is to be apphed there or at the wrist. The
bones of the fracture being properly set, the extension is to be
relaxed, and it is to be bound up according to the method of
Hippocrates, ^'hen the fractui'e is free from inflammation and
recent, we must use linen bandages of a proper length, and
three or four fingers in breadth, which have been soaked in
water or oxycrate, but when there is inflammation, thin soft
pieces of wool steeped in oil are to be used. And if the frac-
ture be at the middle of the arm the bandaging must commence
at the fracture, and two or three tm'ns the bandaging is
after
to be earned upwards, in order, as he says, that the overflow of
blood to the part may be intercepted ; and it is to terminate
there. A second bandage is then to be applied with its head
at the fracture, and, having done as in the former case, cany
it from above downwards, and again reverting from thence up-

wards let it terminate there. There should be a moderate de-

gree of tightness according to our own feeling and that of the
patient. If the fractui'e be near the top of the shoulder, the
first bandage should take in the acromion, scapula, and sternum,

so as to form what is called the crane bandage. The second

one is to extend to the elbow, and fi*om thence to the
reverting
upper parts it is to take in, A^dth the acromion, the scapula and
458 FRACTURES. [book vi.

sternum^ like the first bandage. If the fracture be at the elbow,

the fore-arm is to be taken in with the bandage, the figure
of the elbow-joint being preserved. And so in like manner
with the other members, such as the fore-arm, the thigh, and
the leg ; and when the fracture is in any part near a joint, and
not in the middle of the limb, the joint is to be bound along
with it. After the bandaging the moderns immediately apply
splints, in order to preserve the bones which have been set in
their proper shape, tightening them agreeably to the patient's

feeling and the swelling occasioned by the inflammation. But

the ancients did not apply the splints until after the seventh
day, within which period, as the inflammation had declined, the
limb had become less swelled. Hippocrates orders the band-
ages to be loosed every three days, lest, o^ving to the part being
constantly covered ujd, distension and pruritus should come on,
and that the insensible persj)iration might not be obstructed
after the bone has become firm ; for that by these means not
onh' does a painful pruritus take place in certain cases, but
ulceration of the skin is occasioned by the acrimony of the
sanious humours. He
directs us, therefore, to bathe with tepid

water, so as to dispel the humours, but after the seventh day to

loose the bandages at greater intervals, because the parts no

longer require the expulsion of the humours ; the formation of

callus thus goes on properly. The splints are to be applied in
this manner. Compresses, thrice folded and dipped in oil, are
to be put upon the bandages, and if the limb he of equal
thickness this is to be done even ; but if it is of unequal thick-
ness, the hollow parts are to be filled up with the compresses
so as to make the arm of equal thickness for the application of
the splints ; then the splints being wrapped with a moderate
quantity of wool or flax, we apply them around the fracture,
being not more than a finger's breadth distant from one another,
binding them moderately tight, and taking care, as much as
possilile, that the splints do not come in contact with a joint,
and being more particularly careful of the inner part of the
joint, for therethey sometimes occasion ulcers and inflamma-
tions of tendons. But there the bandaging must be made
slacker; and stronger, on the other hand, where the fracture
swells up. It is better that the chest should be moderately
bound with the arm, lest by its motions it should derange the
SECT, xcix.] ARM. 459

position. If iuflammation sliould come ou (which we know bv

the swelling and redness around_, and from the limb being more
tightly bound than formerly), or if the fracture become de-
ranged, or without these occurring, the bandages become
if,

slacker^ or, on the other hand, tighter than proper, the band-
ages are to be loosed and everything rectified. The patient is
to be laid in a supine position, with his hand upon his stomach,
and a soft pillow is to be placed under the arm having a skin
upon it to receive the embrocations which run from it. The
part is to be bathed with warm oil every day, more especially
if inflammation be present, and during the time of inflamma-

tion he is to be fed sparingly, and afterwards moderately, to

promote the growth of callus. He must lie quiet until the

callus is formed, which, in the arm and leg, takes place about
the fortieth day. Aftei* this the bandages are to be loosed,
and after using the bath he is to be treated Avith plasters suit-
able to fractures. This mode of procedure is applicable in
almost all cases of fractui'e of limbs.

Commentary. Hippocrates's account of fracture of the os comm.

humeri, as quoted by Paulus, is from the eighth chapter of his
—
'
*

work De Fractuiis,^ but our author has used considerable li-

'

berties in making the

extract. The mode of using the piece
of wood suspending the arm is easily understood, from his
fur
own description without the commentary of Galen. (Seep. 541,
t. V, ed.
Basil.) In the edition by Littre it is, moreover, well
illustrated by a drawing. (T. iii, p. 445.) He directs the splints
not to be applied until the seventh day, in order to give time for
the inflammation and swelling to subside. He says, the bone
gets consolidated in about forty days. He justly remarks, that
when distortion of the arm takes place it is to the outside, that
is to say, backwards. His method of bandaging for fractures
of the arm and fore-arm was the same. He directs us in the
first place to put a cerate to the part, and then to apply the first

bandage, beginning at the fracture, and carrying it two or three

turns upwards, so as to prevent the blood from falling down into
the part. The second bandage is to commence above the frac-
ture, and is to be carried dowuAvards.
Afterwards splenia or
oblong compresses, spread with cerate, are to be laid over them,
and these are to be secured by strips of linen cloth. These
 460 FRACTURES. [book vi.

CoMM. bandages are to be removed when they become slack, generally

about the thii'd day. On the seventh the ferulse or splints are to
' '

be applied, the limb by that time having lost its swelling, and
they are to be allowed to remain until the 24th day after the
accident. "When swellings arise on any part of a limb from
pressure, they are to be anointed with cerate or wine and oil,
and wrapped in soft wool ; and if the splints be hurting the
limb they are to be removed for a time. (De Fract. 21.) "When
the bandages are taken off, he directs that hot water should be
j)Oured upon the limb. He recommends a spare diet unless
there be a wound of the integuments. (De Fracc. and Galen.
Comment.) It may be proper to give some more account of
the splenia and ferulae {i'do9r]Kig), used by Hippocrates in frac-
tures of the extremities. In his work entitled ' The Surgeon^s
Shop' he directs the length of the splenia to be made
{i7]Tpeioi'),

proportionate to the part which they are applied to, their breadth
three fingers, their thickness three or four folds, and their num-
ber such as to encircle the limb without doing either more or
less. It appears quite clear that they consisted of folded linen.
The intention of them was to give some support to the part.
He directs the splints to be smooth, even, concave, and some-
what shorter than the length of the bandages, in order not to
hurt the sound skin. It appears, then, that the whole appa-
ratus used by Hippocrates in the treatment of fractures, con-
sisted, 1st, of two under-baudages, 2d, of splenia or folded com-
presses, 3d, of the ferulae or splints, 4th, of an outer bandage
to secure the splints. AVith regard to the cerate used in the

Hippocratic system of bandaging, it is important to state that,

from a passage in his treatise, Officiua Medici,^ it would ap-
'

pear that the cerate was not only applied to the skin, but that,
for the sake of greater security, every fold of the bandages was
rubbed with it. See Galen's Commentary on the work, (T. v.
p. 692, ed. Basil,) and Littre's Hippocrates, (T. iii, p. 316.)
remains to be mentioned, that the bandages were secured
It

by means of a thread or with a needle. (Off. Med. 8.) No-

thing can surpass the judgment and precision with which Hip-
pocrates lays down his rules for the application of the bandages.

(Ibid.)
Galen describes the splenia as being pieces of linen folded
three or four times, which are to be laid along the arm longitu-
SECT, xcix.] ARM. 401

dinallv,. He directs us to spread them with cerate. He says Comm.

'

He says distinctly that all the

'

'

that they support the limb.

folds of the bandages should be rubbed with cerate in order to

give greater support. All his directions for the treatment of

a broken limb are most judicious. When at first there is much
pain and inflammation, he recommends bleeding and purging ;
but when the callus begins to form, he directs the patient to
use a nourishing diet. Spiculse and scales of bone are in ge-
neral to be allowed to exfoliate of themselves, and not- removed
forcibly by the surgeon. (Comment, and Fragment, ap. Nicetse
Collect.)
Celsus lays down the principles of treatment in fractures of
the arm, fore-arm, thigh, and leg so circumstantially, that we
can afford room only for an outline of them. He recommends
no time to be lost in getting the displaced parts properly re-
duced. For this purpose, if the limb be strong, two assistants
may be required to pull in contrary directions ; and if other
means do not succeed, thongs of leather, or linen bandages,
may be attached to each end of the broken limb to make ex-
tension and counter-extension with them. When the ends of
the bone have been adjusted, (which is known by the pain
and deformity being removed,) the limb is be wrapped in
to
linen cloths folded two or three times, and dipped in wine and
oil. Six bandages or rollers (fasciae) are then to be applied.
The first is the shortest, which is to be three times rolled round
the limb upwards in a spiral direction, and three times generally
will be sufficient. The second must be one half longer, and is
to commence wherever the bone projects ; or if there be no pro-
jection, at any part of the fracture ;
and is to be carried first
downwards and then upwards, so as to terminate a little above
the former. These are to be secured by a broader linen cloth
spread with cerate. The third and fourth bandages are then
to be applied upon the principle, that the latter is to be put
on in the contrary direction to the former; and further, it is
to be observed that the third bandage terminates below, whereas
all the others terminate above the fractui^e. Upon the whole,
he adds, it is better to secure the limb with many than witli

tight bandages, these being apt to occasion mortification.

When properly applied they ought not to be loose on
the first
such as not to give pain slacker on the second, and
dnj, yet ;
 462 FRACTURES. vi,
[book

CoMM. loose on the third day. They are then to be

removed and
"""^ '

again a^Dplied, and abandage is now to be superadded to

fifth
them j and again, these are to be taken off on the fifth
day,
and six bandages put on, in such a manner that the third and
fifth
may terminate below, and all the others above. T\lien-
ever the bandages are taken off, tlie limb is to be bathed with
hot water, and proper fomentations applied to
allay the inflam-
mation, which will generally be found to have subsided about the
seventh or ninth day. Then the bandages are again to be put
on as directed above, and ferulae or splints are also to be added,
taking care to put on a stronger and broader splint at the side
to which the fractured bone has a
tendency to be protruded.
These must all be rounded where they come in contact with a
joint, to avoid injuring it ; they are only to be secured with
such tightness as to keep the bones in their
place, and when
they get loose their thongs are to be tightened. The bandages
are to be removed These are his general directions
gradually.
for all fractures of the extremities, and it is to be remarked that
his mode of treatment
is
essentially the same as that of Hippo-
crates. He
afterwards describes at considerable
length the
method of setting the broken ends of the os humeri. After
this is accomplished he directs us to bind the arm
gently to
the side. With regard to the splints, he properly recommends
the longest to be applied
externally ; shorter ones on the brawn
of the arm (over the biceps muscle
?), and the shortest under
the armpit. He advises us to remove them frequently when
the fractm-e is situated near the fore-arm ; and at these times
the arm is to be bathed with hot water, and rubbed with a soft
cerate.
be seen that the methods of Hippocrates and Celsus^
It will

although the same in principle, differ in the following respects,

Hippocrates uses three bandages, Celsus six Hippoci-ates uses
:

small compresses, Celsus large of hnen

pieces Hippocrates uses
:

cerate, Celsus wine and oil.

The Arabians conducted the treatmentin much the same way
as the Greeks. In cases of fracture of the arm, Albucasis di-
rects us to make the bandages of soft, thin linen cloth but ;

of broader and firmer linen if the

thigh or leg is to be treated.
Below them is to be applied a smooth cloth spread with a suit-
able Hniment. After the under bandages have been put on in
SECT, xcix.] ARM. 4C3

the majiner already described, the splints are to be applied,

pro- Comm.
'

vided no swelling nor inflammation be present, for in that case '"""'

they are to be deferred for a few days. These splints are to

be constructed from the middle part of the alcanna, or of pine,
or of the palm-tree, or of a tree which he calls ccdinyi.
Aviceuna directs us to form the splints of the wood of al-

canna, or of oleander, or of pomegranate tree, or the like. The

length of the splints is to be made equal to that of the limb,
and their greatest breadth about three fingers. They are to be
secured with another bandage and pieces of tape made of linen
cloth. There is to be an interval of a finger's breadth between
each sphnt. He says, it is best to apply four splints of such a
length as to reach from joint to joint. They are to be smooth
and exen so as not to injure any part. In cases of fracture of
the OS humeri he directs us to surround the nearest joint with
the bandages, and, if the fi'acture be in the middle, to make
them take in both extremities. He recommends us to foment
the limb with \'inegar and water, or water alone. The arm is

to be fastened to the side and the hand laid on the stomach.

Haly Abbas, in giving directions for the treatment of frac-

tui'es in general, recommends the splints to be made of pieces
of alcanuca, or any hard wood. Afterwards he directs the limb
to be laid upon a table having a pad (pannus) placed on it,
which last is to be secured with fillets. He gives particular
directions not to apply the splints over the processes of bones,
and when inflammation comes on he forbids splints to be used
at all; in that case the patient is to be kept upon restricted
diet. The bandages are to be removed in the coiu'se of three
days.
The directions given by the expenenced Rhases about the

bandages and splints are very similar to our author's, and there-
fore need not be repeated.
See an account of the ancient splenia, or compresses, and of
the ferulfe, or splints, in Scultet's 'Arsenal de Chirurgie.' (29,

30.) Seealso Van Swieten's 'Commentary,' (354.) Van Swieten

remai'ks, that although the eighteen-tailed bandage be supposed
a modern invention, a similar one is described by Hippocrates,
(De Fract.) and by Galen in his commentaries on the same.
Le Clerc gives a pretty full description of the Celsiau method
of treating fractures. (Hist, de la Med.) See also Fabricius ab
 464 FRACTURES. [book vi.

