v/e^

s^
V
THE

BOOKS

SEVEN

OF

iEGINETA

PAULUS

THE

FROM

TRANSLATED

GREEK.

WITH

A
A

EMBRACING

COMMENTARY

COMPLETE

POSSESSED

GREEKS,

OF

VIEW

BV

KNOWLEDGE

THE

AND

ROMANS,

THE

ARABIANS

ON

s
ALL

SUBJECTS

CONNECTED

BY

WITH

FRANCIS

IN

THREE

MEDICINE

AND

ADAMS.

VOLUMES.

VOL.

II.

LONDON
PRINTED

FOR

THE

SYDENHAM

SIDCCCXLVJ.

SOCIETY

SURGERY.

"

TAMKX

EGEKUXT

MULTVM

SUNT,

ET

QLI

KITU

IlEORTM

PRINTED

AN'TE

NOS

BY

BAKTHOIOMHU

SCSPICIENDI

FEREGERLNT.

NON

SEP

FVERrNT,

COLENDI."

(SENECA,

C.

AND

J.

CLOSE.

EPIST.

D,

LXIT.

CONTENTS

OF

THE

SECOND

FOURTH

VOLUME.

BOOK.

CONTENTS.

VI

PAGE

SECT.

86

29.

For

30.

On

Contusions

31.

On

Rupture and tearingof

Sprains and Contusions

of the

and

Flesh

the

87

Ecchymosis

88

flesh

ib.

32.

On

Scirrhus

33.

On

Strumae, or

34.

On

Steatoma, Atheroma,

35.

Of

Fa^i

36.

On

the

37.

On

Agglutinants

38.

On

painful and

39.

On

uncoucocted

40.

On

hollow

91

Scrofula

94

Meliceris

and

97
99

simple Ulcer

101

inflammatory

such

Ulcers,and

102

Sores

103

suppurated

.....

41.

Medicines

42.

For

43.

On

fungous Ulcers

44.

On

spreadingUlcers, putrid Ulcers,

45.

On

Ulcers

46.

On

the malignant Ulcers

47.

For

black

Worms

not

104

Ulcers
for

have

as

cleansingfoul

106

Ulcers

107

in Ulcers

....

108

"

and

109

Phagedaena

112

requiringCicatrization
called

48.

On

49.

On

50.

For

51.

On

52.

Those

53.

On

Hemorrhage

54.

On

Wounds

55.

On

Ancylosis

56.

On

Relaxation

57.

On

Worms

58.

On

Ascarides

59.

On

Dracunculus,

sinuous

Chironian

and

Telephian

114
118

Cicatrices

....

119

Ulcers
.....
'

122

Fistula

in the

Ulcers

out

break

Sores which

125

again

126

Joints
....

thingswhich

Shafts,Javelins,Thorns, and

extract

from

of the

Veins

the like

Arteries

and

ib.

127
132

Nerves
....

137

.....

of the

Joints

139
....

ib.

"
.

144

.....

the

or

Guinea- Worm

150

FIFTH

On

the

Preservatives

from

BOOK.

animals

venomous

2.

The

generaltreatment
animal

3.

On

4.

For

5.

On

6.

On

7. On
8.

On

bitten

Bites

Wasps
the

or

in

general

stung by any

and

of

Dogs

that

Dogs, and
are

not

on

mad

Bees
....

Phalangia, or

Sting of

155
venomous

157

by mad

venomous

the Bite of the Spider

the

bitten

.....

persons
the

of all persons

the Scorpion

Hydrophobia

162
168
ib.

Spiders

169

....

171
ib.

CONTENTS.

VIU

PAGE

SECT.

230

55.

Oh

Bulls'

56.

On

coagulated

57.

On

Ileraclean

5S.

On

Gypsum

59.

On

Ceruse

60.

On

Lime, Sandarach,

and

61.

On

Litharge

.....

62.

On

Lead

63.

On

Mercury

04.

On

Blood

On

231

Milk

....

232

Honey

....

233
.....

234
.....

235

Arsenic

236
237

white

238
.....

the

of the

Down

articles,such

TO

the

and

On

feignedDiseases,

On

Impostors
professional

239
and

Wine

as

2.

On

On

Hydrocephalus

4.

On

Arteriotomy

5.

On

6.

On

7. On
8.

On

same

BOOK.

244

BOOK.

of

the

section

temporal vessels,and

on

upper

other

On

burning of

On

Lagophthalmos, or Hare-eye

Eyelidsby

of the

under

12.

On

Ectropion,

13.

On

Anabrochismus

14.

On

Hydatids

15.

On

adhesion

16.

On

Chalazia,or

tumours

17. On

Acrochordion

and

18.

On

19. On
20.

On

and

of

modes

Staphyloma

operatingfor

Eyehd

it

264

by medicines
.

iron

266
.

Encanthis
.

269

272
273
274

.275

267

.270

"

resemblinghailstones

of the eye

burning of

the

lower

259

265

burning with

of the

Eyelids

medicines

Eyelid, and

of the

Pterygia

Hypopyon

eversion

or

256
258

Eyelid, and

9.

suture

.....

the

10.

the

burning

Periscyphismus

the

253

254

On

......

of

248
250

Trichiasis

11.

.247

Ophthalmia, Dyspnoea, and Elephantiasis

for

Hypospathismus
suture

FIFTH

.....

Angiology, or
the

Water

245

Head

the

243

of them

Detection

Surgicalpart

burning of

cold

THE

SIXTH

3.

Rue,

Cactos

APPENDIX

to the

Agaric, wild

Thapsia, Elaterium, black

Hellebore,

domestic

1. Preface

"

......

Gith, and
65.

.....

277
278

CONTENTS.

IX

PAGE

SECT.

279

21.

Ou

Cataracts

22.

On

or
iEgilops,

23.

Ou

imperforateMeatus

24.

On

substances

25.

On

Polypus

26.

Ou

Maimed

27.

On

Epulis and Parulis

28.

On

the

29.

On

constriction

30.

On

Antiades, or indurated

31.

On

the Uva

32.

On

thorny substances

33.

On

Laryngotomy

301

34.

On

Abscess

303

35.

On

Strumae, or scrofulous glands

307

36.

On

Steatoma, Atheroma, and Meliceris

309

Anem-ism

310

37. Ou

....

fistula

286

Auditorius

have

that

284

lachrymalis
fallen into the

287

auditorius

meatus

289
....

292

Parts

ib.
294

of Teeth

Extraction

of the

295

Tongue, or tongue-tiedpersons

297

tonsils

298
fixed in the

300

pharynx

314

'

38.

On

Bronchocele

39.

On

Ganghon

315

40.

On

Venesection

316

41.

On

Cupping

324

328

42.

On

burning the Armpit

43.

On

and
preternaturalfingers,

44.

On

the

45.

On

Cancer

46.

On

male

47.

On

burning over

the Liver

335

48.

On

burning over

the

336

49.

Ou

burning over

the Stomach

50.

On

Dropsies

having

persons

Spleen

ib.
337

52.

Ou

Wounds

Prolapsusof the Navel

or

of the Peritoneum, and

where

Omentum,

Works

334

the female

resembUng

Exomphalos,

Gastroraphe

also

On

Hypospadiseum, or imperforateGlans

55.

On

Phimus,

56.

On

Adhesion

59.

On

the Prepuce

the

347
ib.

of the Prepuce to the Glans

349
ib.
350

the Penis

Catheterism,and Injectionof

the Bladder

351

354

60.

On

Calculus

61.

On

the Pai-ts about

62.

On

Hydi-ocele

the Testicles

363
365

of the Testicles

63. .On

Sarcocele

and

Tophi

64. On

Cirsocele

and

Pneumatocele

65.

Enterocele, or Intestinal Hernia

Ou

Penis

Phimosis

Circumcision
ou

from

346

54.

Thymi

Intestine

342

Deficiencyof

or

of the

is described:

of Galen

On

Of

340

falUng down

on

53.

58.

330
332

breasts

On

57. On

329

fingers

operationof burning for Empyema

51.

or

on

six

369
370
372

CONTENTS.
SECT.

66.

Oil

Bubonocele,

Hernia

Inguinal

or

of the

Relaxation

67.

On

Rhacosis,

68.

On

Castration

69.

On

Hermaphrodites

70.

On

Extirpation of

71.

On

Thymi, Condylomata, and

or

Scrotum

NjTnpha and

the

Cauda

Pudendi
about

Hemorrhoids

the

Female

of Generation
72. On

and

ImperforatePudendum
of the

Phimus

Womb

73.

On

Abscess

74.

On

Embryulcia and Embryotomy

75.

On

Retention

76.

On

burning the Hips

77. On

of the

Secuudines

Favi

Fistulae and

in Ano

78.

On

Fistulae

79.

On

HemoiTlioids, or

Piles

80.

On

Condylomata,

Excrescences,

81.

On

ImperforateAnus

82.

On

the

Excision

83.

On

the

Dracunculi,

or

and

Fissures

of Varices
or

Guinea-Worms

of the

Extremities

84.

On

Amputation

85.

On

Pterygiaabout

86.

On

87.

On

Clavi, Myrmecia, and Acrochordones

88.

On

the

89.

On

Fractures

90.

On

Fractures

91.

On

Fracture

and

92.

On

Fracture

of the

Lower

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.

On

Fractiu-e

of the Bones

98.

On

Fracture

of the

Vertebrae, Spine of the

Arm

Nails

the

Nail

bruised

Extraction

of Weapons
their

and

of the

Differences

of the

Bones

Head

of the

Contusion

Nose

Jaw, and

of the

99.

On

Fracture

of the

100.

On

Fracture

of the

Ulna

101.

On

Fracture

of the

Hand

Thigh

Contusion

Loins

and

....

and
and

102.

On

Fracture

of the

103.

On

Fracture

of the

Patella

104.

On

Fracture

of the

Leg

of the

Foot

103.

On

Fracture

106.

On

the

107.

On

Fractures

108.

On

the

109.

On

Distortion

110.

On

Bones

111.

On

Luxations

complicated
Callus

from

which

the

have
.

its

Fingers

of the Limb

Arrangement

redundant

Radius

with

Wound

of Fractures
L'uion

not

by Callus

united

by

Callus

of the

Ear

Pubes

Back, and

Os

Sacrum

Parts

CONTENTS.
XI

SECT.

PAGE

112.

On

Dislocations

of

113.

On

Dislocations

of

114.

On

Dislocation

at

115.

On

Dislocation

of

116.

On

Dislocations

at

the

Wrist

117.

On

Dislocations

of

the

Vertebrae

Lower

the
the

Jaw

the

Shoulder

the

Elbow

479
and

Clavicle

Acromion

482

484

489

and

Fingers
of

the

492

Spine

493
.

118.

On

Dislocation

at

the

Hip-

119.

On

Dislocation

at

the

Knee

120.

On

Dislocation

at

the

121.

On

Dislocations

122.

On

Dislocation

with

Ankle,
a

Joint

498

505

and

also

Wound

complicated

of

the

Toes

506
509

with

Fracture

510

JIGINETA.

PAULUS

FOURTH.

BOOK

iu

Well,
the

of

power
and

For

this

for

that

it is

impossible

if cancer,

himself, how
it

as

bile

from

(for it
as

were,

it were,

dregs

overheated)

the

from
of

the

the

first

truly,

less

being accompanied
and

falling

variety,
who

abeady
but

that

none

the

body

and

the

we

must
II.

of

that

or

are

off

of

when
the

become
face

the

of

the

yellow

bile

extremities

idcerated,

the

appears
cure.

has
nor

mild,
which
of

its

is in
fallen

hard

the

not
a

origin,

both

being

to

speak

lignant,
ma-

Avhole

the

more

more

the

by

be

must

commencement,
nor

the

produces

Wherefore,

off,

black

part, and,

are

disease,

the

not

or

produced

are

foul, but
For

double

bile

overheated.

by

affection

black

ulceration

with

yellow bile,

others

the

overpowered
the

cular
parti-

the

But

feculent

and

more

extremities,

fi'om

merely

attempt

from

is the
;

in

it.

by Hippocrates

ha\ing

formed,

or

blood,

variety

malignant

than

powerful

body

melancholic

elephantiasis, which

reddish

eases
dis-

of

cause
incirrable, be-

is

diseases

whole

is

variety

those

elephantiasis

an

that

say,

elephantiasis incui-able, which

the

affection

this

either

arises

of

than

more

incm-able

is not

cancer

which

medicine

the

more

greater

it were,

among

Cappadocian

elephantiasis

find

is, as

much

be

to

reason

to

which

part, is ranked

is,

ought

remedies

the

Aretseus

did

opinion,

my

ELEPHANTIASIS.

ON

1.

SECT.

body
latter
those
doned;
abanso

siu-face

the

as

of

swellings appeared,
altogether unseemly,

few, by merely
1

bm-uing

ELEPHANTIASIS.

iv.

who
Avere
beginning to be
preventedmany
being overpowered by this disease. Wherefore^

headj have

the

affected from
at the

the

of the

commencement

venesection

to

[book

an

them

with

most

interval of
the

apt

to occtir,

and

few

days,say

nine

of

pottage

have

must

its exacerbations.

has

ten, we

or

colocynth,not

may
purge
but
quently,
freonly

once

the dose of the medicine

proportioning
hiera also suits well with

Pui'gingwith

recourse

if in spring,when
especially

more
repeatedly,

complaintis

After

we
disorder^

to its

val
the inter-

After

them.

strength.

days again,we must givethem the Adnegarof

in
divided milk, not in less quantitythan three heminse, nor
and on the followingdays they are to be supgreaterthan five,
ported
of about

ten

with
milk

bv

milk

Avhicli means,

be continued

may

parts, or new-drawn
food
if the affection vield, the same

that is not

; but

divided

if it remains

eatingacrid things,they must

and

frumentaceous

with

but

put

on

of the
a

disease from
of the

by

these

the stomach

and

dry and

to Aomit

same

purging
things,
if possible
when
in spring,

For

neither

offendingmatter,

fom- times

and

in

autumn.

them,

neither
can

roughly
tho-

bled

tion
transla-

inner

parts,nor
plished
longer accom-

be

the

same

is to be

Dry-cuppingis also to be applied

and to the hj^pochondi-ia,
and

places;

but

after

short

interval,

with
repeated,
beginningby pui'ging

which
hiera,and omittingthe venesection,

or

are

any
but
the
is
be determined
to
to
matter
;
used
bowels, and alteratives (metasjoicritica),

to

than

who

means

process

deleterious

radishes

with

After these

to the
superficies

of the stomach

dropacesused
the

the

constrict the skin.

the mouth

over

twice

of hellebore.

coui'se

diminution

to

is proper,

state, after

same

Those, however,
only if in autumn.
overpoweredby the complaint,must be

once

nor

in the

be made

articles of food.

Avhite hellebore

into

beneficial. This process

would

prove

rather

is to be

repeatedthree
of spring
seasons

in the
especially
year, more
The
draughts before meals, most
a

suitable for

and
cyathus of vinegar,with a cyathusof cedi'ia,
two
cyathiof 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
are

"

of Avinc ; or, a tbachm

of hartshorn
and a cyathusof the vinegar
of squills,
is given after the morning Avalk every
day ; and
other

thingsare

to

be administered

at

the

same

season,

such

drs.

as

ELEPHANTIASIS.

I.]

SECT.

in honied
water^ or
squills
of
juice,to the amount

of washed

linctus ; or
with
mixed

Cwenaic

butter

and

honey

or, dr.

ss

hartshorn,with two cyathiof wine ; or,

cumin, with honey, as a linctus. But a
is

drunk

; and

fine

wine, and

may
the

in like

juiceof

and

say that the dose to

calarnint

in

most

as

more

externally.But
cm-ed, nothinganswers

of

of

squills
they praise

when

di'unk,

is three

which
cyathi,
theriac of vipers

be increased to six. But of all others the

may
is the most efi"ectualremedy,both in a draughtand
in

cvathus

cbaught. And
effectual remedy
with

vetch,

shavingsof
iijof ^Ethiopian
suitable remedy

commence

the

of the trochisk

drachm

be taken

manner

drs.

hone}^,as
bitter

trochisk,tritm-ated in

of the theriac

drachm

of

in

when

rubbed

plentyof these animals can be prowell as eatingthe flesh of the vipers

where
so

broth,with much water, salts,leeks,and dill,

of their back-bones,their head and tail being
to the separation
of four fingers'
first cut off to the extent
breadth, and their

boiled in white

entrails and

skin

And
theriac salts are in the
away.
with other food.
taken
By usins; them

taken

celebrity when

same

thus,it happens that

off from

the

scales,
or,

as

it Avere,

the

bark, falls

the skin.

regimen is to be as follows : After sleep,having been

first rubbed, and the bowels evacuated,let the patienthave
then to friction and gymand vociferation,
to gestation
recom'se
nastic
but more
exercises of all kinds,partlyby leaping,
cially
espeThe

by usingthe

halcteres and

off"the sweat, let him

a

wolf,of
and

be rubbed

goat, or of

after

some

leather

Having wiped

grease of a boar, of
ter;
Avingedanimal,or with fresh butwith

short interval let him

bag.

the

bathe, ha^dng his body

of ptisan,
with a little
or
juiceof fenugreek,
ammoniac
dissolved in vinegar. After the bath, having got
of wild
his body wiped,let him anoint with the oil of lentisk,
vine,or of myrtles; and with a little wine, containingalum
anointed

and

with

the

ammoniac,

baths.

so

as

to

be

of the

thickness

of the

sordes

of

again with soft rags, let

him rest for half an hom% after which, having drunk water,
let him make
himself vomit by puttinghis fingersor a feather
down his throat.
Having vomited, let him drink the wine of
of marjoram. The food should be barleybread,
wormwood
or
cake of dried barleyflour,
and of potherbs,the beet, the
a
or

Having

had

his

body

rubbed

ELEPHANTIASIS.

and

capers.
urchin,all shell

in

placeof

the whole
he

the

watery wine
which

at

venery
time of his

the

all acrid

season

dming
; only
covery
re-

substances

Give him ptisan,

from, except condiments.
milk and honey,^dth bread, mallows, dock,
chondi-us,

eggs

and

and
skirret,

flesh ; and of fowls, those which

the fig,
of fruits,
grape, and raisins:

fishes with tender

contain wholesome

and
juices;

but of sweetmeats, those which

almonds,

bastard

or

are

preparedfrom pinekernels,
one

take food twice

may
After taking
meal.

use

detergentointnients

safii'on. He

it is injiu'ious
to subsist upon
of the internal parts, let him

day, as

care

wine

from

and from
of the complaint,

purging,at

be abstained

abstain

let him

But

little thin

must

toasted

waters,

animals,he may take oysters,pelorides,

fishes,
limpetsboiled "oith beets,and old pickle

continuance

from

iv.

sea

medicine.

take

may

in two

cabbage sweetened

lettuce^the radish^leeks,and
Of

[book

(smegmata)

in

bath, from

the

of

decoction

the

beet, or

of

and sometimes,
fenugreekwith aphronitrum,soap, or mjo-obolan,
Purslain tritm-ated with \dnegaris detergent
applydepilatories.
and

houseleek,and the roots of dock boiled in

and red arsenic in equalproporalum with salts,
tions

also the slender

and
\-inegar,
with

compositionfor
and the
of alcyonium,nitre,m^Ttle,sulphur,
alphos,consisting
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, luiripegallsin equal
sprinkleddiy, or rubbed in with vinegar. And tliis
quantity,
and

is admirable

one

of

wine

oil of lentisk.

Of the roots

Also

of dock

bunch

to the amoimt

handful,of natron, dr.

phur, dr.
this

one

xxv

xl ; of fi'ankincense,
di*.xxv ; of siJin with Egyptian vinegar. And
; it is rubbed

is efficacious: Of

di'.x; of sulphm*^i^^.lm,
dr.^iii;
arsenic,

of costus,di'.xii ; of

di\ iv ;
quicklime,
xii ; these thingsare

bay benies, dr.

white poplarleaves,or
rubbed in, having the
fascicidiof
in

the

mortar
oz.

-\nth

thick

consistence

dr. iv

of wax,

mixed

with the

decoction,and

of dried

juiceof
they are

honey. Another : Two

the roots of dock are to be boiled in vinegar,
poimded
and triturated,
then of alcyonium,lb. j ; of aphronitrum,
of
viij
sulphur^ivura,lb. j ; of the bm-nt shells of
;
of

"

with its roots,oz. iv ; these things

cockles,
oz. iv ; of chamaeleon
are
pounded togetheruntil they are of the consistence of the
sordcs of the baths, and are then rubbed in often in the sun,

ELEPHANTIASIS.

I.]

SECT.

but if Avinter,
in the

if summer,
the
And

dry smegma

with

these

cases,

even

unto

those for

of

and

whether

also those
And

agree

sweating.

excellently

about to be

smegmata

complaints.

described,
mentioned, are

now

the tumid

excrescences,
with Indian
to be rubbed

ulcerous,are

or

it occasions

^sculapiuswould

all the

inflammatory

buckthorn:

bath, until

alphos,and

for those
applicable

or the Andronian
trochisk,
poppy, or aloe,
that of Polyides
of chondrus
or
; and let cataplasmsbe applied
with the jmce of knot-grass
of the
or
plantain
; or of pellitory
or

horned

wall,triturated J
when

and

the

leaves

with

of the

Melisian

gi'cen

herb,

cacious,
pounded
applied,are wonderfullyeffiaxunge
for they redden
the parts,but the redness is easily
repressed
from
of bread ; or of the cerate made
by the application
almond
oil.
their natural
colour is restored.
By this means
When
the parts are ulcerated,
suitable : that from
are
plasters
diphryges,and the appleone 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

moderate

more

and

when

the

first ulcers

cicatrized.

are

For

dyspnoeaof
of five

or

under elephantiasis
givea
persons laboui'ing
six slaters in tln-ee cyathiof honied
water.

of the

some

generalremedies

for them.

being most
and

if

Of

natural

useful,the
particularly

possible,such
to diink

has the

same

less

so

as

them.

are

And

and
eff'ect,

since this aftection is

no

the

described for

than

one

the

so

use

have

of those

of the

descend

they may
partlyon their own
they might come
themselves will thus enjoythe use
from

This is proper
of those whom

and

thev will

Commentary.

not

communicate

thence

to

of

But

cable,
easilycommunias

far

cold situations,

accomplished
;
surroundingplaces.

contact
a

shore
sea-

sudorifics.

and

account

in

of the

to be removed

plague,theyare

and lodgedin inland

possiblefi'om cities,
where there are few inhaliitants,
if this can
so

sand

are

as

for

chalybeate,
viceable
serparticularly

all the

which

be applicable

and

It is also

the

And

select,as

must

we

aluminous

cold.

draught

dyspnoeawill

baths

the

more

be

and

also

account

on

with.

For

commodious

they
air,

the evil to others.

Consult Lucretius

1112);
i^A,

Celsus

(iii,
25) ;

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

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

Caelius

xix);

Comm.

^"'

"

(i,
32) ; Isidoms
(Orig.iv,8) ; Yegetius (^Mulom.i,9) ; Aretseus (Curat.Morh.
Cliron. ii, 13) ; Plutarch
(Symp. viii,Quest. 9) ; Galen (ad
Samonicus

Serenus

CoMM.
'

[book iv.

ELEPIIAXTIASIS.

fi

ii,10

Glauc.

de

(11);

Octa^ius

Causis

]Morb.

Horatianus

7) ;

Oribasius

(Morb.

Curat.

i, 105) ;
vii,5) ; Pseiido Dioscorides (Euporist.
62; SjTiops.
iii,
Aetius (xiii,
120) ; Actuarius (Meth. Med. ii,11, and iv,15) ;
Xonnus
;
(op. medicum) ; Leo (vii)
(Epit.233) ; Psellus
A^-icenna
3, 3, 1) ; Serapion
(iv,
Myrepsus (De !Med. comp.);
i,49) ;
7, 12, 26) ; Albucasis (Chirurg.
(ii,
(v, 14) ; Avenzoar
15, Pract. i^-,
3, ix,69) ; Alsaharavius
Haly Abbas (Theor.viii,
v, 35, ix, 93, Contin.
(Pract.xxxi, 2) ; Eliases (ad ]\Iansor,

26.)

XXXV,

AYe

tbe earliest notice -wliicliAve

owe

poet Lucretius, who

the
lines

have

mentions
briefly

of this disease to
it in the

following

"

Est

elephasmorbus

qui propter flumiua

Gignitur/Egypto in

media

neque

Xili

praetereausquam."

is a chronic disease,almost
says that elephantiasis
in certain countries.
He
in Italv,but \erv
common

Celsus
unknown

The
body, even of the bones.
mours,
upper part of the body is covered with frequentspots and tuthe redness graduallychanges to black, the skin is
like scales;the
thickened, and covered with hard asperities
body wastes, but the face, legs, and feet swell ; and when the
the fingersand
toes
become
disease is protracted,
buried in
calls it

the

an

affection of the whole

swelling,and

slightfever

sufferings.Such
patient's

comes

on,

which

finishes the

is his

of the disease.
description
consists in bleedingat the commencement,
His treatment
stinence
abthe strength,purging,exercise,
then supporting
sudoand friction.
Baths are to be rarelyused; fatty,
rifics,
nous,
glutiand

is to be

flatulent articles of food

allowed,except

at the

are

to be

avoided,but wine

beginning. The body is to be

rubbed with pounded plantain.
in Italy
known
was
never
Accordingto Pliny,elephantiasis
of
the
until the days
Great,when it was importedfrom
Pompey
for
a time, but
became
extinct.
soon
He
Egypt, and raged
the face in particular
describes it as affecting
with hard, rough,
which
Idack maculffi,
sometimes
to the bones, the toes
sprejjd
and fingersbeing swelled.

the

CoMM.
'

'
'

aflect

vomiting,the

mention, however, of

face ; he contends that the

that the flesh
the disease, and
much

are

the

same

as

those

commended
re-

autliorities,
namely,bleeding,purging,

other

vipers,and rubbing

theriac of

for scabies.
and

with

remedies

corrupted. His
by the

iv.

the
principally

system is attacked

whole

lie makes

is defective,

symptoms

mucid(Bywhich
is

[book

ELEPHANTIASIS.

also

He

the usual

with

of
speaksfavorably

plication
ap-

the natural

baths.

the sea-water

who is supposedto have flomished in

Eraperic,
the reign of Theodosius, recommends, like Serenus, mint,
for elephantiasis.He describes it as
juniper, and mezereon,
of the extremities,
being attended with hard excrescences
tions
erupHe speaks of its
the face,and disease of the bones.
on
the

Marcellus

being endemic
The
from
and

in

/Egypt.

disease,elephantiasis,
accordingto Isidorus,is
its resemblance

rough,
of the
it is

from

the

to

which

elephant.

it gets its

in it is hard

skin

The

called

so

because
appellation,

the

that of

an
elephant; or
patient's
body resembles
of
the elephant is one
a
as
mighty affection,

face
sur-

cause
bethe

largestof animals.
on
Aegetius,the great ancient authority
veterinary
surgery,
describes
hardness
feet and

it affects cattle.
The
as
elephantiasis
symptoms
and roughness of the skin, squamse,
eruptionson

head, and

of

fetid

bleeding,and

dischargefrom

the

other

means

the

He

nose.

recommended

by

are

the
proves
apthe

regularsurgeons.
We

shall next

Areteeus

of the Greek authorities.

give the descriptions
gives a most elaborate but surelysomewhat
strained
over-

of elephas,
which he paintsin colom-s the
description
hideous and disgusting.We
most
shall endeavour
to convey
to the reader an
idea of his sketch,stripping
his pictureof its
its bulk.
flower}^
The
disease is
ornaments, and contracting
called

elephas,he says, from its magnitude, leontium or morbus

leoninus,from the supposed resemblance
of the eyebrows to
those
which

of the lion ; and

it is attended.
at

from the venereal

satyriasis,
The

as

first,
and preyingupon
being deep-seated

afterwards it is determined
with

The

disease is described

the

bellyis

and
fiice,

to the
at

dry,because,as

tice
escapingnothe A-itals,
but

superficies,
commencing

other
he

desires with

times

with

the

times
some-

extremities.

ingeniously
remarks,

the dis-

ELEPHANTIASIS.

I.]

SECT.

tribution of the food is

and tlie vitiated Comm.

performed regularly,
parts stronglyattract the chyle to them as a pabulum to the
There are largecallous eminences on the skin,and the
disease.
veins appear enlarged,
owing to a thickeningof the A^essels and
of blood.
The hairs of the head, pubes,and
not to a plethora
The face in particular
other parts of the body,drop off.
is affected
'

'

callous tubercles

with
for the

tongue, and
The

them.

with

hair,and

hang
of the

intersected with
to that
as

those

skin, covered

thickened, strippedof
of the lion.

as

it is with

is said
deep fissures,

The

generalappearance
tubercles,and

hard

to bear

then'

resemblance

some

elephant. Sometimes
particular
members, such
the whole hand, or the pudenda,will die
feet,
fingers,

and
dropofl";

forth

Hke

uncommon

parts of the body, to be also covered

eyebrows are

down

it is not

of the

the nose,

and

most

warts, and

or

on

different

are
suffocation,

to have

it is not

for incm'able ulcers to break

uncommon

parts of the bod3^

occasionally
present.

intercourse with

Dyspnoea,and
He

says, it is

sense

of

dangerous

ease,
labouringunder the disthan in the case
of the plague,as
both
so
no
are
by respiration.He directs us, at the
readilycommunicated
to abstract blood
commencement,
freely,because blood is the

pabulum

any
less

morbi.

He

persons

recommends

us

vomitingby radishes,but

to purge

with

hiera,and

particularly
by the
white hellebore,upon which he bestows
a
glowingand eloquent
eulogy. Like our author, he approves of the theriac of ^dpers.
mention
of many
external applications
of a detergent
He makes
praisesa soap used by the Celts for
nature, and in particular
cleaningtheir clothes. He also commends
natron, alcyonium,
with ^iuegar,and the hke, for the
sulphur,alum, ammoniac
When
the flesh is hvid,he dii'ectsus previously
same
purpose.
gestible
to make
deep incisions in it. The diet is to be plainand dito be used : the patientis to
; sulphureous baths are
in sea- water, to take a sea voyage, and otherswim
wise
frequently
not neglectsuitable exercise.
Plutarch
informs us that it was
disputedin his time whether
not elephantiasis
a
was
or
new
complaint.

to procure

Galen,

as

far

as

we

can

has
recollect,

nowhere

but in his work 'De

elephantiasis,
mentioned
that in this disease
briefly

of

he has

more

the lipsthick,and
flattened,

the

ears

treated very particularly

Causis
the

Morborum'

nose

extenuated,the

becomes
whole

ap-

'

CoMM.
""

'

"

'

[book

ELEPHANTIASIS.

10

pearance resemblingthat of
'DeCuratioue ad Glauconem'he

swellings, and

witk
elephantiasis

ranks

cancerous

Alexandria,

about

that the disease is common

savs

entitled

satyr: and in liiswork

iv.

of the

inhabitants,
placeand
the flesh of
of lentils,
snails,pickles,
which consists principally
which thingshave a tendency to engender
asses, and the like,all
wise,
The
the melancholic humour.
temperatui'e of the placelikeof the
the superfluities
he shrewdly remarks, determines
system
have

of the

heat

to the

owing

alreadyhad

occasion

and the theriac of

to

we

mention, namely,bleeding,purging,

In

vipers.

which

the treatment

recommends

He

skin.

to the

the food

the

the
'Isagoge,'

black

and

white

Galen elsewhere calls it

commended.
particularly
dperae.)
contagious.(Lib.ii,Simpl. de carne
but briefly
of
the
recommends
disease,
Oribasius givesno description
the theriac of vipers,and in certain cases
pm-ging
of
it.
and bleeding for the cure
taken from ArThe
account
givenby Aetius is principally
The disease,he remarks,
and is very circumstantial.
chigenes,
of elephantiasis,
leontiasis,
has been called by the several names

hellebores

are

"

and
its

he says, have been

Suspicions,
satyriasis.
being contagious,and he is of opinionthat

hold

intercourse

contaminated

becomes
their

by

concealed

on

appearance

subjectto

from

and
internally,

does

more

are

intemperate climates predispose

and

women,

its

make

not

]\Ien

skin until it is confu*med.

the

it than

their sores, and by

befor it gins
says, is insidious,

the efflmda

manner

it is unsafe to

disease,as the air

ill of the

are

disease,he

respiration.The
in

who

with those

of

entertained

spiration,
torpor, slow recontinued
bowels,urine like that of cattle,
constipated

first

The

to it.

symptoms

disease

of the

are

eructations,and strong venereal appetites

; and when

mined
it is deter-

skin,the cheeks and chin become thickened and

li\'idcolour,the veins below the tongue are varicose,and
to the

of

eminences

are

all

formed

forehead

and

chin.

is borne

down

by

The

an

the

over

body

intolerable

body,

becomes
sense

but

on
especially

increased

in

of heaviness.

the

bulk, and
Those

fected
af-

of
and shun the haunts
pusillanimous,
confirmed, is of the most
Though the disease,when
men.
the sick at the
he forbids us to abandon
hopelessdesciiption,
with

commencement.

author's

it become

His

venesection

treatment
at the

is almost

the

same

as

our

beginning,purgingwith colocpith

ELEPHANTIASIS.

1.]

SECT.

11

hiera,and vomitingwith radisliesor white hellebore. Some,

that eunuchs
he says, having remarked
escapedtakingthis complaint,have castrated themselves as a preventive. He makes
or

of all the medicinal

mention

substances

recommended

the theriac of
author, namely,iron-wort,Cyrenaicjuice,
the cutaneous

For

"c.

affections he recommends

Comm,
'

'
'

by our
vipers,

great many

white hellebore,
apphcations,
containing
sulphur,rue,

external

natron, aloes,and

even

arsenic.

He

also

speaksof cataplasms,
He is very particular
in

and detergentointments.
depilatories,
that the diet be lightand. wholesome.
dii'ccting
of the whole
Actuarius
calls elephantiasis
a
cancer
body,
and
derives its origin
which preys upon all the flesh,
from black
bile corrodingeverythinglike fire. The first symptoms of it
off of the hairs of the eyebrowsand chin,tumours
a
are
falling
the face,an alteration of the appearance
of the eyes, a change
on
of the voice,turgidity
of the sublingual
veins,and afterwards

He then states
eruptionsof an intractable natiu'c.
that elephantiasis,
lepra,psora, and impetigoare diseases of
different gradationsof malignity. In another
place he has
that recomas
mended
giventhe treatment, which is exactlythe same
by Aretseus,namely,bleeding,purgingwith hellebore,
to the skin,"c.
detergentand desiccative applications
cutaneous

are
applications,
seeminglyof little efficacy,
for elephantiasis
in the
Euporista'of the

Some

'

mended
recom-

Pseudo-

Dioscorides.

Nonnus,

as

usual,abridgesour

omits

and

melancholic

the

the

description.He

humour, which
the disease
to Psellus,
lees of putridblood.

The

account

The

humour,
It

which

author's detail of the treatment,

corrodes
is

says

it arises from

the extremities.

ing
Accord-

producedby melancholyadust

and

of

perfect.
elephantiasis
given by Leo is brief and imdisease,he says, is produced by a melancholic
has become
ties.
putrid,and corrodes the extremi-

is,he adds, almost

incurable,but

may

be

benefited

and bm'nby purgingwith the dodder of thyme, by the theriac,

he says, is also
ing the head at the bregma. The affection,
called satjTiasmus.
of the common
remedies
some
Myrepsus merely mentions
for elephantiasis,
He
such as arsenic,
"c.
tm-pentine,
litharge,
of the disease.
givesno description

ELEPHANTIASIS.

12

We

CoMM.

proceedto the Arabians.

givesa very circumstantial account
of juzam or judam, which
the name

now

'

"

Avicenna

'

under

h\

renders

: it
contagious

is

called leonina,because
He

of the lion's.
first

symptoms

the

it.

The

states

in Alexandria.
the

asis,
elephanti-

whole

body,

attended

with

disease,he says,
flesh of asses,

the
It

is sometimes

stern

appearance

its
that,althoughit beginsinternally,

manifested

are

assumes

iv.

his translator

is sometimes

without

face

of

of the

cancer

producedby li^angupon

is endemic

"c., and
lentils,

bile,and

black

is sometimes

and
ulceration,
is

calls it

He

lepra.

arises from

which

[book

on

the

He

extremities.

then

minutelythe symptoms, namely,redness of the face,

off of the hairs,
enlargement of the
incliningto li^ddit}'^;
falling
veins,affection of the breathing,thickening,and discoloration
of the lips
afterwards ulceration of difi'erent parts of the
; and
off of the
of the nose, then falling
body,corrosion of the cartilages
describes

nose

with
the
that

he gives
loss of voice.Sec. The treatment
extremities,
great minuteness, but as it is little different from that of'
it.
Suffice it to say
enter upon
Greeks, we need scarcely
he mentions
earlybleeding,purging with hellebore,coloand

cynth, scammony,
of the

cautery

said to show
the

to

that

Greeks.

"c. ; the

theriac of

the application
vipers,
the head, and so forth.
Enough has been
this description
of
to the elephantiasis
applies

Considerable confusion, however, has

arisen

in

of his translator applying the term

elephantiato a
consequence
different
disease,namely, to an enlargement of the leg
very
with

varicose

Barbadoes
with

knoAvn
veins,now
generally
by the name
This
leg.
complaint he dii'ectsto be treated

of the
at first

local

and astringents
ulceration takes
])leeding
; but when
onlyby amputation.
describes the elephantiasis
of the
Serapion,in like manner,
Greeks by the name
of lepra. The face,he
says, is swelled,

place,it is to be remedied

and covered with hard pustules,

the hairs of the eyebrows
livid,
fall oflF,
the whole aspect becomes
hideous,the voice is changed,
the perspiration
becomes ^dtiated,
and ulceration seizes different
he says, takes its originfrom
parts of the body. The disease,
the liver,
in which the office of sanguification
is improperly
formed.
perHis remedies
t
he
are
"c.
bleeding,
hellebore,
theriac,
Avenzoar
describes the lepraas a cancer
from contact
arising
with

other

or
lepers,

from unwholesome

food.

He

recommends

ELEPHANTIASIS.

T.]

SECT.

leg is

the

disease in which

like the

swelled

leg of

Comm.
""""^^

elephant.

an

incurable.

considers it almost

He

coloscammony,
elephantiahe describes as a

The

hellehore,"c.

cynth^ black

with

humour

melancholic

aAvay the

to pm^ge

13

operationof burning the

of the Greeks.
head for lepra,i.e. the elephantiasis
translator of Haly Abbas, namely, Stephanus AntioThe
Albucasis

givesan

of the

account

about

disease

treatingof by

says he wrote
which we have been

bile.

black

arisingfrom

short,he

falls in ; in

vein

cold
to

the

For

the

arteries behind

the

the

enumerates

precedingauthorities.

from

it proves

says

symptoms, he mentions
hairs,drynessof the
superciliary

and
ciliary

He

the

Among

the

administer

vetches

and

of beans

decoctions

nose,

which

same

symptoms

elephantia.
a generalcancer
spiration.
contagiousby reoff of the
falling

at first; and

and
appliesthe term elephantia,
swelled leg,which he considers to be

also

to avoid

scrobiculus cordis

the

externally

lant
afterwards stimu-

and
lotions,containingarsenic,sulphur,quicklime,
He

as

from

temples,or

hellebore

as

times
some-

to bleed

us

recommends

He

theriac, "c.

the

of

those of the

ears,

; to

arm

name

he directs

cure

giveemetics, such
to
apply cupping-instruments

in the
to

the

represents it to be

others, Haly

the

Like

1127, describes the

the year

chensis,who

sometimes

forth.

so

to
elephas,

speciesof varix.
four varieties of lepra, namely, the
describes
Alsaharavius
and vulpina. The
disease,he
serpentina,
leonina,elephantia,
be contracted, 1st, by an
hereditarytaint ; 2d, by
says, may
the flesh of buck-goats,
as
of corrupted food, such
the use
of the respiration.
"c. ; 3d, by contagion,
tliroughthe medium
cows,
with
the
disease
of
He describes all the gradations

the

greaterminuteness

than

stage,he says, the

nose

lost,ulcers break
fall away,

and

to the

it is
the

out

the

any other ancient

falls in, the hairs

is fetid.

breath

scarcelyat all different

of elephantia he
name

which

he

pronounces

directs

us,

however,

abstinence

from

to
to have

gross

His

of the case,

circumstances

be

but, upon
of

the

that

also

describes the

recourse

its last

intractable
to

varies

treatment

from

very

In

author.

the voice is
drop oflF,
extremities mortifyand

skin, the

the

on

the

cording
ac-

whole,

others.
swelled
disease.

By
leg,
He

bleeding,melanogogues,

food,emetics,and various external appli-

'

ELEPHANTIASIS.

14

CoMM.
"

of

cations

'

ing

the

The

stimulant

wlaicli lie mentions

iv.

bury-

sand.

leg in hot
translator

nature^ among

[book

of Rhases

also

appliesthe

The colomof the Greeks.

elephantiasis
rough, the
changed, the voice becomes
bladder, and red Avith nodes, the hairs
at last become

sw

peculiarin his treatment.

elled and
He

term

of the
face
fall

idcerated.

lepra to

eye, he

the

savs,

is

is

swelled,hke a
mities
off,and the extreThere

is

the
describes,likevrise,

of

nothing
sicelled

elephantiaor elephas. He says that,when

tubercles arise on it^ it is utterlyinciu'able ; but that when
it may
be remedied
simplyenlai'ged,
by bleedingin the arm,
In
his
food, and the like.
cupping, emetics, attenuant
Continens,^ he calls the lepra (elephantiasis)
hereditaryand
from black
contagious. He says, it is a general cancer, arising
bile. For the swelled leg he recommends, as in his other work,
and emetics, with stimidant applications,
ing
containbloodletting
and
also
pearlashes,sulphur,"c.,
tightbandages.
Such
is the histoiyof elephantiasis
givenby ancient authors.
The
earlier of oiu*
modern
writers
on
medicine, describe
a
as
elephantiasis
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 leprsespecieselephantiasisque
vocatm-," "c. Upon this
Cornarius
makes
the followingannotation
Vulo-us
passage
:
medicoiiim
xVrabas in hoc secuti lepram cimi
conelephantiasi
fundunt.
Immo
lepram pro elephantiasi
accipiunt."
Guido
de Cauliaco's account
of the disease is also nearlythe
that of Alsaharavius.
same
He
as
states decidedlythat the
disease is contagious,and recommends
bleeding,purging, the
actual cautery, the theriac of vipers,
(^-i,
1.) Rogeriusremarks
that the disease is contracted
per coitum. (i,15.) And
here,
the
be permitted to state that we
by
have
Avay, we
may
long
been conmiced
that the syphilis
of modern
times is a modified
form of the ancient elephantiasis.
This opinionis maintained
by several of the writers of the Aphrodisiacus,
and also by the
learned
Sprengel,Avho givesa very interesting
disquisition
on
iu
his
of
Medicine.'
Syphilis
History
leg by

the

name

'

"

"

'

AND

LEPROSY

16

PSORA.

[book

iv.

of each, dr. x ;
spears'roots, oz. vj; of sulphurA-ivum,of manna,
of natron, dr. viij
; anoint,mixing with vinegar. The following

simpleremedies

for
particularly
applicable

are

psora :
root of

Staves-

with vinegar,the
Anth
lupins,cardamom
lily
honey, turpentinerosin,sulphur,chick peas, goat'sdung ; and
acre, bitter

these

compound

Avitli

wine,

Another

ones

anoint

and

in

humid

more

leaves

chalcitis and
kinds

of

misy

of

psora.
sextaiius

"

rose-bayin a
dried, and, throwingaway the leaves,add

they are
oz.
iijof white

sprinkleupon

equal parts of

the

the tender

Boil

oil until
the oil

mix

"

it

oz.

to

cool and
and, after it is dissolved,
j of sulphur vivum, and anoint in the sun
wax,

Some

the bath.

of

boil also

with
squills

the

rose-bay.
Anotfier
Of diachylon,
oz.
ij;of wax, oz. ij;of oil of roses, oz. j;
of litharge,
of ceruse, oz. iij;
of liquid
oz. iij;
pitch,oz. vj;of the
dross of silver,
what will be
oz. ij;of siricum,
oz. ij;of vinegar,
sufficient for the trituration of the drv^ things. Another
Of
oz.
or
cenise, oz. ss; of starch,
ss; of lead,oz. j ; of red lotuses,
of alkanet, oz.ij
of
oil
of
of
boil
the
oz.
\j;
;
wax,
roses, oz. ix;
alkanet properlywith the oil of roses, and then add the other
Take ten eggs, or as many
as
are
things. Another
required,
in the most
and having macerated
acrid vinegaruntil their shell
the yelks of them; ha\dug
become
tender; boil in the Ainegai*
triturated with rose-oil and
what
remains
of the A-inegar
a
moderate
anoint,when of the consistence
quantityof litharge,
or

"

"

"

of

the sordes

of oil in baths.

triturated
gar, add

the

most

yelksof

the cerate.

oil,until

rose

the most

of

See

"

'

Three

the eggs and the sulphurwith the AaneAnd

tritm-ated with rinegarand
litharge
of

cleanses
plaster,

the

psora ; and the detergentointments from

of those for elephantiasis,
well in
answer

generalAvith leprosyand

"

"

it be of the consistence

acrid kinds

dock, and

CoMM.

Another

yelks of eggs
of -s-inegai';
of rose-oil,
oz.vj;of sulphurvivum, oz. iij;
haAdng

out

'"

psora.

Hippocrates(de Usu

Humidorum, Epidem. ii); Galen.

G ; ct ahbi); Oribasius
(Meth. ]Med. xiv ; de Causis Sympt. iii,
(Morb. Curat, iii,58) ; Aetius (xiii,
134) ; Actuarius (Meth.
Med.
ii,11); Nonnus
(Epit.234); Pseudo-Dioscor. (Euporist.
Leo
i,128);
(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

LEPROSY

II.]

SECT.

AND

PSORA.

17

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

iv,8); Psellus (op.jMedicum); Yegetius(Mulom. iii,
71);
(Orig.
(iv.7, 2, 9) ;
Geopon. (xviii,
15); Serapion (v,2) ; Avicenna
16 ; Pract. iv^4) ;
Avenzoar
viii,
7, 4) ; Haly Abbas (Tlieor.
(ii,
Alsaharavius
1, 2, 3, 4) ; Rhases (ad Mansor.
v, 31 et
(xxxi,
seq. ; Divis.
As in tbe

in this

et

of the

ginning,
Greeks, Latins, and Arabians,be-

instance,with the Greeks.

only casual mention of these diseases,

characters.
In
marked
theii* distinguishing

Hippocrates makes
and

has nowhere

one

placehe

in another

calls

disease ; and
varieties of it itch before rain.

leprosya blemish

he remarks

that

some

rather

than

speaksof Ainegar,and of lime and water as remedies for it.

It is proper to apprizethe reader that the two works quoted
Collection are, most probably,
not
above from the Hippocratic
He

genuine.

subjectof lepra,having
of it,although
he notices
nowhere
givena completedescription
In one
in many
it incidentally
placehe
parts of his works.
calls elephas,leuce, and
alphos cognate afiections. Alphos,
In another, he
than leuce.
he says, is much
more
superficial
humoui'
which
to the melancholic
attributes these complaints
In the 'Isagogue,^
becomes
fixed in the skin.
which,however,
not to be a genuinework of his,it is said that leprais an
seems
affection of the skin,which becomes whiter and rougher than
natural,the roughnessresemblingthat from prominent psyalso is very deficient on

Galen

dracia.

Psora

as

is said to

the

partakemore

of the nature

from
as
arising
represented
being cured by phlegmagogues, and

Both
and

into the skin.

are

of ulceration.

saltish

ointments

phlegm,
rubbed

fi'om
It is also stated that leuce is distinguished

being no roughness of the skin in the former

disease. In another placehe mentions psora as a disease most
Natur. i,13.)
inveterate to cure.
(Facult.
Oribasius thus distinguishes
leuce,alphos,melas,lepra,and
another.
Leuce is occasioned
by a pituitous
psora from one

lepraby

there

blood,which, in process of time,renders the colour

skin
but the superficial
white.
Alphos arises in like manner,
flesh. When
and not the whole
a
pituitous
only is aflected,
humour
is the cause
it puts on the appearance
of the complaint,
and

viscid

II.

'
*

seq.)
; Contin. (xxxvi.)
precedingchapter,we shall here give a separate

117^

of the views

account

Comm.
'

'
'

iv.

Lepra affects
alphos,and when tlie melancholic,of melas.
For all
parts,and psora the superficial.
mostlythe deep-seated
of lime and water
he recommends
these complaints
a mixture
of

CoMM.
'

[book

PSORA.

AND

LEPROSY

18

and

In
is

other

some

the

'

such

things.

ascribed
Euporista/generally

given a long

flour of darnel

list of medicinal

with

to

articles for

sulphm-, hellebore with

Dioscorides,there

lepra,such as the
vinegar, verdigris,

cantharides,"c.

Archigenes,thus

Aetius, copyingfrom

marks

the

difference

Lepra differs from

cognate diseases.
inasmuch
leuce and alplios,
as leprais distinguished
by roughness
of itching,and yet the skin only is affected,and
and a sense
it is removed, the flesh below is discovered to be sound ;
when
unnatural degree of
but in lerice,
the flesh below assumes
an
whiteness,while the surface of the part is very smooth, and
between

when

rubbed

it

readilycured

the

of

are

scales

of

in those who
red, especially

becomes

soon

; and

of
appearance
psora, inasmuch
skin

its

lepra and

having the
alphos is altogethersuperficial,

scale fastened to the skin.

are

Lepra differs

from

"

in psora the substances which

appear on the
furfuraceous nature, while in leprathey resemble
as

He

largefish.

ment
omits the constitutional treat-

stated by our
tions
author, but his local applicajudiciously
littledifferent.
are
They contain hellebore,sulphur,mis}^,
verdigris,
liquidpitch, cantharides, natron, copperas, myrrh,
vinegar,"c., mixed in various proportions.
galls,
in malignity,
Actuarius
states that leprais next to elephantia
from psora by spreading
and that it is distinguished
deeper and
having scales of a circular shape like those of fishes ; Avhereas,
and of
and its scales are furfuraceous
superficial,
psora is more
determinate
no
shape. Both are attended with asperityof
holds the same
the skin, and itching. Leuce
placeto alplios
that lepradoes to psora, that is to saj^, leuce is more
deep-seated,
so

and

aft'ectsthe

and
affections

colour

the
he

hair

of the
is in

recommends

ban, while alphos is

general unchanged.
an

mixed
hellebore,
arsenic,and cantharides,
resin,or rose oil.

circular
Nonnus

states

that
correctly

ficial,
superall these

containingcopperas,
application

black

Psellus

more

For

the

scales in

with

oil,cedar

leprosyassume

shape.
marks

the

distinction

between

these

diseases

very

SECT.

LEPROSY

II.]

accurately.Lepra
scales fall from

AND

arises from

the surface of the

PSORA.

19

corrodinghumour^

and

skin, and it is attended

hence

Comm.

with

and affects the skin

deep-seated,
pruritus. But leprais more
and
whereas
superficial
variously
circularly;
psora is more
he
figured. Leuce and alphosalbus and niger, says, are allied;
but leuce is deeperseated,so as to change the colour of the
affections.
superficial
hairs,whereas the alphiare more
Pollux, like most of the others,states that in leuce, when
that the disease is
the skin is pricked,it does not bleed, and
cured.
difficult to cure.
Alphos and melas, he says, are easily
Although Myrepsus has not described these diseases,he gives
The
them.
to remove
for various
compositions
prescriptions
in them
active ingi'edients
most
are
natron, sulphur,
hellebore,
"c.
sal ammoniac, quicklime,
bay-berries,
quicksilver,
the contagious
Alexander
mentions
Aphrodisiensis
psora among
but says that lepraand leuce are not contagious.
diseases,
opinionthat psora is a
Chrysostom alludes to the common
The poet Jjlschylus
givesa short description
contagiousdisease.
of lichenes. (1.277.)
of leprosy
in his ''Choepherae'
by the name
the terms lepraand psora, and therefore
Celsus nowhere
uses
of these
in comparing his account
there is considerable difficulty
of the Greeks.
affections with the descriptions
cutaneous
Alphos,
them
connecting
melas, and leuce,he describes very intelligibly,
togetherby the genericterm of vitiligo.We shall give his
of these diseases :
vocharacteristic description
"''A\(}"og
own
continuus,et
catur ubi color albus est, fere subasper,et non
etiam
videantur : interdum
esse
qusedam quasi guttsedispersse
latius, et cum
quibusdum intermissionibus serpit, Mf Aac
similis : csetera
colore ab hoc differt quianiger est et umbrse
habet
Leuce
eadem sunt.
quiddam simile alpho, sed magis
albida est et altius descendit ; in esique albi pili
sunt, et lanugini
ultimum
deficillimam recipiunt:
similes. Priora curationem non
"

vix unquam
he connects

sanescit."

Another

class of

affections

cutaneous

marked
by the genericterm of impetigo,and it is to be reand
not pustular,
that they are all squamous
diseases,
have
and Bateman
Drs. Willan
like the complaintsto which
of impetigo(asBateman
His second species
appliedthe term.
Alteram
remarks,)appears to be the psora of the Greeks :
sed asperius
rubicandiusque,
ferae,
genus pejusest, simile papulse
cute
discedunt.
figurasvarias habens : squamulee ex summa
"

"

'

'
'

20
rosio

CoMM.
'

'
'

quam
His
of
nam

[book

PSORA.

AND

LEPROSY

iv.

etiam
certioribusque
major est, celerius et latins procedit,
priortemporibuset fit et desinit. Kubra coguominatiu'."
to the lepra
resemblance
third speciesbears some
nigricans

Willan

and

Bateman

et crassior est et

et
ditiu*,

vehementius

"

to refer to the

His

account
"

non

deterior

etiamnum

est

durior,et magis tumet, in summa

rodit,ipsaquoque squamosa sed nigra,"c.

:
lepravulgaris

omnino

Tertia

cute fin-

est.'^

Nigraecognomen
tionem

"

"

of the fourth

Quartum

distans colore
recipit

genus
:

nam

seems
species
est qiiod
cura-

sub-albidum

est

quasdam subsquamulashabetpallidas,
albidas,quasdam lenticulae similes : quibus demptis nonunprofluit
sanguis." For all these diseases he recommends
quam
a
compositioncontainingsulphur,natron, and rosin.
"ad lepram,
Scribonius Largus describes several compositions,
pruriginecutis,"and for scabies.
quje quasiimpetigo est cum
They contain sulphur,^Ethiopiancumin, Aincgar,frankincense.
Serenus
of a few popularremeSamonicus
makes
mention
dies
for scabies,prurigo,and papulse,
but he givesno description
of these complaints.
Octavius Horatianus
recommends
for scabies (meaning,we
purging,frequent
suppose, the psora of the Greeks,) bleeding,
baths,and external applications
natron, frankincense,
containing
and sulphur. He
does not mention
lepraby name, nor does
et recenti cicatrici simile:

he

seem

to allude

Marcellus

to it at all.

lepra a composition containing

natron, frankincense,litharge,and
sulphur

recommends

equal parts

of

for

pounded with vinegar.

Vegetius says that the scabies of cattle
contagiosaest et
transit in plures." ProbablyVu'gilalludes to the scab of sheep
in this line:
Nee mala vicini pecoris
contagiaIsedant." (Eel.i.)
He mentions,as remedies for it,sulplnu',
bore,
pitch,hellelitharge,
"c. (Georg.
iii,
18, xviii,
449.) See also Geopon. (xvi,
15);
Columella
and
Gratius
(viii,
5);
(Cyneget.412).
Isidorus givesthe folloAving
definitions of the complaints
we
have been treating
of :
Lepra vero cutis asperitas
squammosa
in nigrilepidisimilis unde nomen
accepit: cujuscolor nunc
dinem vertitur,
in alljorem,
Scabies
in ruborera.
nunc
nimc
tenuis asperitas
et squammata
est.
Impetigoest sicca scabies ;
prominens a corpore cum
asperitatcet rotunditate formae.
Hanc vulgussarnam
appellat."
"

"

"

Justin
treated

In

'
*

scribed
Serapion^lepraand psora are dein quibus exgenericterm of
inipetigines
"

et scinditur

another

one

Comm.

translation of
the

under

from

21

Arabians.

the Latin

coriatur

PSORA.

and scabies to the diseases

appliesthe terms vitiligo
of in this chapter. See Hist, (xxxvi,
2.) We now

to the

turn

AND

LEPROSY

II.]

SECT.

pruritus. The

by

former

humour,

;" but they

cutis

and

titles
specific

the

is characterized
as

further

are

distinguished

nigraand

of albaras

arisingfrom

as

scales.

castingoff round

the

The

lancholic
me-

latter

which
pustules,
appear on different parts of
and cast off furfiu'aceous scales.
the body, are variously
figured,
The
leuce is described by the name
of baras, as arisingfrom
viscid,pituitous
blood, and being producedby a defect of the
assimilative faculty. In it the flesh itself is said to be changed
to a white colour.
If,when prickedwith the head of a needle
of cure
it bleeds,there is a probability
; but if it does not bleed,
described by the names
of
The two alphiare
it is incurable.
the
The
morphea aJba and mgra.
morphea alba resembles
white albaras (leuce)onlythat in the latter the aflFection of the
and the hairs in it are turned to a
shin is more
deep-seated,
white colour ; but in morphea the onlychange is in the external
The morphea nigra (melas?)is said
of the skin.
appearance
the albaras nigra(lepra
to resemble
nigricans
?) only that it is
more
superficial.
In the Latin translation of AA'icenna by BuUonensis, alphos
oi morphea alba
albus and nigerare distinguished
by the names
(oralguada),and morphea nigra; leuce by that of albaras; and
lepraby those of albaras nigraand impetigoexcorticativa. The
differences between
them are stated with great precision.
specific
affections of the skin, but
the
The
morphese are superficial

is said to consist of

albaras

affects also the

bone.

All

these

the assimilative

diseases

A.venzoar
hus

not

said to arise from

the albaras

with

from
makes

described

the

do
The

not

puncture of

guada, but

mention
them

change
not

of the

from

to the

weakness

of

the
nigra,or leprosy,

scales,like those of

formerlyquoted,Avicenna

(alphosalbus) the hairs

they do so in albaras.
blood

are

faculty. In

skin is said to be covered

the authorities

down

flesh,
penetratingsometimes

fish.

Like

states

that in

their

colour,but that

needle

alguada

likewise

tracts
ex-

the baras.

morphea

alba and

These
particularly.

but
nigra,

authors

seem

to

LEPROSY

22

'
"

[book iv.

PSORA.

lepraand psora like tlie Greeks, by bleeding,meto the skin,such as the

lanogogues,and abstergentapplications
"c.
two hellebores,
lime,lupines,
described
In the translation of Haly Abbas, leuce is correctly
as
a whiteness
of lepra. It is represented
times
someby the name
the whole body, and it is said to be occasioned
aifecting
the hairs are
of the assimilative faculty. When
by debility
white,and the skin does not bleed when prickedwith a lancet or
Alphos albus is described by
needle,the disease is incurable.
from the former
of morjiheaalba,and is distinguished
the name
and the colour of the
superficial,
by the whiteness being more
hairs remaining unchanged. In the morphea nigra,that is to
say the alphosniger,the colour is said to be black, owing to
of black bile,and if rubbed
the prevalence
a fiu-fiu-aceous scale
is described
red.
The lepranigricans
falls off,and it becomes
of impetigo and sarpedo,as an
asperityof the
by the names
skin, incliningto blackness or redness, and terminating in
of lepra,he
round
scales,like those of fishes. For the cure
all articles of food which
directs us to abstain from
engender
with pepper, "c., and also
phlegm, to take hiera of colocynth,
He
and various other internal medicines.
the theriac of vipers,
various external applications,
recommends
containingsulphur,
"c.
arsenic,hellebore,
spui'ge,
Alsaharavius
describes three varieties of morphea. 1st. The
which
is attended
with furfiu'aceous scales
morphea terrestris,
the skin, and tingling. This is evidently
the psora of the
on
2d. The morphea alba,which consists of a more
Greeks.
ficial
superwhiteness
of the skin than the albaras (leuce)
: this is the
3d. The morphea nigra,is like the former, only
alphosalbus.
that the colour is black.
This must
be the alphosniger. All
these affections he treats upon much
the same
the
as
principles
to the
Greeks, namely,by evacuants, and stimulant applications
"c.
Albaras
he describes as a
skin,such as sulphur,hellebore,
whiteness
of the skin, and directs us to prickthe
deep-seated
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 it upon much
the same
the morphese.
as
principles

have

CoMM.
'

AND

treated

He

appears

the

lepra.
Rhases

not

to make

describes the

any

distinction

lepraof

between

the Greeks

by the

the leuce and

term

inqjetiyo;

[book

LICHEN.

24

SECT.

Lichen

is formed

by

LICHEN.

ON

III.

of

mixture

the

iv.

acrid ichor

thin and

into leprosyand
gross humours, and passes readily
the most
desiccapsora ; -wherefore it requiresto be treated by
lowing
if necessary, the folAfter generaldepletion,
tive applications.
with

other

simplemedicines

dwells among

the ui'chin which

and

of the land

rosin,the dung

And

rice.

solelyupon
alone

take

several

anoint

warm,

the

children is to be
of the

gum

chaste

wheat

with
frequently

the
complaintis protracted,

in like

The

manner.

The

saliva.

human

of

lichen

The

in, is beneficial in these

rubbed

are
tree, triturated with ^-inegar,

leaves of capers

while

them

flows from

part aflected with hchen.

rubbed

the

complaintwhen
cation
body,by this appliand place upon
a

the

the

fluid which

plum tree, when

"When

cases.

cured

grainsof

stithyred-hot,and takingthe
yet

fed
that of starlings
crocodile,

have

many

chin,or other parts of

the

occurringon

hellebore,
chick-peas,
rocks, pitchmixed with cerate

will be proper

leaves

of the

applied,or the
are
compound
following
be

to

in \^negar, or with
rosemaiy
trochisk for lichen : Of artificers^

: Dissolve
applications
sulphurwith

A
ammoniac, and anoint.
half a cyathus;
glue, dr. iv ; of frankincense,di'.iij
; of vinegai'
of gum,
dissolve in vinegar,
Of chalcitis,
Another:
and anoint.
of each, dr. viij
; of sulphur vivum, of misy,of each, dr. \]; of
with
the flakes of copper, of acacia, of each, dr. ij; anoint
of spuma
nitri,of
vinegar. Another : Of sulphiu"Aivum,
each, dr. iv ; of the seeds of rosemary, Ix ; triturate with "vinegar,
and anoint only the part which
is affected,
not touchingthe
"

"

sound

skin.

Another
of burnt

choenix:

When

Of

white

shell-fishes called
rub

agriuswhich

with

"

buccina, of natron,

it drv.

is nowise

and
pUcations,
ai'e

with
cold water.
it away
hellebore,dr. viij
; of the flom' of lupines,

dry, wash

Thev

remedied

call that

of

variety

by more acrid ones.

which
by applications

These
are

one

of lichen

by moderatelydesiccative

is exacerbated

therefore to be treated

each,

ap-

cases

sufficiently

strong,without being pungent, such as this :

poppy,
of frankincense,
of alcyonium,of bitumen, of sulphur,of gum,
of horned

of

each, oz. j ;

vinegar,and,

anoint

wlicn

with

vinegar.
anoint.
dissolved,
"

Boil

African

pitchwith

Another, for lichen and

LICHEN.

III.]

SECT.

Of

prurigo:

of

copperas,

25

vi^-um,of natron,
sulpliur

for lichen with

equal parts; use

wine.
Another,for
flour of bitter vetch,of

Toth
of the

add to

"

lichen

of frankincense,

vinegar,and

Of

the flour of

for prurigo

ammoniac

perfume,
lupines,
eqiialparts ;

vinegar.

Commentary.

See

Hippocrates(de Humor.,

de

Comm.
Afi'ect.)
;
'

Galen.

de
(Isagoge,

Med.

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
xxxi,7); Rliases (Divis.
(Pract.
117); Haly Abbas (Pract.
iv,10.)
Dr.

Bateman

states, tliat the

lichen cannot

teim

sec.

Hippocrates; but

be

well
Dr.

exact

ascertained

"\^'illanaffirms that he

papulareruptionon the skin.

In the
Isagoge,'
usuallyascribed
'

described,the

are

which

scales

ulcerated

are

acceptationof the
from
the writingsof

lichen

formed

when

mitis,and
the
upon
removed.

restricted it to

Galen, two varieties

lichen agrius,
in both of

to

the

skin, which

almost
appear
to be cured by

they are
They are
and liniments externally.
cholagoguesinternally,
Galen
remarks
the tendencyof the disease to pass

and

scabies.

To

into

lepra

prevent this,he directs desiccative and

gent
deter-

for the preparationof which he givesvarious

applications,
One of these,which bears the name
of Pamphilus,
prescriptions.
is a powerfulescliarotic,
burnt
composed of orpiment,realgar,

and

copper,

canthai'ides.

buf
the "chin,
principally

(Med.
is

apt

sec.

loc.

v.)

He

the face.

spreadover

to

Oribasius,Aetius, Actuarius,and Xonnus,

says it aff'ects

treat

in

the same
author.
terms
as
oiuneai'ly
improperlyrender it by impetigo. Leo
originof the disease to hot and conruptedblood.
describes the lichen of the Greeks
Celsus
by

papula,

of which

he

mentions

two

says, the skin is merelyroughened

and slightly
corroded; the middle

varieties.