CoMM. Aquapendentc (CEiiv, Chir. ii, 3, and i, 4). We are certain it

will be generally admitted that the waxed apparatus of the

ancients in the case of fractures was probably quite as efficacious
as the starched bandages which have been introduced of late

years with so much advantage.

SECT. C. ON THE ULNA AND RADIUS.

The ulna and radius are sometimes both fractured together^

and sometimes one of them only, either in the middle or at
one endj as at the elbow or wrist. The worst of all is when
both are fractured together, after that the ulna alone, but a
fractured radius is, of all cases, the easiest cured. For, although
it be
larger than the ulna, yet it has this bone as a base and
support to it. If only one be fractured, the extension must
be applied principally to it, but if both, they are to be stretched
evenly, the arm being put into an angular position, so that the
thumb may be higher than the fingers, and the little finger
lower than any of the others, for thus the ulna will be placed
under the radius. If stronger extension be required, especially
when both are broken, we must apply it not only with the
hands but also with ligatures, as described when treating of
the arm and everything relative to the bandaging and the
;

subsequent treatment, with the application of the splints, is to

be done as in that case until callus is formed. The bones of
the .fore- arm have their callus formed in about thirty days at
most. And the fore-arm is to be otherwise arranged in the

same manner as the arm, with the exception of those things

which are put under it.

CoMM. Commentary. Whoever would wish to see a full exposition

of the principles upon which these cases of fracture ought to
be conducted may first part of Hippocrates's work.
consult the
(De Fracturis.) He
shows, with a singular precision, the dis-
advantages of the prone and supine positions of the hand, both
of which, it appears, had their advocates in ancient times. The

bandages, compresses, and splints are to be applied in the

manner described in the preceding section. He insists strongly
on the necessity of having the arm and wrist carefully sus-
SECT. CI.] HAND AND FINGERS. 4C.5

pended-in a broad soft sling, and that the hand be phiced Comm.
neither too high nor too low. Hippocrates takes notice of"
— '

fracture of the olecranon, as will be explained afterwards.

Oribasius gives a description and draAving of a laquens cal-
culated to retain the splints, and secure the fore-arm in cases
of fracture. (De Laqueis, 2.)
Celsus directs us to sling the arm, with the thumb a little
inclined, towards the breast, in a convenient napkin (mitella),
the broad part being applied to the arm, and the narrow ends
tied behind the neck.
Albucasis treats of this case of fracture very accurately. He
calls the ulna the larger of the bones. He directs the arm to
be suspended with the thumb uppermost. When the fractured
pieces of bone occasion irritation, he advises us to make an in-
cision and extract them. When a troublesome pruritus seizes
the arm, he recommends us to remove the bandages and bathe
with hot water.
Rhases gives proper directions about not applying the band-
ages too tight or too slack. When the hand swells he recom-
mends them to be slackened.
The accounts given by Avicenna and Haly Abbas are quite
similar to our author's. Avicenna cautions us not to make the

splints too long lest they hurt the hand. None of the Arabians,
we believe, have noticed the fracture of the olecranon. Like
most imitators, they often fall short of their originals.

SECT. Cr. ON THE HAND AND ITS FINGERS.

The bones of the carpus, metacarpus, and of the phalanges

of the fingers, being of a spongy and porous nature, are often
crushed but rarely fractured. The patient then being placed
on a high seat, we are to direct him to lay his hand prone
upon an even table, and the fractured pieces being stretched
by an assistant, we arrange them with two fingers, that is to
say, the thumb and the index-finger. A tight bandage is to
be used at the time that inflammation prevails, for, owing to
the porous nature of the bones, a redundance of callus is
formed. If the phalanx or finger be simply l^roken, and it be
the large one, called also the thumb, after suitable bandaging,
II. 30
 466 FRACTURES. [book vi.

it is to be bound to the palm that it may be kept at rest ;

but
if any of the others, as for example, the index or little finger, it
is to be bound along with the one next to it, or if one of the

middle, itmay be bound along with that on either side, or

all may be bound altogether. For they are thus kept best
at rest, as if the fractured bones had been supported with

splints.

CoMM. Commentary. Hippocrates recommends the general treat-

' '
•
ment applicable in all cases of fracture, with the exception of
the splint, which, as Galen explains, is not admissible in these
cases.
it will be sufficient when a finger is broken to
Celsus says,
bind to one piece of splint (surculum) after the inflammation
it

has subsided.
Albucasis recommends one small splint to be applied upon
the thumb when it is fractured. If one of the fingers be
broken, it is to be bound up with the others, or one small
piece of splint may Avicenna, Rhases, and Haly Abbas
be used.
treat distinctly of these accidents, but supply no additional in-
formation.

SECT. CII. ON THE THIGH.

The case of a broken thigh is analogous to that of the arm,

but in particular, a fractured thigh is mostly deranged forwards
and outwards, for the bone is naturalh^ flattened on those sides.
It is to be set by the hands, with ligatm'es, and even cords

applied, the one above and the other below the fracture. When
the fracture takes place at one end, if at the head of the thigh,
the middle part of a thong wrapped round with wool, so that
it may not cut the parts there, is to be applied to the peri-

nseum, and the ends of it brought up to the head and given to

an assistant to hold, and apphdng a ligature below the fracture,
we give the ends of it to another assistant to make extension.
is fractured near the knee, we
If it
apply the ligature imme-
diately above the fractm'e, and give the ends to an assistant,
with which to make extension upwards ; and while we put a
ligature round the knee to secure it, and while the patient
SECT, cii.] THIGH. 46/

lies tliuSj with his leg extended, we arrange the fracture.

Pieces of bone which irritate the parts, as has been often said,
are to be taken out from above ; and the rest of the treatment
we have already described in the section on the arm. The
thigh gets consolidated within fifty days. The manner of ar-
ranging it afterwards will be described after dehvering the
treatment of the whole leg.

Commentary. Hippocrates has correctly stated the diffi- Comm.

' '

culty attending the management of a fractured thigh-bone,

'

and the disgrace which an ill-managed case entails upon the

surgeon. He directs him to make extension and counter-ex-
tension, andto aj)ply the bandages and splints in the manner

formerly described. He recommends a few tiu'ns of the band-

age to be brought about the loins, in order to prevent the skin
at the top of the thigh from being injured by the splints. He
points out the extreme importance of attending to the position
of the heel, as if improperly laid, it is capable of deranging the
fractui'e entirely. It gets consolidated, he says, in about fifty

days. (De Fracturis.)

Celsus pronounces it impossible to heal a fractured thigh-
bone without deformity. The patient, he says, must ever
afterwards tread upon his toes and yet, he adds, the case will
;

be worse if neglected.
Albucasis holds forth greater encouragement. He describes
the process of treatment very minutely, du'ecting the surgeon
to stuff up all the hollow places in the limb with soft pads be-
fore applying the splints. He also recommends him to sui'-
round the whole limb with a bandage fi-om the heel to the
nates. We are inclined to think, although the language of
his barbaroiis translator is not sufficiently precise, that his

splints extended the whole length of the limb.

Rhases, and we believe, he alone of all the ancient authori-
ties, directs the thigh to be laid in a somewhat bent position,
and for this purpose he recommends something suitable to be
put below it.

Haly Abbas and A\acenna, as usual, borrow everything from

our author.
 468 FRACTURES. [book vi.

SECT. CITI. ON THE PATELLA.

The patella is a porous bone kept firmly in its place by the

parts above and below, and is often crushed but seldom frac-
tured. It undergoes fracture also through its thickness, and
is broken into small pieces, with or Avithout a wound. The
—
symptoms are obvious, a solution of continuity, a hollow, and
crepitation. The fracture is put in order by extending the leg,
for thus the divided portions may be brought together with the
fingers, until the lips of the fracture mutually touch, and are
united to one another, and fractured pieces, when separated,
are thus arranged together. For even if callus does not take
place, owing to the parts being di'awn in difi'erent directions by
the muscles and tendons from the thigh and leg, Avhich are in-
serted into it, yet the separation is much diminished. But it
occasions much lameness to the patients ; for, when they at-
tempt to labour, the knee cannot sustain them long, and in
walking their ascent upwards is impeded ; but in moving along
a plain their lameness is not perceptible. In ascending, how-
ever, as the knee cannot bend in raising and setting down
the leg, the lameness becomes apparent. And in this case any
bone that irritates is to be taken out where it protrudes, and
proper treatment applied.

CoMM. Commentary. None of the ancient authorities have given

so fullan account of this accident as our author. Hippocrates
and Celsus have omitted it altogether. Soranus merely gives
the symptoms, namely, a hollowness in the part and crepitus.
Albucasis recommends us, after arranging the broken pieces
of bone, to apply a round splint over it if necessary. Rhases
likewise speaks of applying a well-stuff'ed splint. Haly's ac-
count is distinct but similar to our author's, from which it is
abridged. Neither he nor Avicenna makes any mention of a
splint.
SECT. CIV,] LEG. 469

SECT. CIV. ON THE LEG.

The treatment of fractures of the leg corresponds with that

of the fore-arm^ for it consists of two bones^ the thicker of
which hears the same name (tibia), and the small one, from its
resemblance, has been called fibula. Its fractures also admit
the same varieties, being deranged on all sides when both the
bones are broken together, and to three when only one, namely,
within, without, and the tibia backwards and the fibula for-
wards. Wherefore it is to be set in the same manner by the
hands, or ligatures, sometimes applied to the leg itself, and
sometimes to the thigh, (for the knee being a strong joint can
bear the extension uninjured,) and ligatures are to be applied
likewise below the fracture, as we mentioned under the head of
the fore-arm. The case is to be managed otherwise, as de-
scribed by us in the section on the arm.

Commentary. Hippocrates has treated of this case at con- Comm.

siderable length. The bandages are to be applied as formerly
described, and the leg on a level board with a soft cushion
laid
under it. he did not approve of the bent posi-
It is clear that
tion of the limb. The splints are to be applied on the seventh
or eleventh day. Ofthe fractures of a single bone, that of the
tibia, he remarks, is the worse, a fractured fibula being easily
managed. He gives particular directions to attend to the state
of the heel.
Celsus treats of these fractures in general terms, like those
of the fore-arm. Albucasis directs us to apply two splints made
of the wood of pines or palms, of moderate thickness, and of
such length as to extend from the knee to the feet. One of
these is be placed below the leg and the other above ; and they
are to be tied in three places, namely, at the extremities and in
the middle.
The other Arabians treat of these fractures in more general
terms.
 470 FRACTURES. [book vi.

SECT. CV, ON THE rOOT.

The astragalus cannot be fractured by any means, being

guarded by bodies on all hands ; by the tibia, the fibula, and
the OS cuboides. But the scaphoides, the bones of the tarsus,
and those of the toes, and the cuboides itself, are fractured like
those of the carpus, metacarpus, and the fingers of the hand,
so that what was said of them is applicable here and need not
be repeated.

CoMM. Commentary. Hippocrates remarks that these bones can

* '

only be fi'actured by some sharp and hea\T body. They are to

''

be treated Uke fractures in general, only that they do not re-

quire splints. He recommends the recumbent position with
the foot somewhat elevated, and states, in strong terms, the
mischief brought on by unseasonable attempts at walking. (De
Fracturis, 10.) Galen, in his Commentary, gives an accurate
anatomical description of the bones of the foot.
Celsus is very brief on this case. He conducts the treat-
ment on general principles. Albucasis directs us to make the
patient put his foot on the ground, the surgeon is then to place
one of his feet on it and stand on it. Bv this means the de-
rangement of the bones will be rectified. He approves of a
splint to the sole.
We find nothing Morthy of notice in the works of the other
authorities.

SECT. CVI. ON THE ARRANGEMENT OF THE LIMB.

When the thigh or leg is fractm-ed, the manner of arrang-

ing the limb will be as important a consideration to you as the
other treatment. For the evenness of the fractru-ed parts is
especially preserved by this means when properly performed.
Some, therefore, lay the fractm-ed part upon a canal, either of
wood or of earthcuMare, or else they lay the whole limb upon
it ; others apply it
only in cases of fracture with a Avound, be-
cause, say they, these cannot be bound with splints. But the
moderns altogether reject the use of these canals for many rea-
SECT, cvi.] ARRANGEMENT OF LIMB. 471

sons, but more especially on account of tlie pressure occasioned

by their hardness. Nor is it improper to apply splints to frac-

tured limbs with a wound, as we shall show afterwards. Let
the patient, then, lie upon his back, and let a thick garment,
equal to the limb in length, be laid under it, more especially
where the fractm'c is, and let both its ends be convoluted and
wrapped round so as to resemble the canal in its middle longi-
tudinal cavity, and let it be covered with a soft skin for receiv-
ing the embrocations and then let the limb be fitted to this
;

canal-like cavity, and let other garments or wool be applied on

both sides to prevent the limb from being moved to the sides.
And let a small board, covered with rags for sake of softness,
be fastened to the sole of the foot ; and, for the sake of greater
security, let the middle of two or three ligatiu'es be applied
under this canal-like garment, and let the broken limb be lightly
bound along with it. But if the patient be unable to restrain
himself from drawing in his leg, his foot should be fastened to
the board by means of ligatures around the ankle, so that he
may be prevented even from drawing in his leg involuntarily
in his sleep. Some likewise cut out a hole in the middle of
the bed, that the patient may void his urine and faeces by it
without requiring to be moved until the callus has become
formed.