In

of the
Their

plaint
com-

lators
trans-

ascribes the

the

name

the

of

he
first,

is reddened
by small pustules,

smoother, and
in a round
it spreadsslowly,
shape. This description
generally
of Drs. Bateman
would seem
to applyto the lichen circumscriptus
and
a

is somewhat

Willan, althoughthe latter author

wider

The
signification.

second

thinks

he
variety,

that it

possessed

says, is called

"

'

"

'

iv.

rough,red,and
Greeks, and in it the skin is more
it departsfrom the circular form the less
The more
corroded.
petigo.
tractable is it, and, unless removed, it is said to pass into imthe

by
ciypia

CoMM.
'"

[book

LICHEN.

26

it is clear that

this account

From

also

mentions

saliva of

the

friction with

impetigo. Celsus
fastingperson, and

difterent from

form, was
Greeks, in its original
recommends

of the

lichen

the

compositioncontainingnatron, frankincense,

sulphur,"c.
translator of

The

by

this affection
the

the

Serapionimproperlyrenders
remedies

His

impetigo.

the term

author's,namely,the saliva of

are

om-

as

nearly
fasting,

person
ashes
the
hellebore,
natron,
compositionscontaining
same

of

name

of

lings,
star-

"c.

impetigo. It is called
doubt meant
papula. It
of

name

is

no

to pass

into

lepra or

(whichare

king's spear,
of
Rhases

and, when

as

Haly

remedies
chaste

are

tree, capers,

mended
recom-

leeches

Greeks),likewise gum arable

vinegar,salt Avater,the roots

Abbas

recommends

lotions of

also

the
misapplies

appears
describes

to

be

by

the

the

Dr. Willan

stimulant

ments
lini-

vinegarand ammoniac,

complaint

of aJcoab.
mentions
of the

it.

four

He

which

represents

speciesof

ancient

it.

authorities,

tendencyto pass into lepraand psora.

called lichen tropicus
The species
to be the
by Dr. Willan, seems
of Hippocrates(Aph. iii,21) ; the sudamen
hidroa
of Pliny
of Haly Abbas
45) ; one of the essere
(Theor.xra, 17) ;
(xxiii,
of the alsara of Alsahara^ius
one
(Pract.
xxx, 8) ; and the hasef
of A^icenna
(iv,7, 3, 8). See also Galen's 'Commentary'

that

has

impetigoto

cutaneous

the statement

confirms

disease

term

name

ulceration,and
superficial

the

which

tendency

"c.
inveterate,leeches, strong friction,

it becomes

Alsahararius
it

"c.

the
and

recommends
briefly

lichen

The

is stated that it has

similar kind.

translator

His

by

vinegar,mustard

dissolved in
of

mentioned

not

saliva, the

human

are

by the
speciesof dry achor,by which

The

psora.

described

it is likewise

In the translation of A^icenna

Galen says it is attended

Avith prmitus,
(v,261) ; ed. Basil.
and
Rhases
asperity,and ulceration. A^icenna
particularly
the
commend
and
the
cold bath.
cleansing
skin,
bleeding,
Most
of Rhases'
authorities in his
for
Continens,'recommend
the asaf,or sudamen, coolingand astringent
conapplications,
'

PRURITUS.

IV.]

SECT.

27

taining roses, myrtles,galls,sandals,camplior,and

the

like.

Comm,
'

In certain
complaintto profuseperspii-ation.
with
dii-ects us to allaythe pruiitusor tingling,
cases, Rhases
He also approves of purging
hot Avater and the flesh of melons.
and
-"-ith tamarinds
myrobalans. (Cont. xxxvi.) See also
alludes
ad ]SIausor. (v,30). ]Mercui'ialisis of opinionthat Virgil
Hues :
in the following
to the sudamiua

Thev

attribute the

"

etiam

Verura

ill^"isossi

papul?eatque

Ardentes

quistentarat
immundus

amictus,

oleutia sudor

(Georg.iii,565.)

sequebatur."

Membra

"

placethe singulardisease of
in the Roman
the face which prevailed
empiredm'ingthe reign
of Tiberius,called mentagra by Pliny,in his curious description
He reUchenes by some.
he says was
named
presents
of it,but which
it as a contagious
disease,which was readily
propagated
the higher class,the lower
by kissing. It attacked principally
ranks and women
and middle
escapedit. The
havinggenerally
seat of it was
commonly the chin,but it sometimes spreadover
notice in this
shall briefly

We

face,and

the whole

onlv

The
bone.
to

appear

cm-e

was

have

that it must
authorities
to

have

Marcellus, 19.) We

been

some

much

more

but
sycosis,

intractable

described by Celsus, among

is distinctly
sycosis

hauy parts. He
figsboiled in water,

the

SECT.

IV.

rcQommends
"c.

are

inclined

varietyof elephantiasis.

it under

ranked

have

been

neck, breast, and hands.

biu'ningwith caustics do^^n to the
the

even

also

(H.N. xxxvii; see

think

Modern

of

means

aff'ected

for it

it would

disease.
the

The

diseases of

elaterium,linseed,or

(^i,3.)

ON

PRURITUS,

OR

PRURIGO.

occiuTing in old age is not to be thoroughly

prui'igo
below:
the remedies mentioned
cm'ed, but may be alleAiatedby
arises from a cacochymy in other ages, is to be
but that which
cm'ed by evacuation, being formed by a bilious or pituitous
It is
that has become
humom'
putrid,or by a saltish one.
of
known
by attendingto the age, temperament, diet,season
The

and the like.

the year, situation,
If, therefore,it appear to
in the blood contained in the veins,we must
begin with
prevail

[book iv.

PRURITUS.

28

if it offend rather

venesection;but
it

evacuate

to external

all times

must

medicines, and turn oui* attention

by corresponding
the bath at
must
use
we
applications.Wherefore

before

be used
may
mectation.
or

we
quality,

its

by

of

meal

time, for the affection is of difficult hu-

second

They

to

are

beet,

it
sometimes, after eating a little,

and

of

or

with

be rubbed

the

of Avild

or
barley-meal,

of fenugreek,

decoction
or

of

garden

malloAvs,or of ptisan; and along with these may be joinedthe

of the
of myi'obalan(ben),
flour of beans, or of lupines,
or
or

detergentointment

and

in like manner,

the bath

use

may

If it is

called peponaton.

foment

we
protracted,

with

the decoction

of marjoram, of
of sage, of tamarisk,of the herb mercuiy,
pennp'oyal,of bay berries,of the root of the wild cucumber,
of capers,

parts are

brine ; and then the

natron, or with the lees of

ley,of ^dnegar and

of strained

with dried
sprinkled
with
the compositioncontainingof

to be

vinegar,or

spuma

nitri

vi'saim,of each, lb. j,

sulpliiu'
of cimolian earth, Ib.ss; or this: of aphronitrum,of sulphur
vivum, of burnt alcyonium,equal parts; to be used dry,or with
of the decoctions
some
ah-eadymentioned ; and, if you please,
But
rub in
dried hellebore,without
sprinklesome
grease.
wdth \dnegar and oil,stavesacre
or
pulverized,
sulphur,or red
all together; or mustard, with the refuse of expressed
or
arsenic,
myrobalan, and vinegar and oil ; or with snails burnt and tri-

sextarius,of

one

tm*ated

with

honey or

prepared

from

Elephantiasis
; or
If the

of

rosemary,

parts become

of

the roots

them,

with

dock,

or

described

as

the

ments
detergentoint-

under

the

head

of

of the

some

ulcerated,use

applicationsfor scabies.
the plastercalled parygron,

that

in a
prepared from pompholyx ; or melt oz. j of wax
and sprinkle
cyathusof oil of privet,
oz.j.
upon it of sulpllIU'^i^nlm
Another
for
Of
application
prurigo:
large nuts in a rancid
state,oz. j ; of sulphur,oz. j ; triturate with the juiceof parsley,
and use
in the bath with much
friction. This alone has proved
sufficient for the cure
of many
of scabies and prurigo;
cases
and green parsley
when
by itself,
pounded and rubbed in while
the patientis in the bath, has been of great service : and in
like manner,
pelHtoryof the wall and maple rosin dissolved
or

with

rose

of pure

strong

oil,and rubbed
and

in.

"

Another

Bruise

three

ounces

triturate with
very Avhite rice,and,having strained,
vinegaruntil it become of the tliickness of the sordes

PRURITUS.

IV.]

SECT,

of the

oil in batlis

oz.
pulverized,
j;

friction.

much

and

of snlpliurvivum
adding separately
in the bath Avith
use
mixing properly,

and

thei'e is

W^ien

nioui's, it will be better

Commentary.

29

to mix

greater redundance

the

of hu-

in equal proingredients
portions.

See

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

(Comment, et alibi)
(Morb. Curat, iii,22) ; Aetius
; Oribasius
(xiv,20) ; Actuarius
(Meth. Med. ii, 11) ; Nonnus
(237);
Alexander
(Probl.i, 24) ; IMyrepsus(pluries)
Aphrodisiensis
;
Octavius
Horatianus
Pliny (xxviii,
(i,31) ; Marcellus
5) ;
Isidorus
Med.
(de
iv,8) ; Serapion(v,6) ; Avicenna
4) ;
(Orig.
(iv,7, S, 6) ; Haly Abbas
(Theor.viii,17, and Pract. iv,6) ;
Alsaharavius (Pract.
xxxi,5) ; Ehases (Divis.
121); Avenzoar
7, 2.)
(ii,
The prurigo of Dr. Willan
is here distinctly
and
described^
*

suitable method

of treatment

Hippocratesremarks
The

reason

of the
He

by

which

system

that

prurigo is common
assignsfor this is,that

Galen
then

and
indigestion

Oribasius
from

givesan

author^s.

our

in
the

the

age.

the

skin.

either be

prui'itus
produced
may
"c., or it may
nettles,squills,

neglectof

cleanliness.

of the disease not

account

old

superfluities

properlydischargedby

not

says in another place,that

external substances,such as

arise from

one

are

recommended.

very

different

he recommends
applications,
with liquid
cerate.
sulphureousbath for the cure

other

Among

of opium mixed
consisting
Aetius speakshighlyof the

of

this disease.
Actuarius

characterizes

that it is allied to
runs

and

from

the

lichen,and

place,or

consistence.

the disease

He

some

that when

well, when

rubbed

slight
humidityof

assigns,as

old age, that the pores

verv

reason

of the skin then

either

he

nothing

various

for its

says

colour

frequencyin

get constricted.

the reason
as
Aphrodisiensis
why the
assigns,
of pruritus,
that it dispels
the
bath proves useful in cases
warm
of the complaint.
phlegm, which is the cause
Celsus givesa particular
but says nothing
of scabies,
account
of prurigo.
the patientis
recommends
Octavius Horatianus
us, when

Alexander

young,

to

bleed,purge,

and

use

batlis medicated

with

frank-

'

natron
incense,

CoMM.
"

'
"

[book

PRURITUS.

30

friction with
Isidorus

also says that the cold bath,and

the oil of roses, myrtles,"c., Avilldo much
good.

the

sulphur.He

and

the term

uses

et ardendo.^^

much

n^

also

^Marcellus
substances

same

"

prurigo:

recommends

this term, and

uses

perurendo

Prurigo vocatur

the others.

as

Arabians, and is
of their translators.
commends
rendered pruritusby most
Serapion reto bleed, and
us, if there is a sanguineous plethora,
and black hellebore,
then to purge with myrobalans,colocynth,
bath is to be used, and the
and along with these the w^arm
liniments for remoAdng the pruritus,
containing^dnegar,roses,
This

prurigosenilis

nitre,"c.

The

Rhases

Avicenna

of

and

prurigoand

clearlydescribed by

is

affection

recommend

alliance.

Hence

terminates

in scabies.

arise from

saltish

which
pustules,

Bateman

warm-bath,

Alsaharavius

Haly
phlegm.

and

is

or

has

the

between
frequently

remedies
disease

body

hot

bath.

or

to

the

into scabies.

run

rose-

like those
arises from

fingersand

oil,the
of

our

use

of

author.

debility of the

of the pores.
He
states that
pruritus

constriction
Avenzoar

of
shai*pness

recommend

omitted

of their

when
neglected,
says that prurigo,
and
that
scabies
Abbas
prurigo
says
consists
of
reddish
he
Scabies, says,

the

doubt

no

the blood.

to treat of

for an account
plithiriasis,
of which see in particular
CnehusAiu'elianus
(deTard.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
(inYita Syllfe.)The authorities quoted by
Rhases

author

other

that

says

arises fi-om bile

there

he adds, is apt
Prui'igo,
as
a
lotion,vinegar with

expulsivefacultyof
praiseshighly the
Our

most

appear

upon the arms.

He recommends,
the

he pronounces
to be incurable.
similar remedies.
They treat

and
together,

scabies

the

of stavesacre,white
compositions
consisting

hellebore,arsenic, nitre,sulphur, sublimed

like.

mercury,

and

the

(Contin.xxx\i.) Antiochus, Herod of Judaea, Phihp II

of Spain, and
other celebrated
said to
are
many
personages,
have died of plithiriasis.
Vu'ey accounts for the disease in the
II est,en eifet,
tel temperament muqueux,
manner
:
following
telle degenerationdes humeurs
dans le plithiriasis
lymphatiques,
la maladie
insectes y trouveut
ou
pediculaire,
une
que ces
extreme
berance
exuqu'ilsse propagent avec
une
pature inepuisable,
le peau, penetrent dans le tissu cellulaire,
sous
et
"

[book

LEUCE.

32

of the

become

and
hellebore until tlie part i^erspire

iv.

colour

same

sinopisor melian earth ;

needles until theybleed,anoint
or,
them
as
formerly
in vinegar; or, ha^ing first rubbed
with sinopis
in
with
rub
much
so
said,anoint Avith the fi-cshjuiceof figs,or

as

body, anoint
them ^ith
ha^^ng perforated

tlie rest of the

with

the leaves of it.

In

Commentary.

CoMM.
^"^""^

fullythe

the

we

the difference

of the leuce, and

natm-e

Section

second

have

for

so

it and

between

that it will be unnecessary

cognate affections,

its

stated

us

now

that leuce is
subject. It is there mentioned
and the baras of all the Arabian
of vitiligo,
Celsus' third species
Avith the exceptionof Stephanus Antiochensis, the
translators,
the term
leprato it. It
translator of Haly Abbas, who
applies
of leprosy. All the medical
therefore the white species
was
authorities represent it as an intractable disease,not only the
cuticle being altered in structure, but also the flesh below, and
All
the hairs, having undergone a change of colour.
even
direct us to prickthe skin Avith a needle,and, if it bleed, the
is to be attempted; but if a slight coloiuiess fluid issiie
cure
to

the

resume

it,the

from

it

as

their

The

from

and

convert

diet is to be

the

hopeless. They

facultyof
nutritive juices
into
nearly the same

the

vaih. a
regulated

strict abstinence

venesection
gross food ; if there be plethora,
drastic pui'gatives
and emetics
then
are
the

parts affected

are

to

be

sider
con-

assimilative

recommend

All

consistence.

proper

treatment.

longer

no

can

as

of
debility

from
arising

part which

the

abandoned

is to be

case

rubbed

with

is to be mised;
prebe
to
given,

stimulant

and

containinghellebore,nitre,sulphm*,misy,
applications,
be applied.
the actual cautery may
arsenic,"c., or even

caustic
red

the

In short, all treat

our

in nearlv the

same

manner

as

(See in particular
Serapionand AA-icenna.)
we
believe,is the first Greek writer who makes
Aristotle,
author.

mention
of the
"

He

of leuce.

body

The

of the

turn

snoAv-white
Greeks.

The

calls it

white.

disease in which

all the hairs

(Hist.Nat. iii,
11.)

leprosy"of

the ancient

Jews

was

the leuce

of
the method
veiy correctly
the alphosand melas ; (LeA-iticus,
c. xiii.)

Moses

it from
distinguishing

in

disease

describes

symptoms of leuce are given in the

the 4tlijof the melas in the 6th.

3d
He

Aerse

of the

calls it

alphos
contagious.

ALPHI.

VI.]

SECT,

33

which

mixed Comm.
might lead us to suspect that elephantiasis
was
with
the
This
Jews.
is
of
the
leprosy
opinion fiu'ther conup
firmed
from what
is mentioned
by Josephusof its heing said
that his countrymen were
driven
out of Egypt because they
affected
with leprosy. (See also Justin, xxxvi,20, and
were
Tacit. Hist, v, 3.) Now
that elephantiasis
know
we
endemial
was
in that country. (See chap,i.) The Englishtranslation of this
failed
chapteris very inaccurate,the translators ha^'ing
evidently
to recognize
the nice distinction between
laid
cognate diseases,
down
by the Jemsh legislator.
is still common
Leuce
in tropical
climates.
fected
Negroes afwith it are
It is merely an
called Albinos.
aggravated
of
the
variety
Lepra vulgaris.
'

"

SECT.

The

formation

VI.

ox

WHITE

AND

BLACK

ALPHI.

alphosis similar to that of leuce,but the

latter producesa deep change of the skin, so that the hairs
affect the skin supergrow of a similar colour,whilst the alj^hi
ficially,
that
when
extend
more
continued,they
except
deeply,
that the hairs grow white,owing to the humour
which causes
so
it. From
the pituitous
humour
then they are prodaced white,
but black fi'om the melancholic.
Wherefore, a common
tion
applicafor both

dracunculus
of

of

is washed

lime

dissolved in water, or, the root of

with vinegar
either species
applied
; in like manner,

the decoction of bitter lupinespoured on

hellebore,

and

their

floiu' when

appliedas

the part,

cataplasmwith Adnegar or
capers with vinegar,the root
vinegarrubbed into the part
a

oxymel,the bark of the root of

of lily
with honey, onions with
in the sun, the dung of the land crocodile,
and in like manner,
that of starlings,
when
they are fed solelyupon rice,and
the bm'ut shells of the cuttle-fish.
The
pound
followingis a comof
of
of
appKcation:
alcyoniura, natron,
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 sulphurvivum,
of the spuma
of each, dr. iv ; rosemary
turate
nitri,
seeds,vij; triwith
vinegar. But rub only the part affected with
alphos,not touchingthe unaffected parts,and when dry,wash
"

II.

"

'

ALPHI.

34

vriih cold

cina,and

with

aud

dry

of the

ij;

with
away
other spots on

chsenix
state.

seeds of

It

of buclupines,
dr.
wliite hellebore,

of

Another

"

of

cucumber,

sponge.
the skin.

iv.

tlie flour of

Of

anoint, and

and

honey

wipe it
and

each, a

of the wild

root

wine

of

it in

bitter vetches, lb.

of the

Another

"

natron,

nib

viij
;

-water.

[book

Of

flour

the

of

rocket, of bitter almonds,

each, lb. j ; triturate with

after

interval

an

also
applies

for

of

hour

an

freckles,
warts,

remedy for white alphos: of sulphurvivum, ii sextarii,of quicklimewhitened, oz. iv ; five whites of eggs, of
nard-oil and vinegar,a small quantity. The
sulphur is first
rate;
pounded, then we add to it the oil of nard, and again trituthe mixture is again
then the vinegar is poured in, and
triturated. But the quicklimeis to be washed
separately,
once,
it
the
with
the
and
then
add
to
and
we
thrice,
sulphur
twice,
A

tried

white

of the eggs

triturate ; and

and

pour out the collected

that the ointment
may
Another
tried remedy :

we

leavinga small quantityso

it thus.
of anointing,we
use
vivum, dried figleaves,aphroniti'um,
alcyonium,
sulphiu'

fluid ; but
admit

Take

"

Cimolian

earth, and

-vinegar.Another of
of fig leaves dried in the
of alum with vinegar,or of figleaves,
ij; of burnt alcyonium, dr. ij; anoint

myrtle, use
equal parts

Avith

"

Archigenes: Rub in
shade, of sulphur,and
dr. iv ; of nitre, dr.
with -vinegar
red arsenic with
in the bath.
But
half of
one
sulphur is excellent for remo^-iug the black alphos; thus
having cleansed the part with natron, anoint -svith it in the
For white
sun.
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,
it is dry, bathe by rubbing. This
rub, and anoint ; but when
appliesalso to the white species.
Commentary.

CoMM.
'

'
"

second

chapterfor
of the

which

thev

of the

genus

as

"We

being mere

are

an

have
account

again to
of these

diff'erencesbetween
allied.

refer the

It -will be

complaints,and
and

them
seen

reader

that

the

to

the

an

position
ex-

afiections

they

are

to

varieties

of Celsus,and that they bear a near

vitiligo
semblance
rewhich
to leuce,from
they are chiefly
distinguished
affections
superficial

of the

skin.

The

Ai'abians

makes

Willan

tlie

under

them

of

treat

Dr.

ALPHI.

VI.]

SECT.

35

of

names

to be varieties of

them

alba

morphea

lepra,in

and

nigra. Comm.

opinion

fullycoincide with him.

is so precise
of the two diseases by Actuarius
The description
The alphi,he
shall give it in lieu of all the others.
that we
in depth, so that
but sometimes
extend
superficial,
says, are
The white species
is tried
colour.
of the same
the hairs appear
to the depth it has spread,by being prickedmoderatelywith
as
has only peneblood flows though the needle
a needle ; when
trated
the skin, the disease is curable, but if the dischargebe
the flesh is converted
into
as
milky it is incurable,inasmuch
we

Others, he adds, rub

the

disease.

and

if it become

the

red

they

have

they abandon
aggravatednature

good
all

colour

same

the

part with

hopes,but

hopes

rough towels,
if it remain

of recovery.

They

of
are

they
parts of
The alphi,he says, are generally
the body and are inveterate.
but when
be cured by gentlermeans,
milder than leuce, and can
The
inveterate
they require similar treatment.
they become
the black alphosis produced
difference between
the white and
humoui*.
by the colour of the prevailing
the auThere
is scarcelyany difl'erence of opinion among
thorities
the generalplan of treatment.
Haly Abbas
respecting
has correctly
remarked, that the alphiare to be cured by the
sort of remedies
as
same
lepra (leuce?) only that they do not
requireso strong applications.The Arabians greatlycommend
Their in"c.
ternal
their myrobalans with ginger,mastich, parsley,
are
powerfuldetergentsand escharotics,such
applications
"c.
as
hellebore, natron, sulphur, vinegar, arsenic,copperas,
of

more

Celsus

says

aff'ectdifl'erent

when

nothing of internal remedies,

but

recommends

ternal
ex-

containingsulphur,
In the
Isagoge'
alum, nitre,frankincense,
cured
be
it is said that all these complaintsare to
by phlegmaand by abstergentapphcationsexternally.
gogues,
of
applications

stimulant

nature,

alcyonium, "c.

Guy
describe

of

Cauliac,and

these

diseases

the other medical

by

nigra. They recommend

alum, natron, arsenic, and

M.

mere

copyistsof

the

the

names

'

authorities of that age,

alba and
of Morphea

containing sulphur,
applications
As usual
the like.
they are the

Arabians.

'

'

which

[book iv.

STIGMATA.

3G

SECT.

VTl.

OP

WORKS

THE

FROM

STIGMATA,

ON

ARCHIGENES.

stigmataby rubbing in that which sticks

rub of
acrid ^"inegar,
or
to a chamber-pot,along with the most
toasted,p. ss ; with water, in
quickhme, p. j ; of red natron
You

the

remove

may

sun

let it be

it ulcerates

when

but

healed

like

ulcer.

an

stigmata,having first scrubbed the part

it with an
of turpentine
Avith nitre (soda),
cover
application
;
the
and
for
six
let
it
remain
on
then ha\ing bound
it,
days,
seventh
perforatethe stigma "oith a needle, and ha-sdngwiped
Crito

But

away

the

for

says,

Avith

blood

some

powdered

it to

remain

sponge,

after

rub

little time

with

Then, having appliedthe medicine, allow

salt.

for five davs.

It

is this

of

frankincense, of

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

will find the blackness
honey, dr. \i\j
; having loosed it,you
the application.Another
ointment : Of pepper, dr. ij;
upon
of rue, dr. iv ; of realgar,
dr. iv j of orpiment,dr. j ; of honey,
the part with
Anoint
scrubbed
with it,have prcAdously
q. s.
natron, of the

"

natron, and

otherwise

done

in like

manner

as

for the

former.

ness,
days,and cleaningaway the blackanoint with it again; for,he says, it removes
the complaint
in twenty days,without
ulceration or cicatrix. Another
called Criticum
Of frankincense,dr. iv ; of nitre,dr. ij; of
:
dr. iij
dr. iv ; of wax,
dr. a-j
copperas,
; of pepper,
; of lime,
dr. iij
dr. iss ; of realgar,
; of thapsia,dr. iij
; of oi*piment,
dr. iij
the former.
Oribasius
as
; of honey, q. s ; use
says,
that crowfoot
the leaves of capers,
or
(ranunculus)if applied,
the marks.
take away
But if they be deep seated upon
only a
small extent
of skin,form an
eschar by a cold cautery, and

Taking

it away

after three

"

thus

Commentary.

CoMM.
'"

"

remove

'

them.

Consult

Aetius

(viii,
12); Actuai'ius (Meth.
Largus (" 231) ; AAdcenna (iv,7, 2, 7) ;
Pseudo-Dioscor.
(Eupor.i, 116.)
Aetius explains
that by stigmataare meant
of injuries
the marks
the face or any part of the body.
on
To eradicate them
he
recommends
compositions containing quicklime, natron,
"c.
arsenic,
Med.

vi,8) ; Scribonius

EXANTHEMATA.

viii.]

SECT,

The

Pseudo-Dioscorides

37

the

recommeuds

juiceof the leaves of capers,

Actuariiis copiesfrom our

or

that of

the
iauunculus_,

Comm.
'

maudragora,"c.

'
"

author.

Scrihonius

Largus mentions a composition

containing
garlic^
"c.
cautharides,
sulphur,chalcitis,
Avicenna

recommends

substances mentioned
Dr.

friction with

by

^yillan defines the

occasioning
no

it will be

stigma,

"

perceived,
applythe

Exanthemata

VIII.

the

other

author.

oui*

small

elevation of the cuticle."

SECT.

and

natron

The
in

term

the

speck on
a

ancient

wider

skin,

ties,
authori-

sense.

EXANTHEMATA.

ON

formed

by thick humoiu's impacted in the

if the cuticle be thick.
In these
skin,and more
especially
if the humours
are
deep-seated,
they must be
cases, then, even
fii'st
purged away ; for unless you do this in the first place,
before attemptingto dispelthem, you will only impact them
the more
instead of evacuatingthem
by the skin. But
firmly,
if the deep-seated
cuate
evaparts be free from crudities,
you may
the humours
by the skin, and not produce revulsion of
them

to

them

by

are

is the case, if you

But the cure
emetics.

which
distance,

the

bellyor

attempt

to evacuate

of humours

fixed

skin,is to be accomplishedby fomentations and calefawhen

the exanthemata
cients,more
happen to be
especially
in the

broad, for these

are

Wherefore, take of

the

formed
tender

bv

cold

leaves of

and

bay, of

thick
manna,

humour.
and

of

and dissoMng frankincense

equalparts,triturate together,
in honey, anoint with it ; or, having boiled and pounded tender
beet, apply as a cataplasm; or, take of wax, dr. viij
; of
dr. vj; triturate them
dry,
sulphm*the same
quantity
; of salt,
and havingpoured on
boil all tothem
gether,
half a cyathusof oil,
But one
must
tentively
atand use
the plaster
that is formed.
It is a very
sit by while the boilingis going on.
rue

excellent medicine.

Commentary.

(Meth. Med.
Morb.

Curat,

; Galen
Hippocrates(Epidem.et alibi)
v) ; Alexander (i,5) ; Oribasius (Synops.vii,7) ;
31) ; Aetius (v,129) ; Actuarius (Meth.Med.
(iii,

Sec

Cumm.

'
"

i,23); Celsus (v,28) ; Pseudo-Dioscor.

17; Pract. iv,8).
Haly Abbas (Theor.viii,

ii^11

CoMM.
'

[book iv.

EXANTHEMATA.

38

i,106
(Euporist.

thema
place,the Greeks used the term exanin
it
is
than
in a much
laxer signification
applied Dr.
Diseases.'
"Willan's 'System of Cutaneous
Hippocratesin particular
be mentioned
as
applyingit to various classes of
may

As

these
head

stated in another

affections.
as

the

describes

Alexander

which
ulcerations,
superficial

are

exanthemata

red and

of the

rough.

Does

of them
for the cure
porrigo? He recommends
a
compositionof litharge,
ceruse, alum, the green leaves of rue,
vinegar,and myrtleoil.
to
is a term
Galen
appliedby some
says that exanthemata
all ulcerative and rough afl:ectionsof the skin,which, according
In
to Archigenes,stand in need of desiccative applications.
another
as
a
common
place he mentions the exanthemata
givesfrom
symptom of the plague. Aetius in like manner
of fevers which
Herodotus
account
are
an
panied
accominteresting
have
to
been
with exanthemata.
Both
supposed allude
pretation
to the smallpox,but we
agree with Dr. Willan, that this interfanciful.
of their descriptions
is altogether
Our author follows Oribasius closely.
Accordingto Actuarius exanthemata, properlyspeaking,are
producedby 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 genericterm
Nam
Earum
pustulse. His words are :
plura genera sunt.
modo circa totum
similis
qusedam fit,
corpus partemve asperitudo
lis pustulis,
vel ex sudore nascuntur
: i^avOi]
quae ex urtica,
/xara
Grseci vocant.
Eseque modo rubent, modo colorem cutis non
excedunt."
For pustulesof all kinds he recommends
exercise,
restricted diet,and abstinence
from all thingsof an
acrid and
attenuant
nature, which regimenis likewise to be enforced upon
the nm-se,
if the child be at the breast.
If the patientbe

he allude to

"

strong,he is also
natron
not

be

and

to be

mixture

succeed lentils are

large;

and

of

wine

to be

after the outer

to be treated with
cure

put into the hot bath, and rubbed

recommended

the
respecting

and

oil.

If this treatment

the

diet

skin

has been

great Roman

are

does

if the pustules
applied,especially

gentle applications.Such

by

with

removed
is the

they are
plan of

authority. His
particularly
important,and

tions
direc-

appear

maideu-hair

with

honey. They

saltish things,
also

^~^

'

avoid all

must

iv.

acrid,acid,and

fomentations,baths, and insolation.

(v,28) ; Aetius (xiv,61); Oribasius

INIed. ii,11 j vi,8) ;
54) ; Actuarius (]Meth.
(Morb. Curat, iii,
Pollux
(Onomasticon iv,24) ; Avicenna (iv,3, 1, 13) ; Serapion (v, 8) ; Haly Abbas (Theor.viii,17) ; Pract. (iv,8) ;
Commentary.

CoMM.

[book

EPINYCTIDES.

40

Rhases

i, 122.)
(Divis.

Celsus

livid

or

inflamed,and

derives its

red, about

coming
Persons

name.

speciesof pustule,
the size of a bean, very painful
at night,Avhence it
principally

epinyctisas

describes the

somewhat
and

Celsus

on

of

bad

all ages,

even

infants

at

the

breast,are subjectto it, and in treatingthem he directs the

In laying
attended to.
to be properly
regimen of the nurse
the
he puts particular
stress upon
down the rules of treatment
hot bath.

Aetius, Oribasius,and Actuarius

Pollux

defines

humid

and

it to

be

vesicle of

treat
a

bloody,and forming about

of it

as

author.

our

palishcolour,somewhat
the legsand feet in the

night.
under the
epinyctis,
Thus Serapiourecommends
of Sare, Serie,and Essere.
names
bleedingif requiredby the generalsymptoms, purging with
containing
myrobalansand pinines ; and external applications,
it
of
who
describes
"c.
one
as
sumach, savin,
Haly Abbas,
The

his

and

Arabians

serie,approves
Rhases

similar account

givea

in hke

the

of much

same

of

treatment.

Aricenna

bleeding,gentlepurgatives,
Khases, in his
tepidbath.

recommend

manner

coohng lotions,and the

Continens,'appliesthe directions given in this chapterby
of the cutaneous
Paulus to the treatment
disease,which he
This establishes their identity(xxxAd,
calls sera.
6.) As
'

stated in the

is also the
the epinyctis
precedingchapter,

"

benat

Aurelius
Marcus
fiha noctis" of the Arabians.
noctis,"i. e.
the
between
is mistaken
in distinguishing
Severinus,therefore,
"

admits their identity.

Ingrassius
of this affection :
Fracastorius gives the followingaccount
sit cholera, pustulam illam facit,
Si inflammata
et accensa
nascatur,
vocatur,
quod stepissimenoctu
quse iirivvKTig
Essere
Arabes
appellant. (Dc Morb. Cont. ii, 15.) Both
Lorry and llayerconfess themselves unable to determine what
and
epinyctis

the benat

uoctis.

**

^^

SECT.

PHLYCT^N/E.

X.]

of the ancieuts
epinyctis
been some
speciesof
peculiar

the

have

been

Avhich certain modern

It would

was.

eczema,

formidable

more

41

appear

extinct.

uow

disease

than

authorities have taken

the

have

to

Comm.
"

It must

'
'

nettle-rash,
epinyctis

for the

of the ancients.

SECT.

X.

PHLYCT^NiE

ON

OR

BULL^,

attended with
are
thqy burst spontaneously
acute pain,it is proper
to perforate
at their under
part with
a
sharp needle,and then to squeeze out the humour
gently,
remain.
And
skin
which
if the
t
he
it
to
covers
suffering
Bullae when

As

wound

should

close up and
againin like manner,
skin is to

the bullge fillup, it is to be evacuated

and pressedout ; and the bent
incum-

kept presseddown until the ulcer below be

healed.
Before the bullae break, applyboiled lentilstritiu-ated
with water ; or, the shoots of pomegranate, having been warmed
hot coals,are
the parts.
to be applied,
to burn
as
so
upon
But if they burst and
form an
ulcer,having melted axunge,
and mixed levigated
litharge,
put into a linen cloth,and apply;
of lilyin water, triturate it with
or, having boiled the root
cerate, and apply.
For epinyctis
andplilyctana.Having triturated equalportions
of litharge
and sulphurvivum
with vinegarand myrtle-oil,
until
it become
of the thickness of the sordes of baths,rub with oil
and w ine.
For hot eruptions,
warm
achores,incipient
papidte,
furunculus,and burns, the compositionof plumbago, and that
from eggs is applicable.
be

Commentary.

(xiv,63) ; Oribasius (Morb. Comj

Cm-at. iii,
3, 1 11 .)
23); Actuarius (Meth.Med. y\,8); Avicenna (iii,
See

Aetius

'

This

and
appears to be the pompholyx of Drs. Willan
that
the
Bateman.
Aetius remarks,
disease principally
attacks
women
seems

whose

menses

are

obstructed.

to affect onlywomen.")

He

recommends

and diuretics,
and forbids
laxatives,
Our

(Bateman

all acrid

Celsus

"

it

emmenagogues,

things.

author

recommends

says,

copiesthe whole from Oribasius.

nearlythe same
appHcations.
describes the phlycta^ntc
of
as
a variety

Actuarius

the

pustulse.

BURNS.

42

Tliere is

CoMM.
'

'
*

in
nothing particular

[book iv.
recommended

the treatment

by

Avicenna.
the
and ulcers among
Thucydidesmentions small plilyctsense
(De Bello Pelopon.ii.)
symptoms of the plague of Athens.
of pemphyx to the cutaneous
Hippocratesgivesthe name
eruption_,
(Epidem.
by which the plagueof Athens was distinguished.
(v, 453, ed. Basil.) Procopius
vi.) See Galen's Comment,
the symptoms of
also takes notice of black phlyctsense
among
the great plaguewhich ragedin the reignof Justinian
ii.)
(Pers.
Some
also Diodorus
Siculus
See
xiv.)
(Biblioth.
suppose,
Prselect.
See
that
meant
were
however,
by phlyctcense
petechie.
Marc.

301/

p.

XI.

SECT.

0\

BURNS.

which
parts requireapplications

Burnt

without

tergent,
moderatelydefore,
coohng. "Wherelight earth, when

are

being decidedlyheating or

Chian, Cimolian, Cretan, and every

with water,
in with vinegarnot very acrid,or mixed
rubbed
excellent applications,
and
are
prevent blisters from forming;
also a whole raw
soft wool, for
egg immediatelyappliedupon
it cools
anoint

moderately,and
the

in water,

di-ieswithout

black

part with

ink, or

And

being stimulant.
frankincense

with

dissolved

For
of tares.
or
lentils,
burning with hot water, before blisters arise,pour frequently
the pai'tthe brine of pickledolives,
selves
on
or
applyolives themor

use

triturated

vinegar,and
with
of

much

rub
water

or
pickles,

or
hyacinths,

cataplasmof

with

polenta;or,

it in

; or, anoint

; or, pour

brine

on

the

triturate

with

narcissi with

bull's

bulbous

with

stone-alum

gall dissolved

part strained leywith

or, triturate the

consistence of the sordes

Marcellus

boiled

roots

of

sauce

lihes,

and having made

it of
rose-oil,
of oil in baths,anoint vriih it.

the
But

:
givesthe followingcomposition
haAing smeared
a
wrapped it around
barley,burn it,
rag with honey, and
and mix of the ashes,dr. viij
; of ceruse, dr. iv ; of butter,dr.
dr. xvj; of goat's
dr. xyj.
fat,dr. xvj; of rose-oil,
viij
; of wax,
For burnt
having triturated sumach
parts already blistered,
and polentawith vinegar,apply it ; or, mix
quickhme Avith
the medicine called
cerate,put it on a rag, and apply. And

SECT.

BURNS.

XI.]

Sphseriais applicablein

such

be covered

with

ulcerated,may

purslainwith
a

rag

polenta,and

linen, burn

of

43

cases.

The

parts which

pounded leeks;
apply; or, put pigeon'sdung

it,and

mix

are

or, triturate

the

ashes

with

oil,and

into
use

also the bark of pine and of

application:)
the burnt leaves
dried maiden-hair
or
levigated,
or
spruce fir,
the part.
of mjTtle,are
to be tritiu-ated and sprinkledupon
of these things answers
Each
appliedwith cerate.
well,when
is formed
But a good application
togetherof the
by triturating

(thisis

dried

an

roots

excellent

of the red alkanet, oz.

also
oz.
rose-oil,
xviij
; and
quantityof stag'smarrow.

that

iv ; of white

made

wax,

of ceruse,

ix ; of

oz.

with

small

Hippocrates (de Ulceribus.) Celsus Comm

"^^~"
(de Simi^l.Med. et alibi.) Aetius (xiv,64) ;
(v,27) ; Galen
Pseudo-Dioscor.
(Euporist.i, 178) ; Actuarius (Meth. Med.
(iv,4,
vi,6, 8); Nonnus
(240); Serapion (v, 11); A^icenna
2, 8) ;
4, 25) ; Alsahara^ius (xxix,
3, 12); Haly Abbas (Pract.
Rhases
(Antid.i, 27) ; (ad Mansor. xii, 18) ; (Div.i, 136.)
author of the Hippocratictreatise referred to above, reThe
commends
old aximge
various
to burns, such
as
applications
rubbed into the part, and the root of squills
appliedabove ; or
of old axunge,
mixture
rosin,and bitumen, spread upon a
a
Commentary.

See

heated at the fire ; or the roots of the ilex boiled in

rag and
white wine
at a gentlefire until it be of the consistence of a
liniment.

Cimolian
Dioscorides,Avicenna, and Galen, agree in praising
Galen says that copburns.
to recent
application
peras,
forms
dissolved
in
when
excellent
an
vinegar,
especially
for
the
ulcers
occasioned
by burning.
application
the
Aetius treats burns upon
as
our
same
principles
nearly
When
author.
blisters rise he forbids an earlyopening to be
he recommends
in them.
As
to them
made
an
application
earth

as

alum

with

an

water

and

the white

of

an

of his apSome
plications
egg.
for the foul ulcers left

only be supposed proper

and litharge,
of verdigris
by burning. Such is that consisting
mends
pounded with wine and oil. For healing ulcers he recomtoasted
a composition
barley
containingceruse, litharge,
pounded, wax, and rose or myrtle oil.
can

BURNS.

44

'
*

iv.

Euporista^Cimolian earth,lithargeand oil, and

other applications
recommended.
are
many
Actuarius
recommends
a
composition of litharge,
cernse,
other articles of less importance.
turpentine,and some
wax,
the oil of turpentine
how
has
mention
much
need scarcely
We
He praises
such things as are
been used of late in such cases.
moderatelyastringent,such as alum dissolved in vinegar,"c.
mediocritcr
Celsus recommends
at first such thingsas are,
and aftenvards articles of a soothing
exedentia reprimentiaque,"
class belong the farina of lentils and
To the former
nature.
honey ; myrrh with urine,or the Cimolian chalk, with the bark
of frankincense ; and to the latter belong all fatty
applications,
and such thingsas contain the dross of lead and the yelksof
He also mentions
to
turpentinerosin,as an application
eggs.
foul ulcers from burning.
which
applications
Serapion,like our author, recommends
frigerant.
are
moderatelydetergent,and neither very calefacient nor reHe
gives the following directions for making a
In

CoMM.
'

[book

the

'

"

preparationfrom
and

water

sweet

let the

wax

be

lime.

This

of

Take

lime.

dried,oz. viij
; of wax,
melted

is to be

along with

oil,and

the

part.

for preparing a
prescription
similar to that which is nowused
exactly
for the

rules

his

usual

in

oil of roses,
well
He

with

givesa
and

of bui'us.

cases

oz.vj:

mixed
also

in

oil,

(vii,28.)

lays down

accuracy,
of

treatment

washed

of lime-water

mixture

Avicenna, with

ij;of

oz.

the

into

rubbed

times

lime, seven

burns.

very particular
prevent blisters from

To

when

the

casioned
burning is ocby hot water, he directs us to apply sandals,roseis
water, and camphor : or a cloth dipped in congealedwater
to be kei)t
constantlyapplied,and it will prevent blisters fi'oni
recommended
rising. Most of the applications
by our author
also mentioned
are
by him.
Haly Abbas directs us to apply

recommends

risinghe

coolingthings;

cloth cooled in rose-water.

of lime
not

and

severe,

Alsaharavius

there
to

is

barleyor
a

sensation

directs

of

us

salt,and

of oats.

applycloths dipped in

speaks of
When

the

the

ointment

biu'uingis

in the first placeto wash

then

Then

burning

also

above.

mentioned
rose-oil,

part with vinegarand

flour of

He

to

sprinkleupon

if blisters do

in the

not

or

it the

rise,but

part, he recommends

cold water, rose-water,

the

us

snow-water,

SCOURGES.

XII.]

SECT.

which

45

emolchanged frequently.Afterwards some

such as the white of an egg', with gum
arahic
applications,
be used.
the burning is more
When
he
mends
recomsevere,
bleed
and
to
such as the
us
a
use
cooling application,
of a sheep,the white of an egg mixed with rose-oil,
or
an
to

are

lient
is to

brain

ointment

be

made

mention

of the

of white

He

rose-oil.

and

wax

from lime.
application

Rhases

also

Comm.
'

'
'

makes

recommends

an

ointment

containing
ceruse, camphor,opium,"c. Like Avicenna,
he directs us to applyat firsta cloth wetted in cold water, or in
If the burning
rose-water, which has been cooled with snow.
be extensive he recommends
venesection,with a coolingand
diet. When
the pain is great he directs us to apply
attenuant
the yelksof eggs mixed with rose-oil.
When
a
largeulcer is
formed, he directs
above.

to dress it with

us

He

also approves

the ointment
of

scribed
lime, dewhite ointment, consisting
of

of ceruse, oil of roses, and wax.

In liis ' Continens,'
he relates a case
of severe
niments
burning,which he treated with li-

composed
wetted

in snow-water

of

sandals,camphor, and

roses;

to
being appliedexternally

opening the blisters. To

it.

He

cloth
proves
ap-

from

forming,
of galls.Like
an
astringentcollyrium
strongly

lie recommends

of the other

many

of

prevent them

Cimolian

he recommends
authorities,

earth

The
recommended
by Haly Abbas
applications
very much.
of a refrigerant
and coolingnature, such
Armenian
are
as
earth in
The

tlie white
\dnegar,

earlier modern

of

an

authors treat burns upon the

the Arabians. Thus
especially

more
by the ancients,

in cases
of extensive
liac,recommends
us
to A^euesection,
alongwith a coolingand
As

"c.

egg, ceruse,

plan laid down

Guy, of Caucourse
burning to have reattenuant

regimen.

local

he recommends
cloth wetted in rose-oil
a
application,
congealedin snow, and afterwards coolingointments containing
and the like. He approves
of openingthe blisters,
ceruse, litharge,
of afterwards dressing
the part with desiccative remedies,
such as the ointmentof lime,seven
times slaked. (Tr.vi,Doct.C.6.)
a

SECT.

Take
use

as

of
a

Xrr.

ceruse

FOR

and

with
plaster

THOSE

BEATEN

WITH

SCOURGES.

equal parts,of
litharge
the oleum

susinum, or

four parts,
rose-oil ; but on
wax

HAIRS.

46

tlie first day

the susinum

use

[book iv.

j ; unite with them

have
For those who

tragacanth,dr.

of

shell,and
of

use.

all remedies
and

the

cures

whole

been

j;

egg, without the

scourged,the skin

appliedwhile yet
this purpose
soonest, effecting

sheep newly taken

of saffron,dr.

separately
; or,

off,when

Avarm,

in

of

day

night.

'

See

Commentary.

CoMM.
"

(xiv,
62);

Avicenna

(Pract.iv,26) ; Alsaharavius

Abbas

Haly

Aetius

4, 2, 7) ;
(iv,

(Pract.xxxi,2, 1) ;

(Contin.xxviii.)
is said to be
givessimilar directions. The following
of a whip : mix washed
for the stripes
excellent application

Rhases

Aetius
an

lime

with

raw

eggs, and

add

some

Aetius,Galen,

cerate.

rose

Nonnus, Avicenna, Rhases, Haly Abbas,

and

Alsaharavius

join
newly-killed

recommending the fresh skin of a

in such cases.
Alsaharavius
mends
recomsheep as an application
and ceruse,
ointment
an
containingwhite wax, rose-oil,
when
the wounds
there is any apprehension
are
deep ; when
and more
of heat and inflammation,
if the patientbe
especially
he approves
of venesection.
When
the other
on
plethoric,
hand
the patientis weak, and is in danger of falling
into a
author

our

state

in

of syncope,

recommends

he

When

there

is much

and

musk

wine
of

appearance
after the heat

to be

ecchymosishe

the part
is gone.
speaks of scarifying
recommends
a
compositionof ceruse, litharge,
wax,
oil,as a generalapplication.
Most

of the

earlier medical

XIII.

TO

and

authors

the ancients in this

SECT.

oil.

pot

MAKE

HAIRS

GROW

of

of

marjoram,dr. j ;

cerate,and

likewise follow

times

use

; or, of

ON

PART

THAT

HAS

BURNT.

grow on a burnt part if you

with cerate, in the form of a

viij
;

rose-

contain
by Bertapalia
(De Ulceribus,16.) The

of modern

Hairs

dr.

and

case.

BEEN

Rhases

recommended
applications

litharge,
ceruse, tutty,wax,
other

nistered.
admi-

applyfigleaves boiled in
fig,
plaster
; or, of dried
oil to the thickness

triturate with
gypsum,

dr.

of squama

seris.

Avicenna

CoMM.
'

[book iv.

MYRMECIA.

48

(iv,4, 2, 9) ; Haly

Abbas

Rliases

(Pract.iv,10) ;

'

'

(ad Mansor.
Our

vi,18,)

from Oribasius.
copiesclosely
for intertrigo
casioned
ocrecommends
a
as
good application
liver of a pig or
by the friction of shoes,the warm

author

Aetius

Here

wool.

lamb, or unwashed

Dioscorides

he follows

37.)
(ii,

ing
containcoolingapplications,
the dross of lead,"c.
ceruse, litharge,
ointment
an
Scribonius Largus recommends
containing
the flour of frankincense,
alum, axunge, old
litharge,
ceruse,
He

also makes

wine,

austere

Arabians
with

agrees

and

roses,

for intertrigo.
litharge
these cases
similarly.Thus Avicenna
ment
recommending the liver,and the oint-

treat

Aetius

in

containingceruse,
such
astringents;
To
any

and

by riding,or
to applya cloth dipped in
After
with ice.
perhaps,

irritation occasioned

directs

Rhases

cause,

bruised parts he recommends

For

"c.

acacia,"c.
galls,

as

relieve the heat

such

oil.

sour

also recommends

Marcellus
The

of several

mention

us

properlycooled,he means,
of ceruse,
the heat and pain have been removed, an ointment
is to be applied. Blisters producedby walking are
or
litharge
with rose-water
to be opened and then washed
; and afterwards
ing
containthey are to be dressed with an astringent
application,
rose-water

the like.
or
bole, galls,
pomegranate flowers,

Armenian

SECT.

Each

XV.

FOR

of these

nature, and for the

a

broad

base,and

bites of ants.

is

MYRMECIA

small

most

when

But

the

ACROCHORDOX.

AND

the

risingof

skin, of

callous

part cii'cular ; but the mp^mecia haw

rubbed, convey
acrochordon

has

sensation

a
a

narrow

like

base

so

the
as

hang, resemblingthe extremityof a cord. "Wherelings

these swelremoves
fore,elaterium with salts,when applied,
frankincense with vinegar,
with vinegar,
; and
green figs
flour and natron, the juiceof the fig rubbed
in, and in like
that of the spurge, the pickledhead of picarel
bui'nt,
manner,
burnt
with sulphur %'i^-um,
the leaves of basil with
verdigris
to

seem

copperas

to

; that

which

flows from

green

vine

shoots

when

a
sheep'sdung with vinegar,
buck-goat's
gallwhen

ing,
burnrubbed

MYRMECIA.

XV.]

SECT.

in,the fruit
rue

with

not

come

of the

49

when
largesun-flower,

and

with the urine of

pepper, natron
the dung of an
to puberty,

natron

Commentary.

appliedwith wine,

ox

of the herd

in

youth

vinegar.

See Celsus

(v,28) ; Galen (Meth.Med. xiv);

Curat, iii,55) ; Actuarius
(]\Iorb.
(Onomast. iv); Ancenna
(iv,3, 1,
seq. ; ad Mausor.
\\\, 15, 16.)

Aetius

(xiv,4) ; Oribasius
(Meth.JNIed. \i,8) ; Pollux
6); Khases (Divisi,131, et
Celsus defines these tumours

in the

terms
:
following
AVpoGrseci
ubi
sub
cute
coit
et invocant,
dui'ius,
^opSoj^a
ahquid
terdum paulo asperius,
colons ejusdem : infra tenue, ad cutem
latius : idque modicum
fabse magnitudinem exceest quiararo

dunt.

Vix

plura,maximeque
nunt

in

to
Bvfiiov

pueris;

tempore nascitur

nonnunquam
inflammationem

convertuntur."

be about the

size of

He

then

excitant ; sub

describes

Egyptian bean, and

an

sed fere

subito desi-

eaque

mediocrem

nonnunquam
etiam in pus
;

qua

eodem

tantum

unum

"

the

of the

."olourof

miliora

huautem
Aocantur
thyme. He adds: "Myp^jjj/cm
altius exignnt,
: quae radices
thymio durioraque
majo-

remque

dolorem

movent

infra

lata,supra

sanguinismittunt; magnitudine \hi

exceduut.

Nascuntur

partibuspedum."
no

roots, and

the

does not

myrmecia.
of alum

Galen
tumours

For

quoque

aut in

it he recommends

an

ing
consistapplication

and red arsenic.

describes
;

unquam

tenuia ; minus
lupinimodum

palmisaut in inferioribus
he says, if cut out, leaves
acrochordon,
with
grow again. This is not the case

ea

The

autem

minutelythe method of extractingthese

belongsmore
properlyto the surgical
part

but that

of this work.

elateApphcationscontainingarsenic,chalcitis,
quicklime,
mentioned
rium, sulphur,and alum
are
by Oribasius and
Aetius.

See in like

the

manner

'

Euporista^of

the

Pseudo-

Dioscorides.
The

myrmecia

is

rendered
generally

translators of the Greek

aris
the

by

medical

those of the Arabians.

myrmecia

with

tin
formicariaby the Lamiliauthors,said /or77iica

A\icenna

seems

to

the

confound

herpes.
to be an
excrescence
thymus,or thymiura,
about the pudenda, anus, fingers,
red colour,
of
a
or
face,
The acrochordonrough,bloody,and not difficultto remove.
Pollux defines the

II.

-i

Cos
OMM.

he says, is white

CoMM.
'

"

tremity.

"

[book

GANGLION.

50

of

The

author

it gets enlargedat the excence

he defines to be a hard,rough excres-

at the root, and

myrmecia

bloody at its extremity.

modem
thus described by an intelligent
dm-ior et asperior,
subcutanea
callosa,

callous natiu-e,but
is

acrochordon

The

iv.

"

Est

verruca

in basi tenuis,summit atis

atque plerumque teres,ciite concolor,

maxime
excedens,juniores
infestans." (Mangeti Bibl. Chiiurg.i, 72.) The terms, thymus,
fallen into disuse.
mynnecia, and acrochordon,have now
fabse magnitudinem raro
latioris,

vero

SECT.

Ganglion is
from

round

GANGLION.

ON

of

tumour

pressui'e,in many
which
in those pai'ts
are

blow

of the

or

uses

and

hands

feet.

In

(tendon?)arising
the body, but particularly

nerve

parts of
moved, such
this case,

as

says

ties
the extremi-

Archigenes,

the grease of geese and turpentine.

But
from
the medicine
agate stone, and Oribasius the

applyquicklime
Poles

XVI.

with

pine rosin,of old oil,of each, oz. j ;

of each,oz. j ; of wax, oz.
of ammoniac
perfume,of galbaniim,
iv ; or, he says, apply a thick plateof lead,like the vertebrae,
and bind it on ; for by its weight
and largerthan the ganglion,
:
following

of ceiuse,

of

this dissolves it in process of time.

'

'

and

i^

we

have used.

Hippocrates(De Ariic. xxvi); Galen

6) ; Oribasius (De
(Comment., de Med. Simpl.ix); Celus (vii,
Yirt. simpl.ii,in voce
Plumbum) ; Aetius (xv,9) ; Actuarius
]\Ied. ii,
3,2, 6) ; Albucasis (Chirurg.
(Metli.
11); A^icenna (iv,
ii,50) j Rhases (ad Mansor. \\i,15 : Contin. xxviii.)
Hippocratespointsout the danger of openingthese tumoui's
Galen remai'ks,
of a "viscid
as
indiscriminately.
They consist,
Commentary.

CoMM.

This

See

Oribasius agree with our author

in dii-ecting
a
pieceof lead to be bound upon the ganglion.
mucous

Nearly the
who
after
much

thumb

directs

fluid.

plan of

same
us

Galen

to

bind

and

treatment

is recommended

pieceof lead

upon

by Aetius,

the tumour,

and

ganglionwill be found
the
softened ; it is then to be squeezed firmlybetween
solved.
disand the fingers,
be speedily
it "\rill
by which means
Albucasis approves of extirpating
the tumour, unless it

some

days to

remove

it,when

the

PHLEGMON.

XVII.]

SECT.

be seated

51

joint. Rhases as usual collects the opinions Comm.

of all precedingauthorities. Antyllus^he says^ directed the
the sack, or to bind a heavy plateover
to break
it,or
surgeon
is
it
to extract
an
by the knife. When
operation attempted,
near

"

''

he recommends

that the surgeon

the whole

He

dissolved

sac.

by

relates

that he has

sure

in which

case

the

removed

swellingwas

application
containingmustard.

an

SECT.

In

be

XVII.

PHELGMON.

ON

call all those

swellings
phlegmons which are
and accompanied with heat ; some
red and painful,
of
diversity
their nature
which
occasions them.
arisingfrom the cause
For when
and
of moderate
dantly
consistence rushes abungood blood
to a part and
from its quantitybecomes
seated in it,
the disease is that Avhich is properlycalled phlegmon ; but
when
yellow bile is seated in a part, it is called herpes;
and when
blood and
yellowbile togetherare collected in a
is formed ; but when
in this case
the blood is
part, erysipelas
hot and
thick,it usuallygivesrise to carbuncle.
^'NHierefore,
shall begin Avith what
is properlycalled phlegmon, which
we
in many
which is red, painful,
occurs
cases, being a swelling
and hot, deriving
its origin,
I said,from good blood
elastic,
as
collected from the whole
which is sometimes
times
body, and someformed
is
that it cannot
so
abundantlyin the part itself,
general,we

be contained
of vapour
supervenes
causes.

obvious

in the

into

the

but
vessels,

escapes

from

And

surroundingcavities.

wounds,
upon
Wlien
therefore a

them

this affection

fractures,ulcers,and
part becomes

precedingit,the

in the form

inflamed

other
many
without
any

whole

body sendinga defluxion

the general system by venesecto the part,we
must
evacuate
tion,
and applyto the part embrocations
and cataplasms,
not
such as are of a heating and moisteningnature, but such
as
calculated
the
is
to
w
hich
the
are
fluid,
repel
flowingto
part,
and evacuate
that which
is alreadycontained
in it. Apply,
cause

a
therefore,
cataplasm

pomegranate

tree

when

the

to be

used; but

pain is

of

boiled
not

when

house-leek,and
in

wine, with

violent,this
there

is

or

of the

sumach

such

like

defluxion

to

bark
and

of the

polenta:

are
applications

the

part with

'

[book iv.

PHLEGMON.

52

greater pain,then
must

not

be

cataplasmsof

hot water

applied(forall these

are

and

oil,or of

lenta,
po-

inimical to such

defluxions)
pain is to be allayedby
; but the vehemence
and a little wax,
is composed from musk, rose-oil,
that which
with unwashed
wool containingmuch
grease : these thingsare
ter,
but tepidif in wincold in summer,
to be preparedand applied
that the parts above the affected placesbe covered with
so
in austere wine
soaked
cold oxycrate. But we
or
a
sponge
such herbs as are
add
must
to the cataplasms
proper for the
is applicaof the wall,therefore,
ble
required. Pellitory
purpose
the
and
while
the
to every phlegmon at
on
commencement,
increase ; and in like manner,
horned
poppy, orach, mallows,
and gourd,when
lettuce,
appliedon hot parts. Both kinds of
and
to inflammatory
defluxions,
are
caltrops
applicable
(tribuli)
the cabbage to such as are hard.
AThen
a
change is thereby
and
no
effected,
accomplish
pus falls into the part,you may
of
the care
of
the
from
or
chalcitis, some
by means
plaster
those plasters
of a similar natui'e,which
applyto defluxions ;
but clean wool soaked in austere
wine is to be put externally
to the medicine.
In this manner
cure
phlegmons
you may
from defluxion.
But such as are occasioned by any external
will not be injm*edby moisteningand heating applicacause
tions,
with advantage.
and if necessity
them
require,you may scarify
But
in phlegmons arising
scarification,
from defluxion,
become
the
more
at the
especially
commencement,
may
of much
mischief to the patient,
cause
of the

CoMM.
^^'"^

Commentary.

(ad Glauc. ii); de Different.

Morb. (12); Meth.
Med.
(xiii,
10); Oribasius
2); Celsus (iii,
(Morb. Curat, iii.41) ; Aetius (xiv.
4) ; Actuarius
31); Leo (vii,
pieth. ]Med. ii,12) ; Avicenna
(iv,3, 1, 2) ; Serapion(v,22) ;
Abbas
Pract.
9
Haly
(Theor. viii, ;
iii,27) ; Alsahara^'ius
xxix,2) ; Ehases (Divis.126, and Contin. xx\-ii.)
(Pract.
Galen explainsthat the term phlec/moneis used either to
inflammations in general,
and painor
a red,i*esisting,
signify
ful
in particular.
It is here used in the latter acceptatumour
tion.
and
He says, when
defluxion of blood of good quality
a
its
consistence
of moderate
takes place to a part, and from
quantitybecomes fixed in it,the person is seized with a violent
pain,unless the part be very insensible ; it is also accompanied
See

Galen

SECT.

XVII.]

with

there
if it

deep-seated
throbbing;
is

burnt

were

who

and

stretched and

seems

been

other

This

means.

it,such

of

causes

being cast
superfluity
time.

Such

to be

is

or

weaker,

off upon
part, from

as
as

at

he says, gets the

affection,

inflammation.

He

merates
enu-

braises,fractures,and

part fitted

some

lax, or

more

or

inactive than

more

it down

as

; Comm.

locations
dis-

these,he adds,it may arise from

distended with humours, and the

without

even

the veins being; immoderately

the

part feels

cooling
; there is a florid redness
in the bath, or have been warmed

of phlegmone,or
genericappellation
many
; but

that the

heat^ so

broken

desires

have

and by
fire,

53

it

sensation of increased

in those
the

PHLEGMON.

the other

to

cause

receive

at

other, happens

or

calculated

more

them

to

parts of the body.

attract,
He

lays

of such affections
that the cure
generalprinciple,
is to be accomplished
Reason
and expeby evacuation.
rience,
he adds, teach us that the general system is to be
evacuated
brocations
by the suitable means, and the inflamed part by emand cataplasms
of a repellent
nature, and such as
as

calculated to

are

give tone

and

of
general principles

treatment.

need

not

in fact

from

him.

this

Celsus

gWen

an

are

his

remedies
we
particular
borrowed
author's are entirely
His

eveiythingwhich

him

they

advance

subject.
does

not

excellent

treat

of

account

of inflammation

inflammationis
dolore.^'

sunt

Isidorus

Phlegmone

quietudo

our

Such

it.

Oribasius,Aetius, Actuarius,and Nonnus, in like

definition

"

as

borroAv from

manner,

upon

mention,

strengthto

vastitate :

quse

of
is

in

"

calore et
quatuor, rubor, et tumor, cum
not
:
so
successfully
attempts the same

est fervor

cum

but he has
particular,
in general. His
inflammation
Notpe
:
appropriate
singularly

phlegmon

cum

extensione

et dolore ;

sive est in-

rubore, et dolore,et extensione, et duritie,et

fieri,
inquietudoet febris inseceeperit
quum

quitur."
of the
comprehensiveexposition
He
information.
doctrines of the Greeks, but supplies
no
new
is at painsto explainthat the term
generally
phlegmon applies
to every inflamed
lar.
part ; and also to a hot aposteme in particuit
He joinsGalen
in recommending a free incision when

Avicenna

is

givesa

clear and

in which
apprehended that the member
corrupted. Serapion'streatment

come
it is seated will beis nowise

dissimilar.

ABSCESSES.

54

CoMM.
'

'
*

[book

phlegmon, says Haly Abbas, is

either from an external cause,
arising
a

wound,

the

or

from

like,or

sanguineouscollection,

such

internal

an

iv.

as

bruise,a blow,

namely,

cause,

de-

fluxion upon the part. He attributes the collection which takes

placein a part to its debihtv, which makes it unable to cast off"
it. AYhen
seated in a vascular
upon
part, phlegmon, he says, is attended with a throbbingpain.
Alsaharavius
He
treats
of fi'ee and bold incisions.
approves

the load which

of

phlegmon

his views.

is thrown

at great

length,but

recommends

Rhases

there
at

is

in
nothing original
first bleeding,
purging,and

of a cooling and
But when
astringentnature.
applications
he properlyforbids depletion,
lest
has commenced
suppuration
He remarks
it only protractthis process.
that phlegmons are
often occasioned by disorder of the stomach,and the use of too
much
food and drink.
He recommends
in generalmaturative
to which, if necessary, narcotics
applications,

SECT.

If it appear
bread in water

XVIII.

ON

EXTERNAL

may

be added.

ABSCESSES.

boil
impossibleto prevent suppiu'ation,
and oil,and applyit as a catasplasm; or apply
barleyflour preparedin Hke manner
; and bathe the part with
infusion of marshmallows.
But
the
an
when
swellingis
either to convert
into pus or to dissipate,
difiicidt,
you
may
But
and
fat
sweet
use
a cataplasm of dried
figs.
figs are to
be dissolved by boilingin water, and made
like thin honey,
and barleyfloirr added
if the swelling
to it. And
is resolved
but imperfectly,
boil with the figshyssop or marjoram
you may
;

the

or, if you

decoction.

dried too

the root

wish

to

But

much,

perceiveany
of wild

to you

you
for thus

such

cucumber,

of

attend

must

will it be

thing,you
or

increase its

must

that

rendered

is

the

or

stronger than

salts to

part be

hard.

If

boil ^rith the water

marshmallows,

of the dracunculus

strength,add

vou

the root

of bn^onv.
these

not

and

But
more

discutient

from the di-acunculus itself

; and the medicine formed
is very discutient.
coctions
Sometimes, therefore,you may apply deof these thingsalone;but at other times you may add
dried figs,
and mix polentawith fat. And
the oil of dill is discutient,
and

crude humours, and

adaptedfor concocting

uncon-

iiu

[book iv.

ABSCESSES.

56

Of
:
epispastic
of

sulphur vi\Tim,oz. iij

;

iv ; of

oz.
eaeli,

of vrax, of

perfume^oz. vj;

ammoniac

pentine,
tur-

of natron,

the application
called smilium, and tliat from garlic
iij
; and
abscesses
of
the
calculated to promote
breaking
are
strongly
seed
that Avhich consists of the juiceof linBut
alreadyformed.
changes, and bursts abscesses most aptly.For
dissipates,
oz.

the milder

sorts of

abscesses,those also which

mentioned

were

parotiswill apply. These observations applyto an abscess

followingphlegmon. But, Galen says, that an abscess will
sometimes
take placewithout being precededby inflammation,

for

in which

he

commencement,
takes

place,and
separated from

they appear

For

originfrom good blood.

humour,
says, owing to some

it has its

case,

in

below.

those

excoriation

solid

of fluid and

all kinds

witliin them

contain

to

the

time, the containingparts are

opened,
And, therefore,when

of

process

at

For, bodies resemblingdung, urine,thrombus, a honey

mucus-like
humour, bones, nails,and hairs,have been

bodies.
or

found

in abscesses.

like to those which

And

animals

even

in
particularly

they afiirm that,more

very

putrefaction.
Nay,

originfrom

derive their

found

been

have

from

abscesses

chronic

bodies have been formed

resembling stones, sand,
metastasis,
shells,
wood, coals,clay,the sordes of the oil of baths,the lees
of oil,and the lees of Anne.
Wherefore, we shall now
givea
such as are seated
of abscesses,
succinct account
more
especially
in

the

external

admit

parts of the

of resolution

veins,and
as

arteries.

and

Of

have

have

cyst,and

of them
then

or

them,

fleshy
parts,such

some

we

stated,but

of the

than

throbbing,and

The

to treat.

in

others

the

cor-

muscles,

as

contained

are

not

are

cyst,

formed

genericname,
of

formation

an

scess
ab-

commonly precededby inflammation,as we

sometimes
it arises at once
as
we
originally,

mentioned.

justnow
red

now

do

which

abscess,then, is

An

properlycalled by

are

have

is most

strong heat

abscess,then, is attended with

swellmg becomes
greater and

An

place,the

formerly,and

is

weight,so that

suspended from

the

fever supervenes

with

are

the flesh

those

atheroma, steatoma, and mehceris, and

without

more

medicines.

by

and change of
iniption

body, and

part. And

greatestat night.

it

hard, with
seems

part be

rigors,and
irregular
Sometimes

too

if

as

if the

pain,
somethingwere
pungent

the

bubo

vital one,

pain and

is formed

fever
in the

XVIII.]

SECT.

ABSCESSES.

57

neighbouringglands. "When the abscess is fairly

formed, the
of these symptoms are diminished,the pungent pain bemost
comes
is more
dull,the swelling
itchyand somewhat
sharpened
into an acute point,
is soft and yielding
to the touch,and
the
skin at the top is separated
I
speakwith regardto those that
;
burst externally.If therefore,
it has burst spontaneously,
or
from medicines,it is to be cured by means
of pledgetsspread
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.
ter

may

All the writers referred to in the last

be consulted

on

the treatment

of abscesses.

Chap-

See

Comm.
'

"

espe-

'

He recommends
Aetius.
when
cially
suppurationis not taking
coction
placeproperlyto applybarleymeal, or bread boiled in the deof figs,
to which if necessary
be added nitre,
pentine,
turmay
AVhen
the abscess
or the like.
suppurationtakes place,
is to be opened where
the skin is thinnest,
(See Book 6.)
The incision is to be made
and
and if any putrid
long
narrow,
it
substance
is to be cut out.
The
opening is to be
appear
with frankincense and suitable pledgets
sprinkled
applied.When
the neighboui'ing
parts are inflamed a cataplasmwill be the
most
the ulcer is foul,turpentine
application.When
proper
and honey will serve
for cleaning
it ; or applications
containing
used
for
the
be
After
the tdcer
same
verdigris
may
purpose.
is cleaned,first incarnants and afterwards incrassants are to be
he recommends
applied. For producingrupture of the abscess,
such as ammoniac, and nitre triturated with
various applications,
vinegar,and the like. This account, however, is mostlytaken

from
The

in

Galen.
treatment

recommended

by

Celsus is

nearlythe

same

principle.At firstif the part be soft he recommends

cations
appliof a repellentand coolingnature : but if it is hard he
directs us to use applications
which digest
and produceresolution,
such as dried figs
pounded. To such applications
may be added
of ammoniac, galbauum,bees-glue,
and birdlime,
equalproportions
-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,
must
we
conclude,he says, that the abscess will ripen. The symptoms

"

"

weight,
unripeabscess are strong motion of the arteries,
which
to be
to
are
hardness
and
;
distension,pain, redness,
there is
added horror and fever if the abscess be large. "When
and
the partbecomes
itchy,
a remission of these symptoms, and
is ripe,
and the matter
livid or white, the suppuration
somewhat
the opening be
Unless
is to be let out by medicines or iron.
to be put into it. When
forbids tents or pledgets
largehe properly
these are used,however, lentils and honey, or pomegranate rind
is applied
Whatever
them.
over
boiled in wine are to be applied
bound.
not be tightly
must
for producing
of applications
The Arabians mention
a variety
and
Avicenna
the rupture of abscesses.
(See in particular
of cana plaster
consisting
Rhases.) Thus, they recommend
contain nitre,
of their applications
tharides and old oil. Some
by producing a
quicklime,and arsenic. Such a composition,
of

CoMM.
'"

'

[book iv.

ABSCESSES.

58

an

slough,would

Haly
boiled

doubt

no

Abbas

abscesses

By
what

abscesses of the

are

and

of

does

not

properlycalled

now

mean

leaven,

onions

Alsaharavius

by

nerves

the

Galen

Aristotle.

that

nerves,

treats

as

of

but

they are

seated in
and

tendinous

in

comprehended under the

older writers,
Plato,
namely,Hippocrates,
the distinction between
pointed out clearly

parts,for all these

these

speaksof

of

tended.
in-

was

stood
underparts it will be readily

nervous

author

our

membranous
name

seeds

it

great length.

at

that

He

of rosemary.
indolent
abscesses.

figs,and the

to
application

an

for which
effect the purpose
made
recommends
a
poultice

parts,but

the

were

is often used

term

in its old and

subsequentto him.
abscesses
which our
author givesof deep-seated
The account
is highly interesting,
from
Galen
but is mostly borrowed
(ad Glauc. ii.) Khases, in his Continens' (xxvii),
givesan
of
the
all
outline
opinionsof
precedingauthorities,
interesting
with some
there is any
observations of his own.
When
ingenious
hope of producingresolution he approves of scarifications.When
the pain is violent he recommends
hot and humid
applications
by
popularacceptation

the writers

'

with

the

addition

openedwith

the

and
indicated,

knife,he

not

the leaven

of narcotics.

After

the

abscess

says that desiccative

ointments

containingwax

has

been

are
applications
or

oil.

He

and others of a similar nature.

cataplasm,
directions for opening abscesses.
Abscesses
givesAntyllus'

scribes
deHe
in

limbs

the

GANGRENE.

XIX.]

SECT.

about

to

are

the ancles

but
abscess,

the

GANGRENE

ON

XIX.

at the lower

it to be made

that Galen

mentions

SECT.

When

opened by a straightincision,but those

as
they are apt to terminate in
by a circular,
be

recommends

fistulse. He

59

prefersthe

AND

is neither

inflammation

Comm.

part of the

thinnest part.

SPHACELUS.

resolved

converted

nor

of which
and sphacelus,
into pus, it often passes into gangrene
of gangrene
shall now
treat.
Wherefore, we givethe name
we
from the violence of the inflammation,
arising
when
they are not yet formed but forming ; and if such a state
is not speedily
cured, the afl'ected part readilydies,and the
the surroundingparts, kills the person.
disease seizingupon
the parts thus afl'ectedbecome
But when
totallyinsensible,
the aff'ectionis no longercalled gangrene, but sphacelus. This
the flesh that surrounds
affection happens also to the bones when
them
impregnatesthe
engendering noxious humours
fore,
them to putrefy. When, therebones therewith,and causes
be speedily
cut
the part is completelymortified,it must
the sound part. Gangrene is to be cured
away, where it joins
of the blood in the affected
by evacuatingas much as possible
part ; and we may either procure the dischargeof the corrupted
the vein of the part is large,
or
blood by opening a vein, when
and deep incisions,
so
divide the whole skin by many
we
may
be permittedto escape ; and we may
that the blood may
apply

to

mortifications

some

the

of the
flour

medicines

of tares,

or

suitable to mortifications.
of

darnels,or

of beans

These

are,

with

oxymel.
add salts,
or
use
walnuts
are
good
cleans them, and

wishingto applystronger ones we may

Old
the trochisk of Andron, or the like.
The
nettle also
for gangrene.
applications
and in proper
the juice of spurge, when
appliedin season
poured on the part,
quantity. Tlie decoction of bitter lupines,
after the incision,for the sake of
Some
is also beneficial.
apply the cautery,in which cases we must use salt
security,
the eschar,we
in order to remove
with leeks : afterwards,
may
flour
applya cataplasmof bread, or of barley,or of wheaten
boiled in Avater and oil ; or the drycephalic
powder with honey,
When

and

the

tetrapharmacon
; and

that called the

Macedonian

may

'

'
'

GANGRENE.

60

be used.

turated
properlyremoved by bread trior
basil,or by ii'is,
parsley^
panacea, or birthwort,

The

with
or

eschars may

be

with honey,
by the sweet-fla";

of Machserion

medicine

and

manner,

[book iv.

the

iris

takes

by frankincense.

or

the

away

in

eschars

pledgetswith

spread upon

And
a

the

proper

but

honey;

in soft bodies the floiu^of tares, with

honey, is sufficient.
Of scraped
the ivorhs of Orihasius,for gangrene.
From
of vermihon, of stone alum, equalparts; triturate in
verdigris,
The

flour of

darnel,with radish and salts,

with vinegar,
and sometimes
will,when apphed as a cataplasm,
be proper for the scarified parts; also dried grapes deprivedof
with the bark, and with salts and oxymel; the
their stones
and mp'tle leaves boiled in wine and
inner parts of Avalnuts,
ti'iturated with
honey. Radish, with vinegar,breaks the
and

water

eschars

CoMM.

anoint.

to the bone.

even

See

Commentary.

the

authors

referred to

in

the

17th

Section.
from Oribasius (Synops.
-sii,
copiesfreely
27.) Upon
with
Oribasius
author
have
ventured
to give
our
we
comparing
of the last sentence
not justified
an
interpretation
by the text
Paulus

it

as

now

Cornarius.

stands, and
Oribasius

at

does

variance

with

the

translation

of

say that the flour of darnel will

he ?) but that it will be a proper

not

the parts (how could

scarify
after the parts are scarified.
application
Galen
in Hippocr.App. vii.50,) is
(ad Glauc. and Comment,
the great ancient
and
from him
authorityon mortification,
Oribasius,Aetius,Paulus, and all the subsequentwriters on
this subject
have copied. He laysit down as the great rule of
the blood which is impactedin the part
treatment, to evacuate

and

prevents the diastole of the arteries.

end he directs free incisions to be

cautery
sound

is to be

at
applied,

To

accomphsh

made, after which

the line of

this

the actual

between
separation

the

and

diseased parts.
Celsus is a strongadvocate for this

which has been

practice,
France.
(See Encyclopedic

latelyand is much used in

Methodique,art. Gangrene,and Cross's Sketches of
Schools in Paris.) He states,however,that when
spreading,amputation of the mortified
goes on

revived

"

auxilium

unicum."

At

the

commencement

he

the Medical
the

disease

limb

is the

approves

of

HERPES.

XX.]

SECT.

61

venesection,if the strengthpermit,and of a restricted diet ; Comm.

food and drink are to be given.
and, afterwards,astringent
He
also recommends, for gangrene,
containing
applications
and the like (v,22.)
chalcitis,
arsenic,quicklime,
is little or
of the Arabians
The
nothing different
practice
"

'

Avicenna

the Greeks.

of

that

from

the

at

commencement

vinegar;but
the part by-

with
bole and terra sigillata
of Armenian
approves
if these have not the effect he directs us to empty

opening the
to apply the

leeches, or
scarifications,
He

recommends

then

Alsaharavius

to.

rotics such

the

disease

be had
the actual cautery must
if
recommends
to bleed at first,
us

powerfulcaustics and eschaor

arsenic,quickhme,and sublimed quicksilver;

strengthpermit;

the

it.

and

incisions

proceeds,free

the

"When

to

and

flour of beans

bv the Greeks.

mentioned

other remedies

recourse

us

lead

veins which

as

then

to

use

succeed,the actual cautery. He approves of

and of amputation,if the mortification spread.
earlyincisions,

if these

do not

to

The

amounts
by Albucasis,which certainly
the same
proof that Alsaharavius was

to terminate

earlier modem

SECT.

When
in

cases

XX.

yellowbile,unmixed

flesh,and

treated

of
practice

of gangrene.

ON

HERPES.

with

any

part,the affection is called herpes:

rather acrid it ulcerates

mation
inflam-

an

cautery.

sui'geons followed the ancient

applyingthe cauteryin

Albucasis.

it is to be
mortification,
the

refused

presumptive

as
person
when
that

and
applications,

stimulant
by scarifications,
The

in

strong

and

is related

case

same

to

inculcates in the strongestterms

threatens

he

of it in which

amputate for fear of hemorrhage.

Rhases

seizes the hand

which

speciesof gangrene
spreadsupwards ; and relates a case
describes

He

the whole

is called herpes exedens

skin

other
but
as

humour

is fixed

if it is thicker

far

as

the

and

subjacent

; but if it is thin,less acrid

the surface of the skin like

hot, it raises small blisters on

ing
and hence has been called herpesmiliaris. Accordmillet-seeds,
of phlegm,with yellowbile,
to Oribasius,a mixture
produces
and

the whole
evacuate
we
may
herpes miliaris. Wherefore
body with cholagogue medicines, and apply cooling and de-

the

'

HERPES.

62

siccant

thingsto

we
therefore,

[book iv.

affected part. At the commencement,

applycataplasmsfrom vine shoots,bi'amble,

the

may

and

times
plantain
; but afterwards we
may add lentil to them, somethe
and
And
with
mended
polenta.
cataplasmrecomhoney
be
for phlegmons from defluxiou may
appliedwithout

the

house-leek.

idcerated

But

trochisks dissolved in must,

old,or

in

or

watery oxycrate.

parts

in

thin and

Administer

to

are

be

austere

rubbed

with

wine,not

also horned

very
poppy, and

thingsin water ; and when these do not prove effectual,

But wine diluted with the juice of
vinegarmay be added.
plantainor strychnosis of great senice,or linseed bruised and
and oil may
be applied;or Cimolian
boiled in wine
earth,
mixed with the juiceof strychnos
be
appliedby anointing:
may
and take of litharge,
iv
of
the
oz.
juiceof leeks,vijcyathi,
;
and of the juiceof beet an
triturate and anoint.
equalquantity,
similar

But

when

Musa

these

and

that

Another

of lead

in

ulcers

have

of Andron

become
'svill
be

chronic,the
convenient

trochisk

of

applications.
"

For

: havingtriturated the di'oss

herpesphlyctsenodes
wine
and anointed
with it, apply above it
austere

beet leaves boiled

in wine,

xvj; of the dross

When
it has
wine.

of

oz.

or

of wax,

iv ; of

oz.

lead, oz. iv ; anoint with

myrtle oil,
half

one

of

stoppedfrom spreading,use the cerate

from the dross ; or applyboiled lentil with honey. For herpes,
under the skin,mix the dross of lead with the juiceof levigated
Another
Of old
rue, or myrtle cerate, instead of the rue.
unwashed
wool wrapped round
a dead
pine and burnt,dr. xijss ;
:

"

of wax,

dr.

xxv

goat^stallow

; of

cured

the dross of lead half

and

washed

an

acetabulum

; of

in water, dr.

xxxj; of myrtle
Another
To those which
oil, oz. V.
the
: of
spread rapidly
rind of the sweet
dr. vj; of
pomegranate, dr. vj; of litharge,
wool
unwashed
about a dead pine and burnt, dr. iij
; of wax,
dr. xij; of ceruse, dr. \iij
; of fissilealum, dr. j ; add to wine
and myrtle oil.
:

"

Commentary.

CoMM.
'"

*"

'

afterwards

of

The

writers

herpes and

dente, Dr. Bateman, and

this

are
subject,

the other Latin

of

phlegmon treat immediately

erysipelas.Fabricius ab Aquapenon

most

opinionthat

authors

was

of

our

the

herpes.

the ignissacer
distinguishes

modern

ignissacer
Scribonius

from zona,

authorities
of

Celsus

on

and

ever,
Largus,how-

which,he

says,

was

tules,which

CoMM.
'"

'

"

'

commonly

spreadmost

and

times affect also the hands

very full account

According to him the

herpes.

the blood and

separatedfrom

bile

it

as

has been

it

as

complaint arises
fixed in
to

part.
the bone, and

the other

herpes. Of

of

yellow

from

two

it is

When
forms
if

But

the

thinner,

it is called

surface,when

the

were

some-

and treatment

exedens.
by Hippocratesherjies

called

only burns
genericterm

neck, but

of the nature

thickish it ulcerates the skin down

disease

about the

iv.

feet.

givesa

Galen
of

[book

HERPES.

64

by

varieties,the

the
one,

said,is called exedens,and the other mUiaris,because

like millet(phlyctsense)
derived from him
is entirely
author's treatment
As our
seeds.
of his practice.
shall not enter into any detailed exposition
we
recommends
We
gatives
purmention, however, that he decidedly
may
is
ulceration
of
the
a
mahgfor proper herpes. Wlien
the
most
it requires
and attended with putridity
nature
nant
fire,namely,
acrid medicines, and such as in power resemble
For, he
misy, chalcitis,arsenic,quicklime,and sandarach.
adds, these medicines burn like fire,and often when they fail,
with

it is attended

have

must

we

Aetius

into three

Like

Galen.

from

of

account

accurate

givesan

bullse

to fire itself.

recourse

borrowed

small

many

it is fessedly
prodivides the disease

herpes,but
he

him

the herpes exedens, and

the herpesproprius,
varieties,

being characterized by an eruption

Dr.
notice
what
shall
here
We
of vesicles (phlyctseuse)
The ancient
this division of herpes:
Bateman
says respecting
of herpes into three varieties,
division
miliary {KEyyrpiac:
and eroding{iaOioiisvoQ),
vesicular {(p\vicTaivu)^r]g),
mayl)e properly
last

herpes miliaris,the

the

"

"

discarded, for there appears

the first two, which

between

the vesicles."
ancient

This

and

Palladius makes

the

miliaris.

herpesexedens
from

incorrect

distinction

was

the size of
of the

account

made

between

the

herpesphlyctsenodes.
of onlytwo varieties of the disease,
the erodingherpes. (De Febribus 2.)

and

to Galen's

account

of the disease

herpes,and

only the proper

is, perhaps the best diAdsion
is eWdently a disease of a very

mentions

This

respectto

mention

the proper,
namel}^,
refers
Leo briefly

Actuarius

no

essential diff'erence

no

difi'eronlyin

an
evidently

is

in which
division,

herpesmiliaris

to be

the other varieties.

(vii,
3.)

the

of any,

herpes
as

the

different nature

XXI.]

SECT.

ERYSIPELAS.

The Pseudo-Dioscorides

6.5

recommends

strong stimulant appli-Comm.

cations

and
miliaris,
he

the

herpesestiomenos

recommends

caustics.

In his

Continens'

'

but his account

the

described

herpesmiliaris
astringent
applications.

to

disease,

nothingparticularly
interesting.
Galen
(Theor.
by
is quitesimilar (Pract.
iii,
29.)

also

treatment

translation of Alsaharavius

by

the latter strong

adoptsthe division laid down

His

viii,
10.)

'

the former

describes two varieties of the

of it contains

Abbas

For

he directs the

cholagoguesand

Serapionin like manner

Haly

exedens.

or

for
astringent
applications,

be treated with

In

'

'

sori^misy^sulphur,
containing
onions,"c.
Avicenna
to confound
seems
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

the

of formica

names

or

the

three

varieties

are

mica
for-

muscina,
erysipelas

corrosiva

(herpesexedens?), and formica miliaris. He

describes the formica corrosiva as being a dangerouscomplaint,
spreadingdeeperand deeper. His treatment, althoughamply
contains nothingremarkable
detailed,
(Pract.xxix, 9.)
The
earlier modern
writers on
medicine being the servile
of
copyistsof the Arabians, describe herpes by the name
and like it
formica, as a disease nearlyallied to erysipelas,
arisingfrom corruptedbile. See Guy of Cauliac (ii,
1),and
Theoderic (iii,
16). For the herpesesthiomenos or lupusthey
recommend
the application
of arsenic or the actual cautery.

SECT.

Galen, givingthe
formed
swelling

of

FOR

XXI.

of

name

ERYSIPELAS.

more
erysipelas,

hot and thin

blood,to

to
especially

that which

the

is formed

from the preappellation

vailing
inflammation
when
it erysipelatous
blood
humour, calling
when yellowbile prevails.
and inflammatory
erysipelas
prevails,
But
in generalthe swellingformed of hot blood and bile is
Whatever
division we adopt,it will
called by him erysipelas.
of both

make

no

to know

blood

great difference
that

II.

the

to, it wiU

suflbcation.

as

is a
erysipelas

about
resorted

an
bile,he applies

and

At

head

to the treatment.
most
so

sometimes

But

it is proper

dangerousdisease,more

that

if active treatment

prove

its first appearance

fatal to the
then

we

must

ticularly
parbe

not

patientsby
open
5

vein

[book

ERYSIPELAS.

(16

iv.

the humeral, or, if it cannot be seen,

elbow, especially
venesection
But if any thing prohibit
that appears.
one
to purging by cholagogue medicines.
have recourse
must

at the

any
we

of other
appliedto erysipelas
parts, or we may administer strong clysters.And we are to
in order
with cooling
things,
rub the partsaffected by erysipelas
ening
moistto repelthe defiuxion,and with moderatelyheatingand
before
that which is collected,
things so as to dissipate

The

treatment

same

the

partsbecome

are

to be

be

may

hvid

or

black

in
kept constantly

the parts which

; but

wet

state,by

are

anointed

changing
frequently

by cleansingthem with
part by convertingthem
soaked sponges :
at
renders it dry. As I have said,erysipelas
into vapour
soon
ening,
such thingsas are
the beginning requires
coolingand moistand
without astringency
; such as house-leek,purslain,
fleawort ; the marsh lentil^
endive,and gourd ; the nightshade,
And
parsley,and the
henbane, lettuce,and horned poppy.
leaves of rhamnus
by themselves,and made into a cataplasm
used with very
with bread, are proper applications
; also cerates
cold water ; but we may mix with them some
opium, the juice
into
of poppy, cicuta,and mandragora, and thus form them
of white
And a cerate may be made
compound applications.
mixed
with four parts of rose-oil,
preparedfrom the oil of
wax
being pounded in a
unripeolives without salts,the ingredients
cold water
poured in as it can receive.
mortar, and as much
be done
may
for the heat of the

which
applications,

the

if you add a little thin and transparent vinegar,you will

Avith some
of the
stillbetter : but polenta,
render the medicine
But

coolingherbs,cool

aforementioned

And

with any of them.

Cimolian,

Ainegarand

the effeiTescence
native

and

beet

;
;

to the head

of

opium

or
:

subsides

or
juice of stri'chnos,

we

must

; or

ceruse,

; or

acacia,with vinegar.

may

use

these

mint, "odth vinegarand

When

simpleapplications,
rose-oil ;

or

rue

with

with the juiceof leeks

vinegar and oil,or litharge
compound ones, as this trochisk,more
especially
of

of ceruse,
litharge,

with must

vermilion, of
of

the

chalcitis with oil and

bvickthorn

sulphm*and

worm-wood

part

earth,with
potter's

or

or
lithargewith rose-oil,

with

the

and fat dates

verj^ properly,
may be anointed with ceruse,

and

in common,

of

saffron,of native sulphur,

for all parts,of

Sinopic
of copverdigris,
peras,

of roasted misy, of
chalcitis,
fissilealum equal p.arts,
with vinegar.
use
"

AnotJter

."

XXI.]

SECT.

Of

ERYSIPELAS.

6/

sulphur,of ceruse, of opium, of acacia equalparts;

with vinegar. A cataplasmfor erysipelas,
use
herpes,abscess,
and burning: of the tender leaves of fresh marsh-mallows,
parotis,
lb. j ; ha^dng boiled in water
and oil,triturate properly,
and adding of rose-oil,
of ceruse, of each,
oz.
iv; of litharge,
iiss; triturate againwith the juiceof coriander,
oz.
or of housethen adding crumbs
of bread so as to
leek, or of strychnos,
form a plaster,
: of oleum
applyit. And use this plaster
cicinum,
i. e. castor-oil,
lb. j ; of oil of myrrh, lb. j ; of wax,
oz.
v ; of
of
oz.
and
oz.
iv;
litharge,
scrapedverdigris,
ij; the verdigris
to be tritiu'atedwith vinegar. A cerate
for eryare
litharge
sipelas
and burns : of white wax,
iv ; of rose-oil,
oz.
oz.
iij
; six
of the wall,oz. iv.
the inflammation
When
eggs, of pellitory
becomes chronic,before the part becomes livid,
ceases
or
apply
if
it
has
but
a cataplasmof raw
become
barley-meal;
already
hAdd,incisions must be made in the part, and cataplasms
moreover
and
hot
sweet
water
and
sometimes
applied,
poured on it,
and
brine
sea-water
sometimes these ingredients
or
to be
are
;
mixed with the cataplasm,
and then we
the aforesaid
must
use
compound medicines with caution : for should these symptoms
or mortification takes place.
continue,a transition to suppuration
native

Commentary.

has stated Comm.

Hippocratesin his Prognostics'
the danger of an erysipelas
being translated to an internal part.
He
also states that gangrene
is
superveningupon erysipelas
account
dangerous. He has not, however, given any A-ery particular
of the disease. In one
of his aphorismshe states that cold
is useftd in erysipelas
when
not ulcerated,
but prejudicial
when
it is ulcerated.
His commentators, Theophilus
and Damascius,
in Hip. et Galen, ii,456).
confirm this statement.
(Scholia
Celsus
recommends
bleeding if the strength permit, and
and
then repellent
\
ceruse
applications,
refrigerant
especially
Cimolian
with the juiceof solanum
earth with
or
1
(nightshade),
When
river water, and the like.
f
ail
to
refrigerants
produce
saffron
the effect,
and
to
be pounded with
are
sulphur, ceruse,
wine and applied. If the part become
putridhe directs us to
corrosive applications
the actual cautery. Afterwards
use
or
'

"

'

the

sore

upon
We

is to

be

cleansed with

honev

and

generalprinciples.
have stated in the precedingSection

rosin, and treated

that the

ignissacer

[book

ERYSIPELAS.

CS

iv.

CoMM.
'~~^^"'

erysipchis
Largus is not herpes. That it was
for
his applications
between
probablefrom the similarity

of Scriboniiis
seems

Celsus and

which

those

it and

for

erysipelas,Tims

for

chalk, diluted with

the

Avith bread
or
itself,
and litharge.

; or

We

Cimolian
ignissacer he recommends
juiceof solanum, or the solanum by
of sulphurvivum, ceruse,
a mixture

further in this placethat the

remark

may

authorities recommend

the other

ignissacer,

or

Anthony's fire of the middle ages, would appear to have

of erysipelas.
l)een some
varietj^
is particularly
of erysipelas
deservingof
Galen's
account
St.

painsto

the

In

attention.

state

14th

the nature

of his

Book

'

difference

the

disease,and

of the

is at

Med.,' he

Meth.

tween
be-

symptoms of both are

plilegmon. The common
in
heat and swelUng. But
they differ,first and principally
but paleor yellow,
pound
or a comcolour,Avhicli is red in plilegmon,
istic
characterof both, in erysipelas.Throbbing is also a
whereas
symptom of a great phlegmon, for it is deep-seated,
culcates
inhe pointedly
is rather in the skin.
Erysipelas,
erysipelas
This humour
is occasioned
by a bilious humour.
being thin, readilypasses the fleshyand rare parts,and flows
to the skin,where, unless it be particularly
watery,it is unable
is retained. When
to pass the pores, and, consequent^,
things,
bitter
bile
this
natural
in
their
indeed, are
state,
passes through
but when
the pores of the skin by the insensible perspiration,
it is either too abundant or thicker than usual,it is retained by
it and

it inflames

skin,which

the

should

the skin

the

or

He

hence

the

tion
prolonga-

states that

the

or
cooling,but that
refrigeration
is danger of carryingthis plan too far,lest the humour
vital part : wherefore coolingapplibe driven to some
cations
to be used until the part change its colour,but are
are

great indication
there

swell

to

lines the internal cavities.

of it which

of

to be continued

part is
nature.

and

causes

affects
chiefly
why erysipelas

reason

not

and

the

is

until it become

black

or

livid.

It is

cessary,
ne-

as
soon
as
a change of colour in the affected
therefore,
remarked, to exchange them for those of a contraiy
His coolingapplications
consist of strj^chnos
(solanum?)

other

part becomes
to

cure

articles mentioned

livid,he directs

and
applycataplasms

us

by

our

to make

fomentations

author.

When

the

and
incisions,

wards
after-

with hot water, to

ERYSIPELAS.

XXI.]

SECT.

(39

It is only at Gomm.
vinegarmay sometiraes be added.
this tiine tliat quicklime may
safelybe added to tlie applicaat first. With
tions ; for it wovdd prove liigbly
prejudicial
of cholarespect to the general treatment^ he approves strongly
in ordinarycases.
gogues^ Ijut does not think bleedingnecessary
arises from idcers or any obvious causes^ ho
When
erysipelas
lie
scarifications and cataplasmsof barley flour,
recommends
the same
i-ecommends much
planof treatment in his 'Therapeut.
He speaks highlyof earlyincisions.
ii.
ad Glauc'
he professes,
as
merely copiesfrom Galen.
Aetius_,
Oribasius recommends, at first,such thingsas are cooling
"c. When
without astringency
; namely, henbane, nightshade,
wbicli salt

or

he directs us, before the part becomes

subsides,
apply a cataplasm of barleyflour; but when it does
free incisions,and afterwards
livid,he recommends

the inflammation

livid,to
become

fomentations

cataplasmsand
salt and

with

the

states

danger

with

and repellent
carryingrefrigerant
recommends
something discu-

of

too far,and
applications
to them.

tient to be added

Octavius Horatianus

by

of

the want

Avicenna

cated
contra-indibleeding(unless
with free
and of cholagogues,
strength),
approves

of

fomentations.

incisions and

states

that

bleedingin generaldoes

be seated

the humour

of cholagogues and

onlyhe

water

or

brine.

Actuarius

most

fresh Avater,

cautions

be determined

not

us

to

Serapioutreats

an

to

between

skins.

He

less
good, un-

approves

stronglyrefrigerant
;
applications
the
disease
lest
too
this
far,
plan
carry
of

internal

of the

the two

no

part,or terminate

disease

very

in gangrene.

by
accurately

the

name

He
Galen.
terms
as
nearlythe same
at the
applications
decidedlyof coolingand repellent
approves
notice the eruption
commencement.
Serapion and Avicenna
of bullss in erysipelas.
with
is not attended
Haly Abbas directs us, when erysipelas
to the part,
to use
coolingand repellentapplications
swelling,
marinds,
and to administer
gentlecholagogues,such as myrobalans,tabe present,and if there
But if swelling
and i^runes.
of al

is

massire,but

in

he recommends
nothing to contra-indicate venesection,

bleed

and

us

to

applycataplasms.

Alsaharavius

describes three varieties of

erysipelas
; namely.

ERYSIPELAS.

70

'
"

eiTsipelas
properlyso called,the ignisPersicus,and tlie
he says, is attended
The
inflatiAa.
first variety,
erysipelas
solely-with redness of the cuticle. It is to he treated hy hleedof a cooUng and humid
and
local applications
ing, piu'ging,
the heat and redness are strong,
In the ignisPersicus,
nature.
the part. It is to be treated by
and
black blisters rise on
and scarifications. The eiysibleedingat the commencement,
like
pelasinflatiA'aarises with a sudden swelling,and blisters,
those producedby fire. It is to be treated by bleedingand
The ignis
"c.
cooHng apphcations,
containingceruse, litharge,
Persicus -would appear
to have been some
varietyof anthrax,
the malignantpustule.
or
the

CoMM.
'

[book iv.

None

favorable to

bleeding as

attributes

it to heated

quoted by

him

but
He

the

in his

he

that

Rliases.

Like

the

so

dedly
deci-

others,he

of the authors
He, and most
Continens,^approve of coolingapplications,
this
too fai*.
against carrpng
practice

vesicles like those

from

bm'uing often

arise

part.

Fabricius

ab

Aquajjendenteis a strong advocate for the

theory,of which he givesa full explanation. The system,
important
says, beingloaded with vitiated bile,the more
tained
cast it off: it is,therefore,sent
outwardly,and is deHe attempts
by the cuticle when its pores are obstructed.

ancient
he
organs

to reconcile

the

regardto venesection.

contrary opinions of the ancients

He

himself

the disease is seated

when

None
the

themselves

express

bile.

'

cautions

remarks

on

authorities

of the ancient

of

the

ancient authorities

apprehensionsas

same

approves
in the head

most

of
decidedly
or

with
ing
bleed-

neck.

seem

to have

of the

moderns

entertained
do

against
prejudice

in cases of erysipelas.When
this
liquidapplications
became
know.
Heister mentions
generalwe do not exactly
that,
in his days,some
of liquidapplications,
disapproved
surgeons

but, as

he

surgeons,
recommend
disease is
to

leeches

gogue

He himself rethought, without any good reason.

commends
The
earlier modern
camphorated spiritof wine.
and Theodoricus,decidedly
as, for example, Brimus
cold applications
at the commencement.
When
the
not therebyresolved,
they direct us to liave recourse
and

scarifications.

but
purgatives,

do

symptoms

run

not

much
of cholaapprove
recommend
flammato
bleeding unless in-

They

high.

[book

PHYxMA.

/z2

iv.

be transferred from our

account^ in
applications
may
the Third Book, concerningparotis,and from what has been
respectingphlegmons. And
latelydelivered^more
especially
be learned from
in like manner
of phygethlonmay
the cure
and erysipelas.But the
them
"what has been stated respecting
other

herb
not

which, on
atticus^

aster

onlyin

the part

Phymata
:

tlie form
an

as

of

this account,

but
cataplasm,

amulet,is believed

to

they call bubonium,

also when
be

of

use

bound

round

for buboes.

in parapplications
ticular
may be discussed by the following
maiden-hair
orache
of
the
wall
the
root
; pellitory
;
;

marsh-mallows, boiled in wine ; ammoniac, softened

But
honey, and applied; birdlime,Avith the rosin cerate.
of

with
bee-

glue,bitter lupinsappliedwith ^dnegar,the root of the wild

and in like manner
of
cucumber
added to turpentine,
root
promote the rupture of
capers, and nitre with leaven,or figs,
these tumours.

Commentary.

CoMM.

The

account

'

*
*

inflammations
'

de Tumoribus^

is taken
and

'

from

Comment,

Celsus describes

here

given of these glandular

Galen (ad Glauc. ii.) See also
in Hippocrat.
Epid.^vi.
resemblingfurunculus,but as
According to Rayer, his
pus.

phyma as
being larger,and turning to
of phyma applies
better
description
of anthrax.

(]Malad.de

la

to the

boil than his account

phygethlon,he
not high,but broad,and containing
says, is a tumour
something
It
in
the
a
occurs
resembling pustule.
mostly
armpits,neck,
He
gerant
of
or
groins.
proposes applications a repellentand refrinature
is hard, digestives
be
must
; but if the swelling
had recourse
such
dried figsbruised,"c.
He
also reas
to,
commends
a
compositionof sal ammoniac, galbanum,bee-glue,
and mistletoe,
with a small proportion
of myrrh. His treatment
is considerably
different from
author's.
"\^Tien matter
is
our
formed, he directs us to let it out by medicines or the lancet,but
lie decidedly
forbids the use of cerates.
In another
ever,
place,howhe recommends
an
application
containinglime, spuma
r
ound
and
salt
mixed
with rose
cerate.
nitri,
pepper, galbanum,
Scriljonius Largus recommends
a
pitch,
malagma containing
aphronitum,pine-rosin,
ammoniac,
bay-berries,
wax,
axunge,
Ilh'rian ii'is,
galbanum, and white pepper, for discussing
phygethlon
Peau, p. 229.)

The

FURUNCULUS.

XXIII.]

SECT.

Aetuarius

Oribasius and
affections in the
with

terms

same

mark

the distinction between

Galen,

as

emollient,concoctive,and

concoctingphymata,

73

and

direct

discutient

us

to ti'eat them

Comm.

recommends

barleyflour; figs,boiled with

with
yeast,"c. ; and for breakingthem, the juiceof thapsia,
"c. (Euporist,
i,
sulphur; cantharides,mixed with turpentine,
southernwood,boiled

Avith

raw

156.)
Nonnus^
he

is mostlyabridgedfrom

account

recommends

and
at firstvenesection,

our

author's.

sponges

Thus,

squeezedout
applied
; and

to be
are
digestives
and such thingsas will favour the rupture
aftervvards cataplasms
bitter
of the abscess,
namely,compositions
containingbee-glue,
vinegar,nitre,yeast,or figsand pitch.
lupins,
of ulthaum.
describes these aff'ectionsby the name
Avicenna
It is remarked
by his translator that the Arabian recommends
the distinction which
medicines as Paulus,but neglects
the same
the bubo
when
attended
between
latter properlymakes
the
without
it.
fever and when
with pestilential
been merely an
tion
acute inflammato have
The phyma seems
of a gland,terminating in suppuration. The phygethlon
inflammation
of a gland. These complaints
an
was
erysipelatous
Avell defined and described
by Fabricius ab Aquapendente
are
(1,i, 23.) Dr. Willan uses the term phyma in a difterent sense

of

oxycrateand

from

that of

our

(ii,
16),where

the like ; then

author.
see

the note

SECT.

Furunculus

is

The

an

term

occurs

in Marcus

Antoninus

of Gataker.

XXIII.

ON

FUKUNCULUS.

apostematous swelling,formed

of thick

body most especially

; being
racter
mild when it is formed in the skin only,but of a malignantchait rises up from
a
when
deep-seated
part. Fm'unculus
be discussed and concocted by wheat, chewed and applied
;
may
and
their
of
mastic
stones,
deprived
; by raisins,
by Egyptian
discusses
either
and
or
with
triturated
salts,
applied (this
breaks the swelling)
apply dried figsboiled in hydromel ;
; or
the figs
with the figsand applied
rosin may be mixed
or
; or
; or
themselves,when they are fet,may be split
open and applied
humours

in the

parts of
fleshy

the

"

'

"

applications.For

Pseudo-Dioscorides

the

these

'

[book

FURUNCULUS.

74

with

leaven

nitre

or

linseed with

henbane, triturated with butter

of

iv.

honey ; or the leaves of

that
compound applications,

preparedfrom leaven and fine flour,and that which is

named
Dothienicon, are very applicable.Foment
particularly
with soft sponges
frequentlydipped in hot water, and then
applythe medicines.
is

which

f
In this and

CoMMENTAKY.

CoMM.

the authorities

on

the

Galen,

differs from

Furunculus, says Celsus,is

inflammation

and

it has

After

pus.

is

inflammatory
and
deep-seated,

an

malignantnature when
phyma only in hardness. (De Tumoribus.)
is of

afi'ectionwhich

an

tubercle,attended with

acute

converted into
when
especially
pain, more
there
been opened,and the pus discharged,

rupted,
part of the flesh below converted into pus and part cortricle
of a whitish or reddish colour,which
they call the ven-

appears

or

bellyof
with

attended

not

Ij

phlegmon.

furunculus, accordingto

The

Sections,see
folloAvdng

two

says that the disease is

and that medicines
are
necessary
For
this
expeditiously.
purpose
He

the furunculus.

danger,

solelyfor removingit the more

commends
applications
galbanum. If repellent
particularly
be
do not
used; and, failing
succeed, suppurativeones
may

he

these,rosin

or

leaven.

When

is

pus

formed, no

further

ment
treat-

of
required. According to Kayer, Celsus' description
furunculus applies
to the malignantpustuleand not to the boil.
is

(Malad. de
The

le

Peau, 233.)

simple remedies
from

recommended

by

our

author

are

rowed
bor-

Oribasius.

Galen, Celsus, Pliny (Nat.Hist,

in recomconcur
mending
xxiii,
7),Octa^dus Horatianus,and Avicenna
figsfor furunculus or the boil. It was with a lump
It is to be

of

remarked

that

prophetIsaiah

figsthat

the

Avicenna

and Khases

treat

cured

Hezekiah's

furunculus

boil.

judiciously
by bleeding

purging,which prevent the formation of a large abscess.

to use
"When
there is throbbingin the tumour, they direct us
and
does
When
it
is
maturative
not break
applications.
ripe,
to open it.
us
they recommend
Haly Abbas says, that
readily,
boils arise from gross and depravedhumours.
11.)
(Theor.viii,
and

Alsaharavius

also ascribes them

He

that he often succeeded

mentions

to

full and unwholesome

in

stoppingthe

diet.

formation

XXV.]

SECT.

ANTHRAX.

75

of the furunculus

it with a pieceof myrtleor any

by cauterizing
other wood.
When
the pain is violent,he recommends
an
the
of
o
f
leaves
henbane
and poppieswith the yelk
application
of

an

When

egg.

the

boil is

indolent,he approves

of

Comm.
"

'
*

mulant
sti-

(Pract.xxix,4.)
plaster.

XXIV.

SECT.

Oribasius
that

dark

terminthus

bulla

over

appears
is found.
But
eminences

colour,like
be

cured

remedies

TERMINTHUS.

says, that

below

are

ON

of

Dioscorides
formed

the fruit

like

it,which
and when
excoriated,

lies

if

as

is

in

of phyma, but
species
having burst,the part
it is

Alexandria

divided,the
"

says,
of a

dark
skin,round,
green
of turpentine." These, therefore,
to
are

other

the

pus
Terminthi

phymatous swellings,
by applying the

there described.

Commentary.

Aetius

account
of terminthus,Comm.
givesthe same
See Hippocrat.(Epidem.ii,11 ;
which is a species
of phyma.
de Humor,. xi,1); Galen
(Comment, in Epidem.); Oribasius
describes these affections by the
(Sjmops.vii,136.) A\dcenna
of albothin (iv,
name
7, 3, 1.) He says that thev are ulcers
producedby black bile ; that they appear upon the leg,and are
'

of the

same

The

nature

terminthus

disease to which

SECT.

When

are

and
one

varices.

XXV.

and

have

to

appear

appliedthe

Willan

the blood

ferments

as

would

ON

CARBUNCLE

having become
fixes in

name

OR

more

the

been
of

cutaneous

ecthyma.

ANTHRAX.

melancholic

than

tural,
na-

part,the diseases called carbuncles

formed, which are sloughyulcers,for the most part beginning

with bullse,
but sometimes without them ;
like burnt parts,
whether
the patients
at first rub the part for its itchiness,
bulla is formed

or

several small

and

like

millets,which,

place,resemblingthose
of a
eschar
being sometimes
sometimes
black,along with its being

having burst, a sloughyulcer

occasioned
by cauteries,the
ciueritious colour

ones,

takes

'

'

[book

ANTHRAX.

76

fixed to the

base,and

spreads at

the

state,black in

certain

is the true

flesh

arc

same

membranes
the

Not

few

to

as

fever.

with

attended

are

giveoriginto erysipelatous
and most
terminate in suppuration,

partsbelow,so

inflammations.

take

affect sympatheticall

long, and

remain

nerves

or

in the

which

those

whereas

form

that

carbuncles

But

black bile.

speedilycircumscribed

placein

it,and it
in a fiery

nailed to

manner

time, the surrounding flesh is

and pitch.
the colour,and shininglike bitumen

Such

cases

in

iv.

We
epidemiccauses.
rying
must
treat them, unless theyare very small,by venesection,caranimi ; and after
evacuation as far as to occasion deliquium
venesection
it will not be improper to make
deep scarifications
also sometimes

Carbuncles

arise from

To
of the thickness of the humour.
part,on account
the aftected part we
apply such things as are moderately
may
and boiled
and discutient,
as the cataplasmof plantain
repellent

in the

lentil,
receivingthe tender part of bread baked
neither

pan,

put
of

very
of the

some

Polyides,and

are

fine

earthern

an

the ulcer

above

foul ; and

nor

in

must

we

such as those of Aiulron,

strong applications,
with must, until they
of Pasion, mixing them

of the consistence of the sordes of oil in batli^s. And

also the

dry ISIassaleoticpowder,which
And

manner.

of

the root

diluted in like

be

may

so

dracunculus,or of birthwort,or the

bed
properlyrubin,each of these with vinegar. Cases of an erysipelatous
for erysipelas
be anointed
Avith the applications
nature
;
may
but those parts which
are
suspectedof being sympathetically
affected are to be wrapped in unwashed
wool, out of wine and
oil. AVhen
the inflammation
abates,we must
applyto the
cai'buncles the cephaliccerates
spread upon pledgets. That

juiceof laserwort,or

from

herbs

is

an

be

Cyrenaicjuicemay

the

excellent

and

one,

that

from

natron, and

and
dry applicationfor spreadingulcers,separately
oil.

When

the hardness

applesascribed

to

remains, we

Serapion.

of the carbuncles

as

But

much

we

them

from

their

attachments

use

must

hasten

one

possible,
by
during the day, and
out
to the

boil in
having divided sour jjoniegranates,
softened,triturate,
put into a linen rag,

rose-

from

the ration
suppuchanging the

as

cataplasms and medicines twice

during the night. In order to root
free

the

must

with

the

once

the

carbuncles,and
surrounding parts,
vinegar, and wiien

and

apply.

When

dried,let
made
or

ANTHRAX.

XXV.]

SECT.

to

be

thera

The

vinegar.

carbuncle

is

snppm'ate and burst,by tlie inner pai-tof old walnuts,

of that which

even

ynth

moistened

77

is not

old, and

bv

leaves and

the

slioots

Avith
by its young and tender balls (pilule),
dried
barley-flom; by raisins deprivedof their stones ; by
figsboiled in wine ; by the flowers of horned
poppy ; by the
honey ; by liquidpitch
juiceof laserwort,with rae and some

of cypress,

or

with raisins and

An

excellent

of old
until

oil,lb.

they do

arsenic,and
levigatedit

axunge.

lb. j ;
Of lithai'ge,
oppUcat'ion
for carbuncles.
j ; of arsenic,oz. j ; boil the oil and litharge

then
in

boil

gangrene,
and
the
ulcers,

old

gout

add the
fii'e,

black, and

it become

it imtil

having

upon pledgets.
ulcers,those called cMronia, strumons

mortar,

For

off the

taking them

stain,and

not

use

it is

adn^irable

tnost

for
application

in the eyelids. Of opium, of acacia,

carbuncle,particularhj
of toasted misy,of flakes of copper, of each, dr. ij; of copperas,

j ; of the seed of henbane, dr. j ; triturate in water,

and use.
Tlieysay also that tlie ointment called tetrapharmacon,
ha-vinga fifth part of frankincense,is an excellent application.
of copin the pudenda, take of clialcitis,
But for carbuncles
peras,
dr. ij; triturate with
of each, dr. viij
; of aphronitrum,
water, and use.
Sheep'sdung roasted with honey is also a
dr.

In

remedv.

which

is also called orchis

as

cataplasmfor

and

The

cm-e

the

use

sreen

with crumbs
triorchis,

carbuncles and

the eschai' falls oft\ thev

Commentary.

thev

Alexandria

ffood

them

carbuncle

all
as

common

of

bread,

; and

sloughyulcers
a

serapias,
when

ulcer.

is brieflv treated of bv

Hip-

mentioned
by him
frequently
fever. (Epidem.iii.)
of the pestilential
as a symptom
of cai-buncle. ^^ itli
minute
Celsus givesa veiT
description
well as
so
regardto the treatment, nothing,he says, answers
immediate
burning, which produces no pain,as tlie flesh is

pocrates (Epidem.ii,1), and

dead.

The

sore

is

parts. Under
is formed, which, being

is to be treated like other

burnt

a crust
erodingapplications
from
the liA-ing
removed
flesh,carries all the corruptedparts
which, is to be filled
alongwith it, and leaves a clean caAity,
corrosive or
the disease is superficial,
When
up by incarnants.

the

use

of

caustic substances

may

be

substituted,of such

degree

of

Comm.

'
"

the
between
produce a sepai'ation
sound flesh. But if these apphcations
recourse
fail,
from
abstinence
had
recommends
to burning. He

strength as

CoMM.
'

[book

ANTHRAX.

78

wine

to

at the

and

commencement,

to be

directs water

dead

iv.

and

be

must

food and

givenfreely,

if fever be present.
especially
Pliny givesan indistinct account of an epidemicalanthrax,
in the provinceof Narbonne.
which, he says, prevailed
(Nat.
Hist, xxvi,4.)
Galen

ascribes

and

thick

He

directs

the carbuncle

blood,which
to

us

to

hot, black,

and eschars.
blisters,
ulcers,

givesrise to

applyto

defluxion of

the eschars

fire,such

those

the properties

medicines

arsenic,
misy,chalcitis,
remedies
His particular
are
quicklime,and sandarach.
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
givenby Aetius is full and
Galen.
Oribasius,
accurate, but is entirelyderived from
of which

Actuarius,and

resemble

Nonnus

heated.

This

is much

the

Octa-sius Horatianus
and

by

names

from

of venesection
He

cautery.
the

use

cold

one.

the

carbuncle

is described

of pruna
and
ignisPersicus.
black
slough which is formed

coal.
resemblinga
but mostlycopied from

by

theory.
ment,
bleedingat the commence-

of Avicenna

burnt

and

over-

Galen's

as

to

us

translation

the

pruna

approves

blood

of an acrid and caustic nature,

applications
cautery itself. When
danger is apprehendedfrom

the Latin

called

same

recommends

hot cauterv, he directs

In

bv melancholic

Actuarius

external

the actual

or

repeat his doctrines.

also

that the disease is occasioned

says

as

His

at

the

also recommends

figs. Alsaharavius
of alcubam

and

and

in

of the disease

account

Galen

It

his

is

was

it,
ple,
am-

Rhases

successors.

beginning,and of the actual

an
mustard
application
containing

describes the varieties of anthrax

alcoasat.

and

(Pract.xxix,12.) At
he approves of generalbleeding
and leeches,
commencement,
afterwards of refrigerant
and analeptic
medicines,to obviate

the

tendencyto sinking.

the

he

names

directs

us

to

Serapion,like
ignisPersicus.

"When

these

caustics

powerful
Avicenna, describes
use

thingsdo
or

succeed,

actual cautery.
the name
of the

the

it under

not

[book iv.

CANCERS.

80

such

whey

of thyme

givingdodder

as

of

the amount

oz.

ivss ; in

hiera, containing the

afterwards

water, and

honied

or

to

black hellebore.
The

be appliedto the ulcerated

may
excitingpain,a linen rag being folded and wetted
strvchnos

juice of

partswithout
in it,and laid

must
to this,we
apply soft
externally
and care
must
wool, which also has been soaked in the juice,
become
be taken that they do not
pouring
dry,by frequently
ulcers
chronic
of
all
In
carcinomatous
of
the
a
on
some
juice.
from
the preparation
use
pompholyx; and
nature, one
may

For

carcinomatous

fundament,

and

In

breasts.

and

or

appliedwith advantage.
maUgnant ulcers,for rugose ulcers
the

the Lemnian

earth

with

oxycrate and honied

black,or

become

the oil of unripeolives^or the

or
rose-oil,
that of wall-pennywort,or of lettuce,or
or
in

diet shonld

on

pudenda, testicles,
leaden mortar, and "uith a leaden
pestle,

milk, so that it

unripe grapes

for

be

for inflammationson
a

having tritm-ated
water

may
and

Tliii'd Book

in the

mentioned

were

in the womb

cancers

the

which

remedies

those

; but

on

hke

ha^^ingtritui'ated
juiceof house-leek,
of

with

anoint

fleawort,or

them.

of

The

patient's
of the juiceof ptisanand
consist principally
manner,

milk, and from among

pot herbs, of mallows,
live among
and gourd,of the fishes which
rocks,
orache, blite,
and of all kinds of fowls,except those that live in marshes.
and
From
maligna7itulcers.
Archigenes,for carcinomatous
Levigate equal parts of bui'ut river crabs and calamine,and

the

whey

of

or
sprinkle
applythe

seed

of hedge mustard

Commentary.

CoMM.

ashes

See

of crabs with

triturated with

cerate

or

apply the

honey.

Hippocrates(Epidem. v) ;

Galen

(de

'

'

'

Therap. ad Glauc. ii)

; Celsus
(v,28) ; Scribonius Largus ; Aetius (xAi,
43); Oribasius (^lorb.
Med.
Ciirat. iii,
(iv,
28) ; Actuarius (]\Ieth.
iv,16); Avicenna
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.)
tended
in the breast,atHippocratesrelates a fatal case of cancer
Tumoribus

with
nature

jNIeth. ISIed. xiv

sanious

but
discharge,

he

does

not

explainthe

of the treatment.

Oiu' author's

of
description

cancer

is

abridgedfrom

Galen

CANCERS.

XXVI.]

SECT.

(deTumor.
Book

1.

of the

'

c.)

Tlie ti'eatment

Meth.

Med.'

the material

remove

tions he

is derived

recommends

of the disease.

the

14th

melanogoguesto

Comm.
'"

In external

metallic substances "which have

been

only chance

he
consists,

of

from

apphcabut prefers
those preparedfrom
confidence^

cause

placesHttle

He

81

radical

burnt

and

washed.

The

says, in making a
complete excision of the part ; but in doing this he forbids us
the arteries with ligatures,
to secure
as
they will occasion a
a

cure

of the disease.

recurrence

The

part,he says, is loaded with

When
the
thick,black,or recrementitious blood.
he disapproves
of cuttingand burning.
idcerated,

Celsus

describes

carcinoma

as

an

of the
tumour, attended Avith swelling
lirid.

His

account

deserves to be
dicamentis

immovable

adm'entibus

own

words

quidam

is

cancer

and

unequal
are
pale or
importantthat it

veins,which

of the treatment

givenin his

is

so

Quidam

"

ferro

usi sunt

adusserunt

me-

quidam
profuit
; sed
;

exciderunt : neque ulla unquam

medicina
scalpello
adusta,protinusconcitata sunt, et increverunt donee occiderent;

excisa,etiam post inductam

mortis

causam

attulerunt

adhibendo,qua

cicatricem,tarn en
:

cum

toUere id malum

lenia medicameuta

reverterunt,

et

interim

nuUam
vim
plerique
tentent, sed imponendotantum

ad ultiquasi blandiantur,
quo minus
senectutem
mam
perveniant,non prohibeantur."In another
place,however,he recommends
arsenic,
compositions
containing
"c. (v,22.) He makes
a distinction
galls,
copperas, cantharides,

between

the

quae

or malignant
cacoethes,
tumour, and the

but says that the difference between

"

only tempore

et

He marks
experimento.'^

disease with
then

carcinoma

them

true

ma,
carcino-

is to be

the

recognized
of malignant
gradations

is cacoethes ;
there is the funlast,

there
: first,
precision
singular

without

ulceration ; and
(The readingin the edition of

gatedulcer.
Milliganis a great
In
doubtful cases
he directs us, first to apply
improvement.)
caustics or heatingmedicines,and, if the disease is alleviated,
to proceedto the scalpel
to circumstances;
or burning,
according
but

if it is

we
exacerbated,

natm'e, and must

are

to conclude

abstain from

that it is of

nomatous
carci-

all acrid and vehement

applications.
Scribonius Largus recommends
for all malignant
ulcers,even
such as are cancerous,
of arsenic,
an
application
consisting
p. \^;
of squama
seris,
p. iij
; of elaterium,
p. j ; of burnt paper, p. iij*
II.

'

"

'

givesfrom

Aetius

CoMM.
'

"

and

and
Arcliigenes

Leoniclas

interesting

an

ulcerated cancer,
describes the disease in

wliicli lie di^"idesinto

of the disease,

account

'

[book iv.

CANCERS.

82

cancer

idceration.

without

He

which is unequal
consistingof a largetumour
and resisting,
extendingits roots far,and being attended
with varicose veins : its colour is either cineritious,
vergingto
but is in reality
redness or livid ; it appears soft,
very hard ; is
accompaniedwith a pungent pain,and givesrise to malignant
the female

I
1

breast

as

phlegmons in the armpits. The pains shoot to the clavicle

and scapula. An ulcerated cancer, he says, goes on corroding
it discharges
and spreading
a sanies
deeper,nor can it be stopped;
of an
abominable
smell,and is aggravatedby medicines and
handling. The disease he considers as generallyincurable.
He
will be stated in the Sixth Book.
His surgical
treatment
recommends
purging with hiera and the theric,iSIithridatic
antidote,"c.
Apparently,in order to mitigatethe 'S'iolence
of the pains, he du*ects us to make
an
containing
application
the wort,
the
seed
of
of
heads,
equalportions plantain,
poppy
he
and other thingsof the like kind.
For ulcerated cancer
recommends
emollient epithemes,such as the one
containing
white wax, oil,and the yelksof eggs.
litharge,
axunge,
Oribasius and Actuarius
supplynothing of importancethat
is not
in our
author.
to be found
Nonnus, accordingto
Sprengel,is the only ancient author who attributes cancerous
idcerations
to
merely
acrimony of the bile. But Nonnus
copiesthe words of our author.
The
in representing
the
Arabians
agree with the Greeks
disease as beingproducedby black bile.
They were, no doubt,
led to form this opinionfrom remarking that the blood in the
part is thick and black,Avhicli theyconsidered owing to its not
The
being properlypmged of its recrementitious sediment.
moderns
deride this theoiy,but they have substituted nothing
in its stead.
Van
Swieten thinks more
satisfactory
favorably
of the ancient doctrines. (Comment. " 485.) A"\dcenna speaks
prived
highlyof a milk diet. Serapion likewise approves of milk deof its butter,and of a vegetable
diet. He speaksof no
other treatment
as
being likelyto prove remediable, with the
exceptionof excision and the cautery. Haly Abbas rather approves
of excision
admits

of this

when

the disease is seated in

operation.However,

like

part which

Galen, he disapproves

of

(EDEMA.

xxvii.]

SECT,

tyingthe

ease,

he

arteries.

says,

are

The

stony

characteristic symptoms of the dishardness

and distension.
The ac-

givenby

Alsaharavius

Httle confidence

in excision.

count

he

83

is

nothing different.

After

ulceration

has

Rhases
taken

Comm.
'

has

place

containingceruse,
using a coolingapplication,
other such
the juiceof nightshade,and some
tutty,rose-oil,
of cancer
He mentions
of the
a case
thingsof a cold nature.
but the disease
was
breast,in which the whole mamma
extii'pated,
of his authorities,
retui'ued
One
the other side.
on
sore
as
Antyllus,describes the cancerous
ha^ing a tendencyto
spreadinwards, its edgesbeing thick,large,and everted,and
When
the disease cannot
the dischargethin and acrid.
be
with it.
he forbids us to meddle
got completelyextirpated,
wi-iters on medicine,
Theodoricus
and all the earlier modern
call the cancer
of apostema melancholicum, and
by the name
approves

recommend

of

the

for it

treatment

same

as

the

Greeks

and

Arabians.

SECT.

XXVII.

ON

(EDEMA.

swelKngs formed by hot humours, we

shall now
treat of those from the opposite,
beginningwith the
is formed
oedema.
For as erysipelas
by a bilious humour, so
is oedema by a pituitous,
being a loose swellingdevoid of pain.
in the
We
are
aware
also,that oedematous swellingsoccur
and in cachexia,
but
in phthisis,
feet,in dropsicalaflFections,
in them
the oedema is a symptom of the complaintunder which
ment;
treatthe person is labom-ing,
and requires
no
very particular
the limbs
for it will be sufficient in general to rub
with oil
and sometimes
sometimes
with vinegarand
rose-oil,
and salts,
be added to the vinegarand rosethe salts may
or
humour
oil. When
the oedema is occasioned by a pituitous
being determined to the part,a sponge soaked in oxycrate
ginning
may be properlyappliedwith a bandage looselyput on, beThe
below and terminatingabove.
ought
sponge
is not
at hand, that which
to be new,
but if such
a
one
Avith what
is may
be cleaned with natron, or more
especially
do not therebysubside,
is called strained lye. If the swelling
mix some
And
alum.
application
a
we
may
very convenient
Having

treated

of

'
^

84

is

good remedy

tender wick

become
then

applieda
a

'
*

in sucli

lamp,soaked

also is horned

of

out

sponge

and applied.
fluid,
the

When

poppy.

part with oil,and

the
it

lye,bind

has

cedema

and
firmly,

will

you

Eveiy kind of earth discusses and represses

the ^Egyptian,and also
more
especially
swellings,

matured

Avoad.

(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
11 ; Pract. iii,
3, 2); Haly Abbas (Theor.
viii,
(iv,
30);
Alsaharavius (xxix,13) ; Rhases
(ad Mansor. Aii,12.)
Commentary.

CoMM.

iv.

cm-e.

(Edematous
the

of

chronic,ha\ing first anointed

effect

'

[book

EMPHYSEMA.

Our

Galen

See

authoi-^s account

Galen,
Greek, Latin, and

Oribasius,Aetius, and, in fact,all the

Arabian authorities adopt his \dews,without

They all concur

with
applications,
friction.
in

Rhases

heated

in

ation.
any material alterastrincoohng and gent

recommending
bandages; and, in

suitable

that

recommends

sand.

He

from

disease is taken

of this

the limb

also approves

certain cases,
should be buried

of various

with
astringentapplications

bandages. In the
is described by the name
A^acenna, Haly Abbas,

Alsaharamis, the oedema

flegmaticum; in those of

by

that of undemia.

undemia
stated
is

for

The

oedema.

In

that the undemia

a
evidently

Emphysema
membranes

late works

some

was

of

of apostema
and

Serapion,

used

the term

we

have

seen

but
speciesof erysipelas,

the

XXVIIT.

is formed

ON

it

this

by

flatulent

skin,sometimes

which

surround

EMPHYSEMA.

under
the

sometimes

collected in the stomach

them

the

and

Paracelsus

translation

mistake.

SECT.

under

celebrated

and

coohng

collected sometimes
spirit,
the periosteum,
the
or

muscles.
and

And

it is also

between
or
intestines,

peritoneum,in those kinds of dropsywhich are

called tympanitic
it diff'ers
from oedema in this,that the
; and
parts do not pitupon pressure like it,and that it sounds hke
The
a drum.
densityof the body co-operates in preventing
the flatus from being dissipated,
at the same
time that the

EMPHYSEMA.

XXVIII.]

SECT.

flatus also is of

85

Wherefore, the indicatiou

tliick nature.

of

rarefythe body, and attenuate the thick air ; which

and heating
of attenuant
is to be accomplishedby means
and
When
the complaintis seated in the stomach
remedies.
this is to be brought about by a fine oil,
having rue,
intestines,
a large
cumin, or parsleyseed boiled in it. And sometimes
appliedtwo or three
cupping instrument without scarificators,
is to

cure

navel,will discuss it.

to sound
so
as
inflated,

times to the
contusion

are

parts will

bear very

not

the commencement,

at

and, when

the

sodden

we

use
may
them
Avarm

is

disease

or
use
as

patienthas

decline,discutients. Thus
of oil,appMng
small quantity

take

care

expedientthat

the

for the
plasters,
: having boiled
following

discutient

baths, strain
throw

it into

it

the

pot, and

still more

from

eflectual

the heat

that

part be cooled.

of

washed
un-

be preserved,
When

it may

of the oil used

sordes

the

having

it become

until
flour,sprinkle
use.

that

so
first,

cerate

to mix

are

aphronitrum, and afterwards

the

the

vinegarand nitre
we
some
lye; and lastly,
may
removal of the complaintsuch

soothed,we

been

an

wool, or mixing

upon unwashed
wool.
And we must

the

use

from

the

on

with

must

for it is not

must

we

muscles

emphysema, the
fore,
Whereapplications.
paregoricsliberally,

like

acrid

heatingand

the

T\Tien

in

pure, and again

tritiu'ated slaked lime hke

of the

become

clay,and
cine
compound medi-

consistence of

is the
application

sycomores.

(Meth. Med. xiv); (Therap.ad Comm.

^'^
Glauc. ii)
; Actuarius
(xv,2) ; Oribasius (Synop. \T.i)
; Aetius
(252); Scribonius Largus ("119) ;
(Meth.Med. ii,12); Nonnus
Avicenna
3, 2, 20) ; Serapion(v,23); Alsaharavius (Pract.
(iv,
127, Cont. xx^ai.)
xxix," 1, 14) ; Khases (Divis.
dications
The
Galen.
from
Our author has copiedclosely
great inof cure, as laid down
by him and acknowledged by
all subsequentauthorities,
to rarefythe containingparts
are
stated in another
and
the spirit.By spirit,
attenuate
as
we
See

Commentary.

place,the

ancients

which

have

we

in which
and

the

meant

mentioned

calefacient

like, have
is

Galen

are

The indications
gas.
best fulfilled by friction Avith oils,

thick

air

medicines, such

been

suspected,he

boiled.

or

as

When,

anise,
cumin, parsley,
however,

properlyforbids

us

to

any
use

mation
inflam-

acrid

or

SPRAINS.

86

CoMM.
"
'

[book

iv.

the pain of the bowels is violent

Wlien
heating medicines.
of tympanites,he allows medicines containing
in cases
opirnn,
small
if
the
be
the
intestines
mouth
which are to be givenby
if the largeintestines
in a clyster
but are to be administered
affected,
be the

part,he directs

muscular
and

of the

seat

to

us

certain

In

emollients.

use

disease is in

combination

of attenuants

he recommends

dry-cupping.
Nonnus, adopt the ^iews of

cases

Oribasius,Aetius, Actuarius, and

Galen, without

the

When

disease.

alteration.

anv

cumin internally.
tympanites,Scribonius recommends
recommends
A"sdcenna, like our author, in ordinarycases
and
of attenuants
combinations
calefacients,
diy-cuppingand
the spu'it
the like,for dispelling
the disease arises
; but when
of the muscles, he directs us to use
resolvents
from contusion
of similar
and
treatment.
paregorics. Serapion approves
For

recommends

Alsaharavius

internally.In

externallyand
the

is called

disease

with

calefacient

Sprainsof

oils ; he

XXIX.

wool,
;

by

by

the tender

water, may
have

be

chaste

used.