Commentary. We have already mentioned that Hippo- Comm.

crates approved of the straight position of the limb. With
respect to the canals {(yh)Xrji'eg) mentioned also by our author
he expresses himself in equivocal terms. He says that they
prove useful, but not to the extent generally believed. He
properly remarks that they do not prevent the body from being
moved, and that consequently they cannot be supposed capable
of securing the limb entirely from derangement. He is de-
cidedly of opinion that unless they extend from above the ham
to the heel they do no good in fractures of the leg. (De Frac-
turis, 16, ed. Littre.)
" Is
Celsus gives the following description of the canals :
canalis et inferiore parte foramina habere, per quse, si quis
humor excesserit, descendat et a planta moram, qua? simul et
:

sustineat earn, et delabi non patiatur : et a lateribus cava, per

quae loris datis, morne qusedam or us femurque, ut collocatum est,

 472 FRACTURES, [book vi.

'
CoMM. detineant/^
'
Galen, in his Commentary on Hippocrates (1. c.)
"
describes these machines as being romid externally and hollow
within, so as to inclose the limb all around :
—
TripiXainfiavsi
to
cr/cfAoc oXov iv KVK\(p. From these words one might think
that the canal of which he speaks was a complete cylinder or
cone. But from our author's direction to lay the limb upon
the canal, it would aj)pear that the machine he speaks of was
open above, and as such it is represented and described by
His words are " 11
Scultet (Arsenal de Chirurg, xxii, 6.) :

faut que le canal embrasse plus de la moitie du membre ;" this,

therefore, is a sort of trovgh. Sprengel calls it a box {hoite,
Fr. edit.) Littre translates it by gouttiere, I. c. For an account
of these and other machines anciently used in fractures of
the lower extremities, see Van Swieten (Comment. 354), and
Heister (Surgery, is, 9.) Brunus and Theodoricus make men-
tion of these canals, but do not much approve of them.
Galen informs us that the canals were made of different
kinds of wood. He speaks of a surgeon in his time who made
them from the wood of the phillyrea. He makes mention of a
method of supplying their place by means of a bolster laid below
the limb and tied round it with fillets. (Nicetse Collect, and
Comment. 1.
c.)
Avicenna and Albucasis take notice of these machines, but
neither of them with approbation. They also speak of securing
the limb in the way described by our author.
The canals would appear to be the machines which Rhases
mentions by the name of barangi. (Cont. xxix.)

SECT. evil. ON FRACTURES COMPLICATED WITH A WOUND.

When a fracture
is attended Avith a wound, if there be a

hemorrhage it is to be first stopped and if there be inflamma-

;

tion, we must use the applications suitable to it ; and if there

be contusion of tlie flesh, we must scarify the flesh to remove
all apprehension of gangrene ; or if gangrene or any other
spreading mortification has come on, we must meet it with
suitable remedies. The treatment of each of these cases you
have had delivered in the Fourth Book. When none of these
is present, nor much of the bone
symptoms exposed, we may
SECT, cvii.] WITH A WOUND. 473

use hooks and sutures, and effect the cure by the treatment for
recent wounds, having first cut out any broken pieces of bone
which move about and produce irritation. But if a large
bone project, which, for its size, cannot be brought into con-
tact by the extension, it will require consideration.
Hippo-
crates, then, in fractures of the thigh and arm, dissuades from

replacing at once the protruding bones, predicting danger

from it, owing to the inflammation or perhaps spasm of the
muscles and nerves which are apt to be brought on by the ex-
tension. But time has shown that this attempt will sometimes
succeed. Of whatever bones, therefore, we endeavour to re-
place the protruded ends, we must not meddle with them when
in a state of inflammation, but on the first day, before inflam-
mation has come on, or about the ninth day, when the inflam-
mation has gone We may set them by an instrument
off.

called the lever. an iron instrument about seven or eight

It is

fingers' breadth in length, and of moderate thickness that it

may not bend during the operation ; with its extremity sharp,
broad, and moderately bent. Its sharp extremity, then, is to
be put under the protruding prominence of the bone, and by
pushing at the other end while moderate extension of the limb
is made, we bring the extremities of the fracture together;
or, if we cannot do so, we must cut off the projections by
counter-perforators (chisels), or saw them off in the manner
described when treating of fistulye. Having removed the
spiculse of bones and set the limb aright, we ciu'e the wound
by dressing with pledgets. But in those members which are
double or in pairs, we must take care when the bones of either
of them are sawn off, that no contraction of the limb take
place, but that be kept of its proper length by extension.
it

The bandaging to be thus applied

is the circular folds are to
:

be arranged on both sides of the wound, and oblique ones ac-

cording to the length of the sore, so that they may intersect
one another in the form of the Greek letter X, and prevent
the lips of it from gaping. And when the ulcer is foul, we
must apj)ly dressing with cleansing ointments ; but if clean,
with incarnating, and the other articles of known efiicacy.
Hippocrates used the pitch-plaster, which is said to have been
the same as the ointment, tetrapharmacon, called also basilicon.
After the sore has incarnated we apply splints. Some apply
 474 FRACTURES, [book vi.

them from the firsts taking care not to hurt the parts about
the ulcer^ and tightening them according to necessity, or again
slackening them. When a scale of bone is going to exfoliate,
which we ascertain from the discharge being more copious and
thin,we must remove the loose fungous flesh about it, and the
bandages must be applied loose ; but having removed the scale
with a hook or some such instrument, we must have recoui'se
to tighter bandages. During the whole time of the healing
of the sore, the dressing called motophylax with some of the
auti-inflammatory medicines is to be laid over the wound, to
be kept on with a simple bandage, which is to be removed at
each dressing; everything else remaining the same as de-
scribed in the treatment of the arm.

CoMM. Commentary. Hippocrates treats of these cases at great

His method of rectifying the protruded ends
" '
'
length. of bones

by means of a lever, is described by our author. He says,

it may be done on the first or second day, but not on the thiid
or fourth, after the inflammation is begun, for fear of occasioning
conAOilsions. Compresses dipped in wine and oil, or soft
bandages are to be used, but splints are not to be applied until
the sore puts on a healthy appearance. He mentions that some
were in the practice of bandaging the limb above and below
the wound, and leaving it bare, in order to allow the discharges
to escape ; but this practice he greatly disapproves of, as tend-

ing to produce swelling in the place ; and he recommends the

whole limb to be well secured with bandages, but then not too
tight. He states that all bones which are completely denuded,
must exfoliate and come out. When a bone projects and
cannot be replaced, he directs the surgeon to cut it ofi" if it
irritate the soft parts. No splints are to be applied Avhcn
there is a bone Mhich it is seen will exfoliate. If it be the
summer season, the compresses applied to the wound are to be
frequently soaked with wine ;
but if it be winter, greasy wool
is to be dipped in wine and oil and applied. Compound frac-
tures of the thigh or arm, attended with protrusion of the broken
bone, are said to be peculiarly dangerous ; for if replaced, they
are apt to occasion convulsions ; and if let alone, they give rise
to acute bilious fevers. Some, however, he adds, recover when
the bone is replaced. (De Fract. cum Comment. Galeni.)
SECT, cvii.] WITH A WOUND. 475

Galeu explains, that tlie danger in cases of fractured femur and Comm.
humerus arises from their vicinity to important blood-vessels ——
'

^
'

and muscles.
Celsus lays down the rules for conducting the treatment in
these cases with great precision. He states, that fractures
complicated with a wound of the skin are generally dangerous,
especially when it is the humerus or femur. In the latter case
he directs us to saw off the ends of the bone. The case of a
fractured humerus is more easily managed. The danger is
greatly increased when the fracture is near a joint. He re-
commends us to divide any muscle which may run across the

wound, to let blood, and put the patient upon a restricted

diet. In other fractures the bones are to be gently replaced.
The wound is to be dressed with a pledget dipped in wine, to
which roses have been added. This apjalication is borrowed
from Hippocrates. The bandages are to be put on somewhat
slacker than when there is no external wound. Neither splints
nor canals must be used, but broad bandages. The parts are
to be fomented with hot oil and wine, and the dressings re-
newed every day. When a small fragment of a bone pro-
jects, if it be blunt, he recommends us to replace it; but if
sharp, he directs us to saw it off, and then replace the bones with
the hands or a suitable instrument. Sometimes fragments of
bones die, and after a time drop out and sometimes sharp
;

spiculse irritate the soft parts, in which case he recommends us

to enlarge the wound and cut off the projecting points.
The treatment recommended by Albucasis is very judicious.
If inflammation be present, he directs us to subdue it by bleed-
ing ; and, in that case, reduction is not to be attempted until
the ninth day; but in all other cases it is to be done at first.

When cannot be reduced bv the hands, an iron instrument

it

seven or eight fingers' breadth in length, and two fingers broad,

is to be used as a lever for this purpose. When the ends of the
fracture are sharp and cannot be replaced, they are to be cut
off or sawed. His saw bears a considerable resemblance to
that of the late Mr. Hey, of Leeds. He recommends an as-

tringent wine as a suitable application, but condemns all

cerates which contain oil. The bandages are to be put on
very slack. Splints are not to be applied while the wound is
irritable and ill-conditioned. When it does not heal, he says
 476 FRACTURES. [book vi.

CoMM. we
ought suspect to that it is
prevented by spiculse of bones,
' — — Avhich
"
'

are to be sought out and extracted.

A^dcenna and Rhases give very proper directions about re-
moving spiculse of bones, and applying slack bandages, but
they evidently copy from Hippocrates and our author.

SECT. CVIII. ON THE REDUNDANT CALLUS OF FRACTURES.

The superabundant callus of fractures occasions always a

deformity, and sometimes also lameness if it be formed near a

joint. If, be newly formed, we use very
therefore, the callus
astringent medicines, and bring it to its form by bandages ;
and sometimes we effect our purpose by applying a plate of lead
to it. But if it is of a stony hardness we make an incision,
and pare it off, removing the prominent part by chisels, if need
be, and boring it with trephines.

CoMM. Commentary. Celsus directs us to rub the limb with oil,

salt, and to pour a great quantity of hot salt water upon

nitre ;

it; to apply an emollient ointment; to bandage it tightly, and to

give an emetic. He also recommends us to produce revulsion

by the application of mustard to another part.
Albucasis recommends nearly the same plan of treatment as
our author. When the case is recent, he directs us to make
astringent applications, such as aloes, olibanum, and myrrh,
with an astringent wine or vinegar. He also speaks of applying
a plate of lead ; and when the callus becomes hard, he approves
of scraping and sawing it off, as directed by our author.
No additional information is to be got from the other
Arabians.
Tlieodoricus, and the other surgical authorities of that age,
describe the treatment exactly as the ancients. When the callus
is hard, they direct us to scrape or saw it off.

SECT. CIX. ON distortion FROM THE UNION BY CALLUS.

When bones heal distortedly by callus, no little lameness

takes place, more particularly if in the feet. The method then
SECT, ex.] BONES NOT UNITED. 47/

of breaking them over again is not at all to be admitted, as it

may occasion the utmost danger; but if the callus be newly

formed, Ave must have recourse to the affusions of a relaxing na-
ture, and to cataplasms, such as those from fat olives and
pigeon^s dung, and the other medicines for dissolving callus ;
and we also dispel it by friction with the hand, and bending it
every way. But if it be of a stony hardness, we make an in-
cision of the skin with a scalpel, and separate the union of the
bones with chisels, and then cure the fracture as formerly said.

Commentary. Celsus approves of breaking the bones over Coms

again. With this intention he directs us, in the first place, to —^
'

bathe the limb with much hot water, and rub it with liquid cerate;
the callus is then to be moved with the hands, and the ends of
the bone properly set ; or if that cannot be thus accomplished,
a rule is to be wrapped round with wool and bound upon the
part, so as to restore it to its proper shape.
Avicenna agrees with Celsus in speaking favorably of break-
ing the bone over again. He also speaks of the
favorably
other treatmentrecommended bv our author.
Rhases recommends emolhent applications, and gentle at-
tempts to restore the figure of the limb. Albucasis mentions the
proposal of breaking the bone again with disapprobation.

SECT. ex. ON BONES WHICH HAVE NOT UNITED BY CALLUS.

Sometimes fractured bones remain without forming adhesions,

beyond the natural period, either owing to their being often
loosed, or from too frequent bathing of the part, or from having
been moved unseasonably, or from the number of the bandages, or
from atrophy of the whole body, by which means the limb be-
comes emaciated. Wherefore we must endeavour to remove all
the other causes, but more especially the atrophy, partly by
calefacient applications which attract nourishment to the place,
and partly by supplying a sufficiency of food and baths, and
whatever also is of a refreshing nature. Among the other
symptoms which follow the formation of callus, the bandages
then become stained Avith blood, although no wound be present,
which probably takes place from the substance about the callus.
 478 LUXATIONS. [i?ook vr.

when unites, squeezing out the drops of blood

it which were
distributed to the hollows of the bones.

CoMM. Commentary. When the fractured portions do not adhere

" '

certain time, Celsus directs us to extend the limb, and

'
after a
rub the ends of the bone together, in order to convert them
again into the state of a recent fracture, taking care, however,
not to hurt the muscles and nerves. The part is then to be
fomented, and the splints applied on the fifth day.

Rhases recommends calefacient liniments, friction, and nu-

tritive food.

SECT. CXI. ON LUXATIONS.

We proceed to the treatment of luxations, which naturally

follows that of fractures. A luxation then (to give a definition
of it)
is a displacement of a member from its proper cavity to

an unusual place, by which means the voluntary motion is im-

peded. We have no other diff'erences of it to mention, except
that some are to a greater and some to a less degree. When
the bone of a member, therefore, is completely removed from
its place, the accident is called by the common name of luxation,

but when only moved a little, or brought only to the brim of

the cavity, it is called a subluxation.

CoMM. Commentary. Celsus gives several important remarks upon

dislocations in general, but as most of them may more properly
be brought under particular heads, we shall notice them here
but briefly. He distinguishes dislocations into two classes ;
the
consisting of a separation of two bones naturally united,
first

such as the scapula from the humerus, the radius from the ulna,
the tibia from the fibula, the os calcis from the bones of the
ankle, which last is of rare occurrence, and the second being
a removal of the bone of a joint from its proper place. When
a dislocation occurs, as he remarks, the finger discovers a cavity
in the part, and inflammation and fever come on, followed
sometimes by gangrene and con\ailsions. If not reduced, the
limb wastes. In a person who is lean, humid, and has weak
nerves (muscles ?) the dislocation is most easily reduced, but is
 '
SECT, cxii.] LOWER JAW. 4/9

more difficult to retain. The inflammation is to be reduced by Comm.

" '

the application of wool dipped in vinegar ; by abstinence^ a spare

"

diet, and drinking tepid water. Afterwards friction, exercise,

and a more generous diet are to be allowed, (^iii, 11.)
See many curious remarks on this subject in Galenas Com-
mentary on Hippocrates (de Articulis), and in Apollonii Citiensis
Scholia in Hip. et Galen. also Avicenna (iv, 5, 1); Haly Abbas
;

(Pract. ix, 101); Rhases (Cont. xxix, 2.)

SECT. CXII. ON THE LOWER JAW.

Beginning then again from the upper parts we shall treat of

the lower jaw. For the upper being immoveable does not admit
of dislocation ; but the lower does not indeed readily admit of
complete luxation, owing to its heads being firmly fixed to the
upper jaw, but it often undergoes subluxation, for the muscles
which are fixed to it being relaxed by the constant exercise of
mastication and speaking, the jaw is readily slackened from the
most common causes. For the term used by Hippocrates sig-
nifies slackened. In these cases the part returns to its natural
place without trouble. With regard to the complete dislocation
of the lower jaw, it will be sufficient to deliver Hippocrates's
account, being, at the same time, brief, complete and clear.
He says, thus " The jaw seldom falls out of the joint, but it
:

is often slackened in yawning, as many other irregular actions

of muscles and tendons do this. When it falls out of the
joint it is marked principally by these symptoms the lower ;

jaw projects forwards, and is inclined in an opposite direction

to the luxation and the coronoid process of the bone swells
;

out near the upper jaw-bone, and it is with difficulty that they
shut their jaws. In these cases the suitable mode of reduction
is apparent. For somebody must hold the patient^s head,
another grasps the lower jaw internally and externally with his
fingers at the chin, while the patient yawns as much as he can
conveniently and we must first move the jaw with the hand
;

hither and thither for a certain time, and order the man to re-
lax the jaw and separate it and then we must attend to per-
',

form three evolutions at the same time, we must move the jaw
from its distorted shape to its natural; push the jaw back-
 480 LUXATIO^'S. [book vr.

wards and then shut the jaws close, and prevent yawning.
;

This is mode of reduction,, and it cannot be performed by

the
any other processes. Very little treatment will suffice after-
wards. Having applied a waxed compress, it is to be secured
with a loose bandage. But the surest process is to lay the
man upon his back, and supporting his head upon well-stufFed
pillows, that they may not yield, to get some person to hold the
head of the patient. And if both ends of the jaw be dislocated,
the treatment is the same, only the mouth cannot be so well

shut, for then the jaw more prominent, but less distorted from
is

the teeth of the upper and lower jaws corresponding exactly to-
gether. Reduction is to be immediately performed, and the
mode ofhas been already described. If it cannot be restored,
it

there may be danger of the life from continued fevers, torpor,

and earns. For these muscles being altered and stretched in a
preternatural manner produce car us. They frequently have
evacuations by the belly, which are purely bilious, and small in
quantity ; and if they vomit, it is pure bile. These, for the
most part, die on the tenth day." This mode of reduction we
have often practised, having first used fomentations of wai'm
water and oil, by a sponge along the dislocated jaw, more espe-
cially when there is any difficulty in restoring it to its position.
Wherefore, having placed the man upon the ground, we stand
behind and operate in the manner described by Hippocrates.

CoMM. Commentary. The account here given of Hippocrates's

method of reduction is taken from his work, 'De Articulis,^ (31.)
When a few of his tehnical terms are explained in the com-

mentary of Galen, the description is sufficiently distinct, and

isupon the whole a very correct account of the symptoms and
treatment of this accident. The prominence of the coronoid
bone is well described by Hippocrates. Galen remarks that
the end of the jaw-bone slips inider the zygomatic arch. It
has been a matter of dispute what Hippocrates means by slack-
ening, or incomplete luxations of the jaw. It is worthy of
remark that such an accident is described by Sir Astley Cooper.
(See fui'ther Littre's Hippocrates, t. iv, 29.)
Galenas description of the method of reduction is given in

the Collection of Nicetas. (Chirurg. Vet. ed.-Cocchius.) It is

substantially the same as that of Hippocrates.

SECT, cxii.] LOWER JAW. 481

A mode of reducing the dislocation by means of a machine Comm.

'

is described by Oribasius^ in his work De Machinamentis, 30. '

The account which Celsus gives of this accident is upon the

whole very accurate, and corresponds very well with modern
descriptions. If dislocated only at one end, the chin inclines
to the opposite side, and the teeth of the upper and lower jaws
do not correspond. If at both ends, the whole chin projects
outwards, the lower teeth are more prominent, and the muscles
appear stretched. The patient being properly seated, and liis

head held by an assistant, the surgeon having wrapped his

thumbs with hnen cloths, is to put them into the patient's

mouth, while the fingers are applied externally. The jaw

being firmly grasped, the chin is to be shaken, and then, at
one and the same instant, the head is to be seized, the chin
moved, the jaw forced into its place, and the mouth shut. After
reduction, if pain in the eyes and neck has been brought on by
the accident, he recommends us to let blood from the arm. The
patient is to Hve
upon liquids, and avoid talking.
Albucasis follows Hippocrates in distinguishing dislocations
of the lower jaw into partial and complete. In addition to the
symptoms ah-eady detailed, he mentions a flow of saliva from
the mouth, and an inability to speak. When the dislocation
is partial or incomplete, he it soon retui"ns of itself
saj^s,
to its proper place. When
the luxation is complete, he directs
us to reduce it by introducing the thumbs into the mouth, and
grasping the jaw in the manner described by Hippocrates.
He states that when not reduced the accident often proves
fatal by superinducing fevers and coma. Avicenna, in like
manner, afiirms, that if not reduced, it may bring on fatal con-
sequences. His account is borrowed entirely from Hippocrates.
Rhases and Haly Abbas give exactly the same description of
the symptoms and mode of reducing as Albucasis.
Monteggia, Fabricius ab Aquapendente, Sir Astley Cooper, and
Mr. Samuel Cooper (the author of the well-known Surgical
Dictionary) affirm that there is no foundation for the prognostic
of Hippocrates, that the accident will prove fatal if the dislo-
cation be not speedily reduced. We
can say, hoAvever, from
our own personal knowledge, that such fatal consequences do
occasionally occur. We once knew a poor woman who was
very liable to dislocations of the lower jaw, which
'
we reduced
II. 31
 482 LUXATIONS. [book vi.

CoMM. three or four different times. At last^ owing to circumstances

'

unnecessary to explain, an interval of more tlian a

'
'
wliicli it is

day elapsed between the accident and the reduction. By this

time she was become seriously indisposed, and died a few days
afterwards with all the symptoms described by Hippocrates.
We may mention also that Heister states that fatal con-

sequences may from the accident. (Chirurg. p. i, iii, 4.)

result
The same thing is affirmed also by Brunus (Chirurg. Mag. i) ;

by Theodoricus (ii, 43) and by Guido de Cauliaco (v, 2.)

;

That species of sub-luxation described by Hippocrates, is

" Man-
mentioned by Guy of Cauliac in the following terms :

dibula quan deque mollificatur." (v, 2.)

SECT. CXIII. ON THE CLAVICLE AND ACROMION.

The clavicle, at its inner extremity, is not liable to dislo-

cation, for there it is articulated with the sternum, where it
admits of no motion. But if from any sudden and violent
force from without, it should be torn from its place, it is to

be subjected to the same treatment as a fracture. And its ex-

tremity which is articulated with the shoulder does not readily
fall out of the joint, being prevented by the biceps muscle and

the acromion. But neither does the clavicle admit any strong
motion of its own, being made solely for the expansion
peculiar
of the thorax, and hence man is the only animal which has a
clavicle. If it should sometimes happen to be dislocated in

wrestling, it is to be replaced with the hand, assisted by the

application of many-folded compresses, together with con-
venient bandages. When the acromion is sub-luxated it may
be restored to proper place by the same treatment.
its It is
a small cartilaginous bone connecting the clavicle to the scapula,
which is not to be seen in the skeletons. This, if moved a
little from its place, exhibits the appearance to inexperienced

persons of the head of the arm being dislocated for the top ;

of the shoulder appears sharper, and there is a hollow from

which it was removed but the cases are to be distinguished
;

from one another by the symptoms about to be enumerated.

CoMM. Commentary. The dislocation of the outer end of the cla-

^ '

from the acromion by Hippocrates, who gives

*
vicle is treated of
SECT. cxiTi.] CLAVICLE AND ACROMION. 483

a very distinct account of the symptoms and mode of treat- comm.

ment. He warns the surgeon not to confound this accident ——
'
^

with dislocation of the humerus^ as he had frequently seen

done. He directs the surgeon to push down the projecting
end of the bone ; and then to secure it with compresses^ and
bind the arm to the side. He holds that the accident always
leaves some deformity. (De Articulis, 15.)
Galen mentions that this accident happens most commonly
to young persons, and that when not reduced it occasions a

wasting of the arm. The account which Galen in this place

and, copying from him, our author have given of the accident
to which they represent the acromion as being subject, has
been the subject of much controversy among modern authorities.
See Cocchi (Chirurg. Vet. 133) ; and Littre (Hippoc. iv, 12.)
Hippocrates, whom they both evidently had in view, (de Artie.
13), clearly refers to dislocation of the scapular end of the cla-
vicle ; and probably Galen alludes to the same, complicated
with separation of the acromion from the scapula in young
subjects. We would beg leave to quote what Monro says of
the acromion " This is an and in some
:
epiphyse in children ;

^^
old subjects I have seen it joined by a cartilage to the spine.
(Anat. of the Bones, p. 231.) Galen states decidedly that in
young persons this process is sometimes bent along with the
clavicle, and in them that replacement of the parts to their
He " as
natural state is
easily effected. adds,dry wood is not
adapted for bending, but such as is
sappy and green bear this, in
the same manner the bones of growing animals can be bent by
force, and more especially such as are porous and fistulous, as
the clavicle is." Galen relates that in his own person he met
with the accident while wrestling in the Palestra, and that by
using oily fomentations and light bandages, a cure was at last
effected. He says he was then thirty -five years old, but adds,
that he had never known another person cured who was so far
advanced in life. (Ibid. 134.) Avicenna gives the same
account of the acromion as the Greeks, (iv, 5, 1, 10.)
Neither Celsus nor Oribasius has treated of this case of dis-
location.

Rhases, Avicenna, Haly Abbas, and Albucasis agree that

dislocations occur more frequently at the acromial than at the
sternal end of the clavicle. Desault and Bover, on the other
hand, affirm that the accident occurs oftener at the sternal
 '

484 LUXATIONS. [book vr.

CoMM. extremity ; but Sir Astley Cooper^s ample experience confirms

'
•
the correctness of the ancient statement. ]\Ir. Listen also

agrees in stating that dislocation at the acromial end is much

more frequent than at the sternal.

SECT. CXIV. ON DISLOCATION OF THE SHOULDER.

The head of the arm_, which is articulated with the ca\dty of

the scapula, is often dislocated; but neither iipwards, owing to
the coronoid process of the scapula, which, prevents it, nor
often backwards, owing also to the scapula, nor forwards

owing to the tendon of the biceps muscle and the acromion.