He

in

But

Actuarius

Med.

makes

most

by

the

by

washed
un-

oil,and

roots

roasted

water,

plied
ap-

Avith

honey,
rated
nitre,tritu-

or

of hot

inflammation

and

sea

pains

sprainedparts.

See Aetius

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

Aetius

calls it

remedied

are

and
tree, salts,

after the

friction

occurs

and
^-inegar

affusion of sweet

works,

CONTUSIONS.

AND

subsided,applyrubbing to the

Commentary.

Rhases

intestines.

parts of boiled bulbous

The

cerate.

disease

contusions

his

recommends

that the

soaked

sponge

of

translation

SPRAINS

jointsand
a

or

and

remedies

calefacient

Rliases

remarks

FOR

the leaves of the

with

CoMM.

the

the

iuflatio.

commonly in the stomach

of apostema inflatum.
name

SECT,

and

attenuant

mention

71 ); Oribasius (Synops.-vii,
(xiv,
14);
ii,35) ; Scribonius
Largus (" 209) ;
of all the remedies

recommended

by
which,

author, with the exceptionof the affusion of water ;

of ti'eatment
however, is a method
deservingof attention.
our

Oribasius

mentions

the
particidarly

affusion of hot

sea

water.

88

SCIRRHUS.

SECT.

XXXI.

OX

[book

TEARING

AND

RUPTURE

OF

THE

iv.

FLESH.

It is
Rupture is altogetherattended with ecchymosis.
cured
which
are
moderately heating,as the
by medicines
resemble

such
from black poplars,and
as
acopon
when
the rupture is deep-seated,
must
we
such

remedies

as

are

instrument

cupping
therefore

the

acrid and

more

is likewise

whole

readilyunites ; but

form

under

if it continue

may

readilyseparate them,

may

be filled with

eccli}Tnosis
may
that it is

that

formed

at

as

commencement

be

birthwort,if
centaury,
drunk

'
"

and

with

69, 70) ;
Nonnus

by

The

is

any,

the

or

Should

them.

separated
; and

small

sordes

occasion

intermediate

the
in

certain

space

manner

commencement,
of

we

blood.

an

except
whereas
Yulsion

in

like

juice of

torn

the

manner,

it,rhubarb,

root

of the

costus, and

large

bdellium,

oxvmel.

Commentary.

CoMM.
'

made

parts; and

torn

that

the

asunder,and it only
the pain is removed; for
the round
coalesce.
to
\^'herefore,
convenient
to
ruptiu-ed
application

certain fibres are

place when
until
requiressoothingapplications
cannot

of

use

longer unite

the

to

long time, and

formed

was

takes

they

The

a thin humour,
as containing
discussed,

sooner

the

at

that

moisture,and

some

be

and

to

But

recourse

discussed, the

be

it,the rupturedflesh can no

only apply the lips together,so

must

and

cutting.

beneficial

ecch^Tnosis

flesh

have

it.

These

remarks

taken

from

Aetius

(xiA-,
Oribasius (Synops.vii,14); and they are copied
(Epit.254) ; and Actuarius (Meth. Med. iv,16.)

Arabians

principles.See

these

treat

in

are

accidents

upon

A^icenna,
particular

as

exactlythe
quoted in the

same

ceding
pre-

section.

XXXII.

SECT.

Genuine
of

scirrhus is

sensibility
; biit

with

diminished

then,

that

ON

SCIRRHUS.

hard and devoid

preternatural
swelling,
which
is not genuine is only attended

sensibility.

is utterlv incurable

That
but

which

that

is whollv

which

insensible,

is attended

onlv

SECT.

XXXII.]

with

diminished

SCIRRHUS.
is
sensibihty

incurable^and

not

cured,for it is occasioned
easily
which

89

by

is fixed in the hardened

yet it is

viscid and

parts,so

to

as

thick
be

not

humour,

difficult to

get discharged. Sometimes, then, the scirrhus is the original

and goes on to increase ; but for the most
complaint,
part, it
is occasioned
by the physicians
applyingtoo coolingand astringent
and phlegmon.
remedies
to erysipelas
If one, therefore,apply stronglydiscutient medicines
to
will indeed
indurations of the body, one
produce a visible
diminution
remainder

short

of the

complaintin an
what
being dissipated,

moisture
hard

of the scirrhus in

time, but

incurable
remains

will leave the

state ; for the thin

is rendered

dry

and

discutient

The

then, ought to
application,
be in a certain degreeemollient,
without possessing
manifestly
and
Such
desiccant
all
kinds
of
are
heating
qualities.
marrow,
that
of
of
more
a
a stag or
calf,and the grease of a
especially
lion,of a panther,or of bears,or of a bull,and among
birds,
that of geese, of domestic
of
but
that of
fowls,or
pheasants:
bucks and he-goatsis drier.
And
to these
be added,
may
ammoniac
the Scythian,
perfume, bdellium, more
especially
the humid
and fattystorax, and
the Egyptian mastich.
To
all other parts of the body, when
in a scirrhous state,these
things may be appliedsingly,and in composition;but for
tendons
and
ligaments,we are to dissolve in the strongest
in the fire. If posstone that has been heated
vinegarsome
sible,
the one
to be used
if not
should be pyrites,
or
it,the
the aflFected part
lapismolaris or millstone. In this,therefore,
as

stone.

is to be
from

moved, so that it may receive the vapour which arises

it j and afterwards,
emoUient
is to be apmedicine
an
plied.
A thin oil then, and not water, is to be poured on the

part,by all

means

once

the oil the root

patientsought
from

the

of

day, and

marshmallows, or
abstain from

to

frequentuse

softened,the

of it.

the

But

softest ammoniac

and the part rubbed

strong vinegar,
succession

; after

emollient

apphcation,ha\dng the

ponax

added

to

Avhich,we

it.

sometimes

Such

Amvthaon, and those which

must

are
we

of wild
use

when

The

bath, at least

sciiThus

is moderately

is to be dissolved in very
with

it for several

again have recourse

fattest galbanum

that from
are

may
cucumber.

of the
the

boil in

one

bacon, that

days in
to

an

and

opoascribed to

about to describe for scrofula.

90

Commentary.

CoMM.
"

'
'

SCIRRHUS.

[book

iv.

(De Tumoribus; Metli. Med.

xiv; Therap.ad Glauc. ii)
vii^34); Aetius
; Oribasius (Synops.
iv^ 16);
(xv, 3, 4) ; Leo (vii,
4) ; Actuarius (]Meth,Med.
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

1. c.)

Galen

See

taken
entirely

contains

(Ther.ad

however, is somewhat

Galen's account,

and
author's,

Galen

from

Glauc.

fuller than

om*

treated upon the principles

which
of hard swellingin the thigh,
case

case

he

It was
a
lays down.
which
had been improperlytreated
arisingfrom an erysipelas
Galen
informs us that
and coolingapplications.
by astringent
he began by pouring upon
the limb an attenuant
oil,namely,
the Sabine

; after

which he caused it to be rubbed

and

fats medicated

and

the like. After this he bathed the whole

of

in very

ammoniac

been

with

lessened,but

not

afterwards

appliedone

effected

cure.

sometimes

In

allied to

discutients

Aetius

has

maiTows

bdellium,mastich,ammoniac

perfume,

limb with

solution

the swelling
had
vinegar. When
completelyremoved by these means, he
of the pitchmedicines,and at length
another place he states that scirrhus is

acrid

cancer.

Oribasius likewise recommends

with

with

and

Actuarius

valuable

the articles mentioned

combination

approves

this

chapter upon

by

our

of

of emollients

the

same

tice.
prac-

subject. Besides

author, he recommends

various

and the like. He forbids

rosins,
turpentine,frankincense,
of aluminous, sulphm'eous,
and chalybeatebaths.
use
indurations
and
ammoniac

as

The

the

of tendons

there is

with

combined
cuttingproperties
dissolved

in

rinegarAvith

iVi'abians treat of scirrhus

Greeks.

thingspossessedof

he recommends

Avicenna

in much

in

For
tenuant
at-

such
emollients,

melons.

properlydirects

congestionof black blood

the

the

the
us

terms

same

bleed

to

part, and

as

when

afterwards

of a solvent and emollient nature.

He and
applications
the same
remedies
identical
those of
as
Serapion mention
Paulus.
For dissolving
hard tumours
he recommends
oil
an
containing
fenugreek,
Haly Abbas
cyperus, and aromatic reed.
to

use

ascribes the

formation

author, and

recommends

of

scirrhus

to

relaxant

and

the

same

emollient

causes

as

our

applications.

STRUMA.

XXXIII.]

SECT.

Alsahai'RA'ius dii'ectsus

to

91

evacuations

procure

of black

bile,Comm.
'

for various
givesprescriptions

and

When
applications.

advises

ON

succeed,he

not

cautery when

actual

the disease

natm^e.

STRUMA

indurated

are

SCROFULA.

OR

in
glands forming principally

the

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

lupinesis to be boiled in oxj-meland applied(thisalso

with phyma ;) or applycows' dung boiled in vinegar.
answers
This discusses all indurated swellings. But
be
strumse
may
of quicklimemixed
with honey,
properlydiscussed by means
the sordes of baths, oil,or axunge
lime
; or, equal partsof quickand natron, and four times the quantityof cardamom
emollient
be boiled with honey for an
and fenugreek may
and aj)phed. This one
discusses hard strumas, and
ointment
produces the rupture of suppuratedswellings
; the floiu* of
darnel boiled with pigeon'sdung, or linseed and wine : or,
green

either
olives,

triturated with

wild

cucumber, and

cultivated

the

burnt

or, the

into
of the

ment
emollient oint-

an

dried root

di-ied leaves of the

tm'pentineand applied;

cardamus

white

of the

bay, may

be

equalparts of stavesand of natron, with double the quantityof rocket may be

acre
apphed,with rosin ; or, goats'or cows' dung boiled in vinegar;

mixed

with

or

liquidpitch and made

apphed ; or, the ashes

be

may

wild

or, the flour of bitter vetches

not

person
and
oil; or,

beingcovered
the ashes
added
an

to

soaked

or,

in the

manhood, and added

to

come

dead

snake

may

be

urine

of

to melted

thrown

into

young

pitch,wax
a

pot, and

Avith gj^sum,
it is to be put into a furnace,
of it mixed with equalparts of fenugreek,and then
over

honey

admii-able

wild cucumber

and

one,

and

used.
also that

that from

'
*

operation. Rhases di\ddes

accompanied with sensibility,
He
that Antyllus
mentions

is insensible.

XXXIII.

do

discutient

and

the

to

of extirpation
and the
ajjproved
is of a corrodingand cancerous

Strumse

remedies

that
varieties,

which

that

usual

be had

to

recoiu-se

scirrlius into two

and

the

emollient

And

the

from

cedar

asps is
the
from

compositionfrom

fullers'
rosin.

herb, that
The

followingone

[book iv.

STRUMA.

92

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

dr. X
of ammoniac
perfume,dr. ij; of the mistletoe of oaks,
di\ j ; pound in a
dr. viij
; of galbanum, dr. iv ; of bee-glue,
"

mortar.

lime,
wrouglitbirdof dry rosin,of wax, of each lb. j ; of galbanum, oz. iij.
Of wax, of pine
For struma
ulcerated and not ulcerated.
rosin,of aximge not salted,of horehound, of scrapedbirdlime,
For

strujna

of each
An

and

hardness

vj.
for
application

of

the breasts.

Of

oz.

strumce.

Of

old

oil,lb. ij ; of

wax,

lb. j;

colophonianrosin, oz. iv; of natron, oz. iv; the heads of

of the garlic,
rate
macegarlicxij. Take away the cloves (nuclei)
in oil for three days,then
having boiled until they are
dients
softened,throw them away, and melt in the oil those ingreoff
the
fire
taken
which
are
soluble,and after they are
It also breaks
natron.
apostemes.
sprinkleon it levigated
Another:
Of the ashes of figs,
oz.
ij; of fissile alum, oz. j ; of
aphronitrum,oz. j ; of hquid pitch,oz. vij.
A
septic applicationfor scrofula. Of fissile alum, of
of each, dr. iv ; of the flakes of copper, dr. j ; of orpirealgar,
the strumae
with it in a diy state ; but if
ment, dr. j ; sprinkle

of

"

thev
a

'

"

of

'

nature, mix

cancerous

with

rose

oil and

use

twice

day.

Hippocrates (De Glandulis)

; Galen
(Meth. Med. xiv,11) ; Oribasius (Synops.vii,29) ; Aetius xv,
(Epit.124) ;'
5) ; Actuarius
(Meth. Med. iv, 16) ; Nonnus
Celsus
(v, 18) ; Scribonius Largus (153); Myi'epsus(56);
INIarcellus (36); Serapion (v, 25) ; Avicenna
(iv,3, 2, 10) ;
Commentary.

CoMM.
'"

are

See

(Chirurg.ii,42) ; Alsahara^-ius (Pract.xxix, 1, 23) ;

iii,
33) ; Ehases (adMansor. vii. 8 ; Cont.
Haly Abbas (Pract.
(i,10, 10.)
xxvii); Avenzoar
Albucasis

as
being one of the worst
Hippocratesmentions struma
in inflammation, and being
diseases of the neck, originating
and indolent defluxion.
producedby a pituitous
directs us when
scrofulous
Galen
glands are not situated
near
largevessels to extract them with the kuife,or consume
In another
with septicapplications.
them
place he relates a
lous
in which
an
case
imprudent surgeon, while removing a scrofugland of the neck, cut the recurrent nenes, and thereby

STRUMA.

XXXIII.]

SECT.

loss of

occasioned

93

Loc. Aff.

speech.(De

i,6.)

For

an

Comm.

account
'

of the

operationsee the Sixth

Part only of oiu' author's

Book.
are
applications

derived

from

Oribasius.
A

minute

of these

complaintsis 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
panied
degree of hardness ; the malignantare accomwith inflammation,and a throbbingpain,feel unequal,
have enlargedveins,and are exacerbated
cines.
by handlingor medivery

The
the

account

latter

said

are

of
authority

to

be

incurable.

He

mentions,

Leouidas,the accident related

by Galen.
however, of the operationin general. Incipient
nation
strumse, he states,may be discussed like scu-rhi,
by a combiof emollients with discutients.
He givesa long list of
for remo\ing scrofulous tumom's.
One of them
prescriptions
upon
He approves,

contains

arsenic mixed

-^-itlithe fat of

goat

regard to the generaltreatment, he recommends

diet,emetics, and the theriac.
Actuarius
and Nonnus, as usual,borrow
from
Celsus

remarks

that

strumse

neck, armpits,groins,
sides,and
them

slowlyto

matiuityand

the

most

female

afi'ectionsof the

or

With

ox.

stricted
relaxatives,

author.

our

in
frequently

breasts.

He

glands,which

the
presents
re-

come

to the physician.
very troublesome
Some, he says, givewhite hellebore in these cases, and
for bringingthem
forward
for discussing
or
applications

use

them.
is

as

indolent

occur

Others

have

removed, theyheal

the

sore

becomes

prove

and when
the eschar
caustics,
ulcer upon generalprinciples.
When

recourse

the

to

clean he recommends

exercise

and

ing
nourish-

diet.
Scribonius

'
*

and Mp^epsus give nearly

Largus, INIarcellus,
the same
author.
Arsenic is an ingredient
as
our
prescriptions
in the septic
of Myrepsus.
applications
A\^cenna
recommends
emetics,phlegmagogues,bleedingin
the arm,
attenuant
food, and avoidingall gross things and
commend
the'
repletion.As a discutient he and Serapion'
diachylonplaster. Haly Abbas likewise mentions this application,
and also directs the swellings
to be bm'ut with caustics.
AlsaharaA-ius briefly
recommends
excision or bm-ning. Serapion
evidently
copiesfrom our author. Avenzoar givesa very full

STEATOMA.

94

CoMM.
'

[book

iv.

lie says, are formed in

-vrliicli,
swellings,
generalof a gross and viscid phlegm. Except in very particular
He
in
lie
of
cases
general
disapproves bleeding.
approves

of scrofulous

account

the
when
swellingtends to
applications
; but
when
he directs us
to promote it ; and
suppuration,
pus is
formed
he recommends
to let it out, but cautions the
us
fairly
not to attempt this operationunless he has a practical
surgeon
acquaintancewith anatomy, lest he wound any of the veins,

of

discutient

or
arteries,

nerves.

forbids the

Rhases

In

deep seated.

or

the tunic with

oil,and

he

cases

of

approves

the

that age, in imitation

consists of

by Brunus
melons

juiceof

common
litharge,
cine
fenugreek. His septicmedi-

and

of arsenic and

quicklime,which
Minor.
with honey. (Chinu'g.
19.)
mixture

ON

XXXIV.

These

of them

the

the

substance

is like

and

each

like

honey, and
all is to

the putrefaction
of them,
l^roduce
tumours

fall under

those which

under

two

contain

all these
a

of them

thin

three

or

the

said

we

Thus

one

the thii'd like pap.

discuss the contents,

cut

them

out.

Some

indications

fluid,as

onlv, as

to

plied
ap-

peculiarappellation

in the tumour.

in them

cure

apostemes, as

receives its

contained

fat,another

indication of

class of

is to be

MELICERIS.

AND

ATHEROMA,

thingsbelong to

from

The

STEATOMA,

treatingof them,

when

destroying

Arabian

recommended

ointment

scrofula is in the neck

direct scrofulous tumom-s

to
authorities,
with discutients,
excision,or septics.A discutient

the

be treated

is

certain

the

septicapplications.
the other surgical
wi'itersof

Brunus, and
of

knife when

of cure, namely,
the meliceris ; others come

atheroma, for it

can

onlv be

But the steotoma

admits of no
by excision or putrefaction.
for it can neither be discussed
cure
operation,
except by a sm'gical
made
to putrefj'.The diagnosis
of each of these may be
nor
found in the Surgical
part of the work, while the materials of

cured

which

the discutients

are

formed

are

under

mentioned

the head

This

ing
apphcationis peculiarly
adaptedfor discussmeliceris : Twenty raisins without their stones ; of squama
Of
Another
peris,di\ iij
; having first fomented, apply.
of scrofula.

"

'
'

and
discoloration,

free from

excision for it.

of

says, is a
soft to the

subject. The steatoma, he

this

CoMM.
'

[book iv.

STEATOMA.

96

The

surrounded

pultaceoussubstance

'contents

tumour,
preternatural

of the

by

He

touch.

mends
recom-

consist

atheroma

membranous

tunic,

found hairs ; nay, Philoxenus

within which are also sometimes
found animals like gnats and flies. The
aflirms that he had
meliceris also has

honey.
meliceris and

He

coat, and

membranous

ble
resem-

surgical
operationfor

also of the

approves

its contents

the

atheroma, but permitsto attempt their reduction

consistingof

as
moniac,
amingredients
He makes
galbanum,vinegar,"c.
ceruse, turpentine,
enter into any
mention
of septics
no
; indeed arsenic does not
of his compositions.
rules of treatment
the same
Oribasius and Actuarius lay down
with
him
usual epitomises
Nonnus
author.
as
as
our
some
shght alterations. The active ingredientsin one of his
is brief
Leo
sandarach and hellebore.
are
septicapplications

by

of discutients

means

such

indistinct,

and

Celsus

the dififerencesof these

marks

with

tumours

his characteristi

Atheromati subest quasitenuis

:
precision
humor
: meliceridiHquidior
; ideoquepressus fluit :
pulticula
excision. (vii,6.)
steatomati pingue qaiddam.^'He recommends
that
is so like our
Avicenna^s plan of treatment
author^s,
terseness

we

need

not

"

and

give it in detail.

The

steatoma

is to be removed

by an operation.For the two others he permitsthe use

solely
the
such as arsenic,
of septic
hellebore,
quicklime,
applications,
lees of wine, "c.
Haly^s definitions are similar to those of
author,and

our

he

recommends

either excision

or

the

of

use

laid down by Alsaliara\ius

such as vitriol. The treatment
septics,
is quitethe same.
In the barbarous translation of his works
and accida.
of alsahamia,asalia,
they are called by the names
xxix,1, 22.)
(Pract.
the veterinary
as
Vegetius,
surgeon, describes these tumours
sion.
they appear in cattle. He directs them to be treated by exci(Mulom. ii,30.)
It will be
well
In

from

the

acquaintedAvith

fact,our

the paste noAV

It

remarked

appears

author

the caustic powers

in this section has

commonly
from

text, that the ancients

the

used

for

works

of

of the

calx

cum

were

kali.

for
givena prescription
forming issues.
Fabricius of Aquapendente,

FAVI.

XXXV.]

SECT,

97

and meliceris by septicComm.

atheroma
practiceof treating
in his time.
Andreas
common
appHcations was
sufficiently
in this way
tumours
Laurentius approves of removiiig
scrofulous

that the

'

'

"

when

and
have
deep-seated
the septics
used in his

they are

enumerates

potest

age

base.

"

He

Secundo

thus

extrahi

affixo in

ejus medio candente

ut sandaputrefacientibus

nunc
caustico,

struma

broad

admotis erodentibus et
ferro,nunc
argento liquidousto, oleo quod ex atramento
raca, arsenico,
sutorio igne elicitur,
calce 'non extincta cum
sapone, axungia
porcinacum
argentisubhmati portiuncula,pulvere merciuui,
He
erinaceorum
cumbustorum, testae saepise,
aui'ipigmenti."
also recommends
in

wet

to tie the base of the tumour

us

solution of arsenic

atheroma

(De

nat.)The

described

well

by caustics is
Chirurgica of Manget.

strum,

with

in

the

thread

treatment

of

Bibliotheca

'

'

SECT.

favus is

The

XXXV.

OF

FAVI.

swellingon the skin, having perforations

through which a honey-likefluid is discharged. Wherefore
to it ; or, the tender
dried grapes with rue
to be applied
are
with linseed in
leaves of the figtree with honey; or, cresses
with honey; or,
honey; or, the root of the garden cucumber
with cerate or turpentine. You
vivum
sulphiu*
vary the
may
of favi by transferring
treatment
hither what is said in the
Third Book regardingachores.
a

Commentary.

from
achores,differing

the

the pores

openingsof
combs

of

cannot

we

Alexander

Aetius
he says,

the

bees,whence

skull.

which

in
solely
the

it takes it

the

favus

resembles

magnitude :

fluid escapes

for the

resemble

appellation
; but

comm.
'

"

'

"

the

in achores

the pores

In

sixth

the

it attacks

and
II.

them

that

by which the fluid issues.

of the complaint,which,
givesa similar description
mostlyattacks muscular parts,as the limbs,soles of
see

feet,over

When

by

states

this
even

the
case

vertebra of the

neck,

and

the sides.

head, he
he

spreadsto the
says, it sometimes
directs us to treat it with acrid applications,

the actual

favus
cautery. For incipient
7

he

'

CoMM.
^~^~'

recommends
and

IV.

of sulphur,barleytlour
consisting
application

an

meal.
recommends

Nonnus

[book

FAVI.

98

of litharge,
:
followingapplication
the leaves of rue, dr. ij; of wine

the

alum, dr. iij

; of
and rose-oil,q. s.
ch'. ij; of

descriptionis

Celsus^s

so

considerable part of it in his

speciesof

the

favus,or

important,that we
own
language. He
"

kij^iov.

Alterum

shall

give a

mentions

two

subalbidum, fu-

est

majore : quod ubi

humor
glutinosus
ad justam maturitatem
et purulentus
tamen
pervenit.Si
; nee
in furunculo,apdivisum
est, multo plus intus corrupti,
quam
Raro
fit nisi in capillis.Alterum
paret, altiusquedescendit.
est minus, super corpus
eminens, durum, latum, subviride,subpalHdum, magis exulceratum
; siquidem ad singulorumpilomm
radices foramina
subpalglutinosus,
sunt, per quse fertur humor
olei :
interdum
visci
crassitudinem
aut
referens,
lidus,
mellis,
simile ; sed majus, et cum
dolore
maturescit, habet foramina, per quse fertur
runculo

si

inciditur,viridis intra

flammatio

ingens est, adeo

consuerint."

For

ut

the second

Dolor

apparet.

caro

acutam

autem,
febrem

quoque

specieshe recommends

as

et

in-

movere

external

dried fig,
linseed boiled in mulse, and emollient
a
applications
plasters.To the other he also directs us to make appliciitions
containingfigs,
turpentine,rosin,"c. But when these have not
he recommends
the effect,
to cut the fungous excrescences
us
down
to the sound flesh,
and then to dress the sore
general
upon
The
afl'ection
above
of
of the
account
an
principles,(v.28.)
is the most
scalp,which we have often met Avith in practice^
accurate
are

even

modern

to

be

in
works

found

doubt
on

in

whether
surgery.

any

author
the

ancient

complaint

It is not

to be

Porrigo favosa,or Porrigo scutulata,of

A\icenna's

Dr.

or

be

modern.

We

at all noticed

confounded

with

in
the

Bateman,

of the aclior and

favus is far from
description
distinct, (iv,
7, 3, 1.) The favi appear to be the pustulse
tis
capidicuntur
of
c/saAc/a Alsaharavius. (Pract.i,11.) His
quse
He
distinct.
description,
however, is by no means
approves
of general evacuants, and
local applications
of a stimulant
"c.
nature, such as sulphur,mercury,
bii-th^^ort,
Serapion
has not described the favus
but he has given
very accurately,
of the treatment.
a full account
He
properlyforbids strong

SECT.

ULCERS.

XXXVI.]

99

at first, (i^
applications
3.) Rhases recommends
as
appHcations
Serapion.(Ad Mansor. v, 16.)

SECT.

XXXVI.

THE

ON

SIMPLE

much

the

same

Comm.
'

'
*

ULCER.

will bring
if one
merely a division,
and
together the parts which are separated,
apply a circular
bandage around, the divided parts will adhere togetherwithout
of its Hps
ado.
It is necessary, however, when
at one
more
the ulcer is everted obliquely,
to begin the bandaging there,
and turn
it is deranged both
it to the oppositeside.
When
double-headed
a
bandage,and
ways, it will be proper to use
thus to bring the Ups together
nothing has fallen
; for when
such as a hair, or a sand, or oil,or filth,
between the lips,
or
the ulcer is
the Uke, the ulcer will adhere
completely. When
that the separated
so
large,
parts cannot be completelybrought
togetherby the aforesaid bandaging,they are to be first united
and
with sutures, and then bandages are
to be thus
applied,
which
have
those remedies
used which are called agglutinants,
the power
of dryingand consuming the collected moisture, and
from flowingto the part.
prevent more

Since

simpleulcer

is

ancient authors may

Comm.
following
Galen
be
consulted
(Meth.
Hippocrates(De Ulceribus)
;
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
28) ;
Largus (94); Avicenna
(iv,4, 1, 2, 3) ; Serapion (vii,
Averrhoes
(Pract.iv, 18) ;
(CoUig. vii,32) ; Haly Abbas
Alsaharavius
(Tract,xxix, 2, 2) ; Rhases (Ad Mansor. vii,3 ;
Divis. i, 138 ; Contin. xxviii.)
treatise quoted above
The author of the Hippocratic
cularly
partilotion
for
ulcers
and
wine as a
tion
menwe
praises
;
may
American
that Dr. Hosack, an intelligent
writer,states it
his opinion,that the surgeons
of the present day might
as
in such
learn from
him
an
importantlesson upon its utility
Commentary.

On

ulcers the

'

"

cases.

Of

He
all

condemns

the

authors, ancient

principles
upon

which

of oils and

use
or

fat.

modern, Galen

ulcers

ought

to

be

has

laid down

treated

with

the
the

'

ULCERS.

100

"-^"

defines

greatestprecision.He

CoMM.
'

definition

a
continuity/'

includingwounds

dii-ections for the

His
wound

directs
with
Wine
in

as

similar to

are

ulcer to

an

of

treatment

of

those

solution of

simple ulcer

author

our

"

spontaneous ulceration.

of

cases

as

be,

bring the lips of it together,and

bandage, or, if that is not sufficient,
by sutures

clasps.

or

the best of all applications

to ulcers,

to be

he pronounces
far as they are

fresh

or

is to say, he
them
secui-e

that

to

us

IV.

comprehensive,and

evidentlyvery

well

as

[bqok

ulcers.

from Oribasius.
copiesvery closely
In applyingthe bandage, Aetius directs us to begin above
if only one
the sore
simple bandage is to be used, but if two
to begin at the
in fractures,he recommends
us
as
are
necessan^,
to beginagainat
ulcer and proceedupwards,and in like manner
Oiu- author

the

roll downwards.

and

ulcer

oftener than

bandages

forbids

He

day; and

every alternate

loose

to

us

directs

us

the

not

to

the sanies with a soft,

apply water to the ulcer,but to remove
dry linen cloth.
the treatment
Celsus describes very accurately
of a recent
stances,
wound
He
or
simple ulcer.
approves, according to circumof bandages,clasps,
or sutures, and his directions respecting
the application
of them
are
highlyimportant,but too long
for

our

After

limits.
it

apply over

sponge

the

soaked

in

or

imitation.

says afterwards :
moveri et ambulare

tum

He

quiesest

OctaA-ius Horatianus
the

sun,

cold air,loud

lest these

should

he

vinegar,or,

borne, in wine

cold water.

dressed

is

sore

This
''

dii'ects us

dii'ects

us

to

if that cannot

be

practiceis desernng

Optimum

etiam

medicamen-

nisi sanis alienimi.''

to avoid

the

bath, the fire,

cries,intoxication,
venery,

occasion

of

and

passion,

rupture of the partswhich

had

adhered.
AA-icenna with

his usual

tions
good sense
givesjudiciousdirecfor the treatment
of simpleulcers,but his principles
are
those laid down by Galen.
He defines an
as
nearlythe same
nicer to be

of sanies

"

solution of

pus."

This

attended
continuity,

with

discharge

nition.
defiunexceptionable
He
forbids all oily and watery applications,
and recommends
to observe
that no
the
us
body inten^ene between
lipsof the wound when the bandage is applied. Ehases gives
condemns
similar dii'ections. He
the practiceof those who
or

seems

to

be

an

AGGLUTINANTS.

XXXVII.]

SECT.

put oil into

and

and

wound,

heatingfood.

who

101

allow

the

take

wine

Comm.
*

con-

siderable

precision.Haly Abhas and Alsaharavius follow the

of Galen
alteration.
without the slightest
practice
difference of opinionhas prevailed
Considerable
respecting
the nature
of the clasps(Fibulteayfcrr/ptg)
recommended
by
Celsus

and

maintain

other
that

no

more

suture,but to this
Hist,

de

la

authorities.

ancient

than

opinionwe

and

Le

Clerc

simple interrupted
subscribe. (See Le Clerc,

meant

was

Rhodius

cannot

Med.

CEu^TCs

iv, 2, 5, and Fabricius of Aquapendente

Chirurg.ii,108.) They would appear to have been

metallic

claspsof

SECT.

Oak

the

leaves

peculiarconstruction.

XXXTII.

and
applied,

fruit,leaves,and

the

austere

more

ON

bark

AGGLUTINANTS.

those

of the

of the

soaked

wrapped round in
agghitinantsof fresh

circular

the

cabbage;
juiceof

oxycrate or wine,

The

followingare
the leaves of the pine and
:
wrapped round like a bandage,

wounds

the
applyexternally

must

in

manner.

and their fresh bark

spruce fii',
with water, oxycrate, or wine ; and
we

and

and

mezereon,

plantain,
papyrus

and

willow

cheese

new

leaves of

dock,

or

pounded.
of

vine, or

But
of

of acid milk cures

But cheese made
even
beet,or of lettuce.
the larger sores;
and the wild pears repress the discharge.
The horse-tail (Hippuris)may
be appliedwith advantage,even
if the

tendons

are

diAided

asunder;

and

the

matui*ed

woad

in the
be used to indiuated
bodies even
when
they occur
may
heads of muscles.
leaves and shoots of cypress, and its
The
and

recent

parts,but

soft balls
we

must

(pilulse)
may

mix

with

it

some

be

appliedto
of the

indurated

fine dust

taken

incense
nibbed with water, or frankINIyrrh
the divisions of
and
earth worms,
agglutinateeven
burnt
leaves Avith honey, and garlic
tendons ; also, cinquefoil
and applied. Old ulcers again are
remedied
by barley burnt
with cerate, and by ceruse
with a quadruplequantityof myrtle
For ulcers on the head
cerate.
sprinklediied myrrh, and do
moisten
not
Or,
it, for it will speedilyproduce adhesion.
it
boiled
and
triturated
dried
aloes
or
Ijirthwort,
having
having

from

wall

near

mill.

'

"

similar rules with

lays down

Averrhoes

patientto

SOKES.

INFLAMED

102

honey in wine until it is of

a
pledget and apply it.

with
upon
nants

called the

those

are

Nicolaus,that

to

similai' nature, which

consistence^
spread
compound agglutiGolden^ that ascribed

and
dittany,

and

produce the

can

iv.

proper
the

Barbarous^the

willows

from

Of

[book

adhesion

others
even

of

of very

largesores.

'
"

givesthe followinglist : glutinant

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

Commentary.

CoMM.
'

ovi
bulbi,lini semen, nastuii;ium,
tragacautha,cardamomum,
testis suis
^itis alba,contuse
cum
album, gluten,ichthyocolla,
vel ex vino,
vel ex aqua frigida,
mel coctum, spongia,
cochleae,
vel

ex

etiam

I
j

expressa,

ex

iisdem

lana succida

si levis

plagaest

aranea.

Aetius has a
copiedfrom Oribasius.
for agglutinatlong chapteron the compositionof applications
various :
of them
most
The ingredients
are
ing fresh wounds.
alum,
sumach, litharge,
galbanum, bee-glue,tiu'pentine,
wax,
Actuarius
"c.
chalcitis,
merely extracts a few articles from
Our

aceto

oiu'

author^s

author^

list is

list.

from
scarcelydiffers in any one particular
and nearlythe same
our
author's,
may be said of Haly's. Isaac
bdellium and
commends
particularly
(ap.Ebasis Contin. xxA^iii)
mprh, with honey and wine.
Galen
has explainedat considerable length the principles
should be used.
these applications
Agglutinants,
upon which
and
he remarks, are
austere
astringentmedicines,being such
fibres ;
occasion a contraction and condensation of the fleshy
as
and they must
not
possess detergent properties.They are
applicablein the case of plane ulcers,that is to say,
principally
A^icenna^s

ulcers without

SECT.

To

list

loss of substance.

XXXVIII.

painfuland
remedies

ON

PAINFUL

inflamed
be

(See Meth.

INFLAMMATORY

AND

wounds

Med.

desiccant

iii.)

SORES.

and

matory
anti-inflam-

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
Of diy medicines,those in generalwill applywhich are
used.
must

apphed.

Of

'
'

Cclsus's list is not

CoMMEXTARY.

CoMM.
'

[book

ULCERS.

HOLLOW

104

different from

very

iv.

our

Concoquunt et movent pus, nardum, myrrha, costum,

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

SECT.

ULCERS.

HOLLOW

ON

XL.

the filling
requires
iip of the deficient flesh,
the materiel of which
is a moderate
quantityof good blood.
Wherefore
we
supplyof it by a sufficiency
procure a moderate
of food,and produce a proper temperament of the sore
by food
of wholesome
and a suitable temperament of the part in
juices,
which
the sore
is seated.
With
regard to the discharge,that
The

which
thicker

hollow

ulcer

is thin

renders

makes

the

the

When

be tried.

But

the ulcer
not

than

if the

dried
of

applya

must

we

is melted
those

when

down,

which

melting of

of

so

have

has

and

pain.
being
applications
acute

of these

of
especially

ulcer

than

was

oil.

more

by

less moisture

with

more

with

increased

to be

proper,
It sometimes

strong,that the flesh

that the ulcer appears foul and moist, like
the

is too
application

been

dried
imperfectly
more

inflamed; and
But

the

but

that from

hollow,its lipsare
sometimes

other, which

less desiccant than

characters.
such

dried

mixed

cerate

the flesh becomes

it is red

the

and its powers

are
properly,
is
but
If
it
clean,
honey.

happens

none

and
appear greater,
that the medicine
it is to be understood

natural,the medicine

and

very

it

account

are

sordes

humid,

more

mixture

and

that

on

is

gent
moderatelydesiccant and deterthat of beans
; such as frankincense,the flour of barley,
and pompholyx.
tares, iris,birthwort, calamine, panax,
another must
incarnative remedy does not answer
one

and

it ;

to

that which

and

humid,

more

adhere

sordes

that
requiresapplications

has

sore

Wherefore

the

the

callous,

patienthas

arises from

the

with
proper, is attended
the caries of wood, more

is

degree of
possessed of a moderate
that of the elm, purges
as
astringentand detergentqualities,
and incarnates
clean ulcers;or anemone
be appliedfor
may
the

same

purpose.

as

Having

shaven

down

the bark

of the

pine

HOLLOW

XL.]

SECT.

ULCERS.

105

pounded it with cerate,and rubbed it

it to hollow ulcers,
to such
more
especially
The
will fillthem.
compound medicines
aud

pledgets,
apply

upon
as

recent, for it

are

for ulcers which

are

from the
that ascribed to Manetho
snails,
the dry powder called meletera,
lees of wine, that from aloes,
of halica,
and
that containing
equalparts of starch,of manna,
cense
the composition from frankinof tares; and in like manner,
that from

clean,are,

aphroditarium.But when the iilcers are

of
and
fouler the powders called cephalicare
to be applied,
made
that are
those applications
pledgets,that called
upon
distaff-thistle
the isis and the athena,and that from
trophos,
that called Italicum,and any others
and moreover
(atractylis,)
of tried efficacy.
that called

aud

The

Commentary.

resemblance

here

between

pointedout

Comm.
'

"

ulcer

an

stronglystimulated

too

and

Our author
deservingof attention.
his description
from Oribasius,
who

Galen

Galen.

and

author, but

our

They

but
flesh,
washed

and

incarnant

give a

only pus.

and

the

dissiccant without

shells of

the nature
Celsus
et ulcus

the

same.

oysters ai'e said

Galen

to be

inculcates
out

of the

intemperamentof the part, and correct it.

alit
givesthe followinglist of incarnants : Carnem
implet resina pinea,ochra attice,vel asterace, cera,

tetrapharmacum
and

wholesome
and

than

genders
intemperamentsenPompholyx burnt

pungency.

He recommends
the use
butymm.
of butter,roses, and
consisting
the

are

from

in treating
these ulcers,
is to find
greatestdifficulty

that the

or

borrowed

abridgesit

treatment

in

ones

highly

fuller account

somewhat

in humid

calamine

and

however

frankincense

dry

little is

to have

appears

of
principles

their

that

remark

Aetius

too

one

even

wine.

nearlythe
Octavius

nutritious
The

hst

articles

same

with

Horatianus

as

of hot water;
a

roses.

food, such

of

He

portionof honey ;
of

approves

that of Celsus.

recommends

giving

fowls,venison,pork,

as

of the Pseudo-Dioscorides

parts of honey,turpentine,rosin,and
mixture

small

tion
applica-

an

contains

i, 186.)
(Euporist.

composition of equal

wax,

melted

in

vessel

powdered rosin,wax,
and a composition
Largus recommends
basilicon,
of calPs marrow,
the fat of geese, butter,stag's
row,
marconsisting
and
roses.
honey,
wax, turpentine,

or

Scribonius

and

fat.

"

106
Avicenna

CoMM.
"

ULCERS.

FOUL

remarks^ that

in

[book iv.

treating hollow

ulcers

must

we

'
"

not

use

very

which
soUj

are

desiccative

necessary

for

strength than to remove

mixture
of equal parts
blood.
Camphor
tive

All

is

the

rea-

greater

recommends

and
olibanum, aloes,sarcocolla,

ingredientin

an

makes

gon's
dra-

of his incarna-

one

of

mention

an

apphca-

ancient

authors

say that

round

ulcers

are

more

difii-

shape ; and Cassius Medifor

Alexander
Aphrodisiensisassign various reasons
most
to be, that in this case
probableof which seems

and

this,the
sound

parts

those of any

are

further

Apollonius Dyscolus

other

SECT.

XLI.

states

MEDICINES

hollow

of the

are

CLEANSING

or

other.

in any

prevented from
spleen,and by varicose

that ulcers

FOR

ulcers,whether

than

removed

healingby pregnancy,
by disease
veins. (Histor.
Mu'ab. 42.)

Foul

Rhases

fluids

olibanum, like that of Rhases.

cult to heal than

the

of

sordes.

applications.Alsaharavius

tion from

cus

the

same

abstergentsof any

nor
astringentapplications,

very

the

as
they dry up
applications,
for the
flesh
forming
; nor

FOUL

level with

ULCERS.

the

surface,may

properlycleansed by birthwort in honey,turpentinewith an

equal portion of rose oil and honey, or instead of rose oil butter
be substituted,
with lUyrianiris and honey ; and by pickled
may
olives applied. To
with
nervous
parts, turpentine melted
be applied. When
the sores
butter may
are
very foul and
with
which
horehound
spreading,
honey is a good application,
the eschars.
The
removes
followingare compound appHcaOf boiled lees of oil,of scummed
tions
honey, of the species
alum
called phormion,equal parts. Another
of
Of the diied
of Illyrian
hound,
serapias,called also triorchis,
iris,of dried horeof birthwort,of each, dr. \iij
flour of tares,
; of the
be

"

dr.
the

; use

in

Egyptian

powder

and

is

with

honey.

And

for foul ulcers

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

cerate

criogenes.

WORMS

xLii.]

SECT.

Commentary.

The

IN

ULCERS.

107

the most

are
following

importantartiulcers : Purcleansing

cles in Celsus^s

long listof substances for

Grsecis
a
auripigmentum^quod dpatviKov

gantj serugo,

(huicautem

tur ;

et sandarachse in omnia

eadem

Comm.
'

'
*

nomina-

vis,sed validior

est)squama
seris,
thus,resina,et pinea,et terebinthina liquida,
misy,chalcitis,
galla,sulphur,pix,oleum, ruta, ammoniacum,
"c.
mention
of many
of these,namely,
Hippocrates makes
flowers of copper, frankincense,
bore,
arsenic,verdigris,
myrrh, helle"c.

Scribonius

and a
Largus recommends
iris,
honey, Illyrian
compound application
containingarsenic,scales of copper, ela-

terium,and burnt
One

paper.
find in Galen

may
but
as

of

further notice

our

Aetius

all formed

they are

as

those

and

from

compound cations,
applithe same
dients
ingre-

many
much

author, it will be unnecessary

of them.

Aetius

commends

combination

turpentineand honey.
Avicenna and Haly Abbas recommend
the same
author.
as our
They make no mention of arsenic.
directions for treating
these
givesvery particular
the

edges are hard, he directs us to rub them

red, or to cut them off and applyto the
ointment; and when the ulcer is covered with
he

recommends

Rhases

to

us

mentions

dress it with

the

the

is to stop the
them.

which
fomi

Worms
are

poleywith

He

relates

got

XLII.

the

much

green

sordes,

ointment.

Egyptian
for
application
us

to consider

worse

case

under

much

or

of the former
the

description,
of the
application

form

FOR

in

WORMS

IN

ulcers,the

ULCERS.

thing to be done
which
occasion
humidity and the putrefaction
be killed by all the things in general
may

described

in ulcers

come
they be-

of the ulcer be the effect of too

sore

which

worms

; when

(Cont.xx\'iii.)

SECT.

For

ulcers

sore

antimony as an
He properly
recommends

too little stimulation.

gi'een ointment.

Alsaharavius

excellent

the foulness

in which

of

applications

until

foul ulcers.
cleansing
whether

take

to

for those in the

ear.

first

But

for those

Archigenessays, mix equalparts

liquidpitch,and anoint with it.

of

ceruse

which

and

FUNGOUS

108

Commentary.

CoMM.

Aetius

ULCERS.

[book
dried

recommends

'

'
*

of the wood

of

iigs,and

also mention

Avicenna

Pliny mentions

the

SECT.

The

which
upon

are

squama

Galen

and

gallof frogs.

XLIIl.

ON

FUNGOUS

ULCERS.

removed

powerfullydesiccant,such

it, the

ashes

calamint.

flesh of ulcers is to be

funo-ous

the
plantain,

calamint.

juice of

the

iv.

seris,all the

as

medicines

bv

diphiygessprinkled

testacca

burnt, both

the

burnt
entire.
But the
(thehedgehog and sea-urchin,)
and repress the
following things are moderately cleansing,
fungous flesh : the flower of the Asian stone, and still more

echini

chalcitis and misy

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

burnt,

the

consume

foul

flesh, and

in

like

manner

sumes
charpiethat has been soaked in strong brine and dried,confungous flesh that is moderatelylarge. But verdigris
with the squama
seris is powerfully
pound
repressing. Of the comthe pov.dercalled rhodium, and the psarum,
applications
and that named
yellow,repress fungous growth without being
But the trochisks called phaustiani,
when
pungent.
levigated
and sprinkledon the sore, and the dry medicine
(or powder)
called heliocaes,make
flesh
off"
the bottom.
to
fungous
slough
the application
But
consistingof equal parts of calx viva,
seris and
with
answers
fungous flesh ; with
manna,
squama

honev

it cleanses

such

as

resemble

and

mushroom,

it proves

with

incarnating.
A powder for 'keeping
dovm
of
fungous flesh Of litharge,
of verdigris,
of plumbago, equal parts. Another,
chalcitis,
which
being pungent, and applies
represses stronglywithout
also to spreadingulcers,
and more
the epulisof the
especially
and whitens
the teeth : Of quickhme, lb. j ; of arsenic,
gums,
oz.
yj; baring triturated the diied arsenic with water, add the
like calamine, and, having rubbed
lime washed
them
together
and
And
of
the
t
hat
called
use.
dry
trochisks,
pantolmios,
and those described for polypus, are
excellent for repressing
But the green plasters,
the
fungus in ulcers.
more
especially
cerate

"

ULCERS,

XLiv.]

SECT.

l(t")

from

one

most

tlie isis,
are
Cappadociansalts,and in like manner
effectual in preventingfungous flesh in ulcers.

Commentary.

The

mentioned
powerfulapplications
by our Comm.
author will be found
amply sufficient to fulfil every intention
in conductingthe treatment
of these ulcers.
Many of them
mentioned
are
by Hippocrates.
Galen
it
lays down as a rule that these fungousexcrescences
desiccative substances,such
to be represhedby powerfully
are
when
burnt
as
or
more
misy, chalcitis,
verdigiis;
especially
and washed
they become mild detergents.(Meth. Med. iii.)
Aetius givesmany
useful prescriptions
for such preparations,
which enter into
but they are entirely
formed of the ingredients
'

'^

those

of

our

author.

in such
givesa long list of caustics highlyapplicable
citis,
: Adurunt, auripigmentum,atramentum
sutorium, chalseris,
misy, aerugo, calx, charta combusta, sal, squama

Celsus
cases

nigi'um,cantharides,sandaracha,alumen
"c.
wool,
scissile,
Pliny speaks of a compositionof unwashed
and verdigris.
with barleyflour,
et album

veratrum

Octavius

et

recommends

Horatianus

of
powder consisting
aloe,and quicklime.

and

and

Rhases

Avicenua

copy

the

from

the

Phrygian stone pulverized,

recrementum
digris,
plumbi,ver-

our

flesh
speaks of removing the superfluous

SECT,

XLIV.

ON

SPREADING

ULCERS,

author.
with

an

PUTRID

Haly

Abbas

instrument.

ULCERS,

AND

PHAGED.^NA.

Spreading and

putridulcers

are

to be

bathed

with

\dnegar

oxy crate, an astringentwine, cold water, sea- water, or the

of pomegranate rind, of the flowers of the
decoction of lentil,

and

wild
or

of myrtles,of Egj^tian thorn,

pomegranate, of lentisk,

some

other

to be

astringentand desiccant medicine.

of

the

flower

of tares

Cataplasms
and

liquid'
of similago,an
old goby
alum, the inner part of bread made
pentine
unwashed
other old pickle,
fish,or some
flesh,and liquidturto be all pounded together in equal
; these thingsare
proportions.Or the parts may be anointed with equal proare

appliedto

them

'

ULCERS.

no

[book IV.

portionsof birthwortjand the juiceof tlie leaves of tlie Palma

made
and half the quantityof verdigris,
with water to
Christi,
is not removed
of honey ; but if the eschar
the thickness
an
of elaterium is to be mixed with the verdigris.
equal proportion
and sprinkledon
them
is an
For putridulcers sori levigated
effectual remedy, and above is to be put diied charpie
; or the
be rubbed
round bii-thwort and gallsin equalquantities
may
in with oil; or the root of the wild cucumber, or of cabbage,
of beet, or the leaves of dock are to be bound in a pieceof
or
linen,and put into ashes ; when they are softened triturate
with salt and apply; they will cleanse powerfully. Or apply
green olive leaves boiled in wine with honey ; or apply clialor
or
applylinseed triturated with
citis,
parsleyseed levigated,
of thyme, dried grapes
and
an
use
or
application
copperas,
of figleaves triturated with honey ; or of nitre,
boiled figs,
or
cumin, and fine flour with honey ; or of the root of the wild
boiled with honey ; or of sori,
dr. xij; of
cucumber, or of squill
dr. x ; of misy,dr. iv ; triturate with half an hemina
of
chalcitis,
the strongest vinegaruntil it is dried, and taking it off use
by
dippinga specillumin it,and rubbing it over the ulcer,and
placingabove it a double pledgetout of wine and oil. But if
it is inflamed
apply henbane with polenta,or cabbage with
honey.
ulcers on all parts of the body.
For putrid and spreading
Of quickhme,of chalcitis,
of each dr. ij; of arsenic,
dr. j. This
of the fingers,
for phagedsenaand carbuncle,
may be used for pterygia
with honey if on the genital
organs, but dry if on any
other part of the body. Above
apply an oblongpledgetwith
"

rosin.
An

universally
applicable
powder for all spreadingsores, and
those of the mouth, for hemorrhages,and for represhing
fungous
of misy,of both in a crude state, dr. xx ;
flesh. Of chalcitis,
dr. yj; of immature
of squama
ferri,
galls,dr. viij.
For
Of salts,
dr. ij; of any
spreading and putrid sores.
speciesof alum which has been burnt, dr. j ; of squama seris,
"of burnt
pumice stone, equal quantities. Scraped verdigris,
with bm'nt
misy mixed with liquid pitch; and the flakes of
iron with
For

oil also

answer

well.

spreadingulcers of

applyto them,

and

also the

the

These
pudendum.
things will
compositioncalled mehterium, the

ULCERS.

[book IV.

Arabians, althoughthey supplynothing new,

add their

112

The

CoMM.
'

'
'

authorityin confirmation of the

Greeks assignedto the substances

remedial
mentioned

virtues
above.

which

the

A^-icenna

arsenic,copperas, misy,sori,chalcitis,
flos ccris,quicklime,alum, galls,
ammoniac, the trochisk of
and

recommend

Rhases

T\Tien

Andi'on, "c.
directs

Abbas
state

us

to

part becomes
a

open

things,such

XLV.

SECT.

ox

and

putrid,Haly

leadingto it,if the age and

afterwards to applyodoriferous

vein

patientpermit,and
as
camphor, "c.

of the

black

CICATRIZATION.

REQUIRING

ULCERS

the flesh of ulcers requiring

By drying and constringing
the precicatrization to such a degree as not only to dissipate
ternatural
in
that
which
is
touch
but
also
to
superfluity,
upon
its natural

state,we

may

render

the surface

of

the

sore

like

mature
skin,and make the ulcer cicatrize. This is promoted by imof pomegranate,
the moderatelydesiccant bark
galls,

and

whatever

else is desiccant

astringency.And

without

of
being possessed

such

things as

and
myrrh, litharge,
sprinkledon the sore dry.

oysters if

And

these

promote

gent
puncicatrization

burnt,for they must be

these things often produce

myrtle cerate, ivy flowers with

burnt
"with rose-oil,
dried pine-rosin,
cerate, the root of the lily
pumice stone, the flakes of copper ; they are to be used in
equal proportionsdiy. The following also repress : mix a
and
of diphryges with
small quantityof manna
levigated
of
and
of
or
use
lithai'ge
diphrygesp. ss, apply
pumice,
;
p. j ;
with
frankincense
trizes
cicawith
Birdlime
cerate.
on
a
pledget
old ulcers,also verdigris
with an
equalportionof diphrjges and vtdth myrtle cerate, or the small centaury applied
fresh.
To
the more
To
humid
apply the root of cypress.
and
if inflamed,
those about the anus
pudendum, more
particularly
use
aloes,either in a dry state or with water,
levigated
with wax, and
seris ; or soften chiysocolla
in the sun
or
squama
apply.
A dry application
Of oysters,
for producingcicatrization.
dr. vj; of calamine, dr. iv.
dr. xij; of manna,
also
It applies
Another
to spreadingsores.
Of birthwort^dr. x] ; of pine
cicatrization :

bark

pine

"

with

SECT.

ULCERS.

XLV.]

113

dr. rj ; of pumice,dr. iv ; of Colophobark, dr. vj; of manna,

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
Of the
oz.
verdigris,
ix; of calamine, dr. xviij. Another:
flowers of pomegranate, of
copperas, of each,dr. xvj; of squama
of fissilealum, of each dr. viij
dr. j. Another
:
geris,
; of galls,
Of ceruse, of litharge,
of each, oz. viij
; of the dross of lead,of
of dried myiTh, of each, dr. iv.
galls,
A cicati'izing
of fissilealum, oz. j ; and
Take
ajjplication.
in a sextarius of water : when
having le\'igated
it, macerate
dissolved in the water
soak pledgetsin it,and having dried
"

"

"

them

apply.

the more
Of wax,
plasterfor cicatrizing
simple ulcers.
dr. xl; of-litharge,
dr. xxxv
dr. viij
; of diphryges,
; of myrtleThe plaster
that from
called phcenicinum,
oil,half a hemina.
in
calamine,the myrsinatum,and the like,are also applicable
such

cases.

For

ulcers

of each,
mp-tle-oil,

of difficultcicatrization

Of

wax,

of

dr.

vj; of calamine, oz. vj ; of lead, of

each, dr. ij; of fissile alum, of bm^nt copper,
dr. ij; dissolve them
scrapedverdigris,
singly.

frankincense,of
of each,oz. j ; of
For chronic ulcers,and
such as
of difficult cicatrization :
are
Of calamine,dr. ^iij
dr. "vdij
; of chrysocolla,
; of fissile alum,
dr.

of the flakes of copper, of each, dr. j ; of

viij
j of verdigris,
dr. xl ; of wax, dr. c ; of myrtle-oil, s.
Another
pine-rosin,
q.
Of wax, of pine-rosin,
of each, oz. vj; of calamine,oz. vj; of
crude chalcitis,
and
The calamine
oz.
iij
; of myrtle-oil,
q. s.
the chalcitis are to be triturated with wine during the season
of the dog-star ; use it upon a broad compress, and applyabove
it a pledgetand
of wine.
out
Of burnt
Another
sponge
copper, oz. ij; of fissile alum, oz. ij; of sal ammoniac, dr. ij;
of wax, oz. ^g ; of Colophonianrosin,oz. vj; of myrtle-oil,
oz.
ij; the dry things are to'be triturated in the vinegarin the
for twenty days,and when
it becomes
sun
of the consistence
of honey,having melted
the wax, mix it and soften. The medicine
from pumice-stone,
the isis,
and the like,are also applicable
"

"

in such

II.

cases.

ULCERS.

114

list of
givesthe following

Celsus

Commentary,

CoMM.

[book
the

IV.

more

'

'
'

articles of this class

active
adustis

Crustas

iilceribus

iuducunt,

igne

tanquam

est, flos

clialcitis,
utique si cocta
pr^ecipiie,

seris,ferugo, auripigmentura,
misy, et id quoque

magis

coc-

tum.

For

suitable
varietyof applications

refer the reader

we

to Galen's

of them
ingredients
escharotic.
Many

The
and

recognizedin

compound

For

towards

to Galen

Galen, in

of this work.

of the

account

an

De

Med.

the

isis,and

the end of this

(1.c.)and

another

sec.

will
prescriptions

author's

our

mentioned

medicines

the reader

refer

we

it.

of

book

'

gen.'
astringent,
powerfullydesiccative,

are

of

4th

this class of ulcers,

to

the

to

place,and

giA'ethe followingimportantdirections

other

section,

Seventh

after him

for

the

Book

Aetius,
of

use

be

these

is
applications.The ulcers to which this mode of treatment
being very foul and filled with a vitiated discharge,
applicable,
and then the
first to be wiped clean with a soft linen cloth,
are
caAdtyof them is to be filled with the medicine,and a splenium
(oblongcompress)appliedexternally.Then having put a piece
of linen above
it

over

to

the

and

the sponge

treatment, which

bound
of

squeezedout

sponge

keep

splenium

cold

it on,

we

cold water

or

duringthe whole

place

to

are

vouring
wine, endeatime

of the

easilybe done by pouring cold water

moved
loosingthe bandages. They are not be reupon it without
until the third day. Galen
that the articles
states
which answer
best in such applications
are
galls,
pomegranateand
the
like.
rind,alum, chalcitis,
misy,
may

similar mode

of treatment, without

is described
that

the

by

medicines
cicatrizing

such
astringency,

SECT.

XLVI.

ON

as

THE

Old

ulcers

chironian, as

which
if

from
telephian,

Haly Abbas
desiccative
powerfully

are

and

MALIGNANT

are

material

Arabians.

alum,
galls,

AND

any

tion,
altera-

remarks,
with

some

the like.

ULCERS

CALLED

CHIRONIAN

TELEPHIAN.

difficult to

get cicatrized

are

requiringChiron himself to cure them

Telephushaving long laboured under

called
; and

such

We

sore.

in

and

attend

must

then

115

whether

of

cacochymy,sends such
is to be
humour
prevailing

state

the

remedies.
the

ULCERS.

XLVT.]

SECT.

Or

legs,the

if it is

varix which

the

whole

defluxions
evacuated
sends

body
the

to

being

ulcer,

by appropriate

these

humours

to

being in it,it is to be cured as will be

described in the Surgical
part of this work ; or the humours
quently,
to be evacuated
are
by venesection, taking away blood freand then
have the
which
using topicalapplications
the disease without
property of extirpating
being pungent.
These therefore are simpleapplications
those
from
pumice and
;
and flakes of copper, verdigris,
and hme moderately
diphryges,
fissile alum
of unwashed
washed; sprinkle
or
wool,
levigated,
dr. iv ; of dried grapes, dr. iv ; of natron, dr. ij; having previously
anointed
with honey,sprinkleof flakes of copper, dr.
X ; of alum, dr. ij and
having softened in the sun with dr. x
;
of wax, apply.
These

ulcer

compound medicines. A plasterfor chironia. Of

ceruse, oz. viij
; of fissile alum, oz. ij; of the flakes of copper,
dr. ij; of sal ammoniac, of frankincense,of scraped verdigris,
of pomegranate rind, of each, oz. ij; of quicklime,oz. j ; of
lb. j.ss ; triturate the dry thingswith
wax, lb. j ; of myrtle-oil,
At first it removes
wine.
callus ; and it is laid by and kept,
and at last when
trizes.
it cicaused, being softened with myrtle-oil,
Of litharge,
lb. j ; of oil,lb. ij; of black
Another
:
of each,
chamseleon,of the roots of birthwort,of immature
galls,
are

"

oz.

of

j;

each, oz.
From

legsand
lb.

iij
;

galbanum, of ammoniac
perfume,of frankincense, of
Avith the roots of green reeds.
ij; prepare, stirring
Archigenes,for chironia,and malignant ulcers in the
breast,for struma,

and

parotis.

Of

the fat of

ox

an

of

oz.
oz.
v ; of manna,
turpentine,
vij: of the earth
called sarda which painters
use, oz. v : ha^dngput the soluble and
dry articles togetherand melted, use.
Another,of Archigenes:
"

Of

iv ; of oil of
of diphryges,
of the
oz.

wax,

tritm-ated the
of

powder

honey, mix

Another,for

having a

the

of burnt

Of

the cerate, and

Tuscan

lead,and

rose-oil

or

manna

cense,
of frankin-

ing
flakes of copper, of each, dr. iv ; havwith vinegar,
and made
thickof the ness
use

malignantulcers

soft skin

pledgetwith

with

unripe olives,of

a
pledget.
upon
and of other persons
"

of women,
pentine,
wax, dr. viij
; of bulls^ fat,of tur-

of pepper,

mvrtle-oil.

of

each,dr. j ;

use

on

ULCERS.

116

Celsiisdescribes the chironian

Commentary.

CoMM.
"

'
"

"

[book
ulcer

IV.

being

as

large,and having hard, callous,and swelled edges, with a

mation,
copiousdischargeof thin sanies. It is attended with no inflamthe pain is moderate, it does not spread,and therefore
cured.
it is not dangerous, although not readily
Sometimes,
and then again
he says, it becomes
covered with a thin cicatrix,
It occurs
the ulcer breaks
out.
mostly in the feet and legs.
it is evident that by the chironian ulcer
From
this description
tinguishe
Celsus meant
merely an ill-conditioned ulcer,and that he disbetween
it and the cacoethes,or malignant ulcer,
Howwhich last he held to be nearlyallied to the carcinoma.
of the Greek
authors
applythe term malignant to
ever, most
the chironian

ulcer.

the

For

of it Celsus recommends

cure

lead burnt
?eris,
application
consistingof squama
calamine,wax, and a small quantityof roses.
Galen

furnishes

Thessalus

the

ulcers.

treatment

of all

He

proposed to
Thessalus
lays it

sores

adds

convert

In

"

must

the

into the

sore

heal

and

up

when

break

as

ulcers

rale

cure,

and

for the
which

or

excitingcause,

the

means

of

state

inflammation
and

down

parts which

the

remove

having allayedthe
which

of chronic

cases

all chironian

cure

remove

washed,
in which

manner

difficult to

are

again when healed,to

local or constitutional,
by

healed,we

sores

which

out

wdiether

of the

account

an

INIethodist

malignant
break

Avith

us

and

an

of proper alteratives.
which
be got
cannot

prevent adhesion,and
recent

ulcer; and

then

proceed accordingly. Those

againduring their

out

ulcerated,are

to

be

cured

like

bations,
exacer-

recent

flammati
in-

until the irritation subside,

by soothingapplications
after whicli cicatrizing
to be used, and
are
applications
then the sm-roundingparts are
to be covered with a malagma
of mustard, or some
other rubefacient and alterative,
to remove
the indolence.

If this is not

we
sufficient,

must

attend

to

the

generalhealth, attemptingto efl'ecta change of the system by

diet increased
diminished
a
or
repeatedexercise,gestation,
and at the commencement
minister
accordingto circumstances,
by ademetic of radishes,
the white hellebore."
an
even
or
plays
(Galen,INIeth. INIed. iv.) Although Galen, who all along disto the Tltessalian asses, (so he calls the
a
strong hostility
in severe
the rules
terms
Methodists,)has animadverted
upon
here laid down, they would
appear to be highlyproper and in-

XLvi,]

SECT.

ULCERS.

117

geuious. Galen in another place (Med. sec. gen. iv) givesComm.

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, scrapedverand larch rosin.
Others by Andromachus
digrisj
wax,
tain
consori,misy,chalcitis,
and
verdigris,
alum, turpentine-rosin,
the like,mixed
with wax.
Hippocratesdirects us to treat a
callous ulcer by applyingto it septicmedicines
to make
the
hard parts slough off,after Avhich the edges are to be
brought
in
locis
together.(De
homine.)
The directions of Aetius,more
the constitutional
especially
respecting
where
treatment, are highlyimportant. In cases
'

"

there is

redundance

others

both

directs

us

He

opening a

bleeding;and

attention
of

case

vein

off the

cut

and

purging

to pay

relates

of blood he recommends

to the

ulcer

an

leadingto it.

callous

for

edges of
of

sores

He

in
venesection,

in

certain

he

cases

hand,

which

also directs

the idcer.

spleen.
by
or
scarify

he

cured

to

us

He

givesvarious prescriptions
description,
containingverdigris,

this

burnt
sori,chalcitis,

copper, alum, "c.

Horatianus
recommends

Octavius

equalparts of chalcitis,
wax,
mentions

old

an

and

alum.

shad-fish triturated

plasterconsistingof
For phagedsente
Pliny
with
saudarach.
(H. N.
a

xxxii,44.)
Tlie Arabians

treat

particular
gives very
When

treatment.

of these ulcers very fully. Avicenna

in
proper directions for the constitutional

the

state

intemperament,it is to
in

when

venesection

sore

down

are

is

the

on

is to

and if the
corrected,

recourse

blood

is to be remedied

contraryit

be had

is occasioned

is connected

to, and

by
with

if the

and

those

copper, copperas,
and

oil.
but

it.

remove

The

to the

an

proper

plethora,

leading

When
are

the
to cut

His

used

alum,

by

is deficient

veins

it may
be proper to open them.
varicose,
kept from healingby a spiculumof bone, we

as
ingredients

wax

of the ulcer

this
quantityor quality,

diet ; and
to it

be

consist of the same

applications
by the Greeks, namely,the flower of

lime, arsenic,"c.,

ceruse,

directions

givenby
He

Rhases

are

mixed

with

less circumstantial,

directs us to
particularly
the callous edgesby friction,
and septics.
remove
scarifications,
He speaksof turpentine
excellent addition to other ointas
an
same

"

of the liver and

state

the

on

'

purpose.