Sometimes, though rarely, it is dislocated inwards and out-
wards, but frequently, and particularly in those who are
lean, downwards. In such persons, however, as it is readily
dislocated, so is it also reduced ; but in those who are
brawny, on the other hand, it is not readily dislocated, and is
reduced with difficulty. In some cases from a blow suspicions
of dislocation are formed, although none has taken place,

owing to the violent inflammation which supervenes. Where-

fore, dislocation downwards may be thus ascertained. The
affected shoulder, when compared with the sound one, appears

very different, the upper part of the arm, whence the disloca-
tion took place, seeming hollow ; and (as mentioned with re-
gard to the sub-luxation of the acromion,) the top of the
shoulder appears sharper than natural ; and the dislocated
head of the arm distinctly felt in the armpit.
is The elbow
also is removed to a distance from the ribs ; or, if you attempt
it,you can only bring it to the ribs Avith difficulty ; neither
can the hand be raised to the ear, owing to the stretching of
the elbow ; nor can any other varied motions be performed
with it. In children, then, and in recent and inconsiderable
displacements of the bone, it may be often reduced, as Hippo-
crates remarks, by the protuberant knuckle of the middle
finger of the clenched hand of the surgeon, or of the sound
hand of the patient, if he be not a child. But the following
are more effectual modes of reduction. HaAdng bathed the
man and used relaxing affusions, let him be laid on the ground
in a supine posture, and apply a moderately-sized ball, either
of leather or some otiier soft thing to the armpit and the ;

surgeon being seated with his face turned to the patient upon
SECT, cxiv.] SHOULDER. 485

the affected side, if the right shoulder he dislocated, let him

put the heel of his right foot upon the ball previously fitted to
the armpit, or if the left, that of the left foot ; and seizing
the hand of the affected arm, let him pull down to the feet, at
the same time making counter-extension by the heel in the
armpit, while an assistant, standing behind the head, pulls at
the other shoulder in an opposite direction, to prevent the body
from being dragged along. There is another mode of reduc-
tion, namely, by susj)ending the patient upon a person's
shoulder. A young man taller than the patient, or stand-
ing on some elevated object, by his affected side, (the patient
also being in a standing posture) is to apply his shoulder
below the patient's armpit, while he stretches and puUs the
patient's hand towards his own belly, so that the rest of the
patient's body is suspended at the back of the person who
supports him. But if the patient be light, another light child
is to be suspended from him. For while the arm and the rest
of the body are pulled downwards oppositely, the shoulder put
under the armpit, readily replaces the dislocated limb. And
the same thing may be done by means of the instrument called
a pestle. It is a long piece of wood which is erected on the

ground upon some other firm object. Its upper extremity,

then, being rounded, and neither very thick nor thin, is ap-
plied below the armpit of the patient, who either stands or
sits,according to the length of the pestle, and the hand being-
stretched along the pestle and pulled downwards, while the
rest of the body is balanced on the opposite side and weighs

downwards, the reduction takes place either spontaneously, or

with the assistance of another person pulling down. Aud this
may be done with the step of a ladder, as we described when
treating of the extension for a fractured arm. Here some round
is to be fitted to the step of the ladder, such as will suit
body
the armpit of the patient, and propel the head of the arm.
But if, owing to the oldness of the accident, or the hardness of
the body, we find the reduction difficult, we must have recourse
to method by the means of the instrument called ambc.
the
The ambe is a piece of wood about two cubits in length, of the
breadth of three fingers, and about two fingers' breadth in thick-
for the
ness, having the one extremity round and adapted
hollow of the armpit, like the extremity of the pestle. Having
 486 LUXATIONS. [book vi.

then wrapped end with Hnen rags^ in order that it may be

its

softer, we
adjust under the head of the humerus in the arm-
it

pit, and stretching the hand along the wood, we bind it at the
arm, fore-arm, and wrist then bringing the hand with the
;

wood over a transverse piece of wood, fastened between two

erect pedestals, or again over the step of a ladder, so that the

armpit may be fitted transversely to the step, we draw the hand

downwards, and allow the rest of the body to hang suspended
on the opposite side for then the limb will return to its place.
;

After the reduction, we must apply to the armpit a secure

and moderately-sized ball of wool, which, if there is no inflam-
mation present, is to be dry, but if there is inflammation, it is
to be dipped in oil. Around this, the shoulder, and the other
armpit, a bandage is to be put on in the form of the Greek
letterX, so that the decussation may take place above the
aff'ectedshoulder ; and the arm is to be bound to the sides ;
and the elbow and hand are to be slung by the neck, so that
the limb may not fall out again while the dislocation is recent.
After the seventh day or later, having loosed the bandages, we
must have recourse to moderate friction, so that the body
being rendered firmer, the joint may become less liable to
luxations. But if the limb is often dislocated, either owing to
its humidity (flabbiness), or from its being long subject to the

accident, we must proceed to burning, as formerly described.

But since sometimes the foetus in utero or the child, while
gi'owing, sustains a dislocation of the part which is not reduced,
the flesh upon the shoulder is nothing reduced from the natural,
nor is the hand obstructed in any of its operations, but the
bone remains shorter, not increasing in size ; and such persons
are called weasel-armed. But in the case of the thigh, the
bone does not grow and the limb wastes ; for, not being able
to sustain the weight of the body, it is not exercised. And
with regard to all the other members, if they remain unreduced
the parts below are greatly impaired.

CoMM. Commentary. Hippocrates delivers his opinions respecting

' '
"
dislocations at the shoulder-joint with singular modesty and a
remarkable air of truth. He savs, that he had never met
with a case in which the head of the humerus was not lodged
in the armpit, and expresses a doubt whether in reality there
SECT, cxiv.] SHOULDER. 4H7

be dislocations inwards or backwards, " I will not

affirm/' Comm.
he adds^ " whether or not dislocation forwards may take place,
'
*
'

only this I can say that I have never seen it.'' (De Articulis.)
Galen, in his commentary on this work, mentions that he had
seen five cases of the uncommon kinds of dislocation, four
of which were dislocations forwards. They occurred mostly
among the athletse. In one case, of which he relates the par-
he eflFected the reduction with his heel placed in the
ticulars,
armpit. Galen states distinctly, that it is the retraction of
the muscles which proves the great obstacle to reduction. (Ed.
Basil, V, 585.) Hippocrates has described several methods of
reduction, most of which are mentioned by our author. By
the fist placed in the armpit, as described by our author.
By the heel, as likewise described by him. He adds one ad-
vice not distinctly given by our author, to apply the ball placed
in the armpit on the side within the head of the humerus, and
not upon it. The process by suspending the patient upon the
shoulder of another person is next described by him. Those
b}' the pestle and ladder are afterwards clearly described. He
then describes the ambe and the application of it to the reduc-
tion of dislocations in nearly the same terms as our author.
We here mention, by the way, that the description of the
may
ambe given by Boyer, does not correspond exactly to the in-
strument recommended by Hippocrates. See drawings of
'
Hippocrates's ambe in Heister's Surgery' (x, 4) ;
in Scul-
tet's 'Arsenal de Chirurgie' (xxii, 1); and in Littre's edition
of Hippocrates (iv, 91.) Hippocrates describes other less im-
portant processes of reduction with a Thessalian chair, and a
door. He remarks, that persons in a reduced habit of body
and illustrates this position by
are most liable to dislocations,
some very acute observations on the occurrence of these ac-
cidents in cattle. After reduction, he directs that a ball of
soft wool should be placed in the armpit and secured with a

bandage and a sling and he attaches great importance to

;

well-regulated friction afterwards.

Celsus mentions two kinds of dislocation at the shoulder-
joint, downwards and forwards.
namely, He describes the
methods of reduction by the hand, and by a wooden instrument
His
(spathula lignea) resembling the ambe
of Hippocrates.
of the latter method is very distinct. His mode
description
 488 LUXATIONS. [book vi.

CoMM. of reducing dislocations inwards merits attention. The man

' '

is to be laid on his back^ and a strip of cloth or a

thong of
*

leather being placed in the armpit, its two ends are to be brought
behind the patient^s head and given in charge to an assistant,
while another takes hold of the arm ; the surgeon is then to
push back the patient's head Avith his left hand, while with
the other he raises the fore-arm and arm, and pushes the bone
into its place. After reduction the armpit is to be stuffed Avith
wool, and suitable bandages applied.
Oribasius treats of dislocations downwards, outwards, and
forwards ; and gives a very elaborate description of complicated
machines for reducing them. Of these it is impossible to
convey any correct idea without proper plates. We must be
content, therefore, with referring the reader to his work. (De
Machinamentis.)
Albucasis describes three kinds of dislocation at the shoulder,
namely, downwards, inwards, below the pectoral muscle, and
upwards^ about which he expresses himself somewhat doubtful.
He denies the possibility of dislocations forwards and back-
wards, the former being prevented by the muscles and latter
by the scapula. His methods of reduction are exactly the same
mentioned by Paulus.
as those
Avicenna expresses himself as being doubtful whether any
dislocation takes place at the shoulder except downwards, at
least, he adds, he had no experience of any other case. He
gives the symptoms of it very accurately, and describes all the
methods of reduction mentioned by oui' author. He approves
of the cautery to ob\aate the tendency to repeated dislo-
cations.

Haly Abbas questions the occurrence of dislocations up-

wards, forwards, inwards, or backwards. He appears, therefore,
to agree with Hippocrates in considering that downwards as
the only unequivocal case of dislocation. He recommends the
processes of reduction described by our author.
Rliases remarks, that
owing to the shallowness of the glenoid
caAdty and the weakness of the ligaments the bones at the
shoulder are more subject to luxations than those of any
other joint. He describes the symptoms very accurately. The
top of the shoulder, he says, is sharper than natural, the head
of the humerus is felt in the armpit, the arm cannot be brought
SECT, cxv,] ELBOW. 489

to the sides without pain, nor raised to the head at all. He Comm
remarks correctly that when the accident happens
during
——
'

*
'

delivery or in childhood, the arm does not grow to its natural

size. He mentions that venesection is often of great use in
reducing dislocations. He also recommends the warm bath.
He denies the possibility of a dislocation in any other direction
except downwards.
The ancient modes of reduction are recommended and de-
scribed by Guy of Cauliac (v, 2) ;
and Theodoricus (ii, 47.)

SECT. cxv. ON THE ELBOW.

Inasmuch as the elbow-joint is more complicated than that

of the shoulder, so, in like manner, are its dislocations more
difficult to manage for they are less readily occasioned, and
;

more difficultly reduced, owing to the number of its processes

and cavities. Sometimes it undergoes sub-luxation only, but
often it is completely dislocated in every direction, and more

especially forwards and backwards. It is easily recognised

even by the sight, and the dislocated bone may be felt in the
place to which it has been removed, while a hollow appears in
the place whence it was moved. A
comparison with the sound
arm particularly discloses the nature of the accident.
Reduc-
tion then must be made immediately before inflammation
comes on, for, if this has supervened, it is difficult to cure,
and some such cases become utterly irremediable, more espe-
cially if the dislocation was backwards for of all the disloca-
;

tions at the elbow-joint, that backwards is the most painful

and dangerous. Small displacements then may be restored by
a moderate degree of extension, the assistants keeping the
hand extended, pulling, and making counter- extension at the
fore-arm and arm, while the surgeon with the palm of his hand
pushes the dislocated bone into its natural place. Hippocrates
rectifiesthe dislocation forwards by bending the hand suddenly
so as to force the palm straight to the shoulder of the same
side and that backwards again by frequent and strong exten-
;

sion inasmuch as dislocations forwards are produced by vio-

;

lent extension, and those backwards by violent flexion. If the

dislocation has continued long unreduced, we must have re-
 490 LUXATIONS. [book vi.

course to stronger extension, sucli in particular as that de-

scribed by Hippocrates for a fractured arm, where he has
recourse to the piece of wood adapted to a spade. Some of
the moderns manage the matter thus Two assistants stretch-
:

ing the arm as aforesaid, the one holding at the armpit, and
the other below at the wrist, the surgeon, standing opposite the
patient, grasps the arm with the palms of both his hands near
the joint, and gi^ang orders to bind a long folded robe or broad
swathe round his hands and the arm of the patient, and to
pull outwards and downwards towards the hand, whilst he, fol-
lowing the same course, drags the parts with his hands thus
secured until they pass the articulation of the joint. The
arm should be first anointed with oil, to render the part slip-
pery and easily moved Avith the palms of the surgeon's hands.
Thus the dislocated parts being violently pulled by the hands
of the assistants -^ill return to
theii' proper place. After the
I'cduction the armto be bent to an angular position, and
is

treated with oblong compresses and suitable bandages.

CoMM. Commentary. No author, ancient nor modern, has given

'
'
'
so complete a view of the accidents to which the
elbow-joint is
subject as Hippocrates. In his works (De Fracturis, De Ar-
ticulis, and Mochlicus,) he has treated of this subject with

surprising accuracy and skill. He describes the following in-

juries of the elbow-joint: 1st. Complete luxations, laterally,
anteriorly, and posteriorly. 2d. Luxations of the radius,

anteriorly, posteriorly, and laterally. 3d. Fracture of the

olecranon. 4th. Fracture of the apophysis of the humerus.
We must give his description of the last-mentioned injurj^ in
his own words " It sometimes
:
happens that the head of the
humerus is broken at its apophysis ; and this, although it
ap-
pear a more serious accident, is, in fact, less so than
many
other injuries of the joint." It is singular that this distinct
account of a very common injury of the joint should have been
overlooked or misunderstood by all his commentators and the
surgical authorities down to the present day. We have often
met with it in our own practice, and seen many instances in
which it had been misapprehended in the practice of other
It is only within the last five or six
surgeons. years that it
has been described in any modern work on Lateral
surgery.
SECT, cxv.] ELBOW. 491

luxation of the radius described bv him under the name of Comm.

is
'

diastasis. (De Fracturis, 44 ; De Articulis, 20.) The Commen- "

taries of Apollonius Citiensis and Galen are worth consulting

althouo'h thev contain no new matter. Galen remarks that in
dislocations of the radius, the power of flexion and extension
is often not much impaired and this, we may add, is con-
;

firmed by modern observation. Galenas account of fractures

of the olecranon is remarkable for its precision and accuracy.
(Chirurg. Yet. 84.)
Celsus describes four diflFerent kinds of dislocation at the
elbow, namely, forwards, backwards, and to either side. He
also mentions that rare varietv, in which there is a dislocation
of the ulna, while the radius remains in its place. (See Sir
Astley Cooper^s Lectures.) The other varieties are all well

described, and suitable methods of treatment recommended.