CICATRICES.

118

'

"

"

nant

ulcer

the

on

connected

leg

that in

mentions

(Contin. xxviii.) He

ment.

CoMM.

[book
of

maligopened the

case

varix,Galen

with

iv.

enlargedvein.
The

of Celsus

cacoethes

tangere by Theodoricus

me

however

very

to

the

retained

been

has

evidentlythe

was

disease called noli

absurd

which
appellation^
present day. Celsus has

recommended
to carcinoma^ and
pointed out its resemblance
of treatment
does any good in these
the only mode
which ever
such as arsenic,
of septics,
lime,
quickcaseSj namely, the application

"c., or the actual

us

to enlarge further

this

on

to No.
referring

with

As

cautery.

subjectat
of the

108

XLVII.

FOK

Let the root of the white

reduced

they are
take
in

away

black

to the

scars

from

lichen, and

all other

by anointingthem

with

triturated with

gall of

be rubbed

in Avith

with

perfume

the

may

be

kinds

the

wine

rubbed

in like

with

litharge
;

austere

til
bryony be boiled in oil unjuice,and the oil appliedwill

of

so

wine, and lithargewashed

CICATRICES.

black

state

and

tent
con-

'

BLACK

and

must

present,we

permit
be

Edinburgh Medical and

given a full expositionof the
(See also the Commentary on

SurgicalJournal,^where we have
of treatment.
ancient principles
s. xxvi of this Book.)

SECT.

limits will not

our

white
are

fat of

goat, of
or

for the
in with

rose-oil.

made

asses
an

Iambus
same

calamint

manner

; or

ox,

the
and

other

scars

skin

seed of rocket
of

foot burnt
purpose

the

But

like the

boiled

sheep may
may

be triturated

; or, ammoniac

swines'

pound
gall. These are comof mint, of frankincense,equal
litharge,

: Of
applications
of natron, of ammoniac
parts with honey. Another
perfume,
of sulphurvivum, of myrrh, equal parts having triturated with
;
not
vinegar,white wine, or water, rub in but a very little,
as
so
ulcer.
to produce an
Another
Of Cimolian
earth,of pigeons'
dung, of soap, of frankincense,
equal parts with vinegar. A
detergentointment 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.
:

"

"

120

[book iv.

ULCERS.

moderatelyincarnated you may apply

of the agglutinating
some
medicines,as if you were curinga case
of recent bloodywound.
those called the barbarous,
Such
are
from
that prepared
especially
dichromos,and gilvus
; and more
If the sinus is

manner.

is
which
palma Christi and the metals without wax
After the applicalled the dun plasterof Galen,is applicable.
cation
of the medicine,a recent
sponge out of wine and honey,
in a soft manner,
wine alone,is to be put on particularly
or

the oil of

and

the

and

end

bandaging is

firmly,
yet so as not to occasion pain,
graduallyrelaxed towards its orifice; and the
put on should be so cut as to leave an opening

to be

which
plaster

is

orifice for the

plasterof
state,so

bind

bandage should

of the sinus

ought

at the

folds of the

of the sinus

bottom

at the

commence

The

at its orifice.

the bottom

but

to

the

as

same

escape
materials

of the matter, but

should

be

appliedto

discharge. This

to favour the

another

it in

is to be left

small
loose

on

till

bandages are loosed,which is to be done on the third day,

when
tion
they are to be taken off"and changed, but the applicawhether
the
You
left.
be
along the sinus is to
may judge
if the matter
bottom of the sinus has adhered,from obser^'ing
at all ;
be small and well concocted,or if there be no discharge
and moreover
if there be no sensible pain alongthe sinus nor
but the whole part is contracted,
dry,and free from
swelling,
the

if you
still more

But

pain.

see

littlewell concocted

pus

at the

orifice,

entertain good hopes. If on

confidently
the
thii'd day a thin ichor be dischargedfrom
or
sinus,you need not despairthat adhesion has taken place,for
often the strength
of the medicine squeezes out from the parts
below a thin fluid,
which being dischargedthe parts become

you
the

may
second

drv and

adhere.

opening,you

and

if

on

the third

or

fourth

day from

the

from
as it runs
appear imconcocted
be sui-e that the sinus has not adhered,

the matter

commencement

the

But

may

with the same

application.When
persevere
is not unlikely,
of the part it falls off,
to the moisture
as

you

owing

must

it will not

be

make

improper to

some

change in

the medicine

itself.
On

sinuous

over

thin

coveringof

skin.

AYhen

the

long opened,owing either to the unskilfulness of

of the patient,
the skin which lies
surgeon, or the timidity
be removed.
thin and ragged,and it cannot
it becomes

abscess is too
the

ulcers ivith

ULCERS.

XLviii.]

SECT.

121

syringingwhich has been described^we must

of a humid
have recourse
to an
sistence,
conapplication
agglutinating
from
that
chalcitis
such
but of desiccative properties,
as
dibited with old oil,so as neither to be verycalled phoenicinum,
of such a consistence as not to stain the finger
hard nor
; and
afterwards
it is to be mixed with moderatelyold wine, and applied
with
in a circular form
correspondingbandaging. To
skin in this ragged state honey, as was
said,is not one of the
when
boiled to the consistence of a
least proper applications
and applied.It will be better,
however, if after spreading
plaster
sieve
it
from
some
a
it on the rag you sprinkle
over
myi-rh
all
of
these
gether.
toor
aloes,or frankincense,or
pulverized,
finely
after the

then

I have

for the

the lesser

puqaose

same

centaury

to it is

; next

wonderful

plication
ap-

comfrey,after which

and after these is the flour of

iris,
Illyrian
Sometimes
during the process of boilingwe sprinkle
the vessel is about to be taken off
the honey when
upon
of the

is the root
tares.

these
from

also found

off,and

then

better,however, to do so after it is taken

it becomes
to be stirred about, and when
sinus,and bandaged as aforesaid.

It is

the fire.

it is

tepidappliedto

the

Similar directions

Commentary.

given by

are

Galen

and

Comm.
'

'

author are
the whole those of our
superior
;
upon
those of the other two supplyno additional information,

Aetius,but
and

as

be

it wiU

multiplyextracts from
ii.)
dii'ects that
briefly
manner,

to
unnecessary
Therap.ad Glauc.

Galen,
Actuarius, in like
sinus open

downwards,

it shall be

cut

In

by

the

the

translations of the
of absconsio

names

the

sinus differs from

its

edges

rules of
he
the

and

smeared

orifice of

it should

with

the

when

only

states

that

and
having a largercavity,
He
lays down very correct
Thus
all copiedfrom Galen.
is above the cavityof
the sore

the fistula in

be

he
accomplished,
conveniently
tent

Avicenna

caverna.

being indurated.
treatment, but they are
the

unless

Arabians, the sinus is described

not

when
directs,
sinus,that

(See

and dressed with

open
think weU
of the case,

apphcation. You may

agglutinative
and free from pain,or
the part is drj^
he adds, when
from it.
a littleweU-concocted
pus is discharged
an

them.

some

cut

open

or,

recommends

incaruaut

or

if this cannot
us

to

introduce

be
a

detergent application.

FISTULA.

122

Upon

CoMM.
'

'
"

the

of
authority

Dioscorides

[book iv.
he

recommends

the

lesser

of
His directions for the application
centaury in such cases.
similar to those of our author.
the bandages are
do not treat of
Celsus,and other of the ancient authorities,

the sinus

from
separately

SECT.

Fistula is

the fistula.

XLIX.

ON

callous sinus formed

FISTULA.

for the most

from
deriving its appellation
(fistula).If,therefore,it terminate with

the

and

scesses,
ab-

part from

pipesof

bone, it

reeds
be

cannot

unless in process of time a

operation,
surgical
off spontaneously.But if it does not
scale of the bone
come
for
terminate with a bone, it is to be cured by the applications
The
and the agglutinative
medicines.
removing callosities,
for removing callositiesare such as these : the root
applications
the callus
of spondyliumscrapedaround and appliedremoves
of fistulte. And
in like manner
black hellebore applied
removes
the callus in two
jected
three days; also lees of oil boiled and inor
with some
and injected
; sori in a crude state,or burnt
with hydromel. Or
diluted wine, or sori and
crocomagma
make
and apply.
coUyriaby mixing elaterium with turpentine,
This melts
Or syringewith the juiceof the root of laserwort.
down
the callus : of verdigris,
dr. xij; of ammoniac, dr. ij;
mix with vinegar,and form into an oblong coUp'ium.
A collyriumwhich I use for reynoving
the callosities offistuloi.
Mix with vinegarequalparts of ammoniac
perfume,of copperas,
of verdigris,
of misy, of chalcitis,
and of gum.
Another, from
works of Heliodorus : Of calamine,of misy,of copthe surgical
peras,
cured

without

"

of burnt

to

citis,
of each, dr. iv ; of crude chalcopper, of gum,
dr. iij
with the urine of a young
; mix
person not come
manhood, and form collyria.Put this collyriuminto the

and
fistula,

soaked

the inner part

applyexternally
water, changing it until the inflammation

of bread

eschar fall off". Another, which

in Alexandi'ia

"

the roots

of

I received

in
the

subside, and

Of

alkanet, of toasted

of verdigris,
misy,of chalcitis,
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,
"

dr.

FISTULA.

xLix.]

SECT.

purest honied water;

be used.
callus,incarnants must
of the

quantity

discharge of

with

; but

water

shells,

coUyria,and

form

water

the

:
collyrium

myrrh, of aloes,of frankincense,of

Of

rind,equalparts,mix
gall. The oil of unripe olives
knew

callus is

cinders of egg

of the

myrrh, of ammoniac,

Another

"

the

incarnative

An

equal parts; having triturated with

apply.

the

when

after the

but

of aloes,of

and

use,

and eighttimes
verdigris

with

off,cleanse

thrown

and

ammoniac

with

mix

j;

123

use

some

pomegranate
bull's

injected, I

is incarnative when

and
ceeded
sucinjectedcedar-rosin into fistulse,
course
surprisingly.After it is incarnated we must have reto the agglutinative
medicine, accordingto the plan
person

who

the fistula is

When

"

described for other sinuses.

and

narrow

long," says Galen, and does not appear to me to contain

but only sordes,I first inject
callus internally,
lye into it,and
then allowingit to remain in the fistulauntil I expect that the
cine."
sordes has fallen completelyofF,I afterwards apply the medimentioned
It was
the one from the oil of palma Christi,
"

above.

treatise
Hippocratic
Celsus

treats

This

'

in
Fistulis,'

De

fistulse with

of

occasion

have

shall

We

Commentary.

"

described all the

with

He

directs

an

with
inspection

probe or

to

sound,

alto,

of it
complications
commence
by making

has

us

Comi

so

to

as

ascertain

the

parts and of the discharge. If a soft body is felt

in the
conclude that the fistula terminates
at the bottom, we
that it ends with a
know
is felt,we
but if a hard one
flesh,
the bone, it is free from
over
If the probe slide readily
bone.
state

of the

but
caries,
it,caries

if it does
has

taken

not

so, and

place,but

unequal and rough,the

bone

yet

no

are
inequalities

it is still smooth:

is eaten

with

caries.

felt

on

if it feel
For

ple
sim-

the plaster
joint,
will be sufficient,
for recent wounds
providedsalt,or alum, or
or
the scales of copper, or verdigris,
any of the other metals,
is to be made
a piece
be added to it. The application
upon
it,
soaked in vinegaris to be put over
of linen,and a sponge
live
the fifth day. The patientmust
and is to be removed
on

and recent

in
not deep-seated
or
fistula,

nuteness.
mi-

est ulceri

nomen

angusto, calloso.'^ He

great accuracy.

the

"

wonted

his

than
Id

refer to

Book.

Sixth

the

more

is his definition :

to

FISTULA.

124

CoMM.
"

If the fistula is at

nutritious food.

upon
'

"

emetics
prsecordia^
When

[book

with radishes

said

are

distance from

him

by

iv.

the

to be proper.

callous^and requiresstronger

the fistula is old it becomes

as
calamine,atramenapplications,
containingsuch ingredients
tum
lime, orpiment,or realgur. He
sutorium,verdigris,
galls,
mentions
solution of ammoniac
as
a
a
very ready application
in vinegar,
added
with some
to it.
However, he remarks,
verdigris
the
caustic
Avill
same
accomplish
purpose.
any other

If the fistula is

and

long

at its commencement,

When

he recommends
in

after which the

the fistula is

be

collyrium
may

applied.

consists of still more

double,or

to blow

us

incision is to be made

transverse, an

in with

a m

passages,
the medicines

riting
pen

powder, or to applythem dissolved in wine,

mulse, or \inegar. But whatever the internal dressingbe, he
recommends
the outside of it somethingof a
to apply on
us
and repressing
refrigerant
nature, as the parts around are generally
affected with inflammation.
When
the dressings
are
moved
rethe fistula is to be sj^iugedwith wine if the discharge
with vinegarif its edges are callous,
of the pus is copious,
but
the form

with

mulse, or

the

By

of

means

be

passage

it will
describing

been

have

we

of tares, if the

decoction

clean.

generally
happen,

he

and
says, that the inner coat of the fistula will slough oft',
leave the ulcer in a clean state.
Agglutinantsare then to be
a sponge
applied,
especially

the sides of the fistula

lest

they do

ulcerations

apt

not

of the

adhere

to

In the

to

Euporista

use

be

often

in

see

fingeris

one

to another.

first to
then

clean there need

honey. When
no
apprehension

adhere, since,he remarks, we

fingersthat without great care
'

'

are

with boiled

smeared

of the

dilate the fistula with

is

mended
recom-

piece of sponge, and

moniac,
amapplication
containingverdigris,

stimulant

it
Pseudo-Dioscorides,
a

"c.
Aetius
borrowed

from
When

extracts.

done

givesan

without

directs

us

for

to

excellent

Galen.
a

of

account

We

can

afford

fistula extends

it is

only for

introduce

examining into

mostly
a

few

obliquely,
nothing can

be

room

free

making

alone
experience

but
fistula,

for which
incision,
sound and cut along it.

he
purpose
His directions

the

are

nature

have

ample
decidedlyof opinionthat,except in
could

of

fistula

dictated.
cases

of

He
a

such

seems

recent

as

to be

or
fistula,

SORES.

!".]

SECT.

125

incision ought alwaysto be made

Comm.
an
deep-seated,
for removing the callus may
at first; after which
applications
be used.
When, however, the patientrefuses to submit to an
be attempted
operation,and the case is recent, the cure
may
of escharotics and incarnants,such as verdigris,
misy,
by means
alum, "c., mixed with frankincense,aloes,and myrrh.
mixture
white hellebore,
of
Oribasius
recommends
a
briefly
and ammoniac, and a few other such
equal parts of verdigris
for fistulse.
as
articles,
applications
several compound applications
Scribonius Largus mentions
alum, "c.
verdigris,
containingmisy,chalcitis,
of ceruse, ammoniac, and oil.
Marcellus givesone
consisting
of the nature
Actuarius
gives a brief but distinct account
it is not

when

'

'

and

of

treatment

but
fistula,

entire from

almost

it is taken

our

author.
inculcates

A\'icenna
free
with

that

fistula is

in Haly
interesting
a

diseased

healing,and
hope of recovery
the

upon

corrosive
with
case

the
when

The

is the

bone

not

'

cured

be

by a
by bm'ning

or
incision,
by removing the callous sides of it
fire or caustic medicines,such
as
arsenic,ammoniac,

This

the flour of copper, or mercury.

in such cases.
of the medical practice

that

only to

inculcates

in fact is the

phur,
sulsum

is

There

nothing particularly
Alsaharavius truly states

Abbas.

of

cause

common

that in this

fistulous ulcers

there

case

be

can

no

Rhases,
portionbe removed.
of the celebrated Antyllus,
directs us to use
authority
fistula cannot
be operatedupon
when
a
applications
the
scalpel. He intimates that this is particularly
the disease is seated in the groins.
until the carious

earlier modern

Arnoldus, Rogerius,Rolandus,
of the

such

surgeons,

as

and

Arabians, dii'cct fistula

Guy
to

Gulielmus
of

de

Cauhac,

be treated

by

Saliceto,
in imitation
the

cation
appli-

the actual cautery,or incision.

Rogerius
septics,
tent
recommends
a
spread with quicklimeand soap, or with
arsenic.
Guy of Cauliac,like Avicenna, speaks favorablyof
corrosive sublimate.
sublimed quicksilver
or
of

SECT.

Some

sores

time become

L.

SORES

FOR

which

have

inflamed

and

WHICH

become
break

BREAK

OUT

AGAIN.

often
cicatrized,
out

again;

for

after
a

bone

no

long
being

'

[book

THORNS.

126

and

appears sound,
placefrom the
and

then

is the

pus

flesh which

the

diseased,sometimes

but in

which

of

Dry

supervenes,
What

cicatrix.

the

corrodes

ulcers ?

such

up readily
defluxion taking

strong
below, inflammation

corruptedbone

is formed

cure

it heals

covers

short time

iv.

diseased

the

bone

to

it may
exfoliate. But the diseased part of
the bone
easilybe brought up if you applya cataplasm,
may
of fig leaves triturated with fine dried barleyflour
consisting

such

and

degreethat

wine.
and

fennel

'
"

bane
applyequalparts of the reed of hentriturated together. The root of hog's-

may

you

of copperas

the laminae

removes
speedily

Commentary.

CoMM.
'

Or

givessome

copied from
such as one
prescriptions,

This

additional

of bones.

Aetius, who

is

chapter

consistingof

the scales of copper, frankincense,

alum, sal ammoniac, pomegranate
another
rind,and ceruse, with or without cerate ; and

of
consisting
Avicenna

red

finelytriturated

arsenic

bear's fat.

such
strong attractive applications,

recommends

of the leaves of
plaster
another
containingthe

with

figleaves

the black

with
poppy
sutorium
atramentum

as

and

(sulphateof

copper.)
SECT,

LI.

ON

ULCERS

IN

THE

JOINTS.

jointsbeing drier than the fleshyparts,they therefore

desiccative applications.
fore
Whererequirewhen ulcerated more
the trochisk of Polpdes, when
rubbed
with wine until of
the consistence
of the sordes of baths,is an
excellent application
and
in
like
all
medicines.
desiccative
manner
equally
;
And
have seen
them
benefited by bathing with sea-water
we
and brine frequently.Wherefore
cative
the most desicmust
we
use
to the joints.
applications
The

CoMM.

Commentary.

SECT.

LIl.

THOSE

This is copiedfrom Oribasius.

THINGS

THORNS,

WHICH
AND

EXTRACT
THE

(Synops.vii,19.)

SHAFTS,

JAVELINS,

LIKE.

Javelins,
reeds,and shafts,and thorns,are extracted
two
with
pimpernels,the round birthwort,ammoniac

by the
honey.

128

[book

HEMORRHAGE.

around it,or
done, either applya ligature

iv.

cut the vessel

asunder,
Sometimes, too,
by which means
you will restrain the blood.
to largeveins,and also occawe
are
obligedto applya ligature
sionallv to

asunder

them

cut

We

transverselv.

sometimes

are

di'iven to this

with regardto veins which arise from

necessity
when
a
through a
deep-seated
they run
place,more
especially
narrow
or
importantparts, for thus the portionswill
passage
be retracted

on

either

and

by

the

covered

to do both

these

vessel

then

and

wound

is to be

side,and

parts above

will be blocked

the wound
But

it.

the

up
is
safer practice

to the root of the

things,applyinga ligature
dividingit. Hanng done these things,the

incarnated

before the
possible,
nated,
incarit is not speedily

quicklyas

as

ligatureslipfrom the vessel. For if

but the emptied portionis dilated,the
aneurism

artery that pours

of

an

You

artery is brighter and

whereas
pulsations,

called

whether
it is a vein or
know
may
forth the blood,from this,that the blood

is formed.

an

disease

that

of

is evacuated

thinner, and

the vein

and

is blacker

by

without

pulsation.
The

know,

excellent of all the incarnative

most

is that used

of the

neck,

with

brain,and
for those

medicines

for hemorrhagesfrom
safety
which

may

be

used

which

we

the meninges
of the

in woimds

jugularveins ; for it will restrain

the bleeding
from them without a ligature.
It contains of the fattest
when
frankincense,p. j; and of aloes,
appbed to soft bodies,
too hard, an
and instead of the
equal quantity,
p. ss ; but when
even

frankincense
mixed

with
of

of

hare

is to be
we

of the

manna

the white

is to be
of

honey, when

to

put

the whole

; and

wound

the first fom*

externally,

to make

if the medicine

should

to

be

of the consistence
egg until they become
it is to be appliedupon the soft down

or

from
on

bandage
of which

five turns

upon the bleedingvessel,and

to the root of it. Then
ha^^ngloosed it

are

are

an

the vessel and

on

These

substituted.

thence

the third

tend
ex-

day,

still be

properlyappliedto the wound,

to put on another one
all around,soakingit,as it were,
we
are
and then bandaging. But if the first pledgetcome
away of
the fingeris to be pressed gently
the root of the
itself,
upon
and it is to be removed
vessel,so as to prevent all discharge,
softlyand another pledgetapplied. Thus it is to be treated
until the

vessel heal up, the

upiight posture being

still pre-

HEMORRHAGE.

Liii.]

SECT.

129

pain. Those thingswhich form

exposed than it was naturally,
sloughsrender the part more
off of the sloughs
a
cases
owing to the falling
; for in many
hemorrhagewhich can hardlybe restrained supervenes upon the
to
off of the sloughs. And
falling
yet we must have recourse
for
A greatnecessity
them
when a greatnecessity
compelsus.
the bleeding
when
cauteries with fire,
occurs
or
using escharotics,
proceedsfrom the vessels being corroded by mortification ;
served,but

so

not

as

indeed,when

and

to excite

in such

part,it is safer

to

afi'ectionswe

cut

its root,

it were,

burn, as

off the whole

tified
mor-

to

or

use

especially
happens more
upon the
The object
of escharotics is to produce
pudendum and fundament.
in chalcitis,
heat with astringency,
as
misy,and copperas.
Those from quicklimeare
stronger indeed, but owing to the
fall
of astringency
in the lime, the eschars from them
want
sooner
away ; but it is better that they should remain longer,
at their root,
for thus will flesh have time to form pre^iously
escharotic medicines.

and

become

it

as

were

This

cover

to

the vessels.

In such

cases

when
sprinkled
sativa)
(isatis
upon
the bleeding,
the part is excellent for restraining
or burnt
galls,
in
and extinguished
but they must
first be heated in the fire,
The
followingSimples stop hemorrhages :
vinegaror wine.
of

hemorrhage matured

woad

Samian

Aloes,frankincense,
manna,

earth,the

of

rust

iron,the

powdered,the dung of an ass or of a

finely
of bitumen, pomegranate-rind,
diphryges,
horse,a small quantity
whether
crude
kinds
dried
all
of alum
or
burnt,
galls,
myrtle,
ashes of burnt

wool

of the

the bark or green leaves of the vine,and the down

rosin,
when
the vessels
especially
peelsof the planetree, more

throw

off their

roasted

sharprush,the

hemorrhage from the

particular,
of the fruit of the
restrained by the application
burnt anthyliis,
juiceof nettle leaves,chalcitis,

the down

hare,the middle

nostril is to be

of

crusts.

with

an
vinegar,

with

frankincense

In

part of

ferule when

burnt

dung dry or moist,the juiceof leeks

applied
upon lamp-wick. The followingare

ass^s

all kinds
compositionsfor restraining

of

hemorrhage

HaA'in^.

and smeared it with bitu-fresh sponge in liquid

pitch,
of the ashes of it,p. ij;
bum
it in a new
pot. Mix together

soaked
men,

lead,p. j ; of antimony,p. j. Another : Sprinkleon the

of the manna
of frankincense,and sulphur
part equalquantities
of
vivum.
Another : Of chalcitis,
dr. viij
; of frankincense,or
of

"

"

II.

HEMORRHAGE.

130

[book iv.

rosin,dr. viij
; of burnt gypsum,
of burnt
di*. viij. Another,an escharotic st}"ptic
: Of
chalcitis,
of roasted misy, equal parts. And
the
of copperas,
copper,
medicine called the Rhodian, and that called the yellow,are
dr.

its manna,

of roasted

xvj;

"

excellent
CoMM.

styptics.
See

Commentary.
et

alibi)
; Oribasius

Celsus

Galen

(v,26);

(Meth. Med.

Collect, x, 22 ; Morb.

(Med.

Actuarius

Synops.y\\,20) ; Aetius
Palladius (Comment, in

\,

36
Curat, iii,

Med.
(]\Ieth.

51) ;
(xiv,
yi,4);
ed
Dietz.
ii,189) ;
Hippocr.Epidem.
Ayicenna
Averrhoes
Albucasis (Chirurg.
4, 2, 16) ;
i,58);
(iv,
(in
and
A^'icennse Cantic. ii,2,
CoUig.\i\,23) ; Serapion(v,16);
Halv

Abbas

(Pract.iv,21);

Ehases

(Divis.i, 139; Contin.

xxAiii.

the
with

is often

to what

Contrary

ancients

been

have

to

appear

in modern

works
well

very

of

gery,
sur-

on

acquainted

Celsus

directs us
hemorrhage.
when a dangeroushemorrhage is apprehended from a wound,
with
to fill it up
dry pledgets,then to apply a sponge
squeezedout of cold water, and to make pressm-e -with the hand.
If

the proper

stated

treatment

bleeding

the

does

pledgetsoften,and
vinegar.
means

if

dry ones

escharotics

he directs
fail,

to

change

to soak

answer

except in m'gent

us

us

he recommends
cases.

us

seize upon the vessels

ha^dngtied them in two

the

them

not

When

to

pour forth the blood, and

the wound, to cut them asunder, so
stillhave

directs

do not

fear of inflammation

For

caustics and

stop, he

not

to

in
use

all other

which
(vense)

placesabout

that

they may contract and

shut iip.
If circumstances prevent this
they are to be burnt with a red-hot iron.

their mouths

from

being done,
He also speaksof stoppingbleedingby re^iilsion,
for examas
ple,
by applyinga cupping-instrumentto the hindhead for
bleedingin the forehead.
Galen has treated of this subject
at great lengthin the Fifth
Meth.
Book
of the
Med.^
"When
from a
blood is discharged
tvounded artery,he directs us to applya fingerto the orifice of
the vessel firmly,yet so as not to occasion
pain,and thus a
'

thrombus

-^^11be formed

the vessel is

that will

deep-seatedhe

into its situation

arteiyor vein

and

advises

size,and

after which

stop the flow of blood.

to

it is to

us

to

examine

ascertain

acciu-ateh'

whether

be seized with

When

it be

hook

an

and

HEMORRHAGE.

Liii.]

SECT.

If the flow of blood

twisted moderately.
he

recommends

an

says,

be

must

adds, we

are

largeveins

one

other

and

of two

things

cut them

and

to him.

to

across.

makes

mention

parts of his works.

He

cut

either

an

ture
ligaHe

across.

apply a ligatureto

this extract

readilyperceivedhow
He

done,
be

From

'
'

of

if the vessel is
"

it must

applied it,or
even
obligedsometimes

'

to

or
styptics,
thingsof

But

be

must

stoppedthereby,Comm.

rosin, the fine down

the like.

to

it will be
practice,

indebted

of

roasted

as

is not

vein, to endeavour

by means
ligatm'e

floiu',
gypsum,

artery,he

vessel is

nature, such

obstruent

wheaten

if the

us,

restrain it without

131

much

of the

of Galen's
author

our

ligaturein

also recommends

the

is

many
actual

cautery.
Oribasius
To stopbleeding,

in the firstplace,
directs,
cooling
if these
to be used, and
do not
and astringent
applications
such as misy,chalcitis,
succeed,caustics,
copperas, or the actual
cautery. Upon the whole, his account of hemon-hageis nearly
the same
author^ s, only he says nothing of the ligatm'e.
our
as
in the same
Aetius treats of this subject
terms
as
commending
Galen, rethe circumstances mentioned
the ligatureunder
of his styptics
Some
are
powerful escharotics and
by him.
such as copperas, chalcitis,
alum, galls,quicklime,
astringents,
He
informs
that Ammonius,
frankincense.
the
and
us
rosin,
famous Alexandrian
lithomist,used a compositionof arsenic,
and quicklime.
sandarach,chalcitis,

Actuarius

recommends

compositioncontainingburnt

per,
cop-

frankincense,"c.
chalcitis,
galls,
in his Commentary on
Palladius,
treatingof hemorrhage says,

by applyinga

to the
ligature

fom'

the
we

'

'

Epidemics

often stop the

of

Hippocrates,
bleeding

divided vessel.

methods

of

stoppingthe discharge
of blood from an artery: 1, by the cautery; 2, by dividing
the artery across
; 4, by styptics
; 3, by using the ligature
appliedupon a bolster or compress, and tightly
bandaged.
to stop bleedingby styptics,
the cauAverrhoes recommends
tery,
the ligatm'e. He says distinctly,
ing
that when the bleedor
the arteryor vein is to be secured with
be stopped,
cannot
Albucasis

mentions

thread.
A^dcenna

treats

singularaccuracy,

of all the modes

but at

so

of

stoppinghemorrhage with
great lengththat we can onlyaff'ord

CoMM.
"
*

for

room
'

OF

WOUNDS

132

few remarks.

He

[book iv.

NERVES.

recommends

stupefyingthings^

and
cold,escliarotics,

cold water, exposure to

also directs in extreme
He

cases

the

the

actual

vessel to

be

tery.
cau-

cut

to be applied,
namely, a flaxen thread.
ligatm'e
His
of the process of taking up and
tying an
description
complexion. He also recommends
arteiy has quitea modern
the
with tightbandaging when
of a compress
the application
hgaturecannot be apphed.
of
mention
of the cautery,of the application
E-hases makes
and
of cuttingthe vessel
of styptics,
of the ligature,
snow,
in certain cases
He
mentions that Galen
approved
across.
it sometimes
of two ligatures,
as
happens that the inferior portion
He further speaksof his having
will pour forth blood.
for the sake of greater
used two or three ligatures
occasionally
security. He also mentions torsion of the artery.
of hemorrhage,and
account
Haly Abbas givesan interesting
He and Serapion
of bandagesand the ligatui'e.
makes
mention
of one
a mixture
as
a styptic
agree in recommending strongly
appliedupon the
part of frankincense,with a half part of aloes,
called the plasterof
This is the application
of a hare.
down
by Zacutus Lusitanus (Pract.
Galen, and is much recommended
Admin,
i, 85), by Scultet (Arsinalde Chirurg. Tab. 33), by
Brunus
(Chir.parva. 5.)
Maj. i,12),and Lanfrancus
(Chirm-g.
mention
of all
writers on
The earlymodern
surgery make
of stoppinghemorrhage.
the ancient methods
Guy of Cauliac
and
the ligatureupon
the authorityof Galen
recommends
A^icenna.
1, 3.) It is also recommended
(iii,
by Bi'unus
(i,12), Theodoricus (i,13), Rolandus (ii,1), and Lanfrancus
of the ligature
that the use
1, 9.) It appears, therefore,
(iii,
well understood by the ancients,
for stoppinghemorrhageswas
been lost sightof even
in the darkest ages.
and had never
across,

or

SECT.

"When

the

LIV.

nerves

great inflammation
and
in

ON

are

and

therefore fever and

some

cases

WOUNDS

wounded

And

THE

NERVES.

pricked,they experience
pain owing to theii' great sensibility
;
or

convulsions

deliriiun,
owing

with the brain.

OF

to

sometimes

supervene
upon them, and
of the nerves
the continuity

phlegmons and

abscesses form

in

wounded

NERVES.

133

parts adjacentto the wound, arisingfrom

other

the

OF

WOUNDS

Liv.]

SECT.

nerve,

owing

to their

with
continuity

it.

the

Wherefore

skin from

adhering,that
in punctures, if they appear
the ichor may
escape by it. And
blind,the part must fc3 di\dded by two incisions intersecting
With
another.
one
regard to the treatment, if the body is
and the inflammation
strong,it will be proper to begin
plethoric,
the body appears to be in a state
with venesection ; and when
We
to.
must
of cacochymy,purgingmust also be had recourse
ing
pain,and for increasapplyto the wound medicines for allaying
if the cross
incisions have not
the discharge,
more
especially
that warm
been practised.It is necessary to know
water, which
is inimical in these
to other inflammations,
is most
applicable
must

we

and

cases,

has

preserve

no

it is better to

bathe

part with

the

thin

oil which

feeling
; for nothing
cold or very hot can be appliedwithout detriment.
is beneficial by itselfin the case of
turpentine-rosin

astringencyand

either very
Of medicines

of the

the wound

is

warm

to

the

but softened with

persons of tender flesh,
etiphorbiumfor those of a firmer fibre ; and if it become too
of the thinner oils. To nerves
hard it is to be mixed with some

children,women,

in

state

and

of inflammation
of
consisting

boilingthat

of tares

the

and

we
mortifications,

may

use

taplasms
ca-

barleyor of beans, or by
out
lye with oxymel. But with-

flour of

in trained

boilingwe may use the followingcerate for punctures : of

for
Avax, oz. iij
; of euphorbium,oz. j ; or of pigeon^sdung ;
of turpentine,oz. j.
harder parts,of oil,oz. ij; and sometimes
When
you
you wish to give the medicine the form of a plaster,
of
of
boiled
the
f
rom
to
add
euphorbium, wax,
preparation
may
of each, oz. vj; but you will make
rosin,of oil,and of fat pitch,
it better by substitutingthe fattest bee-glueinstead of the
rosin.
The followingis a good remedy for puncturednerves,
applyingalso to persons bitten by mad animals : Of vinegarone
solved
of fat pitch,
lb. j ; of opoponax,
oz.
iij
sextarius,
; having dising
and havin the vinegartriturate it more,
the opoponax
This medicine
is applicable
to
melted
the pitch,boil.
of the
not
allowingthe mouth
punctures of the nerves
bitten by
of persons
puncture to close up, as in the case
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

melt

must

it in

NERVES.

OF

WOUNDS

134

[book

discutient article such

some

as

the

oil of

iv.

joram,
mar-

suitable

application
is basilicon with the addition of natron, or quicklime,
or
euphorbium, or sulphurvivum, or wild pigeon'sdung, or opoponax,
or
or
or
castor, adding to a pound of
Cyrenaicjuice,
sagapene,
of

the ointment

"

of

ounce

an

Another

old oil.

opobalsam,or

of these medicines.

one

It

answers

especially
punctures. And
cines,
in the country when
is not supplied
with any other medione
one
applyfresh and fat bee-glueto the wound, or
may
leaven more
if old,by itself or mixed with bee-glue,
especially
with the juiceof tithymal. But cataplasms
or
may be applied
made
of oxymel,or of strained lye,with the flour of beans, or
of barley,
of tares, or of chick-peas,
of bitter lupines,
or
or
or
of the flour of polenta,
in a state of inflammation,
not only when
But rebut theymay be used from the commencement.
laxing
rejectedfor wounds of
cataplasms are to be entirely
If the nerve
is not cut, but laid bare by a wound, the
nerves.
surroundingskin beingdivided so that the nerve
appears naked,
and
is wounded
and not transversely,
must
we
longitudingly
of the afore-mentioned
from euphorbium, nor
use
none
any
thus acrid,for the nerve
being bare will not bear their power
well for wounds

which

is

strong, but

often in the

warm

from
much
not

one

more

mixed

season

also excellent

the

wound, for the

and

continuous

with
that
ones.

make
with

soft wool

an

has

been

washed

honey. The preparation

from honey melted with
But these thingsmust
of
sensitive,

the most

is it proper to bathe such

it become
foul,and we must

that

much

is

nerve

with

neither

lime

use

may

pompholyx, and

are
rose-oil,

touch

and

of nerves,

perament,
cold tem-

importantpart.

idcer with

oil,for

wipe away
onljprobe. When

the

And

it will

ichor

all things
wrapped about a
succeed agreeablyto our
wish, there will be no danger in
For
fomenting with must.
stronger persons the trochisk of
pledget.
Polyideswith sodden must may be used upon a warm
After the exposednerve
has been covered over, we
must
apply
with some
of those thingswhich are fitting
externally
pledgets,
for narrow
wounds, such as that from euphorbium,or that from
pigeon'sdung, takingin also much of the sound parts. When
the wound
is transverse
there is greater danger of convulsions,
the same,
but everythingrelating
is in this case
to the cure

except that while the wound

is recent

some

have

used sutures

in
applications

such

NERVES.

OF

WOUNDS

136

cases,

plasterfrom

the

as

[book ivmetals, those

the mebarbarous, and the cissinum,that from groundsel,

tion
lanchlorum,the indicum, harmonica, and athena, the composicalled

of

which, and

described

in the

of

manner

using

using

them

since

And

Book.

Seventh
of

fond

peopleare

the

will find

you

very wealthy
wounds
of

some

to
expensiveapplications

for punctures of
following
the nerves
Of cinnamon, oz. j ; of dittany,
oz.
:
j ; of marum,
oz.
oz. x ;
oz.
viij
dr.ij
; of opobalsam,
; of wax,
j ; of amaracus,
Another
of cyrenaicjuice,oz. j ; of
of tui'pentine,
x.
oz.
for
oz.
wax,
iij; of opobalsam,oz. xij. This is an application
ment
used for ointments,oz. iij
: Of wax
; of the ointexposed nerves
called spicatum,or foliatum,or that of nard, oz. xij; of
washed
oz. j ; of amomum,
oz. j ;
pompholyx,oz. j ; of spikenard,
of the leaf (malabathi-um),
oz.
j. And these, Galen says, are
excellent.
superlatively
the nerves,

Galen

described

has

"

CoMM.

Galen

Commentary.
'

De

'

Med.

sec.

the

genera

has devoted
to the

whole

of his work
of tendons,

of wounds

consideration

and
membranes, ligaments,

book

properlycalled,and

nerves

in the sixth book of his

generally
He
work
'Meth. Med.'
professesto have had ample experience
wounded
of these cases
while attending
in the treatment
gladiators.As our author has given a very comprehensive
for
of cure, it will be unnecessary
abstract of Galen's piinciples
he

also

us

to

treats

enter

of them

into

any

more

minute

detail of them.

He

states

very

cold water, are highly

that cold applications,
especially
decidedly
dangerous,and inculcates that calefacient oils are the most proper
praisesoils medicated with
applications.He particularly
or
turpentine-rosin.
They are to be applied
spurge, or sagapene,
upon

soft wool.

In

certain cases, he says, I have

mixed

misy,
powerfullydesiccant substances,such as quicklime,
the
oils
and
with
or
sandarach,
chalcitis,
pompholyx, arsenic,

the

tendons

cerates.

When

the

together by

ends

are

cut

sutures.

across

Wounds

he

directs
of

us

to

membranes

unite
and

ligamentsare said to be less dangerousthan those of tendons.

further
In general he
recommends
either bloodletting
or
purging.
ties,
Oribasius,Aetius,and, in short,all the subsequent authoriAs a spelike our
author, copy everythingfrom Galen.

ANCYLOSIS.

Lv.]

sicT.

ciraen

give an abstract of the method

by Octavius Horatianus, who, it
Methodical

the

longed to

of

that wounds

bleed

approves

parts

and

Comm.

probable,bewith

'

'
'

stating

generalvery dangerous,

nature
digestive

In

pains.

is

commences

in

are

of a
applications

symptoms
and

He

sect.

nervous

recommends

violent

of treatment

shall

we

recommended

and

137

such

cases

he

to avert

dii*ectsus

of warm
pm'ge, forbids all fomentations
with tepid oil,after which
of those made

the
to

water, but

dressings

either by itself or with

some
tm'pentine-rosin,
and children of a
to be applied. But for women
sponge, are
dehcate frame he recommends
turpentinealone ; for others,
Avith spurge
and oil,to
however, he recommends
tui-pentine
which occasionally
sagapene, assafcetida,
may be added bee-glue,

composed

and

of

He

opoponax.

also from

ably
personalexperiencespeaks favor-

in watei",
application
prepared from lime washed
and
pitch. He mentions
sulphur,turpentine,
wax,
spurge,
from rosin,spurge, with oil and sea water.
other preparations
The Arabians
copy from Galen very closely. Thus Avicenna
and recommends
calefacient ones.
condemns
cold applications,

of

He

an

of

approves

Haly

againstcold water,

Abbas

cautions

wool

dippedin
owing to

supervenes
divide it asunder

tendons

the

when

sutures

hot

oil of violets.

the

wound

of

are

and
When

nerve,

cut

asunder.

mends
comparticularly

spasm (tetanus)
he directs us
to

lest the affection of it spreadto the brain

also forbids all

prove fatal. Rhases

commends
hot stimulant

and

relaxingapplications.He

oils,and basilicon mixed

with

spurge,

castor,"c.
natron, lime, assafostida,
de

Gulielmus

Saliceto,Guido

de

Cauliaco,Severinus,and

of wounded
nerves
layingdown the treatment
the principles
and tendons, follow closely
delivered by their
Arabian masters.
They approved of sutures when the tendon

Lanfrancus

is cut

in

across.

SECT.

of

Contractions
some

nervous

LV.

ANCYLOSIS.

jointsarisingfrom

tension, we

which
ancylosis,

ox

cases

Wherefore, in

are

accustomed

impacted humours,
to

or

call ancvlse and

requireemollient and relaxingapplications.

for
recommended
t
hose
general,
things

ANCYLOSIS.

138

scirrhous

the

part

mallows, bay, the

oil

have
itself,

the

more

the

one

pyxis;

of the Avild

root

such

simple acopa,
after

and

Azanites.

Of

varium.

the

But

anicetum.

the

is

most

and

bathing

that

from

we

are

ascribed
excellent

apply

poplar,that

ascribed

to

from

Basilius, and

called

those

Sicvonian

the
may

Aristophanian,and

strongest

plasters,that
This

as

that

bromium,
these

linseed,fenugreek, marsh-

cucumber,

After

boiled.

been

called

the applicatious
to
particularly
especially
pouring
proper, and more

oil,in which

and

water

iv.

more

will be

paralysedmembers
upon

still

parts, but

[book

that

ascribed

lysoponium

first

fir,
the
to

and

Amathaon, and the

Of
one
bdellium, of
:

to

iris,of each, dr.

perfume, of lUman
of
of galbanum, of the seeds of rosemary,
xvj ; of opoponax,
clx grains;
; of pepper,
storax, of frankincense, of each, dr. viij
lb. ss. ; of the lees of the
lb. ss. ; of turpentine-rosin,
of wax,
It
is pounded.
oil of iris,q. s. ; of wine, q. s. ; the medicine
of privet,
when
diluted with oil of iris,
or
forms
a
good acopum
and plastersis the
the
between
Intermediate
of bay.
acopa
preparationfrom bacon called polymigmaton. The acopa are
with soft and continued
friction,along with gentle
to be used
attempts to bend and stretch the affected joint.
calves^

'
'

here laid down

principlesof treatment
those inculcated
the
by all the other authorities.
as
are
same
of malagmata, we refer
of the formation
For a complete account
and to Aetius (xii,
the reader to Galen
42.)
(Med. sec. gen. vii),
recommends
Actuarius
an
composed of old oil,the
acopum
oils of bay, iris,and
turpentine,spurge, castor,
storax, with
galbanum, and stages marrow.
ammoniac,
opoponax,
pepper,
indicated,
that emollient and relaxingmedicines
He remarks
are
Commentary.

CoMM.
""

fat,of ammoniac

The

(iv,16.)
Celsus recommends,

"

ad recenti \Tilnere

contractos

articulos,

incense,
ayKvXag Grseci nominant,^^ a malagma consistingof frankrosin, galbanum, ammoniac, and bdelhum, with wax.
Scribonius
of a similar one.
mention
makes
(v,18.) AAicenna
for ancylosisconsisting
of bdellium,
Largus gives a prescription
ammoniac, galbanum, calves^ fat,"c. (civ.)
opoponax,
quas

WORMS.

Lvii.]

SECT.

and
a

humid

and

hot

of the

motion

and
colic,

from

of

elm

will

roots

seizes them
In

jointis impeded.

; or

the rind of

hence

the

cases

poured upon
myrtle,of lentisk,or

well

answer

these

and

be

may

bramble, of

decoction

JOINTS.

febrile complaints,
protracted
when
affections,
especially
paralytic

intemperament

with water

acacia mixed

THE

relaxed from

become

often
joints

The

OF

RELAXATION

ON

LVI.

SECT.

13!)

the

the

juiceof

part ;

of the

or

bark

pomegi-anate may

of
be

or
mjTtleleaves with myrtle ointment
cataplasm,
be applied. For the ligaments
requireto be strengthened
may
by astringentand desiccative powers ; and such applications
that from
as
to the joints,
willows,
therefore to be made
are
with the addition of
and the phoenicinum,
that called oxyrum,
ness
an
astringentwine or vinegar. Some imaginingthat the weakof the joints
proceedsfrom cold,and havinghad recourse
to more
heatingremedies,have only increased the mischief.

into

formed

Our

Commentary.

author

stated that relax- Comm.

correctly
by astringentdesiccant appliof the simplearticles enumerated

has

'

ation of the

jointsis

makes

Aetius

cations.

to be cured

mention

72), and Oribasius recommends

(xiv,
23.) Our author is much
same.
(Synops."vii,
Oribasius on this head. (Ibid.)
here

SECT.

There
and

are

three different sorts of worms,

called ascarides.

those
thirdly,

of crude
such

and

thick

matters

much

food.

chohc

humours

But

They
with

matters
pituitous

collect in

they do

; for these

children,and

not

grow

being

from

in the

whereas
intestines,

of the

fuller than

round, the broad,

the

all the

are
a

suitable

others

offspring
tion,
putrefac-

who

take

hot, acrid,or

too

melan-

strong for nutrition,are

and, on the contrary,bilious

too

of worms
;
inaptfor the generation
of
destructive
are
particularly
superfluities
time yellowbile be dischargedalongwith
or
by vomiting,you may be sure

formed

few

WORMS.

ON

LVII,

them.
worms,

that

if at any
wards
either downOr

they have

been

had

been

the bilious humour

'

WORMS.

140

collected at the moutli of the

We

shall
and

Of

describe

now

the

round

in

stomachy or

The

worms.

other

some

part.

form^ generation,
situation,
diagnosis,

the

beginningwith
variety,

of each

cure

[book IV.

form

of the

the round.

round

must

worms

than
common
everybody,because they are more
in the small
They are generatedprincipally
any of the others.
intestines,and are very prevalentin the stomach ; wherefore
they are often dischargedby the mouth, and sometimes by the
in children,
in
more
nose.
especially
They are most common
of fevers
For they are formed about the commencement
fever.
of the matters
from the mafrom a corruption
lignant
; at their acme
of the disease ; and during the decline from a
nature
be

known

change

to

of the

whole
"

Hippocratessays,

to

system

it is

Wherefore

state.

when

good symptom

crisis of the

the

better

disease,and

round

worms

these

speedily
worms
experiencepain of the
intestines and stomach, small dry tickling
cough,and in some
and irregular
cases
hiccough,sleepwith palpitations
startings
;
their sleepwith a scream,
and some
and again fall
start from
over
asleep. The pulseis unequal, and the fever has irregular
exacerbations,making its attacks with coldness of the joints,
four times in the day or
and coming on three and sometimes
night without any stated form. Children have mastication and
projectionof the tongue without cause, and grindingof the
teeth ; they shut their eyes and wish to remain
and are
silent,
Their
disturbed.
offended when
bloody, their
eyes
appear
cheeks red, and again change to pale. But these things occur
are

evacuated

die."

at

Those

round

have

who

'

at intervals

in

short

time.

Sometimes

the

crawling:

worms

up to the stomach occasion nausea, gnawing

forced to take food
to the patients. When
swallow

for

their bowels
like

loose with

are

; but

bladder

there

manner,

symptoms

about

symptoms
in the

being

But

occur

must

vapours

to

famine
not

certain

the

ones,

animals

bitingthem,
the brain

from

nor

expect

the
occasionally

from
and

is wasted

body

neither

one

in all cases, but

intestines

raisingnoxious

what

corruptionof the food,or

circumstances,and
These

vomit

the rest of the

evacuation.
these

they

or

nausea,

pain,and anorexia
they can
scarcely
have
taken, or
they
inflated

are

in

an

countable
unac-

ordinary
any extrato find all

to
according
most

of

vailing
pre-

them.

turning themselves
aud

the

febrile heat

putridhumours

col-

WORMS.

Lvii.]

SECT.

lected in the

in
belly,

"wliichcase

to the

fever and

alike both
bestow

must

141

the worms,

little attention to the

the

from

sometimes

must

we

and

tion
pay atten-

sometimes

fever,and dii'ectour

we

efforts

the

body. Many havingneglected

them
have been eaten
through by them, and have died con\Tilsed.
them
And
others say that they have seen
out
come
from the groinsof the patient. You
them
fi'om
remove
may
the body by killing
them, and you may kill them principally
by
of the fever
When
both the treatment
using bitter remedies.
and of the worms
is common,
the simpleremedies
will be proper.
to

remove

worms

the

Wherefore

camomile, and of

the fruit of

themselves
the

oxycrate;

be

may

juiceof endive,or
with

or

or

first drink

patientsmust

the sebesten

We

may

these
also

seed,triturated with hot

of the herb

decoction

decoction

plum, or

given boiled.

coriander

of

dicines
me-

give

water

mouse-ear,

the

or

shavingsof hart's horn, or sinopicvermilion finelylevigated.

And
they may swallow by degreestwo spoonfulsof the oil of
for by its bitterness it kills them, and by
bitter unripe olives,
its lubricity
it drags them
along and evacuates them with the
faeces. When

inflammation

of the flower

bryony in

have

must

present,we

aloes.

mix

with

and

medicines,such
of fern,or the

the fevers

as

and

of

wormwood,

we

are

of

administer

may

to

one

tawny-colourednatron,
both

and

of the roots

mint, and give them

some

cardamon,

reduced

southernwood,or

and

Unseed

made

very troublesome

not

the decoction of

seed

pomegranate

plums

fever

no

acid

of

cataplasmof

of

upon the hypochondriathe oil of

infusions of the fruit of wormwood

the

the sebesten

there is

when

to

and
lupines,
hydromel,or pour
When

distension of the intestines are

recourse

of

camomile, wine,
and

and

of

the

seriphum,or

or

of

more

we

may
:

and

drastic

calamint,or

decoction of the root

of

third,or of toasted cumin,

each, scr. iij
; or wormseed,

into

with honey, or scr. iij

pills
of bitter lupines,
the levigated
seed of cabbage or of rocket,
or
wormwood
which
is often sufficient alone.
We
or
giveof
may
washed
aloes to the amount
of scr. iij
is one
of our
; which
most
celebrated remedies ; but to stronger persons we may give
or

the unwashed.
a

cup,

And

theyare

beingforced
the aloes by

since children will not take the aloes from

to be secured

open
means

by
of

their

back, and

their mouth

injectin spiteof them

syringehaving a strong pipe,throwing

spoon,
a

upon
we

are

to

WORMS.

142

it in

[book

iv.

possible.This is an admirable method with

children who can
hardlybe prevailedupon to take medicines^
often inject
and in this way we may
of anorexia.
soup in cases
And cyphi and masuaphium may be properly
administered^and
burnt hart's horn Avith pepper
in honey or oxymel ; and we
in oxymel.
also endeavour
to give the other medicines
may
But the Ainegarof squills
will be still better,especially
when
given to adults. Or mustai'd with oil and vinegarmay be
of a spoonful. Those
whose
bowels are
givento the amount
troubled with a flux owing to worms
take a potion of the
may
the plaintain
itself may be givenin a dry
or
juiceof plantain,
far

as

as

state,for it is of

wormwood,

of the

and

wild

And

since many
give of those we

the

We

worms.

and the
pomegranate rind,acacia,galls,

likewise

flowers of the

flux and

for the

cataplasmsof crude barleyflour,of fern,of

ernwood,
of wormseed, and of southflower of lupines,

them

applyto

may

both

use

pomegranate

are

be mixed

to

loathe bitter

peopleoften

with

them.

draughts,we may
not decidedly
are

mentioned, such as
pane,
bitter,and in addition,ground pine and horehound, elecamcassia,
bay berries,
thyme,pennyroyal,
carpesium,
cyperus,
iris,
bastai'd-safiron,
madder, Egyptian thorn, with
polypody,
of scr. yj,to a
an
equal quantityof pepper, to the amount
decoction of mint, the juiceof the root of mulberrj',
the decoction
or
of stone

have

aloes with

we

of other

or
parsley,

the aloes

be filled with

we

seeds.

the oil of

use
may
whets the aj^petite,
which

With

aromatic

is

apples and
thing to be much

often mix

may

Externally

wine.

wormwood

bulPs

This
attended

also
to.

the navel may

of the bitters formerly
; or

gallalongwith some
rubbed
mentioned; or the oil of rose-baymay be constantly
be apphed alone and alongwith cerate
in, or cedar-pitch
may
to the whole belly
be levigated
and sprinkled
; or dried pitchmay
on
or

it ;
we

may

or

it may

mix
may
triturate

marrow

loins ;

be

anointed

with

them

peach

in the form

of the flour of

and

mint

and

decoction

of
We

apply.

ointment

an

and, if necessary,

wormwood,

the

leaves

of

with

to

the

seriphum;

or

we

stag's
navel, pubes, and
may

use

may

vj; of wax, oz. jss; of oil of camomile

powderswith bull's gall. We may givethem
water, that the

rose-oil ;

applythe cerate of aloes, of

of seriphum,of gith,
of each,
lupines,

we

scr.

of honied

gith in

worms

may

be

q.

s.

; triturate

the

frequentinjections

attracted

downwards

WORMS.

144

[book

removed.
until the affection is completely
when

not

preventedby strong

also of

theriac,

fever.

ASCARIDES.

ON

LVIII.

Give

iv.

Ascarides,as we formerlymentioned, are a kind of intestinal

resembling earth-worms, being formed about the exworms
tremity
and the beginning of the sphincterani,
of the rectum
and occasioninga great itchingof the parts. This species^s
of the food. Whereformed
fore
by bad diet,cold,and indigestion
of
they are to be discharged,in children,by suppositories

honey with a moderate quantityof salts or natron ; but in adults

and
by acrid brine, or a decoction of centamy with natron
honey, or of colocynth,or of wormwood, or of chamaeleon, or
of alkanet,or of bastard saflron,
or of hyssop, or of pennyroyal,
of calamint, or of lupines. After the injections
we
or
may
with these simples: Acacia,or hypocistis
anoint the rectum
with
\vith Hquid alum ; and in those which
natron, or Syriacsumach
are

bound, with

earth

Lemnian

in

medicines,the trochisk of

wine,

Andron

and

with

these

the like.

and

pound
com-

And

we

of cedar-rosin with a syringehaving

givethem an injection
such as those used for the uterus ; or salted
perforations,
many
flesh is to be adapted to the part and secured with a bandage,
as
long as it can be allowed to remain, and changed often. In
derive benefit from fumigations
generalall those infested Avith worms
may

with

the hairs of ichneumon.

The

food

should

contain

juices,and such as are easilydistributed over the

which engendersthe worms,
system, neither increasingthe cause
nor
allowingthe strength to sink ; and on that account we may
diluted wine.
must
And
we
on
give some
givefood frequently
wholesome

that account, and

for want
is when

the
be

worms
sure

in order

that the

of their food.
are

The

full. If there be

that the

you

may

not

and
being properlydistributed,

mixture

of

ai'C

worms

such
astringents,

as

on
we

pears,
acid ; and

such as are
especially
remedies
externally,
astringent

more

testines
not bite the inmay
best time for takingfood

worms

as

defluxion of the

the
are

belly

increase, the food

to

give soups

with

and pomegranates,
apples,
we
may applyto the belly,

mentioned

above.

SECT.

Lvii,

WORMS.

Lviii.]

Comm.
subjectconsult Hippocrates

this curious

On

Commentary.

145

'"^~'
Morbis, iv, 27) ; Aristotle (H. A. v, 9) ;
Celsus (iv,
8) ; Scribonius
17); CseliiisAurelianus (Pass.Tard. iv^,
Largus (36); Serenus Samonicus ; Marcellus (31); Octavius
Horatianus
(Mpth. Med.
; Galen
30) ; Dioscoricles(pluries)
(ii,
xiv ; Isagoge;) Aetius
(ix,39); Oribasius (Morb. Curat, iv,
(172); Myrepsus
90) ; Actuarius (Meth. Med. i,21); Nonnus
30) ; Averrboes (Collig.
16, 5) ; Serapion(iii,
(8); A^dcenna
(iii,
28 ;
(Theor.viii,
7, 22) ; Haly Abbas
vii,37) ; Avenzoar
(ii,
Pract. vii;,,
29) ; Alsaharavius (Pract.xvii,2, 9) ; Rhases (Divis.
Tralliani Epistolaap. Alb. Fa169; Contin. xx-vd)
; Alexandri
bricii Bibl. Grsec. xii,602, and ed. Ideler,1842.

; De

(Aphor.iii,26

that

Hippocratesstates
often passedwith the
This

child ?

bricus

that
the opinion
rejects
which are passedfrom
(taenia)

He

says it does
long as the man
Aristotle
the

in

the

the bowels

are

its

Cato

worms.

he

of

(De

re

rust.

He

and

been

lati and

broad
He

duce
pro-

believed

popularremedy

for

also recommends

emetics

also the seed

of

the

cure

draught containinglupineand
addition

nitre.

For

teretes.

the

some

teretes,

127.)

of the lumbrici

granate rind with

the same,

vinum

mulberry,with

scammony.

as

cating
gives directions for mediof pomegranate and
fennel,of
tinias perpurgat et lumbricos,si

he recommends

of the former
the bark

Id

"

treats

to live

the Censor

addition

the

by

says,
sic concinnes.^^

offspring.

lumbrici

into the

worms

spontaneous generation.
The pomegranate seems
to have

Celsus

the

the broad lum-

lati,and ascarides. He remarks that the

something resemblingthe seeds of the gourd.

which,

bellyof

lives.

divides intestinal

wine

and

death, but continues

occasion

not

ringsof

1.

intestinal

When,

He

are

of children.

bowels

the

from
first discharges

for.
fact very difficult to account
to the
seed of the worm
get access

is

did the

how

lumbrici

broad

and

the round

For

of

hyssop,pepper, or
with garlic,
orpT)me-

the teretes

he recommends

nettle,or of cabbage,or mint,

wormwood, or hyssop with mead, or the seed of cresses with

of oil.
and use clysters
vinegar.He ad\dses,likewise,to eat garlic,

or

Scribonius

be eaten, and
After
II.

Largus
then

four horu's

directs first

Macedonian
mixture

old soft cheese

garbc and

fern

to be

of aloes and

taken

scammonv

to

with

honey.

with

honied

10

146

"

is to be

water

CoMM.
'

WORMS.

'

given,and

also recommends

He

Marcellus

the

administered.

water

warm

iv.

tlie shavingsof hart's horn.

and

remedies.

same

recommends

Samonicus

Serenus

of
clyster

wormseed

mentions

[book

hartshorn,calamint, garlic,

horehound, "c.
southernwood, coriander,pennjT:'oyal,

beginningof

The

bici
which

chapter of

the

mentions

He

lost.

unfortunatelyis

Cselius Anrelianus
the

on

usual

lum-

symptoms

them, namely, occasional deliquium,agitation,

accompany
"c.
grinding of the teeth, change of colour,con^oilsions,

Worms
and

the

dischargedby

are

dead, and

sometimes

he

recommends

when

of oil,to
injection

an

decoction

be

sometimes

anus,

gle,
sin-

rolled up in a ball ;
alive ; and they are
of

times

ascarides

of the rectum

sometimes

or

great numbers
other

at

For

various colours.
inflammation

in

times

other

at

mouth

of wormwood

there

which

is

may

and

joined a
centaury.
bowels
of
the
lie
are
discharged, directs
bloodyscrapings
of pomegranate-rind,
to give a decoction
us
and, if the complaint
continue, equal parts of burnt paper and of arsenic,to
the amount
of six drs.,with the infusion of plantain. Surely
But

if

there
so

be

must

mistake

some

as

to the

of the

amount

dose, for

with safety. When

quantitycould not be injected
he recommends
of salt water,
an
putrefaction
injection

great

there

is

with

other

suitable

remedies.

When

complicatedwith

any

other disorder

he

which

readilybe discharged by drinkingoil,

may
of sebesten plums (myxse),or of liquorice
: these

or

the

properlydirects

us

attention

to pay

to it ; after

animals

decoction

things,he

while by
says, will obviate constriction and swelling,
the bowels
lubricating
they will promote the dischargeof the
When

complicatedwith relaxation
such
astringents
externallyand internally,
the
shavingsof hart's horn, "c.
honey,lupine,
worms.

says, in order to
subsfances,such

expel them
in

wormwood,
vinegar,

detail of the treatment

such
spurge,
be
may

an

the

have

must

he

hiera

mentions

recommends

vinegar with

as

Sometimes, he
to

recourse

onions, garlic,
mustard,

as

assafoetida dissolved

we

he

cresses,

"c.

various

In

other

acrid

cardamus,
statingthe
tics,
anthelmin-

of

aloes,gentian,mulberries,squiUs,
and scammony.
All these things
alkanet, colocynth,
in injections,
with a considerable
given by the mouth
or
as

admixture

of oil.

emetic

oil,and

of

For
next

the lumbricus

day

latus he

clysterwith

first,
directs,
nitre

or

salt.

SECT.

WORMS.

Lviii.]

Lvii,

147

Saltish

things are also to be given in drink,with liquorice,

or
Comm,
When
"c.
the
animals
or
are
polypody,
discharged,
scammony,
to prevent a renewal
of the complaint,he recommends
friction,
acrid
calefacient
vomiting,
food,
plasters,
sinaj^isms,
paroptesis,
'

'

and

the like.

Plinyrecommends
xxviii,
59.)

the ashes

of hart's horn

for tsenia.

(H. N.

Dioscorides ascribes anthelminthic

propertiesto various acrid

berry,
substances,such as garlic,
cresses, fern, gith,mulpomegranate rind,lupine,cabbage,nettle,hyssop,mint,
calamint,wormwood, wormseed, rue, coriander,thyme, "c.
and

bitter

Similar
is

remedies

ascribed
falsely
Galen

mentions

the

ascribed
the
of
the

span

to

somewhat

or

author

The

The

The

round

manhood

ascarides

most

are

and

these

are

as

from
tsenise,

or

about
are

the

broad,

length

formed

short,and form in the

are

sometimes

common

are

rally
gene-

into the

worms

round

work

about
rectum.

their resemblance

the

length of the intestines.

in children,
the ascarides before
difficult to remove
except by bitters,

acrid food.

elecampane,and
Oribasius

a
Isagoge,'

such
especially

more,

said to be

'

divides intestinal

broad, called also fascise

tape, are

of the

the ascarides.

stomach.

The

The

Galen,

to

and

round,
a

testinal
general are destructive of inthium
teres, he adds, is killed by the absinand ascaris require stronger medicines,

latus

the filix.

as

which
^Euporista,'

that bitters in
The

; but

in the

to him.

worms.

such

recommended

are

of lumbrici, recommending for the

briefly
1. rotundus,southernwood,wormwood, calamint,gith,"c.,taken
mint,
or
internally
appliedoutwardly; for ascarides,the juiceof calaand

cedar

of the root
and

of

rosin,in like

treatment
our

them.
their

givesa
of

the roots

of the white
full and

lumbrici, but

and

manner;

mulberry,and

also the root

Aetius

as

treats

as

of fern in honied

chamseleon

accurate

for the taenia the bark

and

detail of the

his remedies

are

water,

costus.

and

symptoms
much

the

same

it will be unnecessary
to deliver any account
author's,
He remarks, that anthelminthics
either kill worms
them

their

of

by

irritate

bitterness,or
acrimony,or remove
by
the parts facilitate
to expel them, or by lubricating
as
so
the expulsionof them.
Actuarius givesa sensible account
of worms,
of the formation

them

'

148

WORMS.

White worms,
or
putrefaction
indigestion.
but the red, and those
product of indigestion,

'

iv.

wliich he ascribes to

CoMM.
'

[book

he

says, are the

of any other colour,arise from

putrefaction.

of this subject.
merely abridgesour
The
by
ingredientsin the compositionsrecommended
southernwood, and
Myrepsus, are such as aloes, scammony,
Nonnus

author^s account

bitter almonds.
Octavius
contains

Horatianus

gives a good

anythingthat
scarcely

of worms,
be found in

account

is not

to

but
our

it

thor's.
au-

fidence
long experiencehe had great conthe
in a purgative draught consistingof scammony,
of burnt
nitre,given in sweet
peas, euphorbium, and
and other acrid things,
eaten.
to be fii'st
But garlic,
are

He

ashes
wine.

says, that from

The

Epistleof Alexander Trallian on worms, first published

by Hieronymus Mercurialis,and afterwards
by Albertus
Fabricius,and again latelyby Ideler,contains an interesting
expositionof the ancient views on this subject. He divides
intestinal worms
into three genera : the ascaris,
the strongylus
or

round, and

the latus

or

He

broad.

found
are
(ascarides)
generally

worms

round

in the small

and
intestines,

up ; while the broad

the intestines,
some

that the small

remarks

in the

hence

the
largeintestines,
often vomited

theyare

sometimes
as
are
long as
(tsenia)
having been dischargedsixteen feet in
length. He states that they are engendered by corruptionof
the food,and putrefaction
of crude humours.
He
lays down
at great lengththe plan of treatment, which he varies according
as
they are with or without fever. His remedies consist
of cathartic,
Of purgaacrid,oily,
acid,and bitter substances.
tives
he

mentions

worms

aloes,scammony,

hellebore ; of acrid
of oilymedicines,the oil

and

articles,
garhc, cresses, and the like ;
of roses, castor oil (oleum ricini),
and common
oil boiled with
rue
wood,
nitre (soda); and of bitters,southern; of acids,salt and
wormwood, hyssop,fennel,and the like. For the expulsion
of

gagate
a

the

strongylushe speaks favorablyof

(jet). For ascarides and lumbrici

preparedfrom juniper. He concludes

stone

lavement

statingthat
as

"ten

thousand''

other

anthelminthics

by

the

in his account

of

worms

Avicenna
contained

in the Greek

decoction

of

he recommends
his treatise

things had

been

by

mended
recom-

ancients.
condenses

authors,but

we

tion
all the informa-

do not find that he

SECT.