When there is a dislocation forwards the arm is extended, but
cannot be bent ; when backwards, on the contrary, it cannot
be extended, and is shorter than natural. "When to either
side, the arm is somewhat bent towards that side from which
the bone has been moved. He lays it down as a general rule
for treating all such dislocations, to extend both the members
concerned in difi'erent dii-ections, until the bones are separated
from one another, and then to push them into their right po-
sition. When the dislocation is forwards, he directs us to
make strong extension with the hands or with thongs,
and
then placing some roimd body upon the anterior part of the
arm, to push the fore-arm over it suddenly to the shoulder.
This method is well described by Hippocrates, but rather in-
distinctly by Paulus. In all the other cases, the best method,
he says, is to make reduction in the same way that it is per-
formed for the replacement of fractures.
Oribasius mentions the four ordinary kinds of dislocation at
the elbow-joint, and describes methods of reducing them by
machines. He has likewise described the separate dislocation
of the radius from the humerus, and he is the only Greek au-
thority, as far as we know,
who has described the separate lux-
ation of the ulna, but which, as stated above, had been noticed
bv Celsus. We need scarcely remark that a few cases of this
uncommon accident have been reported of late years.
 492 LUXATIONS. [book vi.

CoMM. Albucasis says that the fore-arm is dislocated in all direc-

" — '
'

tions, but more especially backwards and forwards.

His de-
scription of the mode of reduction is evidently copied from
Paulus. A^dcenna likewise borrows his whole account from
our author.
Rliases and Haly Abbas describe the ordinary cases of com-
plete luxation at the elbow-joint, but we believe that neither

they nor any of the Arabians take notice of the dislocation of

the radius from the ulna, nor the abruption of the apophysis
of the humerus.

SECT. CXVI. ON DISLOCATIONS AT THE WRIST AND FINGERS.

Dislocations at the wrist and fingers are attended with no

difficulty, imless accompanied with a wound. This case, there-
be treated of under the head of dislocations with a
fore, will
wound. Those without a wound may be remedied by moderate
extension and the anti-inflammatory plan of treatment.

CoMM. Commentary. Hippocrates says that the hand is dislocated

'
'

inwards and outwards, but most frequenth' inwards. In the

former case it is found impossible to bend the fingers, and in
the latter to extend them. He also makes mention of disloca-
tions to either side. He directs us to make counter-extension
upon a and to push doAvn the projecting end of the bone
table,
with the hand or the heel. He also describes the separate
dislocation of the radius and ulna and, upon the whole, his
;

account is very little different from that given bv Sii' Astlev

'
Cooper in his Lectures,^ and by Mr. Liston in his Elements of
'

Surgery.'
Celsus describes, in his usual elegant manner, the disloca-
tions forwards and backAvards. He denies the possibility of
the lateral dislocations, and, in fact, it is now acknowledged
that if ever they do occur they are incomplete. Like Hippo-
*
crates,he directs us to replace dislocations of the fingers by
making extension upon a table. He does not make mention of
the separate dislocation of the lower end of the radius.
Oribasius mentions the dislocations forwards and backwards,
and likewise the separate dislocations of the radius and ulna.
SECT, cxvii.] SPINE. ^93

Sometimes, he says, the radius is dislocated, while the ulna re- Comm.
'

mains in its place, and sometimes the ulna is dislocated while

'

'

the radius remains. lie describes the process of reduction

with machines.
Allucasis, Avicenna, and Haly Abbas describe very accu-
rately the dislocations forwardsand backwards. Thev state
that immediate reduction is peculiarly required in the case of

this accident. A\'icenna recommends a strengthening plaster

to be put on the part before the splints are applied. When
the joint, after reduction, is found to have lost the power of
motion, Albucasis recommends us to pour hot water upon it

and apply friction.

Rhases states that the ulna is more apt to be dislocated se-
parately than the radius, which generally undergoes fracture
rather than luxation. The lingers, he says, are mostly dislo-
cated inwards.

SECT. CXVII. ON THE VERTEBRAE OF THE SPINE.

The vertebrse of the spine, when completely dislocated by

accident, occasion instant death ;
for the spinal marrow under-
goes extraordinary compression ; and even Avhen one of its
nervous processes is compressed, it brings on dangerous symp-
toms. It often suffers sub-luxations, and when this takes

place forwards it gets the name of repandation ; when back-

wards, that of gibbosity; and when sideways, that of wry-necked-
ness. When there is a small sub-luxation of many vertebrae
together, the distortion occasions a circular flexure of the spine,
and in this case some are apt to be deceived, and take it for a
complete dislocation of one spine, whereas a complete disloca-
tion of one spinal vertebra does not produce a circular but an

angular flexure of the spine, which is attended with more dan-

ger. When the dislocation is inwards, it cannot be reduced
because no counter-pressure can be made on the belly. But
those who imagine that they can efi'ect anything in this case
by stretching the patients upon by apply cupping in-
a ladder,

struments, or administering sternutatories, or by producing

coughing, or by inflation, are sufficiently exposed by Hippo-
crates. But since, often the breaking off* of some of the small
494 LUXATIONS. [book vi.

bones of the spine leaves a hollow appearance (as has been

mentioned when treating of fractures), some have taken this
for a dislocation forwards ; and it being speedily healed, (for
its callus is soon formed,) they have given out that a disloca-

tion forwards is readily cured, although in fact it be wholly in-

curable, or difficult at least, to cure. For retention of the
urine and faeces takes place, with coldness of the body but ;

this state is followed afterwards by an involuntary discharge of

the excrements. These symptoms arise from the nerves and
from muscular sympathy, and the patients soon die, more espe-
cially if the upper parts and the vertebrse of the neck be affected.
But that gibbous state of the spine which mostly takes place
from infancy, is a protracted affection and not speedily fatal ;
but, as Hippocrates has shown, it leads to disease and is in-
curable. But when this state occurs from an accident, the
contrivances to remedy it with a ladder, suspending the patient
erect, and inflation with a bladder, are altogether ridiculous.
But the method of rectifying it, recommended by Hippocrates,
will be alone sufficient. For, he says, a board, in length and
breadth such as to contain the man, or a bench equal to it, is
to be placed near a wall, being extended along the wall, and
not more than a foot distant from it, and some robes are to be
spread over it to prevent the body from being injured. Then
the man, being bathed, is to be laid on his face along the board
or bench, and a thong is to be twice passed round his breast

by the armpits along the back ; and the extremities of the thong
are to be fastened to a pestle like a piece of wood erected on
the floor at the extremity of the board or bench, and this to be
given to a person standing behind the patient's head to hold,
so that when the lower parts are secured oppositely, and the

upper pulled towards the head, extension may be made at the

proper time. Then another thong being bound round both the
feet above the ankles, and again another above the loins, so
that its two ends may meet upon the haunch-bone, the ex-
tremities of these thongs are to be again united together, and
bound to another pestle-like piece of wood resembhng that al-
ready described and this pestle, like the former, is to be erected
;

near the extremity of the board or bench at his feet ; and then
we are to order the assistants to make counter-extension by these
pieces of wood. Others effect this part of the operation by what
SECT, cxvii.] SPINE. 495

are calledaselli. They are axles turned upon an erect piece

of woodj wliich is placed at each extremity of the
large board
or bench^ at the feet and head of the patient, and the
thongs
are to be wrapped round them. While the extension is thus
made, we press down the prominence of the back with the palms
of the hands, and if necessary we may sit upon it Avithout ap-
prehension. If the spine is not thus made straight, and the
patient can endure pressure, we may scoop out from the adjoin-
ing wall a furrow opposite the prominence of the back, so that
the length of the furrow may not be greater than a cubit, and
it must be in a situation neither much
higher nor lower than
the patient^s spine. But this furrow ought rather to be pre-
pared beforehand, and on this account we directed the board
at first to be placed near the wall. Then one extremity of a
board is to be introduced into the furrow, while we press the
other downward until it is clear that the spine is rectified.

According to Hippocrates, extension alone without the board,

and again the treatment with the board alone, is sufficient to

accomplish the purpose. If this be true it will not be impro-

per, in cases of dislocation anteriorly and laterally, to make the
aforesaid extension without the compression. After the reduc-
tion, a thin piece of wood three fingers in breadth, and of such
a length as to comprehend the dislocated part and some of the
sound vertebrse, is to be wrapped round with a piece of linen
or some flax, on account of its hardness, and applied to the
spine with suitable bandages. And the patient must be kept
upon a spare diet. If afterwards any remains of the protube-
rance are to be discovered, we must use relaxant and emollient
applications, with the pressure by means of the plate. Some
use a plate of lead.

Commentary. Our author's account of dislocations of the Comm.

spine is entirely condensed from Hippocrates's work ' De Ar-
ticulis,' and the commentary of Galen on the same. The de-
scription of the methods of reduction is so plain, that we
need
not take up time in illustrating it. It will be remarked that
he makes mention of a mode of reducing these dislocations by
means of axles or aselli. In the days of Hippocrates they
were acquainted Avith only three of the mechanical powers,
namely, the lever, the wedge, and the axis in peritrochio. The
 496 LUXATIONS. [book vi.

CoMM. last mentioned is called by him asellus. (See De Fracturis

"

cum Comment.
'

Galeni.) Hippocrates makes mention of a mode

•

of reducing dislocations of the spine, by succussion in a ladder,

but expresses himself unfavorably of it as being a procedure
which none but charlatans would practice. He speaks with
becoming contempt of those who have recourse to ostentatious
modes of performance ad captandum viilgus.
Celsus states very decidedly the fatal nature of dislocations
of the uppermost vertebrae. Even those below the diaphragm
are designated as highly dangerous. They happen either for-
wards or backwards. Those above the diaphragm occasion
paralysis of the hands, vomitings, contractions of the tendons,
difficulty of breathing, pain, and relaxation of the ears. Those
below the diaphragm produce paralysis of the lower extremities,
suppression of urine, or an involuntary discharge of it. Even
these cases, he adds, prove fatal within three days. He says,
that Hippocrates's mode of reduction by counter-extension and
pressure on the part with the heel, applies only to cases of
incomplete luxation.
Oribasius describes the method of reduction by means of a
machine, as mentioned by our author. It will readily be un-
derstood that the whole process consisted in making counter-
extension upwards and downwards, and pressing upon the part
which projects with a piece of wood. (De jNIachiuamentis.)
Albucasis explains the nature of the accident and the me-
thods of reduction in much the same terms as our author.
The patient is to be laid upon a board or bench of sufficient
length, spread with some soft thing to prevent him from being
hurt. Then a pole or piece of wood is to be fastened at each
extremity of the bench ;
and a rope or swathe, being carried
round the patient's body by the armpits and above his head,
is to be fastened to the
upper pole, which is not to be fixed
firm in the ground ; and another rope is to be brought round
below the part affected, and fastened to the pole at his feet.
Powerful counter-extension may be thus made, while the sur-
geon presses upon the protnided part with his hand and pushes
it into its place. If these means do not succeed, he directs us
to fasten a piece of wood into a hole in the wall
opposite the
protuberant part of the patient's back and to press down with
it. Other methods are also described by him. After reduc-
 SECT, cxvii.] SPINE, 497

tion he directs us to apply a splint witli bandages, as recom- com

mended by our author, r-
>
—
Avicenna describes all the methods of reduction here men-
tioned; and in the Latin edition of his Avorks there are plates
to illustrate his descriptions. Judging from our own experience
of such cases, however, we would say that such contrivances can
seldom be required to reduce these dislocations, as there is much
less difficulty in the reduction than in keeping the parts in
place afterwards.
Haly Abbas copies the description given by Hippocrates of
the mode of reduction. After the parts are restored to their
place, he recommends us to apply a board (tabula lignea) three
fingers broad, and of such a length as to comprehend the dislo-
cated vertebrae and some of the adjoining ones ; and to bind it

firmly on to prevent a recurrence of the displacement.

Theancients were well acquainted with the curvature of the
spine occasioning paralysis of the lower extremities. Alsaha-
ravius remarks that it occurs most frequently in childhood, and
arises from an inflammation or collection of humours between
the vertebrae. Sometimes, he adds, it is occasioned by a gross
flatus. This is the disease called spina ventosa. When con-
nected with a collection of blood in the part, he recommends
bleeding, clysters, and various emollient applications. When
itarises from flatulence he prescribes the hermodactylus. If
the usual means do not succeed he approves of the actual cau-
tery. (Pract. xxviii, 9.)
But no ancient author has treated so fully of curv^ature of
the spine as Rhases, He states thatit occurs most
frequently
in childhood, and often proves fatal by occasioning pressure on
the thoracic viscera. The disease, he says, may arise from a
fall, a blow, an abscess, or a gross flatus contained in the ver-
tebrae. In cases of paralysis of the lower extremities connected
with this disease, he approves of applpng the actual cautery to
the back. (Cont. i.)
He states correctly that dislocations of
the upper vertebrae often prove suddenly fatal. He directs the
surgeon to keep them reduced with a splint extending the
whole length of the spine. (Cont. xxix.) On the spina ventosa
or gibbositas, see further Serapion (v, 26.) For the cure of it,
he recommends first discutient plasters, and if these do not
succeed he advises recourse to the actual cautery,
' (v, 27.)
II. 32
498 DISLOCATIONS. [book vi.