WORMS.

Lviii,]

Lvii,

suppliesanything new.

He

Aetius

The

who

and

author.

our

149

in

particularcopiesfreelyfrom Comm.
be said of Serapion,
same
may
bitter lupines,
calamint,peach
'"

recommends

wormwood,
"c.
Aven'hoes says
leaves,cabbage,onions,thyme, colocynth,
that the lumbrici in general are
removed
by bitters,such as
wormwood
or wormseed, but that the cucurbitini
(tsenise)
require
Of the pineaenuces
he says,
Occidunt
strong medicines.
vermes
qui sunt in ventre.^^ (Collig.v, 42.) Probably this
"

hint

have led to the use of turpentines

for the
may
taenia.
Avenzoar
attributes the formation
of worms

digestedfood
remedies

in the

the

as

of worms,

that these

and

the

Greeks.

and

such

by
He

Haly

as

be

to

are

with

He

medicines

recommends

the

same

of

are

general terms bitters ;

called by him
broad,(tsenise,
And
"c.
lupines,narcissus,

very
for the

fully.

The

and

remedies

drastic purgatives.

Rhases

recommends

round, wormwood,

semina

hot

wormwood, fern,

and
oils,bitters,

of lumbrici

in

by

honey,vinegar,"c.

Alsaharavius

treats

much

ill-

Abbas

killed

bitters.

like,pounded

mentioned

recommends

to

describes the three cies

spedetails the symptoms of them.
He remarks

animals

dry nature,

stomach, and

of

cure

for the

seriphium,bitter
cucurbita)

for the

ascarides

he

directs

us

to

of wool dippedin the gallof a bull.

He
apply a suppositoiy
remarks
that they occur
in autumn, being enmost
gendered
frequently
that they often bring
by fruit. He states correctly
and looseness of the bowels.
He much
commends
on
epilepsy,
the oil of unripeolives.
medicines
for removing
Vegetiusrecommends
nearlythe same
the vermes
of cattle as those alreadymentioned, namely,
wormwood, cresses, coriander,fenugreek,and the like,boiled in
oil,and administered
(Mulom.
by the mouth and in clysters.

i,44;

see

also Columella

vi,25.)

According to Michaelis
acquaintedwith

were

chos

and

Sprengel the ancient Brahmins

of the dolianthelminthic properties

the

pruriens.

We

have

stated above

that the most

celebrated of the ancient

This
spontaneous generationof animals.
doctrine,although generally
rejectedat the present time, has
been advocated
by many modern naturalists of great eminence,
believed

savans

in the

BufFon

such

as

very

statement
impartial

Baron

and

Professor

of the

Rudolphi. Yirey givesa

arguments for and againstthis

"

WORMS.

150

'

"

(See Hist,

doctrine.
physiological

CoMM.
'"

'

relates that
traveller,

the

pomegranate is still considered in the east

but also for the tape-worm.
not only for ascarides,
specific,
of the

the bark

decoction of

this

they

called

parts of Egypt

Then

manner.
perceptible

of the

dracunculus

being opened
if the

matter

be

worm

Wherefore

pieceof

the

lead to

worm

worms

formed

in the

in a
they move
at the extremity

and

of

thighs,legs,and

anns,

dracunculus

the skin

forth.

comes

pains,and

it occasions

dragged

They

it generally

in process of time
in the part, and
is formed

of the

the head

it breaks.

when

class

are
dracunculi,resembling the intestinal,

parts of the body, such as the

the skin
in the sides of children,under

He

GUINEA-WORM.

THE

muscular

pint of water,

which
expelled,
Egypt, ii,371.)

OR

DRACUNCULUS,

the upper

and

in

is

worm

as

of taenia.

cure

of the fresh bark

oz.

day.''(Travelsin

ON

LIX.

India

In

two

dailytill the

drink

is the third

SECT.

it fail in the

rarelyseen

I have

"

says,
make

iv.

et de V Instinct

des Moeurs

Madden,

Mr.

Animaux, ii,121.)

des

[book

But

particularly

say that it is proper to fix a

in order that its dischargemay
not
some

place at once, but graduallywith the weight of the lead.

the worm
is
inasmuch
Some
as
disapproving of this practice,
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
come
being warmed
fonvard,when it is
may
to be seized with the fingersand
dragged forth by degrees.

take

But

is of

Soranus

but
originally,

account

opinionthat

of monng.
Whether
this or
of the matter, it appears
to

water, and

or

barley;

plasterpossessedof

and
bay-berries,
of these

But

when

skin

is to

be treated

to

the

the

and

similar
one

dracim

from
cuius

the

is not
has

animal

only the

former

the

pearance
apthe true

be

affusion

of honied

they approve

of

warm

and

water

of sometimes

properties. Wherefore

the

using

that from

For by the
proper.
dies and falls out.
concretion

honey
or

an

Soranus, Leonides, and

with

digestivecataplasmsmade

flour of Avheat

use

dracunculus

concretion, which

nervous

others,that they are

the

are

suppuration takes place,if it does

be divided,and the part being laid

not

open,

fall out, the

that which

suppurationby

CoMM.

mentioned

"

means

by

sometimes
troubles

other

could

be

red

habit

the

which

gives rise

to

the

says

cunculus
dra-

of the

name

occasions

in

increases
protrudesand gradually
to correct

information

blister in

blackish

somewhat

and

kiUed, he

are

Medine, the

prevalent. It

when
brursts,

part which

of time

that in process

parts,and

suppurates. They
things.

it is most

country where

us

Egypt, being generally

regionabove

medine, from

vena

dracuncuh

the

that

comprehends in his account whatever

He
gleaned from precedingwriters.

is called

the

in the

acrid

adds, by bitter and

A^icenna

seldom

but
Ethiopians,

of

li^dd and

part becomes

the

which

piece of corruptednerve

sores

muscular

in the

formed

author, mentions

our

commonly

most

other

people.

Actuarius, like
occur

the

from

comes

the

iv.

author,

our

calls the dracunculus

Pollux

and
cataplasms,

of maturative

means

'

"

[book

WORMS.

152

stance
sub-

length. He directs
it by baths, humid

is similar to that of Aetius

His treatment
food, and the like.
the arm,
and
author, namely,binding a ligatureround
our

fasteninga piece of

the

mentions

Abbas

Halv

to

the

using fomentations

worm,

of

the like.

water, and

warm

lead

vena

as

being

forms

which

worm

countries,
legs of the inhabitants of warm
such as India,Egypt, Ethiopia,and Lybia.
Avenzoar
commonly attacks
says that the complaintmost
which
by gross humours, for dispelling
negroes, being fonned
he recommends
internallyvarious sharp and acrid medicines,

in
principally

such

as

pieceof
be

made

not

be

further du'ects a
He
nettles,colocynth,"c.
squills,
that it may
lead to be bound
so
firmlyover the worm
out gradually,
to crawl
which, however, he says, will

accomplishedin

Alsahai'avius
He

recommends

person

Albucasis
a

pieceof

less time

the

as

dangerof
treatment

same

chapteron

than

the

year.

breaking the
as

(vena).

worm

The

Avicenna.

di'acunculus decides him

clusion
con-

to be the

Albucasis.

recommends

lead from

one

us

to

to fasten to the
two

drs. in

end of the animal

weight, and therebyto

gradually. He says that in some

is as long as fifteen palms,nay, that he had
palms long.
extract

it

states

the

of his
same

the

cases
seen

the

animal

one

twenty

WORMS.

LIS.]

SLOT.

Rhases

He

recommends

the

animal
dr.

He

cautions

'

'

Continens
He

others.
of

See

of

had

he

that

says

bathe

who

persons

Bertapalia,

that

notion,
that

lead

is

it

which

some

the

other

of

our

doctrine

opinion

ancient

the

repeat
direct

They
of

of

the

body.

by

making

He

author.

Galen,

drink

the

In

his

Paulus,
in

and

the

much

bodies

wine.

He

incisions.

free

in

guinea-worm

No.

Journal,'

Surgical

to

its

it

is

66
Mr.

by

English
of
is

in

more

but

we

correct

the

by

East

inclined

are

one.

civilis

attaching

but

Andry

from
of
Indies
to

still

think

small

held
ments
state-

some

the

vel

Galen's

adopted

periodicals
the

writers

vena

Pare

however,

the

surgeons
;

of

matter

appears,
in

seen

Galen

the

animal

modern

early

Ambrose

corrupted
It

the

it

extract

extremity,

have

we

all

accounts

to

us

animah

real

and

Cauliac,

of

Guy

medicine,

piece

in

reed

gradually.

out

our

and

and

Medical

it

when

Madi'as.

surgeon,

medine.

of

account

'Edinburgh

Scott,

extracted

it

interesting

an

the

on

frequently,

seen

of

fruits.

leaden

commonly

most

and

and

aloes,

round

by

opinions

forms

it

of

dragged

part

described

the

that

says

be

and

potherbs

wrapped

may

hot

Comm.
'

'

doses

any

as

collects

he

it

leave

to

incision

of

approves

be

to

that

so

not

us

is

in

place

of

use

increased

it

weight,

the

by

gradually

in

takes

dracunculus

formed

is

protrudes

one

also

and

bodies,

squalid

the

tliat

says

153

day,

that

advocate
that

the

BOOK

SECT.

I.

ON

THE

PRESERVATIVES
IN

In

gi\angan

V.

FROM

VENOMOUS

ANIMALS

GENERAL.

of animals

which

emit

poisons we shall
begin with some
general remarks
them, treating of the
upon
from them
in the first place. If therefore a perpreservatives
son
be compelled to sleep in placesinfested by venomous
mals,
aniin such as salamanders, phalangia,
or
especially
reptiles
abound, it will be proper to shut up their holes under ground
with

account

garlicpounded

mentioned
of goats,

and

to

in water,

or

some

of the herbs

fumigatewith hartshorn, the

about

hoofs

or

to be

hairs

ings
gagate stone, bitumen, bdellium,galbanum, the shav-

of the cypress

cedar,gith,hog^s fennel,the leaves of the

chaste tree, calamint, sagapene,
castor, the root of rosemarj^,
of the strong-scentedthings. Gnats in parfleabane,or some
ticular
driven away
with
the
seed
are
fumigations
by
copperas,
of wQd
and
of
cumin
in
gith,
equal proportions,and by cows'
dung. In addition to these, frequentfires should be lighted,
for reptiles
commonly flee from the light. A couch should be
prepared by strewing asphodel,calamint, chaste tree, pennyroyal,
and
southernwood
if
it
is
not
or
fleabane,
poley,
ble
possi;
of
to make
couch
a
entirely these,they should at least be
laid around
the bed.
Attention should be paid to such things
as

to be

are

or

boiled, to the water, and

wine

vessels that

thev be

properlycovered uj). Fires for the pui'pose of cooking should

not be lighted
under particular
more
ti'ces,
pitchtrees
especially
and
abound
or
pines, for salamanders
on
deadly caterpillars
them, which being warmed by the heat of the fire fall upon the
victuals,or
Those
with

who
a

any
wish

other
to be

liquidcerate

vessels

which

happen to be
guarded, anoint
particularly

composed

of wax,

rose-oil,and

uncovered.
their bodies
a

little

gal-

and

banum,

with

little of tlie

Ethiopian cumin.
rubbed

when

bees and

The
the

on

leaves

skin

of

[book
of hart's

shavings

triturated

mallows

protect in

horn,
with

or

oil

from

especialmanner

an

v.

wasps.

followingis

The

Commentary.

CoMM.
'

ANIMALS.

VENOMOUS

156

list of

the

ancient

au-

'
*

thorities

Toxicology:

on

(Theriacaet Alexipharmaca); Dioscorides (Liber

de Venenis); Celsus (v)
; Galen
; Scribonius Largus [47,et seq.)
(Ther.ad Pison.;,Meth.Med., De Antid.); Aetius (xiii);
Phny
(de Morb. Curat, iii)
(Hist.Nat. pluries)
; Solinus
; Oribasius
Nonnus
Seth
Samonicus
40) ; Serenus
; Simeon
(Polyhist.
;
(Meth. Med. v) ; Vegetius
pluries)
(de Alimentis
; Actuarius
(iv,6) ; Rhases (ad
(de Mulo-medicina, iii,77) ; Avicenna
and Cont. xxxv); Haly Abbas
Mansor. viii,
(Pract.iv,Theor.
viii)
(Pract.xxx) ; Serapion(pluries)
; Anonymi
; Alsaharavius
Nicander

apud

Promotus

Venomous

exists in

which

been

on

pubhshed

Animals

far

of

^lius

substances,
Vaticana, has never
is quoted by Hiero-

It

know.

we

as

work

Poisonous

and

Bibliotheca

in the

MS.
as

Reliq.)' The

Bernardi

Fragmentum

(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
Mercurialis

nymus

in Schneider's

Annotations

It is to be borne

publishedas
genuine by

that the work

in mind

his

all to be

on
great authority

work

Nicander.

Poisons,usually

on

production of Dioscorides,is not held to be

latest editor,Sprengel;still,
however, it is

the

acknowledged by
of

on

the

work

of considerable

subjectof

ancient

and
antiquity
Toxicology. The

'

Euporiston,'which is also publishedwith the works of

is generally
admitted
It connot to be genuine.
tains,
Dioscorides,
however,

medical

These

some

valuable matter

on

Toxicologyand

other

subjects.
directions of

author

for

dri\dngaway

reptiles
fumigations
with
hartshorn, gagate-stones, sulphur,bitumen, galbanum,
rides
juniper,and other such articles. (Ther.35.) See also Diosco(M. M.) ; Orpheus (de Lapidibus)
8) ; and
; Geopon. (xiii,
are

mostly taken

from

our

Nicander, who

recommends

(H.

also Aristot.

(Epit.261) ;

Nonnus
N.

of this

mention

and

PlinyComm.

away serpents In Lucan.

and
that of Nicander

fumigationsfor driving
ix^916.) It is different from
(Pharsal.

by Rhases.
Geoponics (1.c.)

in

author.

our

For

Arsenic

tamarix, costus,thapsoSj"c.

affirms,and

destructive

it contains

the articles
among
It is also mentioned
in

been

it has

example

occurs

(Cont.xxxv.)

mentioned

Nicander

"

used

list of substances

long

cedrum,

chelydros." Georg.Hi, 314.

GalVjaneoqueagitaregraves nidore

the

iv,8) ;

:
practice

stabulis accendere

et ocloratam

Disce

N.

(H.

""^^

Virgilmakes

See

157

90).

X,

"

ANIMALS.

VENOMOUS

II.]

SECT.

generallybelieved,that

serpents. Galen says that

that it is destructive
it will kill the scorpion. Aristotle states,
to most
venomous
(H. A. viii,28.) Redi maintains
reptiles.
saliva proves

human

that this is
that

he

ancient

an

to

serpents.

from

recommends

with

in

He

6.)

Laurentius

the

human

declares

saliva is destructive

ries,
compositioncontaining cedar-ber-

other

such

articles for

preservingthe

directs us to smear
reptiles.Paxamus
greek,
compositionmade of the roasted flour of fenujuiceof the wild mallows and oil. (Geopon.

venomous

the face with

XV,

Andreas

experiencethat

from

fleabane,sage, and

body

; but

en'or

knew

Nicander

to

the

the face from

says it preserves

particular.
here
K(ov(i)tp,

translated

the

it is in

stingsof

bees

the

Enghsh
of the
version
scriptures,(Matt, xxiii,24,) is proved by
Bochart
(Hierozoon.iii,442) ; and by Harris (Nat. Hist, of
from Aristotle,Plutarch, and
the Bible),
others,to mean
perly
proThe

of insect that is bred

kind

II.

SECT.

THE
OR

If

animal
who

in the lees of wine.

TREATMENT

GENERAL
STUNG

as

ALL

VENOMOUS

ANY

BY

OF

sucks

it should
with

wine

part admits, it should

be

not

and

ANIMAL.

be

and
fasting,
retain

cupped

BITTEN

PERSONS

happen to be bitten or stung by any

person
he ought immediatelyto get the part sucked.

rinse his mouth

the

gnat,

he

venomous

ought

oil in it ; and
with

much

The

son
perfirst to

then, if

heat, scarify-

ANIMALS.

VENOMOUS

158

the

ing also

of tlie

out

dra-wn

[book

v.

surrounding parts ; for tlie poison is forced back

and blood Avhich are
body along with the sijirits
part in which

The

out.

the exti-emities

bite be of

that inflicted the

viper,and

the cerastes,the

it,and

on

practisedif the animal

seasonably

be

then

mav

formed

eschars

and

also to be burnt

like

the

Galen

as

the asp,
relates that a

such

deadlynature,

ought
amputation of

is situated

wound

the

as

by a viper,and knowing the

bitten with his
animal, immediatelycut off the fingerthat was
freed from the danger. But if
pruning hook, and was entirely
being

certain vine-dresser

the

body, venesection
if the perto immediately,
had recourse
especially
son
eat
and
to
and
bitten be plethoric
garHc given
;
pepper
to drink, whereby the
the food,and strong wine
system

poison
ought to be

with

bitten

distributed

aheady

be

the

over

After-

fresh vapoiu'S and a suitable heat.

and
warm
Avai'ds cataplasms are to be apphed that can
will be

filled with

the

bite,such

as

with

fie:-with vinesrar,or

pickle.

onions

Likewise

strong leeks with

and

water,

sea

also be

to pour
proper
has been boiled,

calamint

with

or

We

brine.

hens, cut up and still warm,

especially
part fowls,more
the poison and soothe
other such animals, for they absorb

pains.

that formed
the whole

And

we

from

that from
salts,

such

have

must

things as

are

bitten

or

all persons
ought, unless the

of

such
plasters,
and adarce,and

to

recoiu'se

an

rosemary
acrid natm'C.

stung

by

any

And

with
a

with

bitumen

decoction

and

of Christ's thorn

wine, Avhich is

or a
sea-tortoise,

of

or

two

of castor

with

Sicyonianroot, or

of the chaste tree,

seed of trefoil,
or

boiled.

Use

the

or

cypress

bay hemes,

or

diluted

ground pine,or alsander, or cinnamon,

seed

blood

wine, or

followingcompound

of

the

drachm

juiceof leeks,or
bii'thwort,or

or
or
balls,
seseli,
or

lus
astraga-

or

in like manner,

the

the
or

take

of dried weasel

drachms

cried-upremedy

di'achm

of frankincense,or

Christ's thorn

on

general
animal

deep-seated
parts are whollyunhurt, to

vinegar,or

as

in

venomous

in the first place potions containingendive,heath,

the

apply

to

are

the

the

or

of

sauce

with

It will

vinegar in which

the parts hot

upon
with vinegarand
or

or

wai'm

goat'sdung.

cedar-rosin,or

to

salts,or

of

or

polentaor bread,
liquidpitchwith salts,or

be mixed

may

cabbage

Ive, or with the

strained

the

of

of the ashes

mixture

late
stimu-

river crabs
theriac.

the

pepper,

or

roasted

or

(sicenim

initia

CoMM.
'

ANIMALS.

VENOMOUS

100

in

excludi

debent) sed post vomitus

to most

recommends
autborities^
poisonedwound, should be in

studio atque industria

v.

quibus omni

deleteria tralierentur,
a

venas

'
"

[book

alvique

"c.
dejectiones/^

Serapion,contrary
person who
fastingstate; but as
that

sucks

the

it

copyistfrom

servile

the text is in

suspectedthat

be

might

is

he

of the

his

cessors,
prede-

fault,if the

given by Rabbi Moyses, with this

a
: that
fastingperson will perform this office with
explanation
but with greateradvantage to the patient,
risk to himself,
more
food immediatelybeforehand.
had
taken
than one
who
(De
Venenis, i,1.) All this shows how well the ancient savans
fact,that the absorbent
were
acquaintedwith the physiological
directions

same

of the

powers

not

were

vessels is in the

their state

ratio of

inverse

of

repletion.
recommends

Celsus

Thus

Nicander.

ligatureround

he

the

directs

limb, but

torpor; and

then

hot

recommends

he

to

wine

Isidorus

emetics,which

by

nenum

upon
autem

in still more

frigidumest, et
the

ideo

ejus per venas

guit. Unde

sanguinem."

which

calefacient nature,

he,

'^maxima

that the
"

says,

Omne

pars

poisons

autem

ve-

anima

He

mixed

with

quod per venas

vegetatione aucta

eo

non

supposedto

quae ignea est, fugitvenethat poisonsdo not act

states,likewise,

system unless

dictum

He

local

internal

concussion

generalterms

oppressingthe vital heat.

frigidum.^'

num

of

be

may

system by the
articles

As

nature.

and

states

His

scarifications.

because, says
pepper;
interimit."
frigore

as

venenorum

act

same

stimulant

expel the poison from the

they produce, and various
such

the

along with

by a cupping instrument
of a
are
applications
remedies

general remedies as
in the first place to apply a
us
for fear of occanot too tightly,
sioning
extract the poisonby sucking,or

nearly

potest venenum

Lucanus

"Noxia

the

blood

vadit.

Infusa

discurrit
nocere

"

et

Venenum

enim

animam

nisi hominis

serpentum

est

pestis
extin-

tetigerit

admixto

guine
san-

^^

pestis.
This, however, is

imperfectaccount of the action of poisons,

whether
such as act by being introduced
into the stomach,
those that prove
deleterious
when
or
applied to a wound.
the
classificationgiven by Avicenna
Perhaps
may be mentioned
an

as

the most

ties.
or

VENOMOUS

II.]

SECT.

He

by

completeof any proposedby the

states that poisons
act either by some

their whole

corrosive

161

ANIMALS.

substance.

Of

the

former

ancient authoricertain
class

q^

MM.

qualit}^

some

are

flammatory
inlike the lepus marinus
putrefactive,
; some
and calefacient,
like euphorbium ; some
frigorific
and stupefying,
like opium ; some
ratory
prove obstruent of the respistance,
subact with their whole
; some
jjassageSj like litharge
the wolFs bane, and these are the most deleterious of
as
all.
Of these some
member
in particular,
act upon
as
one
cantharides
marinus
the
upon the bladder,or the lepus
upon
the whole
lungs, and some
body as opium, (iv,6, 1.)
upon
Schulze,in his Toxicologia
Veterum,^ has stated the ancient
and
at a loss to
are
we
differently,
arrangement somewhat

and

'

think

what

authors

he

has

says, the
into the
arrangedpoisonsaccordingto their properties

followed.

He

ancients

frigorific
and septic((rrjTrfSovwSr/).
(8ta/3jj3pwor/c"n'ra),
The frigorific,
he properlyremarks, are
those substances
now
called narcotics ; to which class,
as Galen
mentions,the conium,
henbane, and mandrake
belong. On the action of
poppy,
section xliii. Galen
remarks
that the human
see
narcotics,
corrosive
{ipvKTiKo.),

frame

becomes

habituated

to

bear

the

action

without
who

woman,

hemlock

in

Avicenna

the case
injury. He mentions
by little and little had accustomed
(De Simpl.iii.)
any quantity.
states that

the

great indications of

of these
of

cines
medi-

old Attic

an

herself to take

cure

in all

cases

of

the vital heat,and to

poisoningare to comfort and rouse
resolve (neutralize
the poisonis
?) or expelthe poison. When
distributed
and

over

the

the like.

for venesection

system, his remedies

He

states

is either when

are

venesection,purging,

decidedlythat
the

poison is

the proper

distributed

over

time
the

it is in a plethoric
when
state,or when
body, more
especially
the poisonis a substance not likely
His other
to be absorbed.
remedies
such as expelthe poisonfrom the body, namely,
are
emetics and sudorifics,
such as prevent it from enteringthe
or
to the extremities,
sleep,
prohibiting
system,namely,ligatures
applyingcupping instruments,or leeches,suckingthe wound,
amputation of the limb, using actual and potentialcauteries,
and keeping the wound
long open. Upon the whole the general
remedies recommended
by him and the other Arabians are little
TI.

11

'

those

different from

CoMM.
'

the

over

theriacs.

body, and

He

amputation.

of

of ping
cupalso joinsin the general

also,makes

others

distributed

poisonis

the

mention

theriac.

the

Alsaharavius

like the

and

with heat

praiseof

bleeding when

allows

Abbas

Haly

r.

of Dioscorides,
especially

Greeks,

great authorityupon

is the

who

of the

[book

DOGS.

MAD

162

strong ligatures,
cupping,and, in

recommends

applyingthe
of bleedingunder
bodies of hens
circumstances
the same
others,and of the same
as the
general
Rhases
recommends
that
recommend.
treatment
sucking
they
of
stimulant
and
the
the
and
wound,
application
cupping
of
such as a plaster
consisting mustard, lime,and pitch.
dressings,
mend
recomHe, and most of the ancient authorities on toxicology,
also
Most of them
salt as an application
to the wound.
of caustic
join Dioscorides in recommending the application
leys. They also in generaldirect us to prevent sleep. The
by Rhases, as
ligatureto prevent absorptionis recommended
of
As a matter
it is in fact by most
of the ancient authorities.
all of them
course
speak highly of the theriac,and acquiesce
its virtues. (Ad Pison. ii,
in Galenas
celebrated eulogy upon
457, ed. Basil.)
the treatment
of poiThe Arabian authorities notice cursorily
soned
of the Armenian
of war, more
arrows.
especially
weapons
and assafoetida administered
and
Galbanum
applied
internally,
urgent

cases,

to the

wounds

in various

sucking the wound, as in

(See further,B. vi,88.)

SECT.

III.

ON

the

forms, are

generallyapproved

most

of

amputation. He also approves

stillwarm.
Serapionapproves

of

by

other

PERSONS

them.
of

cases

BITTEN

BY

two

articles which

are

They also recommend

poisoningby a wound.

MAD

DOGS,

ON

AND

HYDROPHOBIA.

We

have

placedthe

before all the others

domestic,and

complaintis
unless

are

because

of persons
these animals

frequentlyseized

difficult to

one

account

have

with

to

many

are

madness

guard against,and

recourse

bitten

and

the

by

mad

dogs
and

numerous

; because

the

ble,
danger inevita-

suitable

remedies.

MAD

III.]

SECT.

163

mad

during violent heat, but

part become

for the most

Dogs

DOGS.

When

cold.

also,as Lycus says, sometimes in extreme

they shun drink and food, for they are

mad

thirstybut do not
drink,and for the most part they pant, hang their ears, and
emit much
frothysaliva. Generallythey utter no sounds, and
that they do not recognize
it were
so
delirious,
are
as
persons
Wherefore
attack
familiar.
with whom
equally
they
they are
without

barking

bite them.

Their

wild

animals, whether

all

beasts

or

men,

and

nothing disagreeable
the
afterwards it brings on

bite at first occasions

except the pain of the wound

; but

its attack with conwhich makes

vulsions,
hydrophobia,
of the counredness of the whole body,but especially
tenance,
water
and anxiety
sweating,
; and those affected shun
Avhen they see
it,and some
every fluid that is presentedto
bark like dogs and bite those who approachthem,
them.
Some
of
affection. The cause
and so doing they occasion the same
the other symptoms is obvious, being occasioned by the poison
have
all the parts,but as to the dread of water
some
affecting
if the whole
as
said that it is occasioned
by inordinate dryness,
fluids of the body had undergone a change. But Ruffus has
which affects them,
pronounced it to be a speciesof melancholj^
in like manof that humour
ner
the poisonputtingon the nature
aflFection called

as

we

thing and

melancholic

other

know

another

some

; which

say that they think

Of
in the water.
them

who

know

Avho has

none

the histories of

one

or

had

been

bitten,not

had

been

bitten and

the

persons

been
two

accords also with

reason

theysee

dreading some

persons

image

of the

and

these

have

we

Avere

by

the treatment

thence.

about the fortieth

instances

are

day,and

related of its

supposingthat

learned

of those who
its attack many, even
must
we
dog,have been saved. Wherefore

from

And

the

dog who

in

some

coming

who

have

begin

the attack of

since often from

on

we

who
person
But before

by a mad dog, but by some

impartedthe disease to them.

hydrophobiahaving not yet come

on

that bit

of persons

the affection has made

been bitten

those

this affection

into
falling

saved, except that

cases,

dog

one

most commonly it comes

(for
cases
on

after six

after

inflicted the bite

seven
was

months, nay,
some
years,)

not

mad, and

making haste to heal up the wound have therebygivenrise to

the complaint. By the following
tain
experimentyou may ascerwhether the bite was
inflictedby a mad dog or not : Pound

164

DOGS.

MAD

walnuts
take

[book

to tlie

and applythem
carefully

wound, and

cock

day

next

lien.

v.

At

first

or
present tliem for food to a
ger
indeed lie will not touch tliem^but if he is compelledby hunto eat of them, observe,for if the dog that inflicted the

bite

and

not

was

die next
and

mad,

then

the fowl

and

then

you

day ;

after

as

recommends

have

of
principal

the

wound,

and

when

s^anptoms which

for certain that the

know

we

dog

is

we

mad,

we

layingopen the sore, the

and
is that from pitch,
very acrid vinegar,
in the section on the
is described
accurately
medicines

to

which

which
opoponax,
wounds
of nervous

for

parts. But if the person who has been

of
skin, it is to be diluted with oil of iris,

tender

If from

experiment:

recourse

bitten has

the

open

experiment;

same

he will

die you

this

have mentioned
must

to

if mad

to cicatrization,
may bring the wound
is then freed from danger. Oribasius
the patient

the fowl does not

inasmuch

live,but

hasten

must

days repeat the

few

will

balsam, or the Hke ; or having first fomented

This also forms eschars.
a cataplasm of garhc.

the sores,

apply

dry eschadr. viij

fossile salts,
;

by mad dogs : Of
dr. xvj; of green
rue, dr. iv ;
xvj; of squills,
dr. iv ; of the seed of horehound, dr. j ;
of scrapedverdigris,
it at first dry that it may form an eschar,and then with
use
fall ofi". Keep the parts from
rose-oil that the eschars may
for forty-two
cicatrizing
daysat least. A cataplasmfor persons
of the wound
bitten by mad dogs,which keeps the mouth
open :
Apply a cataplasmof onions with salts and rue, or of laserof the cinders of burnt
wort
with salts,
of old pickle,
or
or
wood with oil,or of garlic,
or
applythe leaves of the elder tree,
bitten

rotic for persons

of chalcitis,
dr.

mint, or baum,

or

and

honey,or

sore

with

as

the ashes

of

But

the firstplace to

germander,and
:

Of river

vessel of copper
one

of
cyatlii

or

onions,salts

with cerate.

in water, and
with

sore

Wash

the root

heated

irons.

the
of the

They

get draughtsof simplethings,such

the juiceof laserwort,
germander,the
These

the shoots

bronze

two

are

compound applications

of the white

"sdne burnt

spoonfuls,of gentianroot
drink

for

wine.

Some

add

partridge. The

crabs

spoonful,
give to

old undiluted

blood of the

the

poley.

crabs,of

with

salts,or walnuts

figsmixed

burn

some

buckthorn,wormwood,

water

with

decoction of camomile

wild dock.

ought in

each

are

fortydays,with
of
two spoonfuls

to be

taken

when

in
turated
tritwo

the
the

p
III.]

SECT.

is

moon

MAD

the

on

DOGS.

increase before

165

sun-rising.But

do not

drink it every day givea double

triple.And the theriac from vipersmay
The
the wild

patientis to be

cucumber, which
of sage,

called

with

or

alysson.Some

the bite to eat.

the

Such

doze,and

sometimes

be

may

tage.
givenwith advanthe preparation
from
coction
given every day with the de-

Heraclean

ironwort,which

givethe liver of

diet is to be

the

and

strong,or milk, and

onions,and
garlic,
the

leeks.

But

the remedies

commencement

which

some

have

we

inflicted

blunts and
time
Both

wine

sweet

in like

if from

is also

dog that

given as

accomplishedby drinkingold

both undiluted

be

the power
of the poison,
and at the same
it from beingcarried deeper into the system.
ends

who

purged with

is to be

also

to those

tinguishes
ex-

vents
prethese

that

is

ing
by eat-

manner

hinderance

at

described have

been

neglected,scarification,
cupping,or burning the wound,

must

not

been

carried

be had

the

poisonhas already

the

the
use
deep-seated
parts; but we must
that is to say, when
the attack
metasyncritica,
has
with
liiera and
not
come
on.
hydrophobia
Purging

remedies
of

to, because

recourse

to

called

divided milk

is also to be had

to, with

recourse

sudorifics ; and

calefacient

and sinapismsare to be appliedto

plasters,
part of the body. But the most eff'ectual of all remedies
of hellebore frequently
course
repeated.

Commentary.

Aristotle is the

first author

who

every
is a

mentions

Comm.

but his accoiint of it is remarkablyincorrect,if

hydrophobia,
the text be not corrupted. He says, all animals that are bitten
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.
of Schneider. (1.
viii,
22.) But see the Annotations
c.) Ovid
ranks

inveterate

diseases

gout and

Tollere nodosam
Nee

nescit medicina

formidatis

Celsus,also,was

he

the

incurable

"

for which

hydrophobia among

well

auxiliatur

aware

podagram,

aquis."
"

JE!rPonto, i,3, 24.

of the fatal nature

of the

disease,

expectedly
says the onlyremedy is to plunge the patientunsions,
into the cold bath, after which, to prevent convul-

he

is to

be

put into

warm

oil.

He

also

approves

of

MAD

166

CoMM.
'

'

givingundiluted

wine.

the

cauterized,

woimd

to be

Pliny in
mentions
But

like

in any

as

doubt
ancient

remedy
the

author

[book

of
preventive
(v,27.)

reckons

manner

hellebore
without

As

DOGS.

the

for it.

the disease lie directs

disease

(H. N.
of

best account
is that

v.

givenby

dangerous^and
63 ; xxix^32.)
^dii,
tained
hydrophobia con-

Caelius Aurehanus.

give a short abstract of it. He says the disease

be produced not only by the bite,but likewise by the
may
breath of a rabid dog.
This fact is mentioned
thorities,
by other auAcut.
and
such
Aretseus
as
(Morb.
^ii),
Yegetius
and
it
confirmed
modern
is
Med. iii,
writers,
84) ;
by
(INIulo.
He
also relates the
as
Gokel, Lister,Rhazoiiz, and others.
fell into the disease from liaA'ing
of a sempstress who
sewed
case
robe which
had
been
torn
a
by a mad dog. Similar cases
related by Hildanus
and Heister.
He likeAvise states,what
are
is confirmed
and
also by modern
authorities,
by the Arabian
experience,that the disease may be brought on by the bite of
He
mentions
the
wolves, bears, leopards,
horses, and asses.
of a person in whom
it was
occasioned
inflicted
case
by a wound
with the spurs of a cock Avhile fighting. Sometimes, too, he
adds,it arises in the human
subjectwithout any manifest cause,
which
also is confirmed
saw
experience. We once
by modern
the horror of loater in a case
of Phrenitis.
He mentions
gular
sina
of hydrophobiain a child which
with a
afli'ected
case
was
horror
of its mother's
breast.
His description
of the symptoms,
if compared with modern
descriptions
(forexample that
Dr.
Goden
in
Hufeland's
given by
Journal,' Jan. 1816), Avill
be found in every respect completeand accurate.
Thus Cselius
says that the pulse is densus,parvus, inord'matus,and Goden
found
it intermittent and
irregular. Cselius says there is a
frequentdesire of making water, wliich Goden found to be a
attendant
of the disease.
constant
Cselius thought that the
stomach
is more
is
deranged than any other part, and Goden
of opinion that the splanchnic nerves
affected.
are
particularly
We

shall

now

'

In

short, Cselius maintained

it appears
believed it an

and

He
that is to

from

him

that it is

that

some

of

an

incendhnn

the

ancient

nervorum

authorities

ing.
and
treated it by bleedinflammatoryaftection,
much
treats it upon
the same
as
Tetanus,
principles
been
to have
to remove
say, his great objectseems

WASPS

168

SECT.

On

FOR

TV.

the

bites

of

THE

AND

BITES

dogs

tliat

BEES.

OF

are

DOGS

not

[book

THAT

ARE

rabid, as

even

NOT

MAD.

in this

case

poisonous quality,
immediatelysprinklesome
they possess 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
and
vinegar or in the vinegar and nitre,apply it for three daj^s,
moisten
it ; for it will effect a completecure.
Or apply the flour
of tares mixed

with

oil,or

new

sponge,

or

unwashed

wool

soaked

in

ble
vinegarand oil may be applied;or tritui'ate the leaves of bramwith 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
cable.
appli"When
inflamed
with
anoint
triturated
they are
litharge
with

CoMM.

water.

Commentary.

See

Rhases

(ad Mansor.

viii,
9; Cont. xxxv);
(Pract. xxx, 2, 31).

Haly Abbas (Pract.iv,28),- Alsaharavius

laid down
Haly adoptsthe treatment
by our author.
recommends
a
compositionof fat^wax, pitch,and

SECT.

Those
and

who

have

V.

been

ON

WASPS

AND

Alsaharavius

galbauum.

BEES.

stung by bees

ness,
experiencepain, redsurrounding parts become

swellingin the wound, the

tumefied, and the stingremains in the wound
stung
; and those
all
the
and
that
in
other
by wasps experience
an
symptoms,
the
does
remain.
Both
not
aggravated degree, only
sting
remedied
cases
are
by rubbing the parts with clay,or cow^s
dung, or with the juiceof figs,or with the tritm-ated leaves of
of mallows
or
sycamore,
; or by applying a cataplasm of barley
flour mixed
with
also with
brine
or
seavinegar. Foment
water.

PHALANGIA.

VI.]

SECT.

See

Commentary.
mended
Seth

169

plan of

similar

and

by Aetius,Dioscorides,Nonnus,
recommends

decoction

the

treatment

Rhases.

of mallows^ which

Comm.

recom-

Simeon
appears

to

used in such cases.

See
remedy generally
also Geopon.(xii^
12); and Pliny (H. N. xx). Virgilalludes to
this practice
in a passage which has been often misunderstood.
cold water
or snow,
(Georg.iv,230.) Haly Abbas recommends
also Armenian
earth with vinegar,and other applications
of the
nature.
same
(Pract.iv,34.) Alsaharavius mentions the same
remedies
to their
as
as
Haly, but expresses himself sceptical
other applications,
(Pract.xxx, 2, 29.) Rhases, among
efficacy.
mentions
of camphor and vinegar;and another
a composition
containingopium,henbane, and camphor, to be used along with
have

been

domestic

cloth moistened

in snow-water.

also recommend
as

bees

of
preservative
and

VI.

When

but

ON

person

itselfappears

the

THE

face

red, and

it does

not

and

Arab.

PHALANGIA,

as

hands

writers
mallows

from

the

on

and

bandry
hus-

oil,

stingsof

Hisp.335.)

OR

VENOMOUS

SPIDERS.

by a phalangionthe part
if prickedby a sharp-pointedinstrument,

been

has

Arabian

compositionfrom

Bibl.
(Casiri,

wasps.

SECT.

the

The

bitten

swell,nor

is it very
Those
who

warm,

but

it is

derately
mo-

have been stung experience

red,cold,and itchy.
of
the
h
eaviness
of
a
cold,trembling,
body,
great sense
and a perpetual
desire to
pain,paleness,
there are dysuria,
erection of the
make
water ; in some
cases
spasmodicdistension about
genitalmember, humid
eyes, and
the groinsand thighs,
a violent gnawing pain of the stomach,
a

cold sweat, constant

loss of taste in the

tongue, vomiting of water,

or

of substances

resemblingwebs, and sometimes these substances are discharged

by the urine or bowels.
By going into hot water they are
freed from pain,but the painreturns againwith violence. They
of the ashes of figsmixed with
relieved by the application
are
of the pounded root of the wild
salts triturated in wine, or
with
pomegranate, or of birthwort with barleyflour mixed
vinegar. Bathe the ulcers with hot sea-water, or with the
also be applied.
decoction of baum, the leaves of which
may
Recourse
also be had frequentlyto baths, and potions
must

PHALANGIA.

170

[book v.

the seed of southernwood^dill,

birthcomposed of these tliings_,
Avort,wild chick-peas,
Ethiopian cumin, pounded cedar-berries,
the bark of the planetree,the seed of the herb trefoil,
the fruit
of tamarisk ; givetwo drachms
of each of these with one hemina
of

or
Avine,

mixed
to

with

parts of cypress,

decoction of the green

"oiue.

Some

with milk^and
juice,

or

of its balls

reduced
say that the river crab when
the seed of parsley,
and given,
removes

the mischief.

Commentary.

CoMM.
'

"
"

Nicander
bites occasion

langia,whose
cold

describes several

horror,trembhngs

speciesof pha-

varietyof symptoms,

of the

limbs, and

in

such

as

instances

some

tension of the

On the phalangia,
totle
Arissee
genitalmembers.
(Hist.Anim.
ix,39); Xenophon (Memorab. i,3); Pliny

(H. N. xix,9, and xxix,27); iElian (H. A. x\ii,11); Soliuus

The
the
distinction between
xvii)
(Polyhist.
; Phile. (66).
is thus stated by Humelbergius
phalangiaand common
spiders
"Araneorum
eorum
prima divisione duo genera sunt, unum
innoxii
Grseci
sunt
Latini
araneos
arachnas,
qui
dicunt,
quos
duo
etiam a Dioscoride
quod
quorum
genera recensentur, unum
holcon
et lycon vocat, alterum vero
dicit esse
quod Candidas,
:

et densas

tenues

noxii sunt, quos

telas
et

Alteram

operetur.

genus est eorum

phalangiavocant.^^

Grseci et Latini

qui

(Apud

Apuleium.)
Similar

modes

by
(270);

Haly

Aetius

Abbas

of treatment
Dioscorides

to

that

[xi,42) ;

(xiii,
16); Actuarius

viii,22) ;
(Tlieor.

of

author

our

Celsus

(v,27) ;

(Meth.

and

Med.

Alsahara^-ius

are

commended
re-

Nonnus

\i, 10) ;

(Pract.xxx,

2, 26).

Sprengel allows that

determiningthe nature of
however, to

refer the

to their proper

in

names

there

is

considerable

in
difficulty

the ancient

phalangia. He attempts,
diiferent speciesdescribed
by Nicander
in the Linnsean classification.(Comment,

Dioscoridem.)
for example, Gesner, Bagh^d, and
Many modern authorities,

Andreas

Laurentius,have held that the Tarantula,so famous in

the annals of the Dancing Mania, was
of the phalana species
This seems
to be
gium. See further Hecker's Epidem. 113.
confirmed
by Rhases callinga speciesof the phalangium by
the name
of tarantula
(Contin.xx and xxii); and, indeed.

SECT.

SPIDER,

THE

VIII.]

171

to settle the questionthat the

Ardyen seems
5.)
speciesof the phalangia.(De Venen. viii,

SECT.

THE

ON

VII.

OF

BITE

THE

tarantula

is

Comm.
'

SPIDER.

the stingof which occasions

spider,
culty
of the hypochondrium,diffiintense pains about the middle
convulsions.
of making water, eiythema,and sometimes
Those
who
are
stung by such animals,are relieved by the
wild
Theban
cumin, the seed of the chaste-tree,and by
draughtsfi-om the leaves of the white poplar,or by applying
garlicalone, and takingfull draughtsof undiluted wine.

There

is also

of

kind

Comi
spider,Celsus recommends
garlicmixed with rue and pounded in oil. (vi,27.)
See also Pliny (H. N. xxix, 27); Haly Abbas
iv,35) ;
(Pract.
Alsaharavius (Pract.
xxx, 2, 24).

SECT.

When

has

and

STING

the

OF

THE

SCORPION.

diately
the part immestung by a scorpion,
inflame, becoming hard, red, tense, and

been-

begins to
painful,being seized
with
cold; and when
remissions

stingof

THE

ON

VIII.

one

the

For

Commentary.

at

one

pain is

exacerbations.

heat, and at another

attendant
an
symptom, it has
These
symptoms are followed

time

with

trembling,coldness of the
shivering,
and erection of the genital
of the groins,
of flatus by the anus
there is a discharge
sometimes
member
:
and a painful
discoloration
with a loud noise,and horripilation,
These
the skin,the pain resembling the prickof a needle.
on
are
immediatelyrelieved by having the juiceof the figpoured
which stung the person may
into the wounds, and the scorpion
be pounded and appliedto the bite;afterwards salts triturated
be apphed.
linseed and the seed of marshmallows
with
may
is also of service;
Native
sulphur,mixed with rosin or turpentine,
and
in like manner,
galbanum, spread out into the
calamint pounded
or
shape of an oblong pledgetand applied,
and applied
crude barley-flour
preparedin wine and the
; and

by sweating,a sense
tumour
extremities,

of

THE

172

decoction

of

rue

and

SCORPION.

in like

manner

herb

trefoil may

be

take

propomata

containingUyo

appliedwith

of its bark
particularly

[book v.
the

pounded seed of the

advantage. They may also

drachms

wine ;
pennyroyalproperlyboiled,and ten
calamint

boiled

long

with

with

of

birthwort,more
gentianpounded^ or
bruised,and
bay-berries
or

oxycrate,and

in like manner,
and
rue, the juiceof the fig,
the Partliian
at hand ; but otherwise
must
we
use
and

fruit of trefoil and

the seed of

draughtwith
wound

has

advantage.
wonderful

wine

with

cyperus

The

juice.

be taken

basil-royal
may
immediatelyappliedto

in

Sih^er

effect.

benefit of all these

The

laserwort,if
a

the
may

be increased

by the frequentuse of the bath,copiousperspirations,

and drinking strong or diluted wine.
The
following
be
taken
Of
"vivum
to the
compound propomata may
sulphur
size of an Egyptian bean, with eightgrainsof pepper in half
hemina
of vdne, or the juiceof laserwort
triturated with
a
crabs in wine, or equal parts of gith,Ethiopiancumin, and
:

the seeds of the chaste-tree

For

in wine.

stingsof scorpions

severe

and

phalangia.

Of the lees of

wine,dr. xvi ; of
of castor,of the

dr. iv ; of the seed of wild rue, dr.

pellitory,
seeds of rocket,of each, dr. ij; let them

mixed

blood

with

the

of the

sea-tortoise.

The

oboli with
Of
the

dose

iij
;
be

is four

three cyathiof unmixed

or
Avine,
vinegar. Another:
of birthwort,
of each, oz. iv ; of pepper, dr. ij; of
pellitory,
of
the
dr. j. The
dose is the size of an
laserwort,
juice
"

Egyptianbean.
Commentary.

CoMM.
'

'

Nicander

describes

several

speciesof

the

The red occasions

scorpion. The white,he says, is innoxious.
heat
with
and
restlessness
a
fiery
great thirst. The
black bringson inquietude,
a
nd
delirium,
laughter. The green
occasions chilliness with horror.
The symptoms superinduced
also detailed.
are
by the other species
(See Theriac. 775.)
tEHus
Promotus
of the
givesa very circumstantial description
effects producedby the sting
of the different species
of scorpions,
but it would appear to be mostlytaken from Galen
and other
Greek
authorities.
On the nature of the scorpion,
see
further,
N.
and
iElian
xi,
(H.
25);
Pliny
(vi,20.)
On the medical treatment, see in particular
Dioscorides (vi,
19) ; Nonnus
(269);Actuarius (Meth. Med.
44) ; Aetius (xiii,

THE

VIII.]

SECT.

SCORPION.

173

vi,10); Celsus (v,27); Rhases (adMansor. viii,

3); Haly Abbas
and
Pract.
(Theor.\-iii,
22^
iv, 33) ; Alsaliaravius (Pract.xxx,
Avicenna
2, 20);
(iv,vi^5.)
Galen
of prescriptions
for the composition
of
givesa variety
antidotes

for the

of

cure

persons

OMM.

stung by scorpions. The

one
following

be taken as a specimen of them:

Of birthmay
wort, dr. iv; of pepper, dr. ij; of opium, dr. j; of pellitory,
dr. iv; form into trochisks of the size of an
Egyptian bean,
and

swallow

give to

along with two cyathiof undiluted wine.

(De Antidot. ii.) Rhases givesanother receiptof Galenas for
the stingof the scorpion,
viz. equalparts of opium and of the
seed of henbane
givenwith honey. (Contin.xx, 24.)
On
the use
of venesection
for the cure
of the sting of the
Celsus says,
medicos quiab scorpione
tamen
scorpion,
Cogno"\i
"

ictis nihil aliud quam

has

pointedout

venesection

"

ex

brachis

sanguinem

miserunt.^^

Rhases

the proper time and cncumstances

which require
When
administered the theriac,and
you have

the

pain has subsided,if fever supen^ene, bleed the patienton

the followingday 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 occasionally
superinduceasphyxy and epilepsy. He directs a
ligatureto be put immediatelyaround the member, and a
bruised
He also mentions
scorpionto be appliedto the wound.
the internal
cataplasmswith olive oil,and recommends
of wine either alone or Avith garlic.The treatment
use
as
given
is
similar.
Alsaharavius
Dioscorides,Aetius, Haly
by
very
Abbas, Alsaharavius,
Actuarius,and Nonnus,

omit

to

mention

venesection.
The

recommend
veterinary
scarifications,
bleeding,
sm'geons
and burningwith red-hot irons.
See Vegetius(Mulom. iii,
77,
and Geopon. xvi,20.)
Sprengelremarks that Nicander^s division of scorpionsis
naturalists. (Hist,de la Med.)
Cornad
adopted by modern
Gesner
The
gives a very elaborate dissertation on them.

ScorpioEuropceuft,
L.,is not venomous.
is a very dangerous reptile. The
the

The

African,however,
of Morocco, at

inhabitants

the cautery,and
present day,treat its bite with the ligature,

by applyingthe body of a
Jackson's Morocco
(108).

dead
The

scorpionto
Arabian

the

wound.

authorities

See

describe

SCOLOPENDRA.

174

whicli they
speciesof scorpion,

venomous
liiglily

CoMM.
'

'
*

and
rastellans,cai'rareti,

algreta.

in

scorpius
particularRliases,

IX.

LAND

THE

ON

AND

SEA

SCOLOPENDRA.

scolopendrathe generalsymptoms
the bite, and swelling;someof the parts around
times
are
li^idity
and
it is of a feculent
sometimes, though
appearance,
and
ill-conditioned
and
ulcer takes
red
a
painful
rarely,
;
place,beginning with the part that is bitten ; and in addition
of primtus over
the whole
to these, there is a sensation
body.
in particular
have a watery
Those
bitten by the sea scolopendi'a
whereas
that occasioned
and transparent swelling,
by the land
scolopendrais red. It is proper therefore to apply to the
wound
pounded salts,or levigatedrue, or ashes mixed with
the part ^dth vinegar and
brine ;
^dnegar,or squills.Bathe
much
hot oil,and
but Archigenes directs it to be done with
mentioned
thus to applythe things formerly
; and to administer
with
wine, or wild thyme, or
potions containingbirthwort
the juice of the root
of
or
calamint, or wild rue, or trefoil,
When

'

"

the

amount

'

two

heads, and
admits

Avicenna
See

in

by

of half

walks
that

in

and

rides.

See

Actuarius
also Aetius

with wine.

the

has
scolopendi-a

upon

its many

feet.

wholly unacquainted with

was

{H.

copy

hemina

says, that
directions

both

he

^'Ehan
particular

author

Nicander

Commentary.

CoMM.
'

is bitten

one

asphodel to

"

See

call

Alsallara^"ius.

and

Haly Abbas,

SECT.

[book v.

A.

iv, 22

almost

15);
(xiii,

every

Tsonnus

and
word

^ii,35.)
from

it.
Oui*

Diosco-

(272); Alsahara^dus

calls them,
(iv,vi,3.) AAicenna
(Pract.XXX, 2, 23) ; Avicenna
saculufudurni; and Alsahara^vius,alhatrabay. AlsaharaAius
with birthwort,rue,
of wine
mint, "c., internally;
approves
A^ith honey,vinegar,
and of salt,
"c.,externally.The Pseudo-

Dioscorides

recommends

salt with

veriiix,pitch,and

honey.
hesitation in decidingwith
this subject,
that the laud

ii,121.) We need have no

(Euporist.
Sprengeland the other authorites on
scolopendrais the scolopendra morsituns, and
aphroditeoculeata,L.

the

sea,

the

SHREW-MOUSE.

176

spreadingulcer
and

besides tormina

and

dischargeof

the

with

oxymel.

the

or
applied,

and

parts may

the

tender
the root

of

of

the bark

cumin,

of

This

or

wild

vinegar;
then

be

of

kid

These

iv.

To

or

of

also be

lamb,

or

tered
adminis-

give in a potion
bite,having triturated

also is eflPectual: Of

dr.
birthwort,

mjrrrh,dr. vj;

of

the bites of the shrew-mouse

scolopendraapplysalts with liquidpitch,or cedarand

honey, or garlicwith the leaves of the fig-tree
the leaves of calamint, or barleywith vinegar.

or

with

oil.

the Mus

araneus

plan of

treatment

says that the bite of the blind Mus

is taken
author's plan of treatment

Nicander
Our

Dioscorides.

mixed

boiled in

thingsmay
cataplasm. But some

one

is mortal.

araneus

from

brine, and

warm

itselfthat inflicted the

Commentary.

'

"

pomegranate,

be

the

of

rosin with

"

with

the rennet

or

vervain.

shrew-mouse

it with wine.

"

inflicted the

triturated with

mustard

bathed

chameleon,

in the form

CoMM.

sweet

barleywith vinegar may

burnt

gentianroot, or

and

of the

propomata of southernwood

take

the

itself which

applied. They
wine, or sisymbrium,
wild thyme, or rocket,or galbanum, or sage, or the
or
with Avine,
balls of cypress with oxymel,or pellitory
or

cataplasmof
may

be

relieved

and pellitory
applied^
may

piecesand

or
pounded garlic,

or

dysuria
by the
They
of an
oblong pledget,by
mixed
of barley-flour
up

shrew-mouse

boiled rind

mallows,

form

v.

with

supervene^
are

vinegar,or

the

in

be torn

bite may

in the

with

And

fluid.

cold

of galbanum
application

triturated
or
itself,

[book

(De
is

garlicand cumin,

Oribasius

recommends

Morb.

iii,70.) Aetius says

resembling the weasel.
author's, (xiii,
our
14.)

an

Curat,

animal

is similar to

Isodorus

"
Mus
says of it :
moritur,est in Sardinia animal

that
His

aranea
morsu
ciijus
forma, quae
perexiguum,aranese
eo
dicitur,
solifuga
quod diem fugiat."
(Orig.xii,3.)
Vegetius,the veterinary
garlic
pounded
surgeon, recommends
with nitre,or with salt and cumin.
82.) See also
(Mulom. iii,
Columella {xi,
17) ; and ^Elian (H. A. ii,37.)

Most
as

the

of the

Buffbn

treat

of this

case

in the

same

terms

Greeks.

Without
which

Arabians

araneus,

doubt

the ancients
and

it is the

The
accounts
sorix' araneus,
L.
said by
are
give of its venomous
qualities

Sprengel to be exaggerated. Probably Agricola

VIPERS.

XII.]

SECT.

in

venomous

he says, it is

warm

nearlyequalto

SECT.

"When

XII.

venomous

has been

part which

the

by

of

cases

is

there

the

reptiles.Swellingcomes
livid ; there

size,

Suhter.)

first of the

at

the whole

body.

little distance

to be the

the

around

on

In

dischargeof
oilyone, but

and afterwards of an
fluid,
which theyaffirm
poisonousfluid,

Comm.
""

viperor echidna,or

at
perforations

which

araneus

ECHIDNiE.

ichorous

and

(De Anim.

weasel.

AND

bitten

two

appear
another,from

one

small

animal,pain supervenes,
bitten,but afterwards of

In the bite there

from

VIPERS

ON

have been

persons

such

some

lie says, tliat the mus

but innocent in cold.
climates,

wlien
correctly

states the matter

is

177

blood
in

all

poison of

wound, Avliichis

palenessof the whole body,vertigo,

and resolution of the stomach, deliquiumanimi,and in some
the bite blisters
bilious vomitingsand dysuria. Around
cases
the disease spreadsby extendfrom burningwith fire,
ing
as
arise,
the gums
to the surroundingparts,and
dischargeblood.
and a cold perspiration
succeed these
Trembling,heavy sleep,
Those bitten by the echidna appear to escape with
symptoms.
the
less danger than those by the viper
; and of these theyrun
In treating
them
taken food.
least risk who have pre^dously
the most eff'ectual
remedy is eatinggarhc and drinkingwine,so

reddish and

that if one
other

can

endure

remedy.

this

course

let them

likewise

Some

pickle.

And

is

he will not stand in need

of any
eat also leeks,
onions,and acrid

give frogspreparedwith

with wine

the dried blood of the

the rennet

of

hare

or

of the dried testicleof

slender

leaves,which

manner

honied

of which

hind to the amount

drachm

also

sea

some

stag,a whole

applyas

an

of
juiceof leeks,to the amount
leaves,wild
water, the juiceof baum
the

to eat.

may be taken
tortoise with wild cumin,

each
following
thingsare eff'ectual,

The

sauce

of three

oboli,a

alkanet with the

In

amulet.

like

half

rue,

the brains of

hemina, in

fowls,the root of panacea boiled in wine, one drachm

of agaric,
the root of asphodel,
pounded pistajuniperberries,
chia,the seed of the chaste tree,two drachms of dried weasel,
domestic

the root
or

with
II.

crabs
river and sea
bugloss,
juiceof vipers'
stavesacre,salts and poley,the root of birthwort

and

12

alone
with

'

"

'

VIPERS.

178

[book

v.

and bay-berries
mixed with honey.
equalpartsof myrrh,gentian,
admirable
The followingis an
remedy of Oribasins for persons
dr. iv ;
bitten by vipers: Of anise,an acetabulum
; of pepper^
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 giveaccordingto the patient's
strengthin
of
three cyathi of diluted wine.
Another, from the works
of castor,
Lycus,a medicine for the bites of ^^pers : Of myri'h,
of each, dr. j ; of the seed of dill,
of pepper,
of purslain,
an
acetabulum
give. Another, from the
; triturate in must, and
works
of Archigenes : Pound
carefullytwenty crabs with a
flour in a mortar, and having
suSicient quantityof wheaten
"

"

mixed

some

dry.

Use

in

honied

with

cataplasmwith
But, says

water.

it,form trochisks of it,and

milk, and giveone in a draught
he, if you have not river-crabs,

salt with

and

calamint

to the wound
dung appliedexternally
with wine is a powerfulremedy ; or bay-leaves boiled with oil,
or
or
calamint,heath, rue, parsley,
southernwood,
bay-berries,
galbanum on a pledget,green marjoram pounded ; also young
and applied
and frequently
fowls torn in pieces,
warm
changed,
with wine, the pounded bark of radish,
the flour of tares mixed
in oxymel,the leaves of the wild
boiled squills,
raw
barley-flour

Goat's

sea-crabs.

use

cucumber
fine

with

salts.

with

Bathe
or

with

bloody let

lees of wine

in like

with

manner

salts and

honey,bran boiled in vinegar,

with
salts,liquidpitchwith
vinegar,cedar-pitch

polenta,me

ashes

polenta,the

with fine

also with

the

decoction

vinegarand

brine.

or
trefoil,

"When

of

royal,
penny-

blisters become

the

taking off"the skin, then

bathe with much
water, and applya cataplasm of boiled lentils
with honey till the cure
is completed. The antidote of vipers
is particularly
in a draught and
both when
taken
efiicacious,
out

their contents

of

without

apphed externally.
Commentary.

CoMM.
*""*

'

have considered

Most
the

below, there is
speciesaltogether.

echidna

seen

Our

from

author's

the ancient

of

the female
to

reason

It is the

Nicander,

Dioscorides in like

manner

also

viper; but, as
it

that

suppose

was

colubra of Celsus.

of
description
who

authorities appear

the

symptoms

recommends

directs

us

to

is

to

will be
difi'erent

(v,27, 3.)

closelycopied

similar

treatment.

givewine, and various

SECT.

XII.]

articles of

VIPERS.

acrid

an

and

calefacient

onions,pepper,
affirms that eating garlicand
most

these

nature, such

Comm.
garlic,
Archigenes (ap.Aetium, xiii,
21)

"c.
squills,

the

179

effectual

as

"

drinkingundiluted
of the

wine,

stitute
con-

Of /course
part
with the view
given upon general principles
treatment.

thingswere
Hence
it may
be
supportingthe strengthand vital heat.
understood
the
ancients
much
confidence in the
why
reposedso
theriac of Andromachus, most
of the ingredients
of which were
and
calefacient
substances.
The body of the
stimulant,acrid,
which
entered
into
this famous
vij)er,
composition,is said by a
modern
authorityon the Materia Medica, Moses
Charras,to
contain
certain volatile oil. (See Book
a
VII, sec. ii,of this
work.)
A^dcenna
delivers his plan of treatment
at great length,
merating
enuArabic substances,
the nature
of which cannot
many
be easilydetermined.
His
now
generalprinciples,
however,
of

to have

seem

recommends

been
in the

much

the

first

same

as

those

of

our

author.

He

and
placethe ligature,

cupping with
and the theriac are
scarifications. Wine
to be given unless
the patientis
inflammatorysymptoms come
on, in which case
to be bled, (iv,
6.) In another place he praisesthe juiceof
the citron as a remedy againstthe stingof the viper. Haly
Abbas recommends
immediate
amputationof the pad; when this
is practicable,
and otherwise directs us to applya ligature
around
and use
stimulant applications,
such
it,to make scarifications,
of the other authorities,
Like most
he
as
onions,leeks,"c.
recommends
and Avine,
the theriac,
with other stimulants,
such
"c.
In certain cases
he
as
pepper, birthwort,bay-berries,
also approves
of bleeding.(Pract.iv, 32.) Alsaharavius
commends
reand in short nearlythe same
cupping,the ligature,
as
plan of treatment
Haly. (Pract.xxx, 2, 18.)
Garlic

was

used

in

and
both internally
theriac,
Geopon. xii,30.)
On

the

cases

common

in

as

substitute for the

cataplasms.(See,in particular,

viper,see ^han
(H. A. x, 9) ; Phile (70); Galen
ad Pison.) The ancient stories of the fatal copulation
of
"(Ther.
the male viperwith the female,and of the loves of the muraena
and viper,
are
probablyfabulous.
(See De Pauw, apud Phile.)
The latter storyis told by Aristotle (H. A. v, 10) ; ^Han
50);
(i,
Oppian (Hal.i,554) ; Pliny(ix,
23) ; Athenseus (vii)
; Achilles

'

AMPHISBiENA.

180

Tatius

CoMM.
'

'
'

One

i.)

of Atlienseus's

[book

v.

authorities^
however^ questions

(Deipn.1. c.)
is the
coluber
According to Sprengel,the Asiatic ty^lBva
j^gyptius; the ty^iQ,
probably the C. ammodytes ; and the
the C. berus. (Comment, in Dioscor.)
European i/i^ua,
of the viper,
It is clear^
however, from Nicander^s description
that the term
nomous
apphed to a considerable varietyof veeyrig was
It must
not then be supposedto applyin all
snakes.
It is also certain,
will be
to the coluber ammodytes.
as
cases
the truth

of it.

under

seen

heads, that

their proper

other

serpents,to which

given,such as the cerastes,the hsemorrhus,

and the asp, were
merely varieties of the vipera.
authorities on Toxicology,
The seps is not treated of by the Greek
noticed by the Arabian
except Nicander,but is briefly
names
specific

states that the treatment

famusus. Avicenna
of the viperappliesto it.
scriptio
(iv.6, 3, 48.) From the deof it given by Nicander, it would
appear to have been
mentary
(See Theriac,320, with the Comvarietyof the hsemorrhus.

under

the

of

The
are

of them

"

"

name

'

of

Eutecnius.)

ON

THE

AMPHISB^NA

SECT.

XIII.

same

symptoms follow their bites,and

to them
applicable

AND

SCYTALA.

the

same

therefore it is unnecessary

dies
reme-

to treat

particularly.

Commentary.

CoMM.
'"

were

Nicander

that

the

amphisbsena is a
small serpent with two heads,and small eyes.
The scytala,
he
but thicker and largertowards
says, is like the amphisbsena,
the tail. Avicenna
doubts whether
the amphisbsenamoves
He says it is a serpent of equalthickness at both
both ways.
which probablygave rise to the supposition
that it
extremities,
had two heads.
He calls it a snake of the fragile
nature, which
pointsto the blind-worm.
evidently
description
(See further,
in
Comment,
We
the
altahban.
Matthiolus,
Dioscor.)
suppose
and alhuidia of Alsaharavius are
the amphisbsenaand scytala.
He
recommends
generaltreatment,namely,
(Pract.
XXX, 2, 19.)
the ligature,
with cold water to drink.
cupping,scarifications,
Sprengel inclines to think that the scytalawas the anguis
says

XIV.]

SECT.