SECT. CXVIII. ON DIS^LOCATION AT THE HIP-JOINT.

The other bones of the human body sometimes undergo sub-

luxation^and sometimes complete luxation^ but the articulations
at the hip and the shoulder are subject only to complete lux-

atioUj more especially the hip-joint, because it has a deep and

round cavity which is further strengthened by a strong brim.
The limb, then, being subject to displacement from its cavity
by some great violence, many differences arise according to the
greater or less degree of the dislocation. Dislocation at the
hip-joint takes place in four ways, or rather places ; for it is
dislocated either inwards, outwards, forwards, or backwards ;
inwards and outwards frequently, more especially inwards; but
forwards and backwards very rarely. When the dislocation is
inwards, the affected leg, if compared with the sound one, ap-
pears longer, the knee is more prominent, the patient cannot
bend the leg at the groin, and a swelling is clearly felt in the
perineum, from the head of the thigh being lodged there.
When the dislocation is outwards, the symptoms are the con-
trary to these
;
for the leg appears shorter, there is a hollow in
the perineum, a protuberance about the nates, the knee is
turned inwards, and the leg can be bent. When the disloca-
tion is forwards, the patient can stretch the leg without pain
at the knee, but when he attempts to walk he cannot turn the
foot inwards ; the urine is retained, the groin is swelled, the
buttocks appear wrinkled and destitute of plumpness ; and in
walking he supports himself upon his heel. Those who expe-
rience a dislocation backwards can neither extend the ham nor
the knee, nor can they bend the limb before bending the groin
also. The leg appears shorter, the groin looser, and the head
of the thigh is to be felt at the buttock. When, then, from
infancy, or simply, when for a length of time the limb has been
neglected after being dislocated, and allowed to remain so, the
cure is impracticable, callus having been already formed. But
when the luxation is recent, it may be managed in the way re-
commended by Hippocrates. We must, then, proceed imme-
diately to the reduction, for dislocations at the hip-joint, when
allowed to remain long, are wholly irremediable. In general,
then, in all the four kinds of dislocation, the reduction may be
SECT, cxviii.] HIP-JOINT. 499

accomplished by rotating it, by bending the limb^ and bv ex-

tension. For if the accident be recent and the patient young,
we may sometimes succeed in reducing the hmb by graspino-
and rotating the thigh this way and that. When the disloca-
tion is inwards we
may sometimes accomplish our pm-pose by
bending the limb at the groin inwards frequently and strongly.
If the dislocation does not yield to these means we must have
recourse to extension, first with the hands, certain assistants
grasping the thigh and leg and pulling the limb downwards,
while others grasp the body at the armpits and pull upwards.
Or, if a stronger extension be required^ the leg may be bound
with twisted cords or thongs, above the ankle, and a little
higher than the knee, lest it suffer injury ; but it is not neces-
sary to secure the breast in this manner, for, as has been said,
the hands may be put under the armpits for this purpose. And
the middle of a soft and strong thong is to be applied to the
perineum, and brought up to the shoulders anteriorly by the
groins and clavicles, and posteriorly along the back, and the
two ends are to be given to an assistant to hold. Then, all
pulling together so as to raise the patient's body, extension is
to be thus made. This mode of extension is applicable gene-
rally in all the four varieties of dislocation. But the manner of
replacement varies according to the nature of the dislocation. If
the bone has been dislocated inwards, let the patient be stretched
by having the middle of a thong applied to the perineum be-
tween the head of the bone and the perineum, and let the
thong be brought upwards by the adjoining groin and the cla-
vicle, and let a young man with both his arms grasp the thigh
which is affected in its thickest part, and pull strongly outwards.
This mode of reduction is easier than any of the others. When
the limb does not thus yield we must have recourse to other
contrivances more complicated but more efficacious than these.
Let the man be stretched upon a large board, or bench, like
that upon which we stretch those who have dislocation of the
spine, and along nearly its whole length let certain gutters be
scooped out, in breadth and depth not more than three fingers,
and not more than four fingers distant from one another, so
that the extremity of the lever being inserted into them may

impel the limb wherever it is required. In the middle of the

board, or bench, let another piece of wood be fastened about a
500 DISLOCATIONS. [book ti.

foot in length, and in thickness like that which is inserted in

the extremity of a spade, so that when the man is
pulled along,
this piece of wood may come between the perinenm and the
head of the thigh, so as to prevent the yielding of the body
Avhen pulled by the feet, and thereby often obviating the neces-
sity of making counter-extension and at the same time when
;

the body is extended this piece of wood will push the head of
the thigh outwards. The extension is to be made in the man-
ner described above, more particularly by the foot. But if it

is not thus reduced, the erect piece of wood is to be taken

away, and two other pieces of wood fastened on the sides of it
like posts, not more than a foot in length, and let another piece
of wood be adapted to them like the step of a ladder, so that
the figure of the three pieces of wood may resemble the Greek
letter H
;
the middle piece of wood being fixed a little below
the upper extremities. Then the man being laid on the sound
side, we bring the sound leg between the two posts below the
piece of wood corresponding to the step of a ladder, while the
affected one is brought above it, so that the head of the thigh
isto be adapted to it ; but a folded garment is to be first

wrapped about it to pres^ent the thigh from being bruised. Then

another board of moderate breadth, and of such a length as to
extend from the head of the thigh to the ankle, is to be bound
along the inner side of the thigh. Then extension being made
either by the pestles mentioned in treating of the dislocation
of the vertebra, or some other instrument, the leg is to be
pulled downwards along with the board which is fastened to it,
so that force exerted the head of the thigh-bone may
by the
return to its
proper place. There is another mode of reduction
without making extension upon a board, which is much com-
mended by Hippocrates. The patient^s hands, he says, are to
be bound loosely to the sides, and a soft but strong thong put
round both his feet at the ankles and above the knees, four
fingers distant from one another, so that the aff'ected leg when
stretched may come two inches lower down than the other.
The man is afterwards to be suspended with the head two cubits
distant from the ground. Then an expert young man is to
seize the aff'ected thigh in his arms, at its thickest part, where
the head of the thigh is lodged, and suddenly suspend liimself
from the man, by which means the joint will readily return to
SECT, cxviii.] IIIP-JOINT. 501

its place. This mode of reduction is

simpler tlian any of tlie

others, being performed without much apparatus, but many

now reprobate it as dangerous. If the dislocation is outwards,
the extension is to be made as above, but the thong at the
perineum is to be passed by the opposite parts, I mean the groin
and clavicle. The surgeon is to propel the limb from without
inwards, the lever being fastened into one of the furrows for-
merly prepared, and an assistant fixing the sound nates that the
body may not yield. In dislocations forwards, the patient being
stretched, a strong man is to apply the palm of the right hand
to the affected groin, and press down with the other hand, so
that the depressing force may be exerted downwards, and to
the knee. In dislocations backwards, the man is not to be
stretched so as to raise him up, but he is to lie upon a hard body
as in dislocations outwards and, as we mentioned with regard
;

to dislocations of the vertebra backwards, the man is to be laid

on his face upon a board or bench, and the ligatui'es are to be ap-
plied, not to the loins, but to the leg as mentioned a little, above.
But the depression, by means of a board, is to be applied at the
buttocks, where the dislocated bone is lodged. And thus much
respecting dislocations at the hip-joint occasioned by some ex-
ternal cause. But since dislocation sometimes takes place at
the hip-joint, as at the shoulder, owing to a collection of hu-
mours, Ave must, in this case, as we mentioned in the other,
have recourse to biu'uing.

Commentary. Although the descriptions given by the me- Comm. ' '

who preceded and followed our author will be

dical authorities *

found in the main exactly the same as his, we are induced to

give a brief outline of them, in order to illustrate by every
means in our power a subject so important as the one now on
hand.
Every subsequent author is indebted to Hippocrates for his
lucid and correct exposition of dislocations at the hip-joint.
He says truly that the thigh-bone is dislocated in four direc-
tions, namely, inwards, which occurs frequently ; outwards, the
most frequenth' of all ;
backwards and forwards, both very
rarely. The following are the symptoms of dislocation in-

wards, as described by him. The leg is longer than natural,

the buttocks outwardly appear hollow ; the knee, foot, and leg
 502 DISLOCATIONS. [book vi.

CoMM. are turned out ;

the patient cannot bend his thigh at the
" '
'
groin ; and the head of the thigh-bone occasions a tumour in
the perineum. This appears evidently to be the variety de-
scribed by modern surgeons as the dislocation inwards and

downwards, the head of the bone being lodged near the thy-
roid foramen. The symptoms described by modern authors are
exactly the same as those mentioned by Hippocrates. Ha\'ing
seen cases of it, we can bear testimony to the correctness of
Hippocrates's description. The symptoms of dislocation out-
wards as enumerated by Hippocrates are, shortening of the
limb, relaxation of the inner part of the thigh, and projection
at the buttock, inclination of the knee, leg, and foot inwards,
with inability to bend the limb. This case is described by
modern authors as a dislocation upon the dorsum of the ilium.
From personal experience we can also testify to the accuracy
of the description of it given by Hippocrates. The next variety
is the dislocation Ijackwards, which, he remarks, is of rare
occurrence. It is rather obscurely marked by inability to
extend the leg at the hip-joint and ham, relaxation of the
flesh in the groin, distension of the nates, a slight degree of

shortening and inclination of the limb. He

states that the
head of the bone is situated below the flesh of the nates.
This assuredly is the dislocation backwards upon the tuber
ischii, the symptoms of which are admitted by Sir Astley

Cooper to be sufficiently obscure. Hippocrates describes with

great accuracy the appearance which the limb puts on after-
wards when the dislocation is not reduced. (De Articulis.)
Reduction, he says, may be accomplished by the hands, with
a bench, or with a lever. All these modes of reduction are
mentioned by our author, and therefore we shall not take up
time in describing them. (Ibid, and De Yectiariis, 15.)
The figure of the bench of Hippocrates, given by Littre, would
appear to us excellent, and it renders the description easily
understood. (Hippocrat. Op. t. iv, 44.) Littre also gives an
excellent figure of the reduction
by suspension. (lb. 291.)
ApoUonius Citiensis gives a most elaborate and interesting
commentary on the methods of reduction recommended by
Hippocrates in cases of dislocation at the hip -joint. These
methods, however, may be best learned by examining the
figures given in the Index Galeni, or in H. Stephens^s Latin
SECT, cxviii.] HIP-JOINT. 5U3

Translation of Oribasins Med. Art. Princip.), or in

(Ap. Comm.
' '

Littre^s Edition of Hippocrates (iii, and iv.)

"
There is one
curious passage in tlie commentary of Apollonius^ which we

must not pass by. He says that Hegetor, one of the followers
of Herophilus, had maintained that dislocation of the
thigh
being attended with rupture of the tendon fixed into his head
(ligamentum teres) it was impossible ever afterwards to keep
the ball of the femur in the acetabulum. This, Apollonius
correctly argues, is contrary to experience and the authority
of the ancients. (Ed. Dietz. p. 35.)
Celsus describes the different modes of dislocation at the
" Femui' in omnes
hip-joint in the following terms :
quatuor
partes promovetur, ssepissime in interiorem; deinde in exteri-
orem ; raro admodum in priorem, aut posteriorem. Si in in-
teriorem partem prolapsum est, crus longius altero et valgius est :

extra enim pes ultimus spectat. Si in exteriorem, brerius va-

rumque fit, et pes intus incliuatm'j calx ingressu terram non

contingit sed planta ima; meliusque id crus superius corpus,
quam in priore casu, fert, minusque baculo eget. Si in priorem
crus extensum est, implicarique non potest ; alteri crui'i ad
calcem par est, sed ima planta minus in priorem partem incli-
natur :
dolorque in hoc casu prsecipuus est, et maxime urina
supprimitur. Ubi cum dolore inflammatio quievit, commode
ingrediuntui', rectusque eorum pes est. Si in posteriorem, ex-
tendi non potest erus, bre^iusque est ubi consistit, calx quo-
;

que terram non contingit." His statement, however, that dis-

locations inwards are of most frequent occurrence of any is
at issue with that of Hippocrates, who more coiTCctly states
that the dislocations outwards are the most common of all. He
likcAvise describes clearly themethods of reduction. If the
muscles of the limb be weak, will be sufficient to make ex-
it

tension by means of thongs applied at the groin and the knee ;

but if strong, it will be better to fasten them to the upper ex-
tremities of two sticks loosely fixed in the ground, and to make
counter-extension by pulling the ends of the sticks in opposite
dii'ections. A
more powerful method is by stretching the limb
upon a board having axles at both ends with thongs fastened
to them, by turning which such powerful extension could be
made as would be sufficient even to break the muscles and
tendons. When these are stretched, if the bone is dislocated
 504 DISLOCATIONS. [book vi.

CoMM. forwards, some round body is to be placed in the groin, and

"

knee to be suddenly carried over it, for the same reason

•
tlie is

and in tlie same manner as in dislocations at tlie shoulder.