He

eryx.

he

DRYINUS.

makes

the

be the

amphisbsenato

questions,
however,

respectingits

181

the

L. ;
anguisf7'agilis,

of the

accuracy

Comm.
'

'

ancient

accounts

'

quahties.(Notsein Dioscor.) But,

that these serpents are not veindeed,Aetius states distinctly
nomous,
and that their stingmerelyoccasions inflammation
like
that of wasps and bees. (1.
c.) Nicander also merely describes
these serpents,and says nothingabout their being venomous.

SECT.

XIV.

venomous

ON

THE

DRYINUS.

THE

INTRODUCTION

FROM

GALEN.

The
and

dryinus,that

destructive

an

lives at the roots of

animal, that

if

one

oaks, is

tread

so

pernicious

him

on

he

will

excoriate one's

will seize upon the whole

foot,and great swelling
limbs ; and, what is more
tempt
atwonderful,they say that if one
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

has been

stench

as

overpowers

stung by the dryinus,tumefaction

place with redness,and blisters on

with

with

wine

all other smells.

the

one

part takes

surroundingparts,along

lowed
dischargeof a watery ichor. These symptoms are foland tormina.
Birthwort
by cardialgia
givenas a draught
is ser\dceable

in these cases, and

the root of asphodel,
taken
in like manner,

kinds of oak triturated and taken

the roots

of

of the

When

of the ilex

pounded

in

and

the herb

and

and
trefoil,

the fruit of all

ner
draught. In like manappliedto the part are

use.

Commentary.

Nicander

says it is also called

the
distinction between

and
chelydros
chelydrosand

Comm.

makes

'

'

a
hydros.
the chersydros,
but subsequentauthorities confound
them together.
(Seebelow.)He says it inhabits lakes and marshy grounds,
feedingupon locusts and frogs. Its back is black, and its
smell fetid.
The
symptoms occasioned by its stingare livid
dimness of vision,supdelirium,cutaneous
swelling,
pustules,
pression
of urine,coma,
and vomitingof blood or bile.
singultus,
Haly Abbas calls it adresa,and says that it emits a fetid
redness with an aqueous discharge
smell,and bringson inflammatory
from
the wound.
calls it
(Theor.viii,
21.) Avicenna

He

182

CoMM.
^~^

ILEMORRHUS.

kednsu

dvras.

v.

"

Isidorus

Chelydros serpens
says^
dicitur quia et in terris et in aquismoratui"/^

{\x,6, 3.)

qui et chersydros
(Origines.)
Virgiltranslates Nicander^s
of inimitable

[book

spiritand

of this

account

serpent into

It "will be remarked

elegance.

verses

by

the

lected
togethercircumstances colof the chelydros
from Nicander's
separate descriptions
and
425.) Though critical emendation
diyinus.(Georg. iii,
of the text of ancient authors be foreignto the designof this
work, -we cannot omit the present opportunityof statingthat,
from a comparisonof the descriptions
givenby the Greek and
reader

curious

Latin

that

poets,we

Yirgilshould

he

up

thus

that the

think

inclined to

are

run

mixes

line of

434th

Sae^-itagrisasperque

siti atque exterritus oestro.

This is founded
It

the 417th line of Nicander's Theriacs.

upon
alludes to in the
to be the chersydros which Dante

seems

followingverses

"

Come

le

innanzi

rane

Biscia per 1' acqua

Finch'

alia terra

alia nemica

si

dileguantutte,
s' abbica."

ciascuua

Inferno,canto
For

of the

account

an

hydrus, see

the sixteenth section.

According to Sprengel,the dryinusis

(Notsein Dios.)

Agricolafinds
the

from
is

hydi"us

or

speciesof hydrus. (De

held

the

fault with

be

to

sixteenth

SECT.

Those

different.

XV.

bitten

blood.

sore

The

Idood which

natrix.

lebetinus.

the
distinguishing

He

Anim.

coluber

remarks

that

sub.) They

See, however, our

are

sydros
cher-

the boa

now

rally
gene-

commentary

on

ON

THE

H.EMORRHUS,

hsemorrhus

PRESTER,

DIPSAS.

riolent pains,
and
experience

lateral contractions
the

OR

of the porous

parts

by
pains.
o
f
and
if
there happen
copiousdischarge blood,
on
any part of the body it bursts out and discharges
alvine evacuations
likewise are
bloody,and the
is evacuated is thrombous.
When
theycough they

the bite there is a

a

for

the

section.

by the
both longitudinal
and
of the body, occasioned
to be

Lucan

vs..

persistenceof the

From

H.EMORRHUS.

184

'
'

(See Bocliart,Hieroz. ii,367.)

Galen
states that he was
informed
by the Marsi, who made a
livingin Rome by dealingin serpents^that the dipsadeswere
not
a
peculiarspeciesof serpents,but a varietyof the viper
found
the sea-shores
of Africa. (De Simpl.x.) Isidorus
on
thus defines them:
Haemorrhois
aspisnuncupatur, eo quod sanfuerit : ita ut dissolutis venis,
guinem sudet qiiiab eo morsus
Dipsas genus est
quicquidvitse est per sanguinem evocat."
siti perit."
memorderit
aspidisquaj Latine situla quia quem
(Orig.xii,4.) The effects produced upon the system by the
of a highlyinflammatory
to have been
stingof the dipsasseem
nature.
Accordingto Nicauder,it kindles a flame in the heart,
the lips become
quenchable
parched,and the person is seized with an unthirst.
These
symptoms are stronglyportrayed
Lucan
:
by
belonged to

CoMM.
'

[book v.

the

viper kind.

"

"

"

Ecce subit virus taciturn,

carpitquemedullas
accendit viscera tabe.
Ignisedax, calidaque
Ebibit humorem
et
Pestis,

circum

in sicco

Csepit.

....

Ille vel in Tanaim

missus,Khodanumque, Padumque,

Arderet,Nilumque
Accessit
Famam

vitalia fusum

linguamtorrere palato

bibens

vagantem.
minorem
\ji\iye,factique*

morti

Dipsas habet

per

terris

rura

adjutaperastis."
Pharsal.

The

Arabians

give a

similar

Abbas

says, that it occasions

treats

the wounds

of the

principles,
namely,by

ix,754.

the

of its eff'ects. Haly

description
great heat and burning. Dioscorides
dipsasand hsemorrhus
general
upon
external application
of cauteries and

of wine and acrid

cataplasms; and the internal administration
food.
undiluted
wine
recommends
Actuarius,in like manner,
and acrid food,and
also directs us
to amputate the part, or
apply acrid cataplasms accordingto the degree of danger.
Most
of the ancient authorities concur
in recommending the

theriac; for

operandiof Avliich in
this case, see Alexander
Aphrodisiensis
(Prob.i,152.)
"We
mention
that, after consideringthe descriptions
may
arius,
given by Nicander, his commentator
Eutecnius,Galen, Actuand Avicenna, we
are
disposedto think that the text of
an

of the

account

Sic

modus

legewonfactiq.

XVI.]

SECT.

author

our

but

at tlie

have

we

not

HYDRUS.

185

this section must

beginningof

to deviate

ventured

from

it,as

to satisfy
emendation
hit upon
a
us.
conjectural
contractions of the interstices or
others mention

of the

all state

body, and

the pores of the skin.

author should have omitted

there

substituted

hemorrhage,and

we

None

Comm.
"

could

'

not

of the

parts

porous

dischargeof blood
Noav it is not probablethat our
this cutaneous
as
symptom so striking

that

from

is

be corrupt ;

one

which

the others take

notice of.

no

the

Sprengelmakes
the

hsemorrhus

C.

quiteobvious from
from the
especially

SECT.

XVI.

the ancient
account

THE

the

both vipersis
they were
of them, and more
descriptions
them
givenby Galen. (1.c.)
That

cerastes.

ON

be the coluber prester,and

dipsasto

of

OR

HYDRUS,

WATER

SERPENT.

by a water serpent, the

wound
becomes
broad, large, and pale,and a black, copious,
and fetid discharge,
a spreading
ulcer, takes place,and
as from
of the mischief is accomplishedonly after a length of
the cure
Wherefore
powdered marjoram
time, and with difficulty.
oak ashes
is to be appliedto their bites,
mixed
with water
or
with melted honey is given to
mixed
with oil,or barley-flour
When

person

has

been

bitten

of two drachms
in diluted
drink,and birthwort to the amount
wine, or two cyathiof oxycrate; and afterwards the juiceof
horehound, or its decoction with wine, or wild cresses, or the
with
the flour or the seed of hog'sfennel,
fruit of asphodel,
or
also be eaten with vinegar.
wine.
A fresh honeycomb may

Commentary.

This section is taken

almost

word

for word

Comm.

Dioscorides.

The

"

Bochart

makes

this to

'

'

chersydros,
says Nicander, is like the
The
its bite is followed by malignant symptoms.
asp, and
becomes
skin about the wound
parched and putrid,along with
the body. Isidorus says of it :
heat and painsall over
dros
Hyicti
a quo
obturgescunt.^^
(Orig.xii,4.)
aquatilis
serpens
N.
See also Pliny.(H.
sions
xxix,22.) Haly Abbas says, it occaof the part, from
which
black fetid discharge
a
lividity
takes place.(Theor.viii,
21.)
from

have

been

the

serpent which

so

"

CENCHRINUS.

18G

the

annoyed

CoMM.
^^^

children

ii,421.)
According

[book

Israel in

of

the

wilderness.

v.

(Hier.

Sprengel,it is the coluber natrix. (Notsein

Dioscor.) Gesner and Dr. Milliganmake it to have been the
It is now
coluber lutrix vel chersea,L.
held not to
generally
be

to

section to

fourteenth

Schneider

dn,'inus.
in his

have

We

venomous.

has

learned

annotation

THE

ON

is bitten

by

on

the

with

the

commentary

our

of the

Nicander's

XVII.

person

in

confusion

posterioresto

SECT.

the

Curse

When

alluded

Iwdrus

this

on

subject

Theriacs^(1.432.)

CENCHRINUS,

the

bite is like

cenchrinus,the

echidna,mortification supervenes, and the flesh melts

he
swelled as in dropsy,and
having been previously
away,
Erasistratus
becomes
lethargicand comatose.
says that the
bladdei',and colon are affected ; for upon dissection these
liver,
found
corrupted. Wherefore they are remedied by
parts were
a cataplasmcomposed of the fruit of lettuce with
linseed,and
that of the

by pounded
with
shovdd

cyathiof
also

'

"

also the

wine,
and

this

by

the root

or

wild

rue,

and

of birthwort

by

wild

of the
a

turated
tri-

thyme

root

of

draught with

in like manner,

taury
cen-

three
and

so

gentian.

lion,has

squamse.
Dioscorides

and

asphodel;and two drachms

be immediatelygiven in

Commentary.

CoMM.
'

cresses

savory,

Accordingto Nicander,the cenchrinus,called

a body of varied
size,and marked Avith punctated

and

Actuarius

of
account
give exactlythe same
scribes
deHaly Abbas in like manner
serpent as our author.
it as occasioningmortification and putridity
of the part.

(Theor. viii,21.)
flexuosis qui semper

Isidorus says of it, " Cenchi'is serpens in

efficit. De quo Lucanus
iter rectum
: Et

lapsuruslimite cenchris.'^
that it is a variety
of the coluber berus,
Sprengel conjectures
or
viper,which is highlyprobable. According to Belon, it is
three palms long,of the thickness of the littlefinger
reous
; of a cinesemper

recto

colour,Avith black spots. Aetius makes

as

the

acontias,which

there

can

be

no

doubt

it to be the
was

the

same

same
as

CERASTES.

XVIII.]

SECT.

187

Yet
Lucan
jaculusof Lucan.
cenchris separately.
(Phars.ix.)

XVTII.

SECT.

ON

THE

Accordingto Galen,there

of the

treats

the

Comm.
'

AND

three kinds

ASP.

of asps: that called

chelidonian,and the third the ptyas, which is

its neck, and measuring
perniciousof all ; for,stretching

the land

asp, the

the most

it disgorges
distance,Avith great sagacity,

convenient

body. This is said to be the kind of asp

which
Queen
Augustus,having vanquished
Cleopatra,when
Antony, wished to seize on her, took and appliedto her left
a
breast,and being bitten by it she died very quickly. When
tumefied,with
person is bitten by the cerastes the part becomes
the

the

poisoninto

and

hardness

which

blisters,and

the whole
of the

sometimes

black and

is sometimes

of

system becomes

privymember,

and

the bite there

from

dark

mental

flows

pale,and
;

then

ichor

like leeks ;

palecolour,with

alienation

an

erection

dimness

of

they die at last convulsed,as in tetanus.

is bitten by an asp, the bite resembles
the prick
When
a person
and without tumeof a needle,beingvery small in appearance,
faction,
and
blood
it discharges
not
copiouslybut in small
and of a black colour.
Straightwaydimness of the
quantity,
the body,which are
eyes seizes them, and various painsall over
fore
and not without enjoyment,
altogether
slight,
supervene ; wheredies
has properlysaid, and without sufi'ering
Nicander
the man."
The
colour is changed and becomes
as
as
green
grass, there is a gnawing pain at the orifice of the stomach,the
drawn
forehead is constantly
upwards,the eyelidsare moved
in sleep,
and with these symptoms death cuts off
as
insensibly
In
the man
before the third part of a day has passed over.
both these cases
speedyamputationof the extremities averts the
Wherefore
the bitten part is to be amputated without
e^dl.
the flesh is to be cut off immediatelydown
or
delay,if possible,
sightcomes

on,

and

"

to the

bone, in order that the poisonmay

parts which
remains
like

are

bitten

is to be seared

that

the blood

of
and

the

and

by

not

pass

adjacentones.

cauteries.

basilisk and

in
spirits

the

'

'

CERASTES

are

jaculusand

bull's

the arteries.

through the
Then

what

poison of these,
blood, quicklycoagulates
For

the

CERASTES.

188

'
'

According to Nicander^ the most pestiferous

its eyes of a
ell in length,its colour squalid,

Commentary.

CoMM.
"

asp is about

an

and

drowsy appearance,
small
"

wound

and

the

is the

; neither

without

man

serpent which

borrows

his account

person

it leaves

inflammation

this

upon

very

is

perceived,
profound sleep. This

painsinks into a
Cleopatradespatched herself

(Ther. ad

Galen

serpent in

it bites

when

swelling nor

remarks

curious

some

[book v.

event, and

the

Pison.),from

^^

with.

of the

nature

which

See

author

our

of it.

that it resembles the male

says of the cerastes
viper,
onlythat the latter has no horns,whereas the former has
Xicander

either two
morsu

four.

or

Isidoi*us says of

immittat

venena

et

aspergat :

dicunt,et inde aspis quod morsu

xii,iv); and of the cerastes,
"

in

habeat

capitecornua

them,

"

tog

Grteci

similia arietum

sunt

eo

illiciens

esca

sollicitata animalia

(Orig.
quod

quadri-

autem

ostentatione,veluti

gemina cornicula,quorum

"

dictus

serpens

quod

venenum

interimat

venenato

Cerastes

Aspis vocata

enim

perimit.''^
(Ibid.) Harris says, The shephephon (Gen. xlix. 17) is probablythe cerastes,a serpent of
the viperkind."
(Nat.Hist, of the Bible.) Bochart,however,
has provedthat the shephephonsignifies
both the cerastes and
the hsemorrhus,which
alike,being both vipers.
are
very much
(Hier.ii,416.)
be the

same

as

"

is

Aetius,however, givesthe

stingof the most

hours
nine

and

that

days.

hsemorrhus

to

the cerastes.

Oiu' author^s treatment

the

the

Spreugel, in fact,makes

He

taken
piincipally

fullest account

those

at

speciesof asp proves

wounded
by the cerastes

asp
last convulsions.

as

Dioscorides.

of them.

fatal

representsthe

torpor,and

from

He

says

fatal in

three

live
generally
ness,
occasioninggreat coldBesides

the local

dies
reme-

in all such cases, he recommends

in an especial
applicable
which is to be administered in great quantities.
manner
vinegar,
Celsus thus explains
the way in which vinegarproves
cious
efficafor counteracting
the effect of a fi-igorific
poison: Credo
\dm
quoniam id (acetum) quamvis refrigerandi
habet, tamen
"

habet
Eadem
rem

dissipandi. Quo

fit ut

terra

respersa eo spumat,
\i
verisimile
est
intus humospissescentem
ergo
quoque
hominis
ab eo discuti,
et sic dari sanitatem."

The
those

etiam

author
of

of the work

'

Euporiston,'
usuallypublishedwith

recommends,
Dioscorides,

in the

case

of

person

stung

BASILISK.

XIX.]

SECT.

by tlie asp^ constant

189

shaking,beating,and

of tbe

movement

Comm.
'

'

whole

body, with

affusion of

the

hot

salt water.

(Euporist.

ii,120.)
the

Pliny says
when

introduced
is

sore

old,and

the mouth.

by

poison of

The

account

taken

from

into

resembles
its head

Hke

and

be

asp to

four feet

long,and

of the

cerastes,he says, in other respects

The

spear.

it has two

late traveller in the

of the horned

four substances

or

on

East, givesa different

account

serpent (colubercerastes)
; he says that of

which he

purchased from

the other

foot and

of them

the

half.

called

the

killed

Psyllione
A

was

foot

lancet smeared

two

long,and

with the

venom

The French naturalists

dog in three hours.
who
attended the expeditionto Eg}-ptfound a Adper,
which
hage by the inhabitants,
they held to be identical

one

with

author.

our

horns.

Madden,

of

more

swallowed
innoxious when
perfectly
(N. H. xxix, 18.)
which Avicenna givesof these serpentsis mostly

Adper,
except that

immediatelyfatal
slowlywhen the

proves

it is

that

Aetius

of

asp

wound,

fresh

Agricoladescribes the
thickness

an

of

asp

the

ancients.

need

We

have

no

hesitation

then in
asp of
seems

decidingthat the coluber ^Egyptiacusis the celebrated

of the asp
a variety
antiquity. That the cerastes was
Nicander
which
highlyprobablefrom the description

givesof

both.

'Thebes,^p.

(Theriac 177
In

378.

varieties of the

^aper of

of

XIX.

reptileseldom

Erasistratus

says, when

259.)

fine,the asp and

common

SECT.

This

and

comes

also Wilkinson^s

cerastes

merely

were

Egypt.

THE

ON

See

BASILISK.

under

the

the basilisk bites one

sight of
the wound

men

but

becomes

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 juiceof poppy;
but we
have
had no
a

faint

trial of these

things.

Commentary.

sharp body

about

The

basilisk,
accordingto Nicander,

three

palms

in

length,of

has

Comm.

brightyellow

BASILISK.

190

OoMM.
'
'

[book

v.

because
all the others
king of reptiles,
flee from
his hiss.
Pliny, Solinus, and most of the ancient
of the basilisk.
authorities seem
Nicander's
to copy
description
tion
The
produced by his sting are said to be inflammasymptoms
of the whole
body, lividityand putrefactionof the flesh.

colour,and

is called the

(Theriac.1. c.)
Avicenna

states

which
transfixed

also

See

that

basilisk with

both

to

with

the

spear.

army

of

Cato, who

him

his

and

relates

He
his

Lucan

the

the

having wounded

mals
ani-

soldier who

poison proved

fatal

wounded
accidentally

lipwas

relates

of

case

the

spear, and

horse, whose

and other

birds
stupefies

basilisk

the

him.

approach

(Ther. ad Pison.)

Galen

of

case

basilisk

soldier

with

in

spear,

the
and

having felt his hand aS'ected with the poison, saved his life by
(Pilars,ix, 830.)
immediately cutting it off with his sword.
Similar
histories are
given by Pliny, Dioscorides, Actuarius,
and

Isidorus.

birds,and

Solinus

affirms

vegetables.
exj)lanationof

it proves

that

passages

of

to

almost

fatal to all

beasts,

wherein
scriptui'e
is made
Bochart
of the basilisk,see
mention
(Hier.ii,339.)
fabulam
Linnaeus
ad
omnem
Spreugel says :
(de Basilisco)
Lacertse
capite cristato, Iguance proximum, reduxit."
genus,
Bonneterre
also affirms
(Comment, in Dioscor.) M. TAbbe
that the basilisk is not
It may
poisonous. (Encyc. Method.)
be doubted, however, if we
be now
acquainted with the basihsk
For

an

the

''

of the

ancients.

ancient

basilisk

of the

one

the

It would
must

have

appear

been

serpents described
of

names

buskah

and

either

the

certain

cobra

di

that the

capello,or

traveller under
intelligent
in
effah as being still found

by
el

us

an

Morocco.

of Morocco, 109.) The

former of
(Jackson'sAccount
these,indeed, judging of it from the draAving which he gives
be a varietyof the cobra
coluber
must
We
or
naja, L.
may
that
add
modern
a very
intelligent
authorityon the toxicology
of the
ancients, Ardoyn, gives such a descriptionof the
basilisk as appliesvery well to the cobra.
The
crown
(corona)
on

the

snake.
cobra

head

can

refer

to

no

(De venenis, vi.) It is

is indigenous in Africa.

other
now

serpent than

the

Avell ascertained

hooded
that

the

SEA-SCORPION.

192

steepedin

fig brandies

[book

wine,

sweet

or

of the brains

v.

of the

fish itself.

Commentary.

CoMM.
'

"

of the

great varietyof remedies

by iSTicauder.

described

sea-dragonare

for the
For

an

wound
account

(H.
riii,
13) ;
draco,see Dioscorides (vi,45)|;
^lian
(276); Pliny (H. N. xxix,20);
(H. A. xiv,12) ; Nonnus
6, 3.)
Aetius (xiii,
39) ; Phile (80); Avicenna (iv,
A.

Aristotle

of the

the sea-dragonof
referring
the ancients to the trachinus draco,L., Angl.,the great weever
tators,
or
sting-ball.This is agreed upon by all the best commenas
Rondelet,Artedi,Coray,and Sprengel. Fishermen
still very
are
apprehensiveof its sting. See Yarrel (Brit.

need

We

have

hesitation in

no

Fishes,i,25.)

SECT.

or

'

'

THE

SEA-SCORPION.

is cm'ed by a
sea-scorpion
by sulphur \-i's-umrubbed
piecesand applied,
pounded and drunk.
by tlu'ee bay-berries

SeeDioscor.

Commentary.

CoMM.
'

ON

of the

wound

The
in

XXII.

(xiii,
40);

Athenseus

(353,ed.

surmidlet
with

torn

vinegar,

(277); Aetius
Casaubon.);Avicenna (iv,6, 2t,
(vi,45); Konnus

23.)
Bochart
habet

says of the

scorpion:

sea

"

Is

cum

terrestri nihil

aculeos,non in
(Hierob.ii,635.)
sparsos,"

prsetervenenatos

commune

cauda

sed in

capiteet toto corpore

Accordingto Sprengel,it is either the scorpana scrofaor the
Bloch.
coitus scorjrius
(Comment, in Dios.) It is a fish still
di-eaded on account
of its sharpspines. See Yarrel
very much
(Br. Fishes,i,76.)

SECT.

THE

XXIII.

PREPARATION

OF

THE

BLOOD

OF

THE

SEA-

TORTOISE.

The
in

this

blood
way.

upwardson

preparedfor keeping
Having stretched the tortoise with its belly
wooden
cut off its head quickly.
or earthen
vessel,
of the sea-tortoise is to

be

CROCODILES.

XXIV.]

SECT.

and

when

with

its blood

reed,put

layit up in the
capers,
the
on

and

drachms

with

day four drachms

third eightdrachms

with

of

translation

our

author

For

marrow,

Aetius

followed the text

have

BITTEN

(xiii,
24.)Comm.
of Aetius,that
'

the

BY

CROCODILES,

crocodile

until
natron
apply levigated
fillit with honey, butter,stag's

cleansed,then

or

with

PERSONS

ON

the bites of the

the ulcer be

cyathus of vinegar,
two
cyathiof vinegar,
three cyathiof vinegar.

corrupt.
beingmanifestly

XXIV.

SECT.

we

for bites of

use

one

This section is copiedfrom

Commentary.
our

it and

dried take

second
the

parts
many
of
lid
and
a
place

the vessel in

When

sun.

it into

divide
coagulated,

sieve upon

two
aforesaid;

as

on

In

is

193

But

fat of geese.

Galen

says, that

he

has

relieved by the
persons bitten by crocodiles manifestly
to the wounds.
of the fat of the crocodiles themselves
application
knoAvn

This

Commentary.

case

is

fullytreated

more

of

by Aetius

Comm.
'

6.) His remedies ai'e mostlyof an acrid stimulant nature

(xiii,
"c.
The applisuch as misy,pickle,
salts,myrrh, verdigris,
cation
author
the
recommended
authorityof
by our
upon
Galen is ascribed by Aetius to Apollonius.

XXV.

SECT.

It will not
animals

also

be
to

ON

foreignto

treat

inflicted

BITTEN

PERSONS

my

of persons
much
more

in

II.

poisonousanimals

with

advantageat

the

applya cataplasmof the

applythe flour of beans

roots

with

MAN.

for

exceptionof such as
haring first rubbed
particular

with

subjectalong with venomous

bitten by men,
since the bites
mahgnant than other ulcers,
who
bit happens to be fasting,
dried lentil.
pulse,particularly

are
by men
if
more
especially the person
had previously
eaten
some
or
remedies
Wherefore,the general
to the bite
appliedexternally

caustic ;

BY

of

the

be

mencement,
com-

very acrid and

the bite with oil,

are

hog'sfennel

oxycrate,and

may

with

honey,or

\'inegarand

"

13

rose

POISONS.

ON

194

[book

V.

Of
plaster:
oil,
spongingit frequently. And use tlie following
of each, oz. 3 ; of wax,
of garoanum, of verdigris,
?evis,
squama
sextarius. The molybdsena
lb. ij; of oil,
lb. y, of molybdsena,
one

being first boiled

as

ulcer.

common

by Aetius

is recommended

Similar treatment

Commentary.

CoMM.
'~^^~'

subsides treat it

the inflammation

When

squama
soluble substances.

it receives the

it thickens

and when
seris,

and
verdigris

in tlie oil receives the

4);
1) ; Apuleius(9,2) ; Serenus (45); Pliny(H. N. xxviii,
(xiii,
Oribasius
6, 4) ; and
(de Morb. Curat, iii,71); Avicenna (iv,
iv,28.)
Haly Abbas (Pract.
in this placethat instances
be proper
to mention
It may
wanting in modern
of
given by ancient authorities,

by

bite of

the

(xxx,12) ;
Lusitanus

See

man.

(Diss,de

Hoff'man

(Prax.adm.

to confirm

times

been

have not

being occasioned
i); Forestus
(Chirurg.

fatal effects

liildanus

saliv. et op. morb.

XXVI.

ON

treat

Zacutus

POISONS.

of

Having given a compendiousaccount

shall next

5) ;

84, 89.)
iii,

SECT.

we

the accounts

of deleterious

animals,

venomous

substances,givingan

tion
exposi-

the symptoms of them

detailing
As to the comremedies.
with their generaland particular
pound
leave them
to be treated of by any person who
we
ones
of certain
have described
the compositions
chooses ; for some
than
likelyto prove injurious
deadlymedicines which are more
of the

beneficial
which

simple ones,

to

and

For

the reader.

occurred

in those

who

neither
took

are

the exact

symptoms

described,by which

them

remedy might be found out ; for the symptoms

ingredient,
varjdngaccordingto the nature of the prevailing
one
might, from conjecture,
according^.
vary the remedies
here againwe
Wherefore
must
begin with the prophylactics.
suitable

'

We

Commentary.

CoMM.

and

now

enter

upon

the

consideration

of

importantdi^dsion of toxicology
; namely,
wardly.
inAvliich
of
taken
treats
substances
alexipharmics,
poisonous
All the writers on theriacs treat also of alexipharmics,

the second

and

most

of these the most

ancient,and

one

of the most

interesting.

PRESERVATIVES

XXVII.]

SECT.

is the

Colophonianpoet

POISON.

FROM
Of the

Nicauder.

195

subsequentauthors,Comm.
'

and

Dioscorides

the Greeks, and Avicenna

and
among
the Arabians, are
serving
demost
particularly

Aetius

Alsaharavius

among
of notice.

doctrine

the

Of

of

FROM

PRESERVATIVES

THE

ON

XXVII.

SECT.

'

poisonous substances,the

part is the prophylactic

; because those who
in

concealed

Thus

skilful.

substances
smell
while

by

them

manner,

with

aromatics.

administer
and

southernwood, opoponax,

poisons with

namely,in the harder

)
,

as

administer
to

poisons

deceive the most

them
and

such

things

castor, for
; or

more

in

Sometimes

as

diseases,
wormwood,

beneficial purpose,

they give them

in

the

food,

complex articles,
mixing the

who
entertains susWherefore
picions,
a person
poisonswith them.
ought to avoid all prepareddishes and every intense
and acidity
such as sweetness, saltness,
quality,
; and in partiis satiated,
the appetite
cular to take plentyof water, for when

afterwards

There
easilydetected.
of prophylaxis
is likewise another
efficacious mode
: for
they
who suspect anythingof this kind should take such thingsas
the eff'ectof the poisons,as dried
will blunt and take away
Let
with walnuts, rue, a lump of salt,and citrons.
grapes
in wine,
to the amount
of a drachm
them also take rape-seed

the

so

difficult

most

prepare
take
the bitterness of deleterious
they
away
mixing them with sweet things,and the fetid

by a mixture
appearing to

they mix

POISONS.

or

are
particular
qualities

the leaves of

of rue,

calamint,or Lemnian

they will

be hurt

earth,and

twenty leaves

by any poison. And certain

of an
antidotes taken with wine
every day to the amount
such as the one
from
Egyptian bean will protect completely,
skink, that from blood, and the Mithridate,which king
took
Mithridates
every day as a preservativefrom deadly
and
poison;
being captured by the Romans, he drank twice of
and not being able to despatch
himself thereby,
a deadlypoison,
he killed himself with his sword.
And
since peopleare sometimes
in desert places
exposedto deleterious thingsaccidentally
if they happen to take up their abode under
without design,
certain trees,such as pinesor firs,
they ought to be on their
and

not

[book

TREATMENT.

196

v.

guard againstdeadly animals, whicli fall from them and the

their wine
is
roofs of houses,and keep the vessels in which
well covered up, as
contained,and in which they boil victuals,
from
has been stated when
mous
venotreatingof the preser^^atives
animals.

Commentary.

CoMM.
""^^

taken

are

The

of the

account

the

Dioscorides.

from

our

Avicenna

whole

the

of this section

(Prsef.)
givenby Aetius is
different.
not materially
of the

says nothing of any

mentioned
substances

and

contents

treatment

author^ s, but
mention
makes

fuller than

Of

Nearly

medicines

same

other

by

somewhat

as

rides,
Diosco-

remedies.

author,and the others

demulcents, and may

our

from poisons,
some
are
preservatives
such
be supposedto act by obtunding the acrimonyof poisons,
are
as
simple absorbents,
figs,walnuts, and rape-seed
; some
such as Lemnian
earth,which probably resembled red ochre,
also emetic : some
and was
are
stimulants,such as rue, calaare
mint, and Avine ; and some
acids,such as citrons,
refrigerant
which
be supposed to act as analeptics
and
restoratives.
may
mentions
this propertyof the citron :
A irgil
as

"

Media

fert tristes

non

Pocula

sajvae

si

quando

tardumque

succos

Felicis raali : quo

infecere

Miscueruntqueherbas, et
Auxilium

saporem

ullum,
prsesentius

venit,ac membris

non

novercas

innoxia

agitatra

verba,
venena."

Georg.ii.
in

Seth (invoce
Simeon
particular
Ktr/oa)
; and Athen.
ii.) Dr. Paris states that when a narcotic poison has
been ejected
from the stomach, citrons or any fruit containing
a
vegetableacid will produce the best effects. (See Pharraacologiai,254.)
See

\(Deip.
SECT.

XXVIII.
TAKEN

If any

THE
ANY

GENERAL
SORT

have

TREATMENT
OF

DELETERIOUS

OP

THOSE

WHO

HAVE

SUBSTANCE.

alreadytaken some
deadlypoison with
the intention of despatching
themselves,such as often happens
from the wicked designof others,if it be obvious to
in life,
or
persons

the suitable
But

have

taken

taken,

is unknown

straightwayapply

can

we

in the account

to us,

have

must

we

any

consequent symptoms

have

hopeless,since owing

to the

render

is to

on,

come

force them

hot
or

water

of

and

be

may

or
spelt,

will not

to

of

only

vomit, or

given,or

if oil is not

by

the bad

of

decoction

fenugreek,or of

evacuate

counteract

recourse

the

case

being too long of being

remedies

appliedsuch symptoms can hardly be removed

oil by itself or
without
delay,we must give warm
and

of them.

to those
thingsas are generallyapplicable
poison whatever ; for to wait until the

such

immediatelyto

197

will be described

remedy,as

if the medicine

Avho

been

has

substance

what

us

TREATMENT.

XXVIII.]

SECT.

wherefore,
with

water,

hand, butter with

mallows, or of linseed,
at

For these

nettle seed.

things
belly
by bluntingtheir
poisons,

vomiting,but

effects of the

will

loosen the

oil will do this, as you

especially
acrimony; and more
may
For if you
from the following
consideration.
ascertain clearly
of cantharides,
Avish to produceulceration of the skin by means
such acrid substance,and the body has
quicklime, or some
been previously
rubbed with oil,no ulcers will take place,and
neither also can
astringethe body if previouslyrubbed
you
with oil.
Besides,vomitingis not only useful by evacuating
the oS'endingmatter, but by showing the poison which had
For by its
colour.
been taken from its smell, particles,
or
is known; by their colour,
smell and bitterness poppy-juice
ceruse
and fresh blood ; by their
and gj^sum
; by their coagula,milk
the sea-hare and toad : so that by
heavy smell and quality,
these

means

which

are

we

are

enabled

suitable to each.

to

have

With

the

mallows, or the grease of

flesh or fowls,or the cinders

decoction of
from

fat

hydromel,much

triturated

with

which

prepared from

are

fat

or

of the

to

recourse

old

butter
stomach

oil may

the remedies

be mixed

the

geese, or broth prepared

Natron
also
of wood.

wine,
are

and

those

efficacious.

things

Having

by emetics,we must
mulant
bring away whatever had passed into the intestines by a sticlyster. 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
the
which
to all such cases,
are
generallyapplicable
among
Lemnian
vermilion,southernwood,agaric,hedge-mustard,the
of eryngo, the seed of parsnipor of calamint, the Celtic
root

evacuated

the

contents

[book

TREATMENT.

198

v.

the flowers
fennel-giant,
the
and rhododaphon),
of nerium
(calledalso rhododendron
juiceof leeks, laserwort or the juicethereof,sagapene, opothe long birthwort,
ponax, the juiceand root of hog'sfennel,
of oestrum,
the seed of Avild rue, the leaves of that species
called

betony;

part of green

inner

uard, castor, the

of

of

decoction

wine.

The

is

and
efficacious,

also

of

each

these

drachm

liquidpitchin

poley and

aforesaid antidotes

the

the theriac from

remedies, especially
the

not

substances, for

or

day.

For

if
sufficient,

been

bad

consequences,
quantity,in order to

fivefold

administered

twice

but

once,

have

prevent any

fourfold

eff'ectual when

prove
not

given in

be

would

which

dose

beforehand, to

administered
must

they have
poisonous

before the

as

linctus

excellent

are

vipers. But

after

taken

when

power

same

in

taken

be

may

that

afterwards,and
such

is the

too

opinionof

the

celebrated Galen.

Commentary.

CoMM.
"
"

"

"

'

this section is
far

ubi

they
primum

go, are
sensit

as

to the

excellent

"

Celsus'

Commodissimum

same

est

purpose
to be
is particularly

as

our

epoto

given by

author's,but somewhat

tamen,
vomere:

; si id

antidotum

directions

The

of

so
dii'ections,

aliquis,
protinusoleo multo

vinum."

merum

the whole

sentences

exhausit,bibere
prsecordia

deinde,ubi
est, vel

Except the last two

copiedfrom Dioscorides.

non

Aetius

are

He

fuller.

with which
precision
the rules of treatment, when
he laysdown
any organ happens
affected in an
to be
Thus, if the poison
especialmanner.
into a hipattack the bladder,he du'ects us to put the patient
bath
of oil or water, in which fenugreek,
linseed,mallows, or
emollient
and
have
herbs
boiled
such
to give him
some
been,
to

di'ink the

for the

commended

decoction

of

vegetable diuretic,such

some

fennel, or spikenard.
parsley,
directs us to givethe seed of cucumber

If the bladder

In

the

same

manner

seed is to be
When

from.

when

in diluted

the intestines

are

as

be corroded
sweet

corroded the

he

wine.
same

given,and all heatingarticles are to be abstained

the poison is determined
to the skin,he recommends

oil,
hip-bathof oil or water, friction with warm
Avitlithe intention of evacuating
it from
like,evidently

the
and

the

the

pores

of

the

skin.

Food

honey, tender fishes,and the

of
like

easy
are

to

digestion,soups
be given. When

with

the

wards

CoMM.
'

'
'

SUBSTANCES.

DELETERIOUS

200

provoke vomiting once

and

the hands

rub

descended

stone

as

XXIX.

SECT.

v.

tlieriac,
to

have

Rhases

the bezoar

poisons.

OF

CATALOGUE

the

the

authorities recommend

Arabian

antidote for

an

administer

poison appears
1. c.)
(Contin.
giveclysters.

feet,and when

to the intestines

other of the

and

more

[book

SUBSTANCES.

DELETERIOUS

SIMPLE

tive
animals are destructhe following
substances,
the
:
cantharis,buprestis,salamander, pine-caterpillar,
lowed;
marsh
the toad,the mute
sea-hare,
frog,and leeches when swallock,
fieawort,hemand, of seeds,the henbane, coriander,
Of deleterious

gith; of juices,meconium, opocarpasum, thapsia,

elaterium,and maudragora; of roots, chamseleon, wolfsbane,
ixia,hellebore,black agaric,ephemeron, which some
thapsia,
and

call colchicum,because

smilax,which

some

it grows in Colchis ; of trees and potherbs,

called
call thymium, but the Romans

dorycnium,the

is called

which
taxus, the strychnusfuriosa,

of ranunculus, horned poppy,

herb, which is a species
pharicum,toxicum, wild rue, and mushrooms
ductions,
; of animal profresh bull's blood,coagulated
milk, Heraclean honey ;
of metals, g^^sum,
lime, arsenic,sandarach, litharge,
ceruse,
adarce,lead,and that which is called mercury; and of domestic
much
wine taken at a draughtafter the bath, or must,
articles,
Sardoan

cold

or

Commentary.

CoMM.
*

'

"

in like

water

manner.

Nicander, in

his

treats
Alexiphai'mics,

of

bane
1, Aconitum, or wolfsor litharge
; 2, Argenti spuma,
; 4, Cantha; 3, Buprestis
riander
rides;5, Ceruse,or whitelead; 6, Conium, or hemlock; 7, Co; 8, Dorycnium (seebelow); 9, Ephemeron, or meadow
saffron;10, Fungi, or poisonous mushrooms; 11, Hirudines,
or
leeches;12, Hyoscyamus,or henbane; 13, Ixias,probablya
of chamseleon ; 14, Coagulated milk ; 15, The sea-hare;
species
16, Papaver,or poppy;
17, Pharicum, probablya composition
the

deleterious
following

substances

:
"

from

figaric
(seeSchneider's note); 18, the red toad and marsh
frog; 19, the salamander; 20, Bulls' blood; 21, Taxus, or the

yew-tree
The

22, Toxicum,

lists of

x\etius,and

not

ascertained.

poisonoussubstances

Actuarius

are

nearlv

Aricenua.

See

treated of
the

same

as

by Dioscorides,
our

author's.

CANTHARIDES.

XXX.]

SECT.

and

of Nonnus

Those

201

Scribonius

Largus

less

are

Comm.

numerous.

"

The

Arabians

it is

now

and

Rhases

ra^dus

so

on

called leunza

extremityof

the

different animals

most

of
(lesena?),

tail,and
stages

is also included

SECT.

The

XXX.

ON

tormented

or

cedar

with

the

bad

may
the

shark,

tion
justmenof
leopard,

and

The

also of
sweat

of

administration

of

castor.

in their lists.

CANTHARIDES.

follow the

grievoussymptoms

for almost from the

cantharides,
are

'

cataloguesof A-sdcenna
Haly Abbas and Alsalia-

toxicology.Among these we
they treat of the gallof the viper,of

animal

the

of

of which

nature

articles; all of them, however,

many
treated of by the
not
substances which
are

several
-^Titers

The

fullest; those

the

are

contain
scarcely

that
an

substances,the

difficult to determine.

contain
Greek

of several

treat

mouth

The

gnawing pain.

bladder the parts

taste resembles pitch

to the

rosin,and the patientshave inflammation

of the

right

hypochondiium,with dysuria,and frequently

they pass blood
it is discharged
as
by urine, and sometimes
by the intestines,
in dysentery
: they fall into
tigo,
deliquiumanimi, nausea, and verand at last they become
delirious.
The proper remedies
are
vomitingwith water and oil,di-inkingmilk, taking four
of Cimolian
earth with honied water, pine kernels,
the
drachms
seeds

of

cucumber, fat beef soup, or soup of geese or of

flesh of fowls, lambs, sheep,or pigs,being tender

the
when

boiled with
; and

linseed

; much

must

; dr. iv

mutton

of the

and

fat,

bark

of

after the food

the juiceof rice,

injectby clyster
of chondrus, or of spelt,
of ptisan,
of mallows, or of
or
or
or
linseed,or of marshmallows, or of fenugreek. And sometimes
ha^^ng cleared out the intestine with honied water and nitre,
then injectthese things, and afterwards allaythe inflammation
we
may
with cataplasms
of linseed and barley
; for at first
these thingsare pernicious.Then
have
to
we
recourse
may
baths of sweet
of iris and of
water, and give the ointments

rosemaiy

roses

in

draught.

Commentary.

The

symptoms

tharides,
accordingto Nicander, are

occasioned

by taking

erosion of the whole

can-

intcs-

Comm.
^^

'

CANTHARIDES.

202

CoMM.
'

tinal

canal^ulceration of

wild delirium.

His

of iiis with

or

taken

bv the

author, and

our

emollient
lows.
such

and

like

cataplasmsand

as

because

their heat

by

as

the

decoction

the

hot

bath

they promote

or
clysters

of linseed

at

with
terms

same

emetics

recommends

him

in the

symptoms

of
author, he disapproves

our

as

of vine-shoots

decoction

the

describes the

clvsters,such

Like

emetics^ such

are

and
cliest,
fat^the oil

milk in
aster, laxatives,

Samian

mouth,

v.

tlie bladder^ affection of tlie

remedies

Dioscorides

honey.
as

rue,

[book

of

oil and

or

of mal-

applications,

warm

the

commencement,

the distribution of the

poison

over
system ; but after a time they are useful,he says, by
the pains and
promoting the dischargeof the poison
allaying

the

by

perspiration.His

tlie cutaneous

same

as

states

that

removing

the
the

His

bodies.

need

author's,we

oiu'

wings

deleterious

is very
Asclepiades,

recommends

them.

enumerate

effects occasioned

otherwise,which

prove

earth, or

Galen

useful for

by taking
borrowed

is

similar to that of Dioscorides.

the Lemnian

being the

remedies

feet of cantharides

and

treatment

not

other

He

their
from

in particular

an
as
sigillata,
speaks favorably

terra

(De simpl.ix.) He also

of milk.
(lb.and de antidot. ii.) He approves veiy much of
to
animal and vegetable
oils givenin sweet wine or tepidwater
that the viscus upon
produce vomiting. Galen states decidedly
which the action of cantharides is exerted is the bladder.
(Ad
recommended
Pison.) The treatment
by Scribonius Largus is
Httle diffei'ent. Aetius, Oribasius,and Actuarius
only copy
from Dioscorides,
without
suggestingany improvement. A^iemetic in this

case.

and Rhases

cenna

of

mention

the

that cantharides

tion
occasion inflamma-

penisand erections.
They agree
in recommending oilyemetics,clysters
of the
believe is an improvement which
we
we
owe
of rose-oil into the bladder by means
injections
(flexible
catheter). Rhases

long since
regionof

the

with

the

Greeks

and, what
the Arabians,

same,
to

of

a waxen

tube

approves of bleeding,providedit be
bled,and violent pain be felt in the

patientwas
the thighs,
that is to say, if the urinaryorgans are
affected.
much
Haly Abbas mentions ardor urinse,strangiuy,
oil by
and bloodyurine among
the symptoms, and recommends
the
mouth
emetic
and
as
an
purgative,and by injection.
Alsaharavius mentions swellingof the penis,
bloodyurine, and
that the same
eft'ectshave
suppressionthereof,and remarks

BUPRESTIS.

SECT.

XXXI.]

been

sometimes

brought on

which

tbarideSjin

he

case

fomentations.

emollient

countiymen

; for

by

203

tbe external

recommends

His

of
application
the tepid bath

is like that

treatment

example^he joinsthem

in

can-

and

Comm.
'

"""^

of his other

approvingof injecting

rose-oil into the bladder.

It would

that

appear

cautharides

the ancients for the purpose

of

Cicero,it was by this means

(Ad Familiar, ix,21.)
Ambrose
and
Pare, ]Matthiolus,
to

follow
toxicology,
Notwithstandingthe

concurrent

all the earlier modern

laid down

testimonies

by

the

ancients.

rities.
autho-

Orfila,in the last edition of his Toxicologic,'

in his late work
that
Cluistison,
on
Poisons,'affirm

Dr.

'

'

oil is the

of

reverse

the

antidote.''

an

free administration

mixed

with

the

oil.

"

Yet, in

of

both upwards
copiousdischarges,
No.

by

writers

of all these

Professor
and

used

ing
committing suicide. Accordthat C. Carbo destroyed
self.
him-

the treatment

on

sometimes

were

olive-oil

and

(Edinb.

latelypublished,
by

case

followed

was

downwards,
Med.

and

of

rides
cautha-

Surg.

Jom-n.

And

if laxatives are to be administered

siu'ely,
at all,oilyones
to be preferred,
are
as
producing least
and
irritation, not being likelyto be absorbed.
It can
admit of dispute,
that the mylabris cichorei
scai'cely
is the same
the ancient cantharis.
It is still used in Turkey
as
and India for the compositionof blistering
plasters,
being possessed
of much
the same
the
a
s
Spanish fly.
properties

104, p. 214.)

XXXI.

SECT.

Those

who

drunk

have

ON

BUPRESTIS.

THE

of the

buprestisexperiencea taste
resembling fetid natron, which is followed by violent pain of
the stomach
and bowels ; there is swellingof the abdomen, resembling
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

rides;
cautha-

but

they derive benefit in particularafter evacuations by

ing
vomiting and by the bowels, from taking dried figs,and drinkthe
wine

and

decoction

of

them

with

honey, and theymay

wine
eat

or

milk,

all kinds

or

mixture

of pears, and

of
take

SALAMANDER.

204

woman^s

milk.

they may

When

the violence

of the

disease has

advantage Theban

with

eat

[book v.
sided
sub-

palm-nuts boiled

in Avine.

Commentary.

CoMM.
'

'
*

says of the
scarabseo

Isidorus

buprestis, animal est

in Italia parvura, simillimum
xii.
longipedi." (Oi'ig8.) See also ^Han
(H. A. ri,35); Pliny(H. N. xxx. 10.) The
symptoms and treatment^ as described by the other authorities,
are
nearlythe same as in our authoi*^s description.
Among the remedies recommended
by Kicander, the most
efficacious are
milk and emetics of tepidoil. (Alex.360.) The
Arabians
do not
of this article separately
treat
from cantharides,unless it be the stupheof Alsaharavius.
(Pract.xxx, 2, 8.)
We
have
hesitation
in
that
the buprestis
of
can
no
holding
the ancients
the h/tfavesicatoria,or
was
Spanish fly. See
Sprengel (Comment, in Dioscor.)and Schneider
(ad Nicand.)

SECT.

When
the

become

that

drop

honey,

salamander, inflammation of"

of speech, trembling,
with difliculty
Certain

often,if

ofl". In
; but

or
pine-rosin,

or

this
more

boiled with

Nicander,
aberration

we

medicine
should

tify
remain, they morsame
things

do the

administer
must
we
particularly
pitchtree, or galbanum with
decoction
of ground-pine,or
a

that of the

tortoise,soup

of

liHes in

oil,the

frogs,having the

boiled
root

eggs

of

of

eryngo

them.

Commentary.

CoMM.
'~^'

parts of the body all around

the

case

or

sea

SALAMANDER.

of

pine-kernelswith
nettle-leaves boiled along with
land

THE

taken

supervenes,

for cantharides

to them

has

ON

ulceration.

livid,so

and
as

person

tongue

torpor, and

XXXII.

"

are

of

The

principalsymptoms,

inflammation

of

as

detailed

by

the tongue, torpor, tremblings,

mind, vibices,"c.

He

it like

treats

narcotic

poisons,with stimulants and attenuants, such

leaves of ground-pine,
nettle-seed mixed with

the flour of tares,

"c.

authorities

us

Dioscorides,A^dcenna, and
to

treat

this

case

of

most

of the

poisoninglike

that

as

the
pine-rosin,

of

direct

cantharides

SEA-HARE.

XXXIV.]

SECT.

205

emetics, draughts containing

pine-Comm.
wine, "c., with fat flesh. Oil and milk
seed,honey,vinegar,
recommends

Alsaharavius

"

"

recommended

are

Avicenna
mentions

A.

which

was

ii,31), and

Phile

(c.17) repeat

foundation

it

which

cold mucus,

x,

(ii,
56.)

ftalamandra

It is the

67), iElian
confidently.On
story is entirely

N.

Pliny (H.

related.

hand, Dioscorides affirms that the

the other
without

of the authorities.

most

of lizard. Aristotle
says the salamander is a species
fire as a
the fabulous storyof its being proofagainst

circumstance

(H.

by

"

""

may

Sprengelsays it emits a
small fire. (Notaein Dios.
a
extinguish
terrestris.

1. c.)

SECT.

XXXIII.

ON

THE

OR

PITYOCAMPA,

PINE-CATERPILLAR.

is drunk, there is straightway

pain of
pine-caterpillar
of the tongue, pain of
and palate,
mouth
strong inflammation
with a prurientsensation of tension
stomach
and intestines,
heat of the whole body, and anxiety.
; and there is a fiery

When
the
the

Such

cases

drunk

are

to be relieved

cantharides

but

Our

Commentary.
copy

from

of

as

manner

in their case,

substitute the ointment

may

in like

instead

those
of

w'ho have

plainoil

we

apples.

author,and indeed all the others,onlyComm.

"

Dioscorides.

Sprengel mentions

'

speciesof

several

erucse

which

infest

such as the leparis

monacha, lasiocampapini,"c.
pine-trees,
the Romans
(Notsein Dioscor.) Virey remarks, that among
there was
of the
an
express law forbiddingthe administration
of
hairycaterpillar

symptoms,
des

and

even

the

loss of

it

serious
Mceurs

Anim.)

XXXIV.

of

ON

THE

SEA-HARE.

the sea-hare has been drunk

When
that

producesthe most
des
life,
by its hairs. (Hist,

pine,as

fetid fish,
supervenes,

painedand

the urine becomes

and

an

after

like
ill-savoured taste,
a

or
obstructed,

time

the bowels

are

if any is discharged

'

[book

TOAD.

RED

206

v.

purple colour. They loathe and detest all kinds of

We
blood.
mixed
with
and have fetid perspirations
fishes^
or
a
must
givethem therefore asses' milk or must frequently,
of
hogsdecoction of the root and leaves of mallows, or the root
of
or
fennel triturated with wine, or di'.j. of black hellebore,

it is of

blood of
in honied water, and the warm
juiceof scammony
if
be borne,
a newly-killed
goose, and river-crabs alone, theycan
of recovery when
they can eat
may be given. It is a symptom

the

fish.

'

"
"

Nicander's

Commentary.

CoMM.

like

our

Haly Abbas
When

afterwards milk.

the

symptoms

is

hellebore,and scammony,
recommends
onlyemetics at first,

and his remedies

autlioi-^s,

asses' milk, "c.

and

of
description
are

there

oppressionof
givethe syrup of poppies.
Nicander, depends principally

is continued

breathinghe directs us to bleed and

like
(Pract.iv. 49.) Alsaharavius,
and hellebore.
such as scammony
drastic purgatives,
upon
(See also Nonnus, 279.) Galen says it producesulceration of
the lungs. (See Ther. ad Pison. and de ^led. sec.
gen. i.)
of the lepusmarinus, see ^Elian (H. A. ii,45 ;
For an account
ix,51j xvi, 19);Pliny (H. N. ix,48; xxxii,1); Dioscorides
cording
(vi,32); Phile (93). Ac20; vi, 34,); Philostratus
(ii,
in France.
to
Schneider, it is called chat marin
and resembles the land
of lizard,
Gorreeus says it is a species
hare
only in colour. Sprengel inclines to think that it is
the ajjlysia
depUans. See also Paris and Fonblanque (]Med.
ii,141.) Rondelet refers it to the class mollusca,
Jurisprud.
and givesa drawing of it. (De Piscibus,
xvii.) BeUonius and
its
of it,
and all agree respecting
account
Gesner
givethe same
of neai-ly
poisonousquahties. They describe it as being a mass
unorganizedflesh. Virey says it has long appendageslike the
of the hare,but which are its eyes.
ears

SECT.

XXXV.

ON

THE

RED

TOAD

OR

MARSH

FROG.

frog is taken,it brings on

swellingof the body, \vith intense paleness resemblingthe
colour of the box-ti'ce ; and dyspnoeasupervenes with foetor of
emission
an
the mouth, hiccough,and sometimes
involuntaiy
When

the

red

toad

or

marsh

CHAMELEON.

208

[book

v.

garglesof nitre (soda)with water be used,

and of copperas with vinegar. When
they have stuck to the
hip-bathand givehim cold
throat,put the patientinto a warm
to the
water
to hold in his mouth, and
they will readilycome
Some
cold.
givebugs to those who have swallowed leeches.
I, says Galen,by usinggarlicin such cases, have not stood in
need of bugs.
with

Let

Nicander

Commentary.

CoMM.
'
'

oxycrate.

leeches have

from

swallowed

water, fossil salt

sea-

snow,

been

Dioscorides

sea-water.

Celsus

"

merely says,
recommended
by

are

Aaron,
to

if the

forceps.If

Anatolius.

leech
be

this cannot

the throat with

some

be

author.

our

est."

Bugs

(Geopon.xiii 17.)
quoted by Rhases, directs
and

examine

detected

to

his throat
extract

effected he recommends

bitter decoction

the leech has descended

hold

can

like

case

sale bibendum

cum

the sunshine

laythe patientin
and

acetum

the

treats

authorities

of the

one

when
judiciouslyrecommends
ice or
to drink vinegar,
to take
(salgemmse?), or salt prepared

or

to the stomach.

him

to swallow

He

the

us

fully;
care-

it with
to

gargle

same,

also directs him

if
to

in the mouth.

(Contin.vii.)
Avicenna
recommends
nearly the same
plan of treatment,
device in order to
and, like our author,mentions the following
get a leech extracted that is fixed in the gullet. The patient
is to go into a hot bath and hold cold water in his mouth, which
the leech towards it. (iii,
will have the effect of attracting
9, 5.)
snow

"When

and cannot

leech has fastened in the throat of

be got at

by

the hand. Columella

beast of burden

directs hot oil to

be

of a pipe,or if it has passed into the

poured in by means
pour
stomach, it is to be killed with hot vinegar,(vi,18.) The vaalso a popularremedy in such
from pounded bugs was
and Geopon. xiii,
cases.
(Ibid,
17.)

SECT.

When

one

has

XXXVII.

taken

ON

THE

the black

CHAM^ELEON.

chamaeleon

intense

gnawing

pain supervene, and tremors with disturbance of the whole

and frothyvomiting,
body ; then convulsions attack,with pituitous
and in some
and distortion
cases
hiccoughwith loss of speech,
and

HENBANE.

XXXVIII.]

SECT.

of the

of wheat

fattydecoction

countenance.

209

taken

hot

will be

applicablein such cases^ and a sweet watery wine also

and fomentations
hot,vomits,drinkingof milk, emollient clysters,

by cataplasms.To
a
lividity,
draughtof

and
or

of radishes will be

that kind
wormwood

proper,

occasions sufibcation

which
or

of natron

with

also fomentations

and

oxymel
to

the

hypochondrium.
Commentary.

Dioscorides and Aetius

givea

Comm.

similar account

'

of the treatment

see Apuleius
symptoms. On the chamseleon,

and

'

(deHerb. 109.) The black chamseleon treated of in this section

is the carthamus
corymbosus. It is quitea different plantfrom
the white chamseleon

SECT.

XXXVIII.

remedied

that of

drunk

HENBANE.

with

eaten

not, of that of goats or

figs. Pine

kernels

fresh axunge

and

are

taken

the seed of cucumber

cases, and

salt wine

or

or, if

asses

of the decoction of dried

in such

ON

bringson disorder of mind

of persons in intoxication ; but is easily
cm^ed,being
pecially
by copiousdraughtsof honied water and milk, es-

Hyoscyamoswhen
like that

is treated of in the 46th section.

which

must, and

cows,

also serviceable
with

must, and

nettle-seed in like

will be proper, also succory,

onions,and garlic,each of these
cresses, radishes,
taken with wine.
They must then be made to remain
manner,

or

with water

natron

state

of rest

they

may

that,like

in order

digestwhat they have

those

who

and

have

drunk

tard,
mus-

being
in

wine,

taken.

of the symptoms in Nicander^s

description
is imperfect
Alexipharmics
owing to an hiatus in the text. His
remedies
are
milk, fenugreek,nettle-seed,
succory, cresses,

Commentary.

mustard,the
This

The

heads

and

of
description

somewhat

fuller than

and

Dioscorides.

the

our

of

symptoms,

Celsus recommends

asses.
as

author^ s, but not

givenby Aetius,is
otherwise

different.

of the members.
Largus mention lividity
it induces sleep,
stupor,and coldness of the

Scribonius

Alsaharavius
II.

from

that
milk, especially

The

He

says,

'

"c.
garlic,

of

section is taken

hot water

Comm.

14

"

'

'

^-^"

Haly Ahhas recommend the tlieriac

of milk.
Rliases speaks liiglily
Mitliridates.

antidote of

and

and

Avicenna

extremities.

CoMM.

[book v.

CORIANDER.

210

ult.)
(Contin.
The generalremedies
vinegar,milk,
such

See

sweet

mustard

as

onions, and the theriac.

and

of the different varieties of henbane

account

an

are
emetics,
they all recommend
wine, and at last,vegetablestimulants,

ancients in Dioscor.

to the

Pliny (H. N.
also the

and

4) ;

xxv,

in Schulze

(Med. Simpl.viii)
;
vet. 20.) See
(Toxicol,

Galen

of this work.

Book

Seventh

64.);
(iv,

known

to which

treat of another narcotic

Arabians, in this place,

The

they give the

(iv,6, 1, 4) ;

of

name

Coriander
it renders

Derufitum or

XXXIX.

from its smell

the

CORIANDER.

ON

Wherefore

brings on
those

who

drunk

When

be mistaken.

cannot

voice thick, and

intoxication.

Avicenna

Dai'fion. See

(xxxix.)

Ehases

SECT.

from

which

like

madness
have

taken

that

it talk

from
and the smell of the coriander is perceptible
obscenely,
of the
the whole body. They are relieved after the removal
oil or that of iris (asmentioned
above),by
poisonby common
undiluted wine with wormwood
and drank by itself;
by eggs
emptiedinto one vessel and triturated with brine and swallowed ;
and

brine

goose,

"

"

sweet

be

wine

drunk, and
taken

with

salt broth

from

hen

or

lye.

According to Nicander, the symptoms are

toxicati
violent delirium,and great derangement of the mind, as in inand wine,
His remedies
emetics
are
principally
Dioscorides
the intention of gi\^ngwhich is quite obvious.
of the symptoms and treatment.
account
givesnearlythe same
Galen
(de Simp. Med. viii)attacks Dioscorides in the most
unmeasured
for saying that the action of coriander is
terms
while,on the contrary,he maintains that itis calefacient.
frigorific,
Avicenna
the reasoningof Galen
combats
and
agrees with
Dioscorides ; as do Apuleiusamong
the Latins,and Alsaharavius
Commentary.

CoMM.
'

and

also may

'

and

Uhases

austere

among

medicine.

the Arabians.

Pseudo-Macer

calls it

cold

XLi.]

SECT.

With

HEMLOCK.
the treatment, the Arabians

regardto

emetics,with

6, 2, 8) ;
ancients

recommend

oilyComm.
(iii,

soda,pepper, salt,strong wine,"c. Avicenna

Ehases

Schulze

211

(Cont.xxi);

is satisfied that
the

Alsaharavius

the

corion

coriander.

or

He

'"

xxx.
(Pract.

2.)

coriandrum

of the

"

"

however,
only
in particular
states of the body that it
all
at
injurious.
proves
vet.
is
also
satisfied
to
the identity
(Toxicol, vii.) Sprengel
as
of the ancient and modern
coriander.
(Comment, in Dios.)
to have

was

same

our

rather overrated

SECT.

Fleawort
and

as

XL.

when

its deleterions

ON

PSYLLIUM

drunk

occasions

torpor,with relaxation

by the
drunk

and

remedies

same

OR

as

appears,

properties.It is

FLEAWORT,

coldness of the whole

lowness
those

of spirits,
which

givento persons

body
are

who

lieved
re-

have

coriander.

Commentary.

All the authorities agree in representing

its
similar
those
to
being
produced by coriander. They

effects as
treat

the

case

other

and

Schulze

then

such

upon

Comm.
'

with wine, pepper,

general principles

stimulants.

finds

some

sect.

XLI.

in acknowledgingthat the
difficulty
plantagopsyllium,L. is the true psylliumof the ancients,and
yet he admits that no other planthas so good a claim to be
identified with it. We see no groundsfor scepticism
this point.
on

Hemlock, when
that the
so
vision,
distance

OR

HEMLOCK.

vertigoand
longer see even

drunk, brings on
can

person

no

dimness
to

of

small

ness
hiccough, disorder of the mind, and coldand at last he is suffocated in convulsions,
extremities,

; there

of the

CONIUM

ON

the breath

is

being stopped. At first,

in other cases
of poisoning,
must
as
we
therefore,
bring it up
of an injection,
and afterwards,
evacuate
by vomiting,
by means
whatever part had passedinto the intestines ; and then, as our
to undiluted wine, givingit at
great remedy, we have recourse
in the arteria aspera

intervals,
diu'ingwhich

we

must

administer

the milk

of

cows

'
"

HEMLOCK.

212

or

of asses,
and

rue
or

answers

and

wine, and
pepper,
dram
of cardamom

Avith nettle-seeds in wine

tree ; and

with

CoMM.

mint, with wine,

of pepper,

bay

with

wormwood

or

[book

in

like

wine

common

or

; and

must

sweet

or

the
Avine

; and

of storax;

the tender

or
laserwort^

manner

or

castor

v.

leaves of

juicethereof,
drunk

alone

well.

to have been acquainted

Theophrastusseems
with the sedative properties
of hemlock, for he recommends
antidotes
and
to it.
as
(H. P. ix, 24) ;
pepper
rosemary
and
Athen.
(Deip,ii,73.) The operationof this poison in
the case
Phsedo.'
of Socrates
is well described by Plato in his
about
Socrates,after swallowingthe poisoned cup, walked
for a short time as he was
directed by the executioner : when
he felt a sense
he lay down
his
in his limbs
of heaviness
on
back ; his feet and legsfirst lost their sensibility,
and became
stifli'
and cold ; and this state gradually
extended upwards to the
heart,when he died convulsed.
The symptoms, accordingto Nicander, are dimness
of sight,
coldness of the extremities,
impeded
of suffocation,
a
sense
vertigo,
His remedies
emetics of oil,
and death.
are
respiration,
and undiluted
undiluted wine, clysters
of the same,
wine
or
taken
and the
b}^the mouth, with pepper, nettle,assafoetida,
like.
recommend
Dioscorides,and all the other authorities,

Commentary.

'

much
after

the

same

death,as

Pliny and

treatment.
a

P.

described the conium.

of

Schulze

mention

lividitv,

cicuta.

poisoningby
vi,2) and Pbny (H.

sjonptom

(H.
Theophi-astus

Aetius

N.

xxv,

is satisfiedthat it is the

95) have
conium

macuJatum, L., and in this opinionwe fullyagree with him.

He
of the
mention
no
adds, that the ancients have made
cicuta A-irosa.

Dioscorides
among

the

and

most

symptoms.

of the

others

enumerate

It will be remarked, that

given above of the symptoms

of Socrates,
have stated
case
we

of

couATilsions
in the

stract
ab-

poisoningby hemlock
that the great philosopher
This we think the true interpretation
died convulsed.
of the
used by Plato (f/cd-rj^/;),
term
derstood
althoughit has not been so unin another
Dioscorides,
by most of his interpreters.
ness,
place,states somnolency,coma, stertor, lividity,
torpor, coldand
pruritusof the whole body.
stupor, insensibility,
in the

SECT.

JUICE

OF

symptoms

of

XLii.]

as

tlie common

or

conium.

THE

POPPY.

213

poisouingby opium, mandragora,Comm.

'
"

tlie assertion of
Scliulze ranks,amongancientmistakes,

that

Galen,

in some
gested
diinstances,become
may,
But Dr. Christison says, that both
nutritive.

prove
and
animal
vegetable

poisonsmay
interesting
example

gives an

"

substances

narcotic
and

he

become

of which
digested,
Avith regard to opium (On

Poisons,p. 52.)