In the other cases the siu'geon is directed to push the bone
towards its place,while an assistant propels the hip-joint.
Oribasius mentions the four varieties of dislocation at the
hip-joint. In tlu'ee of them, he says, the leg is extended and
cannot be bent but in the dislocation backwards, it is bent
;

and cannot be extended. He has described the method of re-

ducing these dislocations by machines, of which he gives plates,
Albucasis describes the four varieties of dislocation and the
methods of reduction in much the same terms as Paulus. His
modes of reducing them are 1st. By rotating the limb in all
:

dii'ections. 2d. By making extension and counter-extension

with the aid of two assistants. 3d. By suspending the patient,
and getting a strong assistant to grasp the affected leg and
swing himself by it. 4th. By making extension with ropes
fastened to two sticks or pieces of wood as recommended for
dislocations of the spine. When the dislocation is forwards,
the surgeon is to press down the prominent part with his
hands ; but if backwards, a board is to be used in the manner
described by our author.
A\dcenna agrees with Hippocrates, in opposition to Celsus,
that dislocation outwards (on the dorsum of the ilium) is of
more frequent occurrence than the dislocation inwards (on the
foramen ovale.) His description of the modes of reduction is
eAddently taken from Paulus.
Haly Abbas describes the four varieties mentioned by Hip-
pocrates, and recommends much the same treatment. The
account of them given by Ehases is exactly the same.
The earher modern writers on surgery, describe the four
varieties of dislocation at the hip-joint in the same terms as
the ancients. They evidently follow the Arabians. See
Theodoricus (ii, 51); Guido de Caidiaco (v, 2, 7.) From the
contents of this section it will be clearly seen how erroneous
is made by the late Sir Astley Cooper, that the
the statement
profession was entirely ignorant of the uatui'e of these acci-
dents until within these last few years.
SECT, cxix.] KNEE. 505

SECT. CXIX. ON DISLOCATION AT THE KNEE.

The knee is dislocated in tlireeways inwards, outwards,

:

and toAvards tlie ham for it

;
isprevented by the patella from
being dislocated forwards. Using, then, the same modes of ex-
tension, sometimes by the hands alone, and sometimes by cords,
we must have recourse to suitable bandages, and the other suit-
able treatment, the part being in particular preserved free from
motion.

Commentary. Hippocrates, like our author, mentions three Comm.

'

directions in which the bones of the knee-joint may be dislo- '

cated namely, inwards, outwards, and backwards.

: He has
not noticed the dislocation forwards, which is, in fact, a very
rare case. Celsus mentions, hoAvever, that Meges had related
a case of dislocation forwards, which was successfully treated by
him. But most of the other authorities, he says, have denied
the possibility of such an occurrence. He directs the surgeon
to reduce dislocations at the knee upon general principles, by

making extension and counter-extension. Hippocrates repre-

sents dislocations at the knee as being of more frequent occur-
rence, but less dangerous, than those of the elbow.
Oribasius, like our author, treats only of three kinds of dis-
location at the knee. Albucasis denies the possibility of a
dislocation forwards. He directs the surgeon, in making re-
duction, to turn his back to the patient, and take the limb out
between his knees ; then while an assistant makes extension at
the foot, he is to replace the bones with his hands. This seems
a very proper method of reduction.
Avicenna likewise mentions only three modes of dislocation.
He has described dislocation of the patella, a case omitted by
our author. He directs us after making reduction, to fill the
hollows with compresses, and then to apply splints and bandages.
He says that the knee is often dislocated in walking. He must
surely allude to a species of sub-luxation first well described by
the late Mr. Hey, of Leeds ; for a complete luxation is a very
and is never occasioned but by great violence.
rare occurrence,
Halv Abbas and Khascs describe only three kinds of dislo-
 50G DISLOCATIONS. [book vi.

CoMM. cation at the knee, and deny the possibility of a dislocation

' '
'
forwards. Both evidently copy from our author.
The modern surgeons, as usual^ adopt the \dews of the
earlier

Arabians^ and accordingly deny the possibility of a dislocation

forwards. See Theodoricus (ii, 52.) They would appear to have
been wholly unacquainted with the works of Celsus^ and to have
derived all their information from the Arabians.
Dislocations at the knee-joint are now found to be of much
rarer occurrence than they are represented to be by the ancient
authorities. In fact only a very few cases have been reported
in modern times. We
would beg, therefore, to refer our readers
'
to a case related in the Medical Gazette,' Dec. 16, 1842, by
the author of this Commentary. It is necessary to remark,

however, that several typographical mistakes occur in the Re-

port, which are partly corrected in a subsequent number of the
same periodical.

SECT. CXX. ON DISLOCATION AT THE ANKLE, AND ALSO OF

THE TOES.

The articulation at the ankle, if but a little displaced, is

remedied by moderate extension ;

but if
completely dislocated,
it requires greater force. may We endeavour therefore, in this
case, to make strong extension by the hands ; but if reduction
does not take place, having stretched the man on the ground in
a supine posture, we are to fasten into the floor a long and strong
peg, between his two thighs, so as to prevent the body from
yielding to the extension by the foot ; or rather let the peg be
fastened before the man is laid down ; or if we have the large
board at hand on the middle of which, as we said, a wooden
peg a foot long is fastened, we may make the extension upon it.
An then grasping the thigh, and making counter-
assistant

extension, another assistant is to pull the foot with his hands

or by a thong, and the surgeon is to rectify the dislocation with
his hands, while some other person keeps the other foot down
it is to be bound
below. After the reduction carefully, some
folds of the
bandage being carried along the front of the foot,
and some towards the ankle ; but we must take care not to in-
SECT, cxx.] ANKLE AND TOES. 507

elude the posterior tendon which is inserted into the heel. And
the man is to be kept from walking for forty days ; for those
who attempt walk before the cure is completed impair the
to
actions of the part. If from a leap, as commonly happens, the
bone of the heel is moved from its place, or if any inflammatory
state is brought on, it is to be remedied by gentle extension and

reduction, anti-inflammatory embrocations and secure bandages,

theman being kept also in a quiet state until the part is restored.
And dislocation of the toes, as we said with regard to the fingers,
may be remedied without difficulty by moderate extension. In
all these luxations and sub-luxations, after the reduction, and
rest for a suitable number of days, any inflammation or swelling
which may remain in the joints, and occasion a protracted im-
pairment of the function thereof, is to be cured by emollient
applications, the materials of Avhich must be known to every one
who is conversant with the matters relative to our art.

Commentary. Hij)pocrates states that dislocation at the Comm.

ankle generally produced by leaping from a great height.
is

He remarks that the accident gives rise to excessive swelling of

the part. When the parts have been reduced, he directs us to
apply a bandage to retain them properly in position, which, he
says, it requires some address to perform
in a suitable manner.
He recommends us to reduce dislocations of the toes and of the
bones of the foot like those of the hand. His account of dis-
locations of the astragalus and of the os calcis is curious, but
there is some difficulty in clearly apprehending his views.
We need scarcely say that it is a subject still requiring eluci-
dation.
According to Celsus, dislocations at the ankle-joint may take
place in all directions. He recommends us to reduce them with
the hands, by making extension and counter-extension. He
advises us to make the patient lie in bed longer than in ordi-

nary cases.
Oribasius makes mention of only three modes of dislocation
at the ankle ; namely, inwards, outwards, and backwards.
According to Albucasis, dislocation at the ankle can only take
place inwards or outwards. When the bones of the tarsus are
displaced, he directs us to restore
them by making the patient
 508 DISLOCATIONS [book vi.

*
CoMM. put his foot upon the ground and the surgeon, by placing his
;

upon and standing erect, is to push them into their place.

•
foot it

After reduction, a splint is to be put under the sole, and secured

with bandages. Rhases, Ancenna, and Haly Abbas evidently
copy from our author. They give the same account as
Hippocrates of dislocation of the astragalus.
Luxations of the tarsal bones are described in Sir Astley
Cooper's 'Sm-gical Lectures/ and other modern works. Modern
authors are agreed that dislocations may take place in all di-
rections, and that they may be complete or incomplete. It
will be remarked that Paulus makes mention of sub-luxations.
This is the place where we shall be expected to give some
account of the knowledge possessed by the ancients of the nature
and treatment of Club-foot. It is singular that Hippocrates
is almost the
only ancient author who has treated of the subject
in an interesting manner, and of him one need have little hesi-
tation in afiirming, that he displays more practical acquaintance
with than any other -UTiter until the time of Stromeyer. He
it

states that there are more than one variety of this imjjediment ;
that it is not, properly speaking, a dislocation, but a declination
of the foot from its natural position ;
and that most cases of
congenital club-foot admit of cure, if it be attemj)ted before the
limb is much wasted. He gives minute directions for restoring
the limb to its proper shape by the fingers, and for
securing it
with waxed bandages and compresses, above which a piece of
stout leather or a plate of lead is to be bound. Over all a
leaden boot, like the Chian shoes, may be applied if necessarj^
By these means, he does not hesitate to declare that the de-
formity may be generally overcome more readily than one would
have believed, " without cutting or burning, or any other com-
plex mode of treatment.'' (De ArticuHs, 62.) Galen's commen-
taiy on this chapter is of use in illustrating the text of
Hippocrates, but supplies no additional information for any
practical pm-pose. (v, 642, ed, Basil.)
SECT, cxxi.] WITH A WOUND. 509

SECT. CXXI. ON DISLOCATIONS WITH A WOUND.

In the case of dislocations with a wound the utmost dis-

cretion is required. For these, if reduced, occasion the most
imminent danger, and sometimes death, the suiTounding nerves
and muscles being inflamed by the extension, so that strong
paiiiSj spasms, and acute fevers are produced, more particularly
in the case of the elbows, knees, and joints above, for the
nearer that they ai*e to the ^ital parts the greater is the danger
they induce. "NMierefore, Hippocrates, by all means, forbids us
to apply reduction and strong bandaging to them, and directs
us to use only anti-inflammatoiy and soothing applications to
them at the commencement, for that by this treatment life
may sometimes be preserved. But what he recommends for
the fingers alone, we would attempt to do for all the other
joints at first, and while the part remains free fi'om inflam-
:

mation, we would reduce the dislocated joint by moderate ex-

tension, and if we succeed in our object we may persist in
using the anti-inflammatory treatment only. But if inflam-
mation, spasm, or any of the afore-mentioned symptoms come
on, Ave must dislocate it again if it can be done without violence.
If, however, we are apprehensive of this danger (for perhaps
if inflammation should come on it will not peld,) it vnH be
better to defer the reduction of the greater joints at the com-
mencement ; and when the inflammation subsides, wliich
happens about the seventh or ninth day, then, liaA-ing foretold
the danger from reduction, and explained how, if not reduced,
they will be mutilated for life, we may try to make the attempt
without "violence, using also the lever to facilitate the process.
"We are to apply the same treatment to the ulcer as recom-
mended for fractures with a wound.

Commentary. Hippocrates, as stated by our author, was Comm.

decidedly averse to immediate reduction in cases of dislocation
complicated with an external wound. Hence, in compound
dislocations at the ankle, he forbids us to interfere at first, as

attempts at reduction will certainly bring on coiiAailsions or

gangi'cne. Modern experience agrees with that of the father
 1'
510 DISLOCATIONS [book vi.

CoMM. of medicine as to the danger attending these accidents. Com-

' '
'

pound hixations at the wi'ist, he says, prove fatal if reduced,

but if let alone they generally get better. (De Artie. 64.)
Compound dislocations at the knee are said to be particularly

dangerous. (Ibid. 66.)

Celsus follows the line of practice recommended by Hippo-
crates. In cases of compound dislocations at the shoulder and
hip-joint, he states that the danger is great if they are left un-
reduced, but pronounces death to be certain if they are re-
duced. Like Hippocrates, he approves of immediate reduction
only in dislocations of the bones of the feet and hands. Even
these, however, are not to be interfered with while the parts
are in an inflamed state. He approves of bleeding, a spare
diet, and rest. When a naked lione protrudes and cannot be
got restored to its place, he advises it to be sawed off", (^dii, 25.)
Galen gives his unqualified sanction to the practice of Hip-
poci*ates. See his commentary on the work * De Articuhs^ and
'
Nicetse CoUectio.^
Albucasis, like o\ir recommends gentle attempts
author,
at reduction before swelling and inflammation come on, and
soothing treatment afterwards.
The practice of Haly Abbas difi'ers nothing in principle fi'om
that of our author and Albucasis. If reduction has not been

performed early, he forbids it until the inflammation has sub-

sided.
Rhases appears to have copied his rules of ti'eatment from
our author. He recommends us, if possible, to replace the
pai'tsbefore inflammation comes on, but forbids it while they
are in that state, for fear of occasioning convulsions and death.

SECT. CXXII. ON DISLOCATION COMPLICATED WITH FRACTURE.

If a dislocation be attended with fracture without a wound

we must apply the common and replacement by the
extension,
hands, as described for simple fractures. But if complicated
with a wound, we must apply the suitable treatment from what
has been said of fractures with a wound, and dislocations in
particular.
SECT, cxxii.] WITH FRACTURE. 511

Commentary. Haly Abbas says that when a Avound, a Comm.

and a combined in one case, each is to ^
fracture, dislocation are
be treated upon general principles.
Albucasis directs us to remove any spiculre of bone which
may protrude in such cases. He exhorts the surgeon to act
cautiously but confidently, as such conduct -will prove most
pleasing in the sight of his Creator, and redound to his own
glory.

END OF VOL. TI.

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