SECT.

When

XLII.

drunk

has

one

with

THE

ON

JUICE

of the

coldness

and

THE

OF

the

juiceof

POPPY.

poppy

drowsiness

itching,so that often

when
the medicine takes effect such an itchingcomes
that
on
the person
is roused
from
sleepthereby. The smell of the
medicine
too is emitted from
the whole body. The remedies
in such cases, after rejecting
the substance taken
by vomiting
with oil,and evacuating
downwards
are
by a stimulant clyster,
rose-oil,and
oxymel drank with salts,or honey with warm
comes

on,

much

undiluted

wine

with

intense

wormwood

and

cinnamon, and warm

water, and marjoram with

and
with
natron
vinegarby itself,
lye,the seed of rue and pepper givenwith castor, and oxymel,
savory,

also

the

or

of

by aromatics,put

rouse

foment

decoction

account

on

the bath
also drunk

we

marjoram
the

person
of the prurituswhich

fat broths, with

use
may
with oil is useful.

with
into

wine.
a

hot

We

must

bath, and

; and after
supervenes
wine or must.
Marrow

Accordingto Nicander, the symptoms of poi-Comm.

coldness of the extremities,
are
soningby poppy-juice
eyes fixed,
of the eyelids,
heaviness
profuseand fetid perspiration,
ness,
palespiration,
swellingof the lip,relaxation of the under jaw, slow reCoM-AiENTARY.

'

'

lireath,and the usual precursors of dissolution,

of the nails,
and hollow
lividity
namely, distortion of the nostrils,
His remedies are emetics,such as the oil of iris or
eyes.
and honey ; hot drink and rousingthe patient
of roses, wine
by cries,strikinghis body in different places,and wrapping it
in cloths smeared Avith oil and hot wine, and the hot bath
as
cold

restorative.

'

'

'
*

POPPY.

THE

[book

v.

violent
by Dioscorides are lethargy,
and tlie perspiration
smellingof opium. His remedies
pruritus,
the same
those of our
as
are
author,namely, emetics at first,
wine
and vinegar,with various
and afterwards
then clysters,
stimulant and strong-scented
things; such as pepper, cinnamon,
is to be roused as directed
The patient
castor, marjoram,"c.
by Nicander ; and baths and fomentations are to be used to
relieve the pruritus.
Tlie

CoMM.

OF

JUICE

214

symptoms mentioned

relates the

Galen

of

he

coldness,whom

of

case

to the last

reduced

person

stage

saved

freelya strong,
by administering
and fragrant
wine.
Yet, he remarks correctly,
light-coloured,
small quantityof weak
wine operates unfavorably
a
by promoting
the system.
the distribution of the poison over
He,
first
with
wine
and
in particular,
recommends
at
oil,
vomiting
and

afterwards strong

clysters.
and
the symptoms, violent pruritus
Aetius mentions,among
None

convulsions.
but
,

of the
the

among

Greek

other

writers mention

vulsions,
con-

Arabians, Avicenna, Rhases,

Alsaharavius,have mentioned

them.

Modern

and

experiencehas
not
a
frequent

they are an occasional,but

symptom producedby the immoderate administration of opium.
Scribonius Largus directs us, after repeatedvomiting,to
apply embrocations of vinegarand roses to the head, to rub
the feet,and to put sinapisms
to them and the thighs. Simeon
Seth strongly
recommends
vinegar.
Abbas
and
Alsahara\dus,
and, in short,all the Arabians
Haly
recommend
treatment
nearlythe same
; namely, emetics of oil
and water, or oil and wine, hot clysters,
acrid and
strongsuch
scented things,
as
castor, assafoetida,
savin,"c., and the
determined

that

and
bath, friction,sternutatories,

warm

and

to arouse,

every

prevent sleep.

to

Serapion,Rhases,Avicenna, Haly Abbas,

agree

in

prove

destructive to human
are

prove

has
four
other

statingthat
not

agreed

fatal,but
fixed the

mentioned

by

the

as

smallest

surely,as
be

the
Dr.

dose

think

the Arabians

of

Alsaharavius,
opium which will
Modern

quantitywhich

Christison
too

and

drachms.

smallest

sufficient to

should

dose

life is two

to

minimum

grains may
hand, wc

lated
calcu-

means

remarks.

Dr.

thors
au-

may
Paris

when

he affirms that
low,
produce this efi*ect. On the

that

might

be

smaller

dose

sufficient to

than

that

destroylife.

JUICE

216

between

CoMM.
"

'
''

OF

POPPY.

THE

[book

v.

tlie vital actions is very apparent also in the

inferior animals^who are not providedwith such an apparatus
for

heat and

of temperature.
an
preserving
equability

Thus

heat,lose

also

et
insecta,

Avith the loss of

vermes,

energy, which
In this case
restored.

muscular

least the

at

It has

actions of heat.

that heat

it is evident

alwaysappearedto

is

their heat

is the

actions,and

vital

the

zoophyta^
and
sensibility

againwhen

they recover

co-cause)of

the

not

me

(or

cause

the vital

strikingfact,
vital actions,

the
illustrativeof the great influence of heat over
that the strengthof all animals is,bulk to bulk, proportionate
to the
"

the

their animal

degreeof

heat.

of the supreme
of the heart,as being
authority
of heat, thus maintained
was
eagerly
by Aristotle,

This doctrine
focus

great Arabian commentator, Aven-hoes, and

bv his countryman,
Avenzoar, who keenly attacked Galen for
defended

by

the

havingquestionedits truth, and taught,as they represent,that

After
the brain is the leading organ
in the animal frame.
ransacked
hanng, however,carefully
every part of Galen's works,
in which
I could suppose it likely
with any allusion to
to meet
this

heat

doctrine, I

Ai'abians,in the

led to believe that these

am

the real opinionof

misrepresented
their master's rival. .Galen
tained
decidedlyto have mainappears
with Hippocrates
that there is in the body no
one
beginning,but that all parts are alike,beginningand end : for
circle has no beginning.' Agreeablyto this idea,Galen rea
marks,
that the brain cannot
its
be
said
derive
to
properly
powers

of

controversy,have

'

"

from

the

its heart

heart,since
has been

to derive

and

an

taken

its powers

animal
out ;

will run,
nor

can

breathe,and
the

be

heart

cry after
said properly

brain, since it will palpitate

with the brain is cut off,
contract, after all commimication
from

the

from the body.

nay, after it has been removed
the functions of the brain and the heart are
one

another.

and

its

unable

hand,

But

the

appendagesfor

brain
vital

is

In

so

independentof
the

dependent upon
which

heat,without

far,then,
heart

it would

to continue

its functions ; and the heart,on the

is dependent upon
the brain for impartingnervous
to

preserve

the

respiratory
organs,

its vital heat

and

insisted upon

without

unaltered.

sympathy of important
by ancient authors,and

which

organs
which

mutual

the

Hence
"

it could

be

other
fluence
innot
nexion
con-

doctrine much

bears

some

resem-

JUICE

XLiT.]

SECT.

blance

to the

THE

OF

POPPY.

theorylatelyadvanced

by

Mr.

217

Morgan

and

Dr.

Addison.
"

We

Comm.
'

'
"

shall now

in understandingthe ideas
difficulty
of opium.
of the ancients regardingthe operation
Galen and
Avicenna
believed that the poisonexerts its primary influence
sidered
they conupon the heart,and impairsits vital heat. Of course
its operation
the brain as secondar}^ They called
on
the action of narcotics frigorific
doubt because
or congealing,
no
that it was
attended
Avith a diminution
of vital
they remarked
and
heat, and to this they attributed the loss of sensibility
muscular
I leave it to the reader to judge whether
energy.
this theoryor the modification of it lately
proposedby Messrs.
IMorgan and Addison be the more
plausible."(Edinburgh
Medical and Surgical
Journal,No. 103.)
But althoughthe ancient physiologists
maintained that the
in cases
prime organs of the animal frame suffer sjonpathetically
of poisoning,
they did not hold, it will be remarked, that all
poisonsexert their primaryaction on the nervous
system. This
is the hypothesislatelyadvocated
by IMessrs. Morgan and
Addison,but which is,in fact,onlya revival of that maintained
He thus states his
Veterum.^
by Schulze in his Toxicologia
theory of the action of poisons, Omnia
sj^mptomata et le-

have

no

'

"

"

thales

venenorum

strant,ab omnibus

effectus hoc
veyienis

unum

nervos

quam

luculentissime demon-

Nervea
ipsosgraviteraffligi.

veneni
stimulis commota, aut majori
a
igiturvis sen Adtalis,
veneni
vehementia
silet,
impetu agit,aut prsevalente
prorsus
sensorii
nervis turcommunis
omnes
cum
reliquis
nexusque
aut
bantur, vita animali aut gra^dterperichtante,
prorsus
interitura."
also,in his last
(Toxic.Vet. vii.) Dr. Mead
edition of his work on Poisons,advocates this hypothesis.
It appears
to us, however, that this theory,althoughvery
is somewhat
that there
too exclusive. And
simpleand plausible,
other modes by which poisons
are
operatethan throughthe brain
and nerves
by the fact now
clearly
appears to be demonstrated
that poisonsact upon
established,
vegetablesas well as upon
animals. (V. Annales de Chimie, t. xxix.) Now
as
vegetables
are
nor
motion, it seems
possessedof neither sensibility
posterous
prethat they have any nervous
to suppose
system.
do
than
to the old
revert
better
cannot
we
then,
Perhaps,
doctrine delivered by Alsaharavius.
Sometimes, he says, poisons

MANDRAKE.

218

act

CoMM.
'

'
"

fatal ;
heart,and therebyprove instantly
the liver,
producingjaundiceand phthisis
;
the brain,when
theyoccasion delirium ; and

the

upon

times upon

upon
their action is
of the

to

us, upon

XLIII

'

from

THE

givento

OF

JUICE

what

to determine

are

it

bringson heavy
relieved by the same

have

who

persons

CARPESIA.

THE

drunk

These

Matthiolus

Dioscorides.

drunk

confesses that he
it was.

substance

It is doubtful whether

vi,13.)

and lividity
corruption

to

hemlock.

section is taken, almost word

This

Commentary.

CoMM.
"

those

as

ON

suffocation.

acute

remedies

times
some-

2, 18.)

juice of carpesiais

the

sleepand

times
some-

subject.

the

SECT.

When

some-

primary action of narcotics is upon the heart appears

vanced
the whole, the most
probabletheoryhitherto ad-

the

upon

"

local,givingrise

part. (Pract.xxx.

That

[book v.

the

for

able
quiteun-

was

(Comment,

word,

in Dioscor.

Ka^irriaiovof Galen

and

the

of Dioscorides be the same

substance,and whether
KapTraaoi'
the oTroKapTraaov.
either be the same
as
Sprengelcan ai'rive
at

certain conclusion

no

it to be the

SECT.

comes

on,

sleep,so that
is called

or

loss

MANDRAGORA

ON

has

MANDRAKE.

OR

been

drunk, stupor immediately

and a strong inclination to
of strength,

nothingfrom

the affection differs in

that which

on,
any of these symptoms come
in this case ; and afterwards honied

lethargy. Before

vomitingwill
water,

XLIV.

with

posed
sup-

j^iperlongum.

mandragora

When

Valerius Cordus

it.
respecting

be proper

natron

and

wormwood

wine, embrocations

with must,

to the head

with

or

taken

in

fied
dulci-

rose-oil and

vinegar,
things,
rousingby shakingthe body,and by strong-smelling
and
with
rue
pounded
-sinegar,
liquid
pepper, mustard, castor,
and
will
of
the
wicks
and
lamps lighted
extinguished, be
pitch,
When
they are difficultto rouse we may also apply
proper.
and
sternutatories,
such

cases.

have

recourse

to

the

general remedies

in

MANDRAKE.

XLiv.]

SECT.

CoMMENTAKY.

OuT

Matthiolus, by

priety of
things are

author,

the

in his

usual, follows Dioscorides.

as

cold nature, whereas

stimulants

"Perhaps these things,when

head, might prove restorative

the

upon
other

Greek

authorities

Actuarius, approve

the

vinegar to

indicated.

are

questionsthe

commentary,

way,
applying rose-oil and
of

219

and

and

'

pro-

these

as

calefacients

poured from

as, for

however,

head,

Comm.

height

stimulant.

The

example, Aetius

and

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

fossil
and
to

recommends

salt; after

rose-oil
be

vomiting by

which

poured

wine

sweet

the

upon

however,

that

who

he

had

knew

castor, pepper,

sternutatories.

old medical

an

fallen into

honey, and
given,and vinegar

is to be

head

administered, along with

of water,

means

He

who

man

of syncope,

and

rue

are

mentions,

cured

young

with

flushingof
face, after swallowing the apples of mandragora, by the
aff'usion of snow-water
her head.
Avicenna
on
properlydirects
everything to be done to prevent sleep.
is satisfied that it is the atropa mandragora of LinSchulze
naeus.
There
seems
no
doubt, however, that the mandragora
of Theophrastus is the atropa belladonna; while the mandragora
of Dioscorides
is the mandragor'avernalis,
Bertol. ; and the
mas

woman,

state

the

M.

femina

of the

the

same,

ma?idragora

autumnalis.

Theophrastus,Dioscorides,Galen, Athenseus, Aetius, Suidas,

Hesychius, Apuleius, Pollux, and Frontinus, have made mention
of the hypnotic property of mandragora.
It is singular
that it should
fallen into neglect. It appears
have
to
now
have
been
used
medicine
in the days of Shakespeare.
as
a
I ago

says

"

Nor
Shall
Which

Not

all the
ever

thou

poppy

drowsy
medicine
owed'st

mandragora

nor

syrups
thee

of the
to

that

world,
sweet

sleep

yesterday."
Othello.

We

will have

occasion

to

treat

of it in the

Seventh

Bouk.

'

WOLFSBANE.

220

SECT.

Wolfsbane

XLV.

ON

[book

ACONITUM

of sweetness

on

the

WOLFSBANE.

OR

immediatelyafter being

v.

drunk

tongue^ with

occasions

sation
sen-

littleastringency
;

when the person attemptsto

especially
vertigosupervenes, more
rise up, and
it brings on
a
watering of the eyes ; there is
heanness
of the chest and abdomen, with eructation of much
the medicine
be brought up by
flatus.
In these cases
must
vomits,and the contents of the bowels evacuated by a clyster.
We
also givedraughtsfrom
must
marjoram and rue, or from
horehound
with wine, or from
wormwood, or from rocket, or
from southernwood,or mezereon,
or
ground-pine. Opobalsam,
of one
drachm, with wine, will hkewise
too, taken to the amount
of a kid, or of a hare, or of
with them ; also the rennet
answer
or
a fawn, with
vinegar,and the dross of iron, or iron itself,
be dissolved in wine, and the liquidtaken,
gold,or silver^
may
and lye with wine, and the broth of a boiled cock,or the broth
The ground-pine,
of fat flesh taken with wine.
which is said
of Pontus, where wolfsbane grows,
in Heraclea
to be a specific
is called holocleron,
but ionia in Athens, and sideritisin Euboea.
Commentary.

CoMM.
"

'
"

The

symptoms,

as

described

by Xicander,
gnawing painsat

of the lips,
palate,and gums,
astringency
the stomach,singultus,
flatulence,
runningfrom the eyes, double
to have been
vision,as from intoxication. His remedies seem
emetics and calefacients.
Thus
he recommends
a
principally
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.
of the treatment
The
accounts
given by Dioscorides,Aetius,
author's.
and Actuarius
our
Avicenna,
agi^ee exactlywith
recommend
Rhases, and Haly Abbas, in hke manner,
emetics,
and
calefacient
medicines
clysters,
internally.
Laertius
of Eumelus
the
the
states,upon
Diogenes
authority
that Aristotle the philosopherdespatchedhimself
historian,
with a draught of aconite. (Yita Aristot.)Pliny relates that
this poisonproves fatal when
appliedto the genital organs of
women.
(H. N. xxvii,2.)
are

The

ancients

have

described

several

varieties

of

aconite.

IXIA.

XLVI.]

SECT.

221

See

Theophrastus(H. P. ix,19); Pliny(H. N. xxv, 75); Schulze Comm.

and Sprengel
vet.);Schneider (inNicand. Alexiphar.);
(Toxicol,
authors in generalare disposed
(Rei.Herb. Hist.) These modern
to think that it was
the iris tuber osa.
Sprengel^how'

'

in

the

Dioscorides^is decided
that the second speciesof Dioscorides
(Mat.Med. iv^78) is the
aconitum
napellus; but respectingthe first species,he is in
All agree that the aconitum
of Theophrastus is
great doubts.
ever^

notes

diflferentfrom
We

may

be

his

to

edition of

the A. of Dioscorides and

permittedto

add, that the

the other

toxicologists.
symptoms of poisoning

by aconitum, as given by Nicander, agree

reportedlatelyof cases of poisoningby the
that we cannot doubt their identity.

XLVI.

SECT.

Ixia,which
resemblance
on

ON

well with

so

aconitum

those

napellus,

IXIA.

is also called

ulophonon,when drunk has some

and smell to basil-royal.
It brings

both in taste

strong inflammation

of the

tongue, and disorder of the mind;

it suppresses all the secretions,

borborygmi and
occasioning
cuations.
rumbhng, with dehquium animi ; but there are no alvine eva-

After

the

greater part of the

poison

been

has

brought up by vomiting,or evacuated by the bowels,they will

experiencerelief 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

of the aforementioned,or with

tragoriganumwith some
of turpentine,
of nard,of castor,of laserwort,
of each an
or
in wine.

The

be proper

; or

and
dr.

in like

ij,with

fruit also of the walnut

of

manner

honied

triturated with

rosin, of castor, and

of mezereon,
water

and

dr.

hot

of rue,

ij; of the

of

the decoction

milk ;

obolus

wine

of each

will
dr.

j;
thapsia,
drunk
by

juiceof

vinegarmay

be

itself.

of the symptoms is Comm.

description
aiithor,and his treatment
very similar to that given by our
been
the same
conducted
to have
seems
principles
;
upon
and
a
t
e
metics
a
nd,
first,
namely,by administering
purgatives
and
discutient
afterwards,
detergentmedicines,to overcome
Commentary.

Nicander's

'

MEADOW

222

""

"

of the

the viscid nature

CoMM.
'

differs in

ment

author's

Our

poison.

material

no

[book

SAFFRON.

by

the

and

of aldabach

name

of

treat-

that recommended

respect from

Dioscorides,Aetius, Actuarius,Avicenna,
A"\dcenna described it

plan

v.

by

Alsaharavius.
;

Alsaharavius^

i. e. arbor risi.
by those of alfos,alclolia,
Apuleiusmake ixias^ulophonon^chamseleon,ocymoides^and
various
cardui synonymes
(109.) The ixias,accordingto
be
cannot
of chameeleon,but what species
Gorrseus,is a species
determined.
(See,also,Schneider's note on Nicander.) Matthiolus calls it a glutinoussubstance,found in the root of the
is decided

Schulze

chameeleon, or carline thistle.

that it

was

note
vet.,22.) See Harduin's
speciesof carlina (Toxicol,
we
consideration,
on
Pliny (H. N. xxii,21.) After mature
it to the carlina acaulis,
in referring
have no difficulty
or
cara

line thistle.

ON

XLVII.

SECT.

When

it grows in
placeover the whole
a

heaviness

stomach, with
when
the affection gainsstrength,
bowels,mixed with the scrapings

The

thereof.

of acorns,

with

thyme

remedies

gain ground

the medicine

leaves,or

same

the

are

milk,

or
or

we

appUed as to those who

before
and clysters.But
give a decoction of oak-

must

of the rind of

the

of the

to be

salamander,in vomits

dnink

have

; but

dischargedfrom

blood is

SAFFRON.

call colchicum,
ephemeron (whichsome
takes
Colchis,or bulbus silvestris),
pruritus
body,as if stung by nettle or squill
; there

gnawing pain within,and great heat

considerable

juice of

pomegranate,
bloodwort, or

of wild

or

of

vine-

brambles, or of the medulla of fennel-giant,

of myrtleberries,
with wine; and when
levigated
myrtles

tops,
or

MEADOW

swallows

one

because

is

OR

EPHEMERON,

or

of

themselves

thereof may
the

middle

are

be

pounded
taken

and

mth

of
pellicle

in water, the

advantage. And,

liquor

in like manner,

chesnuts,called Sai'dian,
may

be

be drunk
and marjoram may
juices,
with lye. Those affected are
manifestlyrelieved by drinking
hot cow's milk, and
it in the mouth, so that they
retaining
who
stand in need
of any other
have plenty of it do not
remedy.
taken

with

the aforesaid

the

macerated

CoMM.
"

"

224

STRYCHNOS

others,affirm that
(chap,iv, cl. 4.)

it is.

FURIOSA.

Orfila holds it to be
haA-e

We

[book v.
narcotic

poison
proving
melancholy-

of its

instances

known

contained a
lately
at Winchester.
of a boy poisoned by yew-berries
case
for making it to
thiolus is not pleasedwith Dioscoiides
medicine
gives it the
frigorific
; but Orfila,it appears,
fatal to cattle.

The

newspapers

that is to say, he holds it to be

alludes to its poisonousqualities
:
character

narcotic.

Sic tua

Cymteas fugiantexamina

XLIX.

ON

STRYCHNOS

THE

one

there follows
furiosa,
constant

hiccough,wateringof the

of blood

; and

there

are

Schulze

DORYCNIUM,

mucous

call

some

it were,

as
sensation,

same

SOME.

dorycnium,which

of

drinks

Yirgil

and

CALLED

FURIOSA,

BY

When

be

taxos.

9) ;
See, also,Theophrastus(H. P, i,5, and iii,
(Tox.vet. 17).
SECT.

Mat-

of milk

strj'chnos

to the taste

and

frequentejection
dischargesby the bowels,as
tongue,

They are to be remedied before any of

these symptoms supervene,
by those thingswhich are taken for
emetics and clysters,
and whatever else can
ephemeron, I mean

in

cases.
dysenterical

evacuate

is

the substance

which

had

been

taken.

particularly
good remedy ; or the mUk
and
sweet
wine, in a tepidstate, may be
quantityof anise. Bitter almonds also are

of

"

'

"

'

mostly from
The
same

Our

Nicander,

poet'splan of
as

that

of emetics and
of

or

with

water

of
a

goats
small

proper, the boiled

and boiled,crabs

fowls,all the shell-fish eaten raw

crawfish,and the broth of them when drunk.

Commentary.

CoMM.
'

asses

drunk

breasts of
and

Honied

poisoning
;
such

as

detail of symptoms is taken

Dioscorides.
or, perhaps,direct from
author's

treatment

of Paulus.

He

seems

have

been

omits,indeed,to

much

make

remedies
as being general
purgatives

the

mention
in all

cases

but he recommends
the

cea,
milk, must, and the CrustaThe
other authorities
pinna, echinus,"c.

supplynothing additional. Avicenna

of uva vulpis
name
stupefactiva
mala;
6
(iv, ; i,7.)
There

to

is considerable

treats

he

of it under

copiesfrom

difficultyabout the

nature

the

Dioscorides

of the do-

SARDONIAN

L.]

SECT.

rycnium.
the

same

HERB.

225

Our

author, Aetius and Apuleius,make it to be

the strychnos
which is generally
as
held to
furiosa,
the solanum
the
sodomeum, or
atropa belladonna.

be

either

On

this

was

either the solanum

Comm.
""

'

"

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 littleknown
the doas
rycnium. He is undecided as to its nature, except that it
and he is
or
belonged to the diadelphous
leguminousplants,
inclined to think that it was
an
astragalus.
(Toxicol.
Vetemm,
either
inclines
to
the
convolvulus
2.) Sprengel
cneorus, L.,
the
L.
But
far
or
con.
as
as we
can
dorycnium,
see, the most
that can
be made
probableconjecture
regardingit is,that it

SECT.

The
when

herb

sodomeum, or atropa belladonna.

ON

L.

THE

SARDONIAN

called the Sardonian

HERB.

is

speciesof ranunculus,

drunk, or eaten,it bringson disorder

convulsions with contraction of the

so
lips,

of the
as

and
intellect,

to exhibit the appearance

of

pression,
laughter. From this affection that ill-omened exthe Sardonian
took
its rise.
In these cases,
laugh,
after vomiting,
it wiU be proper to givehonied water
therefore,

and

milk,

body,by

with

embrocations

calefacient

of hot

them

after the baths

treatment

as

lubrications of the whole

remedies; and

baths

on

and

and

water, and
;

and,

to

to

have

anoint

the

upon

to

recourse

properlyand

whole, to conduct

hotrub

the

for convulsions.

Commentary.

and

Dioscorides

our

author

perfectly
comm.

are

Aetius recomagreed as to the symptoms and treatment.

mends, likewise,castor with sweet wine.
Solinus,like om'
author,says that it bringson contractions of the muscles,and

the risus Sardonicus.

of the nature

Avicenna

and

reason

to

Schulze makes

doubt

that it

was

it the ranunculus

speciesof

culus.
ranun-

L., which
sceleratus,

bears the

of celery-leaved
crowfoot ; and we are
Englishname
of the same
to make
clearly
although Avicenna seems
opinion,
II.

"

acknowledgeshis ignorance

of this herb, but supposes

proper treatment
that it belongsto the class of acute .poisons.There seems,

however,no

""

15

"

'

CoMM.

'

or

apinm

risus,which

Alsaharavins

is the

THE

ON

LI.

it is to be treated

'
'

poppy because
horns.
See
remarks

that

kebekenyi,
See

by

it is

called the

poppy

symptoms

same

the

of it in

horned^ when
as

the

jniceof

remedies.

same

says that the

of poppy
species

account

some

POPPY.

HORNED

Miller

Commentary.

CoMM.

the

of Dioscorides.
^ur^ayiov

Seeing that the speciesof

eaten
or
drunk, bringson the

'

and

v,

(Pract.xxx, i,39.)

SECT.

poppy,

herb

Sardonian

distinction betAveen the

'

"

[book

PHARICUM.

226

glauciumis called horned

having husks resembling
Apuleius (53.) Schulze

Dioscorides has described

several varieties of the

1, Papaver hortense ; 2, P. opiiferum

; 3, P. agreste;
poppy.
4, P. rhseas ; 5, P. ceratites sive corniculatum ; 6, Hypecoum.
is the glaucium luteum.
The
fifth of these,or horned
poppy,
but treats of it
Scop. Dioscorides gives a distinct description,
as

medicine

rather

of the Arabians

than

of it

treat

SECT.

substance

The

LII.

poison.(M. M. iv,66.)
separate from opium.
as

on

None

PHARICUM.

called

bles
pharicum in taste completelyresemand
drunk
order
diswhen
with
it brings on
nard,
paralysis,
After evacuation by vomiting,
of the mind and convulsion.
must
we
givethe patientto drink, along with wine, some
call
wormwood, cinnamon, myrrh, or Celtic nard (whichsome
of spikenard,
dr. ij,or two
oboli of myrrh mixed
or
saliunca),
The
with must
or
iris,and the flower of safi^ronwith wine.
head is to be shaven,and a cataplasm consisting
of barley-flom',
with le\ngated
and vinegar,
is to be applied.
rue
ft

Commentary.

CoMM.
'

'
*

taste
one

Nicander, like
of

spikenard,and
day, inducing delirium.
to

that

medicines,and

cataplasmto

the

also makes

our

author, compares

says that it proves

He
the
recommends
mention

with
head, evidently

its

fatal in
same

ternal
in-

lant
applyinga stimua view of relieving

of

the

TOXICUM.

LiiT.]

SECT.

phrenitis.The

227

other authorities recommend

similar treat-

Comm.
'

ment.

"

is

There

great disagreementamong

the nature
toxicology
respecting
of Gorrseus

and

Schneider

of the

the

ancient

writers

""

on

pharicum. (See the notes

Nicander.) The former remarks

that many
of nard.
Dioscorides (Prfef.
suppose it a species
vi)
and
Galen
Scribonius
(Antidot.ii)make it to he a herb.
Largus, and Hesychius consider it to have been a compound
medicine.
After balancing
all the statements
Schneider
comes
to the conclusion,
that most probablyit was
from
a composition
agaric. Schulze is whollyundecided as to its nature.
(Toxic.
Vet. 21.) Sprengel,
in like manner,
certain
to no
can
come
conclusion

respectingit. (Notsein Dioscor. 1.c.)

SECT.

The

toxicum

anointed

on

LIII.

to

seems

TOXICUM.

ON

be

so

called because

the

barbarians

their darts

with it. When

a
{ro^evnara)
person has
of it,inflammation of the lipsand tongue comes
on, also
irrestrainable madness
so that in
leadingto various fantasies,
the treatment
of them
they are difficult to cure, and it is rare

drunk

that any

of those who

they are

oak

of

quinceswhen
in water

But

with wine

eaten,

and

escape
to bed, and
a

Commentary.

of the

as

mouth

or

he

to vomit.

Turnip

or

for

and

and

them,

she-goatwhen

ilex triturated with

or

milk

with

; also

drunk
wine.

dangerthey remain for a long time

when
they get out of it they spend the
state of timidity.

those

symptoms detailed by Nicander

enumerated

and

by

throat,with

are

much

take bruised

the

taken,

pennyroyaland

the fruit of balsam

are

fined
con-

rest

much

Comm.
'

author,namely,swelling

our

pains. His
the patient,
namely,forcing

violent internal

the same,
after he is well secured,to drink wine

him

pelled
com-

the

The

remedies likewise

of

proper

ever,
How-

and
ligatures,

and
rose-oil,

will be

be saved.

can

with

triturated with

ammomum,

if any

same

blood

of the beech

of their lives in

the

wine with

the
cinquefoil,

bark, that

of it

drunk

bound
forcibly

sweet

also,drunk

seed,
root

be

to

to drink

have

until he

ing
vomit, and mak-

"c.
roseoil,oil of iris,
apples,

He

says.

'

'

MUSHROOMS.

228

'
*

v.

nations upon the Euphratespoisonedtheir

sioning
immedicable,occait,which rendered theii'wonnds

tliat certain savage

CoMM.
'"

[book

arrows

with

and putrefaction.
Dioscorides,
Aetius,Actuarius,
lividity
ancient
all
the
in
authorities,
and,
short,
copy his account.

It is very

difficultto determine

the

natm-e

of the toxicum.

of
of calamus
describes a species
by the name
Theoplu'astus
toxicus. (H. P. iii,
12.) Avicenna,however, admits that he was
6 ; i,29.) Some have
whollyunacquaintedwith its nature, (iv,
that it was
a preparasupposed,with considerable probability,
tion
Schulze is only decided
from
the rhus toxicodendron.
that it was
a
vegetablepoison.(Tox.Yet. 19.) But it even
it was
doubtful whether
a
seems
simpleor compound medicine,
of an animal or vegetable
and whether
natui'e. (SeeSchneider^s
inchnes
Nicander's
note
to the
on
Alexiph.248.) Sjirengel
of serpents.(Notse
opinionthat it was collected fi'om the venom
this subject.
in Dioscor.) All,however, is mere
on
conjectui'e

SECT.

Of

mushrooms,

ON

LIV.

some

prove

MUSHROOMS.

deleterious from

their

general

by the quantitytaken.
They all bring on
suffocation resemblingchoking. The generalremedy which is
to be instantly
appliedis to compel the persons affected to
vomit by means
of oil. They are also wonderfully
relieved by
from the wood of the
or
drinking of the lye from A-ine-shoots,
wild pear with oxycrate,salts,
And wild pears or
natron.
or
their leaA'es,
if boiled vrith mushrooms, take away
their suffocative
and if eaten they prove beneficial.
Hen^s dung,
quality,
di'unk in oxycrate,
proves beneficial to them ; likewise a drachm
of birthwort,
with wine, and honey when hcked
or of wormwood
nature, and

or

drunk

some

with

water

fruit of all-heal with

and

copperas
And
eaten.

and baum

with natron, or the root and

the burnt lees of wine with water,

with

wine,
vinegar,radish,mustard,

since

certain

mushrooms

or

cresses

when

having been tasted of

not
by venomous
only suffocation but also
ulceration of the intestines,
must
we
givein such cases plenty
of Avormwood, and the decoction of figs,
and of marjoram, and
honied water.
Emetics, the hot hip-bath,and raw
barleywill also be proper.
flour when appHed to the hypochondi-ia,
animals

occasion

Liv.]

SECT.

MUSHROOMS.

Commentary.
effect of

mon

rue,

Nicander

229

mentions

taking mushrooms.

suffocation

His

remedies

as
are

the

com-

Comm.
'"

radishes,

"

"

the

flowers of copper, natron, mustard, lixi\ial ashes,"c.

author
Simeon
Seth recommends
copiesfrom Aetius.

Our

honey

with

Ruffus

and

tepidwater,

(ap.Oribas.

Med.

moderate

quantityof

natron.

Collect,

viii,
24) recommends
clysters
of natron, wormwood, the juiceof radish,and the decoction of
Dioscorides recommends
rue.
emetics of oil,natron, "c.,and
afterwards

vinegarand stimulant decoctions. Avicenna^s remedies

the
those
of
are
author.
same
as
our
Alsaharavius
nearly
directs us to giveat first emetics,and then calefacients,
such as
if
pepper, cumin, wine,and, necessary, the theriac. Haly Abbas,
in like manner,
recommends
emetics,and then wine with honey,
the

"c.
theriac,

The

symptoms, he says,

embaiTassment

ings,and

affirm that mushi'ooms

we

remark

in the

that

sense

of

are

breathing. All

cold sweats, faint-the ancient authors

the organs of respiration,

and
of suffocation is e;enerallvmentioned

act

upon

reportedby modern writers.

For a full reportof fungi,
Dioscor. (iv,
or mushrooms, see
53)
N.
Pliny (H.
xxii,46) ; Schulze (Tox.Vet. 14) ; Sprengel'
in
(Comment,
Dioscor.)
; Schweighseuser
(inAthen. Deipnos.ii,
59); Schneider (ad Nicand. Alex. 521). Diphilus,as quoted
which are black,hvid,
by Athenseus,states that all mushrooms
and hard,or which grow hard after beingboiled,are of a deleterious
He
nature.
recommends
to give mulse, oxymel,
us
so
as to producevomiting.
natron, and \dnegar,
Dioscorides givesthe following
characters of poisonous
fungi
cases

Such

as

grow

near

rusty nails,or putridrags of cloth,or

near

the

of reptiles,
or
lodging-place
by trees which have bad fruits,
deleterious j such have a glutinouscoagulum (membrane
are
adheringto the cap ?) and when gatheredsoon become putrid
and melt away. (M. M. iv,83). Accordingto Sprengel,
these
characters are not imiversally
applicable
(1.c.); but considering
the experience
which the ancients had in the use
cles,
of these artidoubt
The
amanita
they are no
so.
generally
muscaria,
the agaricusnecator,and many other species,
may be set down
as
belongingto the ancient list of poisonous mushrooms.
ject,
Schulze,who appears to have paid great attention to the subenumerates
the poisonousmushrooms
of the ancients as
foUows :
1, Agaricus muscarius ; 2, Agaricus piperatus
;
"

"

'

CoMM.

3, Agaricusemeticus

^--^

Vet. xiii,
5.)
(Toxic.

SECT.

blood

The

of

BULLS^

ON

LY.

newly-killed bull bringson

red

in such cases, is also found

are

BLOOD.

dyspnosaand

the tonsils and

about

the

violent spasms ; the tongue,

and there
the teeth are stained,

with
deglutition

in

In

them.

clots between

v.

5, Boletus larieis.
4_,Boletus versicolor;

suffocation^obstructingthe passages

partsconcerned

[book

BLOOD.

BULLS'

230

this
blood

vomit, because the grumous

case

we

will be

avoid

givinga
firmlyfastened

must
more

by being raised upwards with the contractions.

We
must
givethose thingswhich are calculated to dissolve the
coagulatedblood and loosen the belly; green figs,therefore,
filled with juice,
to be administered when
are
alongwith oxycrate
also proper with vinegar,
All kinds of rennet
and natron.
are
also
and the root of laserwort,with its juicein like manner;
cabbage seed, the lye of figs,and the leaves of fleabane Avith
with vinegar. The bowels
the juice of bramble
pepper, and
have
Those who are going to recover
also to be evacuated.
are
fetid and bloodydischarges
Cataplasms,made
by the anus.
to the regions
of barley
-flour with honey, are also to be applied
in the

stomach

and

of the stomach

'

might
indigestible
in the

of

prove

works

we
on

do not

find any

of it,

mention

toxicology.Themistocles

is said

despatchedhimself with it. Nicander makes no

like our author,condemns
emetics,and Dioscorides,
Nicander

of them.

use

being exceedingly\-iscidand
deleterious by becoming quicklycoagulated

stomach

however, in modern
to have

blood

BuHs^

Commentary.

CoMM.

bowels.

remedies

as

our

author.

recommends

almost

It will be remarked

the

same

tion
men-

the

identical

that they

are

all

penetrating,
attenuant, and solvent nature, such as aa^UI
figs,natron, laserwort,the rennets of certain animals, "c.
the perniciousefi'ectsof coagulatedblood in
Galen mentions
hot vinegarfor it. (De Al. boni et
the stomach,and recommends
Oribas. Med.
Collect, viii,
mali succi.) Ruffns (ap.
mends
24) recomcomposed of natron, vinegar,the decoction of
clysters
cabbage,and of its seed,with vinegar.
of

CoMM.
'
"

in

concur
'

with

same

and
hydromel,

for the deleterious effects of curdled milk

marks,
as he does for those of buUs^ blood,and re-

manner

of certain animals

that the acid contained in the rennet

and
of hares,is well calculated for dissolving
especially
the coagulum (Comment, in Dioscor. 1. c.)

in

wet

in this state,Khases

eaten

and
are

become

placeuntil they have

pm^ging,and
applied. For

emetics and

then

and

cooked

unwholesome.

theybringon

says

violent

prove fatal unless the proper

may
these symptoms he recommends
after which

pm-gatives
;

ating
evacu-

stances,
the deleterious sub-

authorities treat, among

of flesh and fish which have been

Arabian

The

after-

pepper.

Sprengelaccounts
in the

emetic of

recommending firstan

"wards wine

[book v.

HONEY.

HERACLEAN

232

wine

hung

up

When

vomiting
remedies

repeated

and pepper

is

rooms.
mushgiven; and, in the end, the remedies for poisonous
27, 28.) See also Alsaharavius (Pract.
(Ad INIansor. viii,
iv.)Haly Abbas recommends
(Pract.
XXX, 2, 15) ; Haly Abbas
of tepidwater, oxymel,and salt.
vomitingby means
of rancid fruits;which they
They treat, in like manner,
in large quantity. For the
eaten
state act as poisonswhen
of these they recommend
emetics,the rob of bitter grapes,
cure
and medicines to whet the appetite.Rhases
(ad Mansor. viii,
6 ; i,30.)
(iv.
30); Avicenna
of a case
the history
Avenzoar
at considerable length,
relates,
and other bad symptoms had been brought
in which dehrium
and kept up by drinkingout of a cup which had been poisoned
on
with some
putridmeat, (i,9, 9.)
to be

SECT.

Those

who

eat

LVII.

drink the

or

readilyrelieved

the leaves of

mixed

This

Avicenna

mention

makes

Arabia,for

those recommended

symptoms

with

Commentary,

in
as

rue

honey

formed

in

Heraclea,of

theywho have drunk

remedies will be applicable.They
of mulse, having
by drinkingfrequently

the same
Pontus, experience
and the same
of wolfsbane,
are

HONEY.

HERACLEAN

ON

it.

section is taken

which

by

as

of
he
our

from Dioscorides.

poisonouskind of honey produced

the
remedies
m
uch
same
applies
author, (iv,
6; i,32.J
a

SECT.

GYPSUM,

Lviii.]

233

madness
is menhoney in occasioning
Anabasis^ of Xenophon (iv,
cha8.) The same
and
Pliny,Diodorus Siculus,
givenby Aristotle,

effects of Pontic

The

tioned in the

'

of it is

racter

iElian.

effects.

Gypsum,

"

'

'

of its inebriating

ON

LVIII.

GYPSUM.

drunk, producessuffocation,
bybeingconverted

when

into stone ; hence

have

accounts

'"

Sprengel(ad Dioscor. ii,103.)

See

SECT.

those who

the ancient

Toui'nefort confirms

Comm.

we

taken

must

transfer the

remedies

mushrooms, givingthem

to
applicable

in this case, and

the decoction of maUows

for oil; for being of a
substituting
fattynature it lubricates the parts, and prevents them from
beinginjm^edby the stony hardness of the gypsum.
Oil,also,
in honied water is proper ; and the decoction of figs,
and the
of the ashes of vine-shoots with much
or
lye of figs,
wine, and
marjoram, or thyme with lye or vinegar. Clystersare also
to be administered,
consistingof must and the decoction of
mallows.

Commentary.
Rhases

Our

and

A\icenna

author
treat

from Dioscorides.
copiesclosely
this

case

upon

much

the

same'

Comm.
"

'

"

the Greeks, onlythey give scammony

as
principles
freelyat
and if dysenterysupervene
the remedies
first,
they recommend

suitable for it.

and the other

Aetius,Dioscorides,

althoughthey approve
drastic purgatives.
A\'icenna
ceruse,

but

is

even

more

of

Greek

thors,
au-

clysters,
say nothing about

says, gypsum

in its action

powerfulthan

it in

bles
resem-

inducing

occasions colic and

strangulation.Haly Abbas says, gypsum
ileus with drynessof the mouth, suffocation,
of making
difficulty
at first,
and afterwards
urine,and so forth. He directs clysters
of pepper and mustard to be given. Alsaharavius
an
electuary
forbids emetics,
mixed with honey,and ohvewater
recommends
oil for drink,also emollient clysters,
and sweet wine.
of gypsum,
For an account
see
PHny (H. N. xxxvi,59) and
scription
deTheophi-astus
(deLapidibus.) Isidorus givesthe following
of it :
autem
Gypsi pluragenera : omnium
mum,
opticoronis
enim
est
et
:
lapisspecularis
signissedificiorum,
The
gratissimus.''
(Orig.xvi,3.)
specularewas evigypsum
"

"

'

234

CoMM.
"

'
'

CERUSE.

[book

v.

of lime.
See Matthior
dentlysclenite^
crystallized
sulj)liate
olus (Com. in Dioscor.)
Dr. Kidd
of the varieties of the
account
givesthe following
ancient
It was^ by the generaldescription
of it^
:
g}^sum
an
earthycompound of lime ; but the ancient naturalists seem
of the present day^
of lime, the gypsum
to applyit to sulphate
and sometimes
of lime, or quicklime,
to a calcined carbonate
which
b. i,p. 70).
they called calx." (Mineral,
""

"

Sir John

Hill

in his notes
"

on

ancient gypsums
he
Theophrastus(deLapidibus.) " G^^^Dsum,"
full account

givesa

of

the

is

than a selenite less elegantthan the

nothingmore
rhomboidal
There can
be no doubt that the
or
platedkinds."
of Philoponus(Com. in Aristot. de Anima.
ii)
yvdiOQS^o(^o'l'TJc
that our
recent authorities on
was
pure selenite. It is singular
have not included gypsum
in the list of poisonous
toxicolog}^
substances which
they treat of, although there is good reason
is
to believe that the powder,if given in any great quantity,
highlydeleterious. We know for certain that gypsum, or stucco,
is often used for poisoning
rats and mice. It is further deserving
says,

of remark
down

that all the earlier modern

at least to the
as

active

an

middle

of the
All

poison.

authorities

on

medicine,

16th

the

century,treat of gypsum
ancient authorities,
it will

be seen, represent it in this light. Pliny makes

mention
of a
of suicide committed by means
of gypsum
case
(H.N. xxxvi,24.)

SECT.

Ceruse, owing to
taken

its

LIX.

of the

tongue, and

of

be proper

mallows,

or

to

bones

of

peaches,with

of the

order
extremities,with dis-

of moving.
difficulty

givehonied

or
lye of Aine-shoots,

mistaken, and when

palate,
tongue, and the intervals
bringson hiccupand cough, dryness

coldness

hot milk,

be

the

It also

of the intellect and

wiU

CERUSE.

colour,cannot

it whitens
voluntarily

betAveen the teeth.

ON

or

water

sesame

or

In

this

the decoction

triturated with

of

case

it

or
figs,

wine, or the

the oil of
a

marjoram, or of iris ; also the

decoction of barleyor frankincense,

the gum
of prunes, or the juiceof the elm which is contained
in its follicles,
ately
along with tepidwater ; but let them immedior

vomit.

The

juiceof thapsiawill

also be proper

for

them,

or

ARSENIC.

LX.]

SECT.

oboli of tlie

three

honied

juiceof

23.1

when

drunk

colour

of

scammony,

with

water.

Nicander

Commentary.

compares

the

to Comm.

ceruse

The symptoms of poisoning

by it are constriction
frothymilk.
of the tongue, singultus,
of the palateand gums,
a dry
asperity
cough, nausea, heaviness of the head, unnatural vision,and

of

oil,thin milk, decoctions

triturated with wine, prunes or elms, which

His remedies

torpor.

'

mallows, sesame

emetics

are

of

givenpartlyas emetics,and partlywith the intention

is to be
of their being digested
; for which
piu'pose the patient
See the Paraphraseof Eutecnius
bath.
put into the warm
;
to be

are

Aetius,Avicenna, and Rhases,who recommend

Dioscorides,
similar treatment.
Aetius, like our author,directs us to give

also

its astringency. Alsaharato counteract

evidently
scammony,
vius recommends
emetics of the decoction of figswith mead
or
infusion

common

oil,the

with

hydromel^and

the decoctions

(Ad

of

hot

of wormwood
milk.

figsand oil,with
and
^nii,

Mansor.

as

Rhases

diuretic,
scammony

recommends

and
purgatives

drastic

Contin. xx,

emetics of

A^dcenna's

2.)

retics.
diu-

ciples
prin-

quitesimilar,that is to say, he trusts to

from
and prevents the patient
and clysters,
emetics, diuretics,
emetic consisting
an
6, 1.)Haly Abbas recommends
sleeping,
(iv,
retics,
of honey with hot water, vinegarand salt ; he also givesdiuwood.
such as the infusion of parsley,
fennel,anise,and southern(Pract.iv.)
of
the ipi/nvOiov
white lead is certainly
Dr. Alston says,
our
of Pliny.^' It was
Dioscorides and the cerussa
preparedby
exposingthe carbonate of lead to the vapours of vinegar. See
Milligan(Ad Cels. p. 112.)
of treatment

are

"

SECT.

on

LX.

ON

LIME,

SANDARACH,

taken
when
Lime, sandarach,and arsenic,
pains of the stomach and bowels, with

Wherefore

we

must

administer

all thingsof

ARSENIC,

AND

in

bring
di-aught,

violent

corrosion.

diluent and

solvent

thingsas will producereadyvomitingand lubricate

mallows, and
the bowels, as the juiceof the marsh or common
of rice,copiousdraughts
of spelt,
decoction of linseed,
or
or
a
nature, such

'
'

of milk

"

Nicander

by these
poisoning
Actuarius
givealmost the

has not treated of

Aetius,and
Dioscorides,
author.
of the symptoms and treatment
our
as
account
and laxatives.
The
remedies
are
emetics, lubricants,

substances.
same

Their

contain

juices.

Commentary.
'

fattyand

are
water, broths -uliicli

and honied

wholesome

CoMM.

[book v.

LITHARGE.

236

Arabians

follow theu'

Thus

to be

and
copy their descriptions
Alsaharavius directs these cases

emetics of

treatment.

treated

by giving

and
oilyand fattythings,emollient clysters,

unctuous

Avicenna
of the intestines.
to prevent ulceration
articles,
and oil,
then
water
orders,in the first place,an emetic of warm
such as those of linseed and mallows,and
emollient decoctions,
fat broths

and

milk.

The

cough

is to be

by

soothed

cents,
demul-

(iv,6, 1.) Rhases states that quicklimeand arsenic

of the intestines. (Cont.xxxvii. tr. 1.)
occasion
putrefaction
ing,
Galen,however, has stated that arsenic is not, properlyspeakbut
caustic.
a septic,
a strong
(De Simp. 1.)
of
these importantmedicines
this
account
However
meagre
may

appear,

works

on

it will be

seen,

that
toxicology,

upon

the

reference to the

treatment

at

standard

the present

day

in any one
differs,
point,from the ancient mode of
scarcely
practice. Emetics, demulcents, consistingof decoctions of
emollient herbs, or copiousdraughts of milk, laxatives and
form the present practice.
clysters,
The
ancient arsenicum, or auripigmentum,was
orpiment;
the sandarach was
the
or
realgar,
orange-redsulphuret. Our
oxide of arsenic is a factitioussubstance,
preparedby sublimation
from cobalt : it is much
deleterious than auripigmentum
more
tious
or
orpiment. Servitor and Avicenna have described the facti-

arsenic,or
chemist

oxide of arsenic of the

Geber

The

moderns.

bian
Ara-

of orpiment,
and ingeniously
largely
which he holds to be closely
alhed to sulphur. He also speaks
of sublimed arsenic, (iii.
29.)
treats

SECT.

when
Litharge,
and

LXI.

ON

LITHARGE.

di-unk,bringson

bowels,with intense tormina

heaviness
sometimes

of the stomach

by

its

weight it

LEAD.

LXii.]

SECT.

237

occasions retention of urine and

Avounds tlie intestines^

swelling

an
hodj, wliicli becomes of a leaden luie^and assumes
it will be proper^ after
In such cases
unseemly appearance.
vomiting,to givethe seed of the wild clary(horminum)to drink
witli wine,three oboli of myrrh,wormwood, parsley-seed,
pepper,
wild
dried
of
and
the
the flower of privet
with wine,
dung
geons,
pi-

of the

with nard

wine.

and

symptoms which Nicander

The

Commentary.

mentions

being superinducedby lithargeare borborygmi,pains resembling those of ileus,retention of urine,and discoloration

the

His

skin.

hedge
and the
privet,
pepper,

"

'

"

of

warm
stimulants,
carminatives,
St.
Jolm^s-wort,hyssop,
myrrh, clary,
the
shoots of
taken in wine,
green

remedies

such
diuretics,

and

Comm.

as

as

mustard

are

commends
pomegranate. Scribonius Largus reemetics and calefacient medicines,such as pepper,
myrrh, parsley. The Arabians,namely,Rhases,Avicenna,and
in recommending emetics,drastic purgaconcur
Alsaharavius,
tives,

calefacient medicines.

and

ancient

The

fruit of

the modern.

preparedlike

was
litharge

It is

semi- vitrifiedperoxideof lead.

LXII.

SECT.

person has
the same
experiences

When
he

is to be treated in the

tained to be
Most

symptoms
same

shavingsof
as

those

the

modern

from

or

its

soil,

and
litharge,

need

'

"

and treatment

same.

lead

manner.

of the ancient authorities state,like

symptoms
some

the

is now
ascerscarcely
comj
say that litharge
of lead. (Seethe precedingsection.)
preparation
We

Commentary.

drunk

LEAD.

ON

of

our

author, that the

are
actly
exby lead and litharge
poisoning
that it should be asserted in
singular

It appears
works on the materia medica

that the ancients

Avere

Galen

of lead.
properties
mentions that water
even
conveyedin leaden pipes sometimes
dysentery.(Med. sec. loc. vii.)
proves deleterious by occasioning
the same
observation, (xi,
Aetius makes
45.) Palladius,the
writer on
speaks of it in the followingterms :
agricultm'c,

unacquaintedwith

the

deleterious

MERCURY.

238

"

CoMM.

[book v.

ratio est, plumbeisfistulis

Ultima

ducere,qufe

'

'
"

reddunt

liumanis."

nocet

plumbo

cerusa

nam

impregnatedwith

of

the

also mentions

that water

(Arch,viii.)Plinynotices

lead is deleterious.

deleterioiis effects

the

noxias

attrito,
quae corporibus

creatur

(ix,11.) Vitruvius

aquas

exhalations

from

lead mines.

(H. N. xxxiv,50.)
The

Greek

writers

but

the

on

toxicologydo

Arabians

have

treat

not

done

in

of

copper

brief terms,

poison;
in cases
treatment
as
agreeingin recommending the same
arsenic.
of poisoning with
(See A^dcenna, Rhases, Haly
These
and
likewise,lay
Abbas,
authorities,
Alsahara^ius.)
in
the
of
treatment
down
poisoningby
very succinct terms
iron,which they direct to be conducted upon general principles.
recommend
cent
demullaxative and
They in particular
medicines. (See Avicenna iv,6, 18.) As a slight
novelty
in their practicewe
mention
that
he
recommends
the
may
affusion of vinegar with
oil of roses, violets,
the
"c., upon
as

so

all

head.

Averrhoes

recommends

from

to

dr.

of

balsam.

(Coll.
V.)

SECT.

LXIIT.

ON

MERCURY.

Mercury, when swallowed,bringson the same

symptoms as
and
the
remedies
be
used
in this case.
to
same
are
litharge,
A copiousdraughtof milk seems
and vomiting
to be beneficial,
ought to be produced.
Commentary.

CoMM.

Dioscorides,Galen,

and

Aetius

give the
and poison

imperfectaccount of this importantmedicine

author gives,
and supplyno additional information of any
as our
better acquaintedwith its
importance. The Arabians were
properties,
having ascertained that it might be taken in its
metallic state with impunity. Rhases
I do not think
says,
that any great harm will result from diinkingmercury
when
it
is pure, unless it be painsin the stomach
and intestines.
It
afterwards passes out in its natural state,especially
if the person
who swallowed it moves
about.
I gave a draught of it to
same

"

an

ape,
as

nor

did I

cept,
perceiveany inconvenience arise from it,exhave mentioned, that it appearedto be pained in its

ETC.

HELLEBORE,

240

Such

themselves.

namely,white hellebore,
following,
for these bringon either
black agaric,

the

are

and the
elaterium,
thapsia,
in
suffocation or hypercatharsis,

suffocation in the way

[book v.

which

described for

cases

we

may
and

mushrooms,

the

cure

such

like

by such thingsare
stop the hypercatharsis

substances, and

as

discharges.Likewise certain
to any considerable
which might seem
not injurious
substances
will sometimes occasion dangeroussymptoms, and should
degree,
and the fresh
the wild rue, gitli,
not be neglected. Such
are
calculated to suppress

poppy,

such

have

the

are

flowers

administration

the

cases

who

COMM.

which

immoderate

taken

of

alone relieves those

them.

This

Commentary.

section is taken

says, like our

called cactos,and that

Actuarius

the pappus

vomit

In

called cactos.

of the thorn

from

Dioscorides.

author,that

Of

it is the Aoat er

vomitingrelieves those who

have taken it. (Meth. Med.
(iv,6, I);
v, 12.) See Avicenna
and Rhases
49.) Alsaharavius directs us in
(ad Mansor. viii,
of hellebore to clear the stomach
the case
by emetics,and to
For the
of citrons,
apples,and roses.
applycoolingplasters
and
emetics of oil,emollient clysters,
wild rue
he recommends
and vinegar.
the ashes of vine tops taken with water
of the thorn

In

the

opinionswhich
albus

of

Book

Seventh

the

have

been

ancients.

we

shall have

is very undecided.
to be the same

thapsiahe makes
has
foetidaof Linnaeus. Theophrastus
Pliny says it occasions swellingof
43.)
(N. H. xiii,

vet.

iv.)

We

The

shall treat

of the elaterium

to

the
respecting

entertained
Schulze

occasion

state

the

helleborus

(Toxic,
as

the

T.

described it
the

(H. P. ix,23).
body, with erysipelas.

also in

the Seventh

Book.

for all drastic

the word as a generalterm
Hippocratesuses
but by Dioscorides,
and the subsequentwriters on
purgatives,
to the fsecula of the momorthe materia medica, it is applied
dica elaterium.
is a
agaricusmuscarius
Schulze properlyremarks
and
Dr. Cliristison placesit in
poisons. See sec. liv.
The

Schulze
here

is much

treated

well-known

room.
poisonousmush-

that its eflfectsare

the

narcotic

class of narcotico-acrid

inclined to believe that the trrtyavov aypiov

harmala
of is the peganum
of Linnseus,a plant

and

tlie ruta

intermediate between
to
disposed

ETC.

HELLEBORE,

LXiv.]

SECT.

241

melanthium.

He

of the ancients

think that the melanthium

is also
was

the

Comm
'"

"

adopt this opinion from

the text of Avicenna,
(iv,6, 1, 16.) Sprengel agrees with
and Dalechampiusin opinionthat the cactos was the
Anguillara
of the
Jj.,or cardoon artichoke^a variety
cynara cardimciilus,
inclines
C. scolymus.(Comment, in Dioscor.)Schweighaeuser
translator of Athenseus,
to the opinionof Villebrun,the French
which he says
it to be the C. sylvestris
who makes
latifolia,
at the present day. (In Deipnos.
grows commonly in Sicily
We

sativa,L.
nigella

are

inclined

to

ii,83.)
may notice the treatment
euphorbium,and the spurges, of which
this head

Under

by

gnm
made by the Greek

of

we

no

poisoning

mention

is

For the Arabians,

toxicology.
A^dcenna (iv,
see
6, 1,4, 5) ; Rhases (Contin.
xx, 2 ; ad Mansor.
viii,48) ; Alsaharavius (Pract.xxx, 1, 19.) The symptoms
as
givenby them all are, violent pain and heat in the primae
and death, unless timelyrelief be
with bloodydischarges,
vise,
given. Their remedies are immediate vomitingwith hot water
and in
and
demulcents,barley-water,
oil,then administering
the end,the theriac. G-alen and Haly Abbas, in their treatises
of poisoning.
it in this case
the Theriac,recommend
on
noticed
is not
The
mezereon
by the Greeks or Romans
either as a poisonnor as a medicinal substance. The Arabians
See Avicenna
both these heads.
treat of it under
6, 1) ;
(iv,
Rhases (ad Mansor. viii,
53.) The symptoms as givenby them
violent vomiting and purging,for which they recommend
are
in the first place,
and in extreme
sweet
milk,butter,juleps,
cases

authorities

sealed earth.

the theriac and

their

confound
treated

of in

with

mezereon

the

on

the

The

Arabian

chamseleon

authorities

of the

Greeks,

section of this book.

thirty-seventh

The

the strychnos
Serapionwas
colubrinus,
accordingto Sprengel.(R. H. H. i,250.)
vomica
classes the nux
Rhases
along with the articles

dende

and

of Avicenna

treated of in this section.

cases

to

give warm

water

He
to

recommends

promote the

us

in all these

vomiting,and

and if violent convulsions come

easier,
on, he directs
the patientto be put into a warm
bath, and anointed with hot
oils. (Ad Mansor. viii,
49.) Serapiontreats of it in his Materia

render it

Medica
II.

(163.)

The

Arabians

also treat of the methel-nut.

16

We

CoMM.
'

'
'

ETC.

IIELLE130RE,

242

unable

are

which
condisi,

to determine

is treated

head.

Rhases

See

[book

of the

the nature
satisfactorily

by the Arabians,under the

49) ; Avicenna
(ad Mansor. viii,

of

calls it cundes.

6, 1, 16.) Alsaharavius

The

v.

sent
pre-

(iv,

symptoms,

he

dryness of the nose, throat, and palate,sneezing,

pain of the stomach, and, unless speedy
muttering delii'ium,
tions
relief be brought, death. (Pract.
xxx, 1, 24.) Ardoyn mensays,

are

that
characters

further

The

is the

under

(ad Mansor.

applyto

the

but

above

the

nalis,
officisoapwort [sajjonaria

andDioscorides.
of Theophrastus
arpovOiov

Sprengel(Comment, in

Dioscor.

i,192.)

[cyclamenEuropceum) is also treated of

-bread

sow

Arabians

at all

do not

L.),which
See

struthium

referred it to the

some

this head.

viii,
59) ;

See

by the

6, 1, 16); Rhases
(iv,
1, 24.) The
(Pract.
xxx,

Avicenna

Alsaharavius

to Alsaharavius,
are
swellingof the throat,
symptoms, according
is treated of as
The sow-bread
and strong pain of the bowels.
Medica
article of the Materia
193.)
an
by Dioscorides (ii,
Dioscorides (M. M. iv,82) does not reckon the oleander
(neriumoleander,
L.) destructive to man, but the Arabians rank
of a heatingand desiccant
the deleterious substances,
it among
for it emetics,with the decoction of
nature; and recommend

fenugreek,figswith
6, 18) ; Alsaharavius

honey, and the like. See

(Pract.
xxx, 1, 27) ; Rhases

AAdcenna

(iv,

(ad Mansor.

viii,
36.)
The
anacardium, or Malacca bean, is treated of as a poison
(iv,
by Rhases (Contin.xx, 2 ; ad Mansor. viii,35) ; Avicenna
(Pract.
6, 1, 9) ; Alsaharavius (Pract.
xxx, 1, 42) ; Haly Abbas
mend
iv,50.) They all describe it as an irritant poison,and recomwith demulcents,to
emetics of animal and vegetable
oils,
obviate

the bad

effects of it.

thorities
althoughnot treated of by the ancient auis described as a deleterious substance
on
toxicology,
(Mat. Med. iv,81) ; by Galen (De Simpl.);
by Dioscorides
and by Pliny (H, N. xxv, 83.) It appears to be the periploca

The

apocynum,

Graca, L.
Dioscorides

and

Pliny likewise

or
saffron,

reckon

the

cus
cro-

sativus,a deleterious plant. Its deleterious action is very

weak.
The
was

atramentum

used

as

sutorium,which

poison.

See

Cicero

was

solution of

vitriol,

(ad Familiar, ix,21.)

COLD

Lxv.]

SECT.

SBCT.

DOMESTIC

ON

LXV.

WATER.

undiluted
violent

or

wine,

sweet

the

cold

have

and

tremors

mode

same

however,

of

in

unseasonably
Rhases

Thus

and

and

thus

either

to

prove

the

nerves

resembling

practice of

the

support

the

Greeks

Avill be

come

on

of the
those

indicated

of

stomach,

which

wine

the

has

been

Greek

concur

with

evacuation

of the

stomach

and

cold

or

with

troches

Avicenna

whey,

drink

may

the

(iv,6, 1, 31.)

violent

pression
im-

superinduce

the

former
in

proper

case

order

to

that

of the

inflammatory symptoms

have

bled

Arabians
For

an

under

these

immoderate

in

of

to

camphor.

which
See

Arabian

immediate

recommending

venesection,

cumstances.
cir-

draught

unseasonably, the

taken

authorities

water

may

system, whereas

of the

even

most

seem

ference
dif-

Arabians

it may

gastritis. In

may

when

or

nally,
interThe

large draught of cold

fatal at once
by producing a

(Avicenna, iv, 61, 31.)

of pure

wine

powers

and, indeed,

and

water

Greeks.

liver.

the

Greeks

the

cold

the

undiluted

plaster over

whole

Arabians,

of

from

manner

'
'

ix, 5.)

The

draught

Comm.
'

recommending

author.

recommend

Arabians
and

heat

by

their

Med.

in

concur

taken

practiceof
for.

accounted
threaten

such

evacuation

word,

(Meth.

our

different

very

the

upon

the

have

applicationof

the

symptoms

as

Avicenna

between
be

who

in

Actuarius

treatment

those

treat

been

affected."

and

Dioscorides, Aetius,
the

In

pains.

by taking an immodeinstantly seized with

Some

"

says,

become

has

system

mucli

bath, running,

to, and

recourse

water

dyspnoea, convulsions,
nervous

had

the

and

suffocation

on

Galen
of

AND

impending danger.

Commentary.

draught

WINE

great quantity, and

especiallyafter

more

quickly

clysters,remove

rate

in

exercises, bring

venesection

cases,

AS

WATER.

drunk

when

water

SUCH

ARTICLES,
COLD

Cold

243

in

they add
particular

V.

BOOK

TO

APPENDIX

opportunityis likelyto occnr, we shall in this

place give a short notice of two subjectsconnected with medical
which are entirelyomitted by oui' author.
practice,
As

better

no

ON

FEIGNED

Galen, we

DISEASES,

beheve, is the only

of
professedly
his

short

AND

the

treatise

detection
on

this

THE

DETECTION

ancient

of simulated
head

with

author

OF

who

diseases.

remarking,

THEM.

has treated
He
that

begins
persons

feign diseases from various motives,and that it is expectedthe

physiciansshould detect such impostures. That, for example,
and cedema, when
inflammation,erysipelas,
produced artificially,
ginate
from the same
diseases when
they oriought to be distinguished
in constitutional
He
causes.
adds, that haemoptysis,
hsematemesis,and bloody dischargesfrom the bowels, are often
simulated.
Haemoptysis is simulated by opening a vein in the
and
sucking blood from it while one aff'ectsto cough.
gums,
all which
and insanity,
Others, he says, affect dementia, fatuity,
ward
Inthe vulgar expect that the physicianshould detect.
cases
to be
pain, such as that of colic,he had often known
simulated,and relates briefly
an
interestingcase in point. He
remarks, that experience and natural sagacitywill enable a
all impositions
He
of this nature.
to expose
man
givesa very
he detected the
in which
interestingaccount of the manner

IMPOSTORS.

PROFESSIONAL

APPENDIX.]

245

tionally
swellingat tlie knee^ that liad been produced intenrot?)
by the juiceof tbapsia{thapsiagarganica, deadly cartinguishe
Feigned inward pains,lie remarks, may often be disfrom the real by the aversion which the malingerer

of

nature

discovers to swallow

medicines,which

he

be anxious

would

to

actuallyin acute pain; and adds,

tinal
that the state of the pulse,and the other symptoms of intesdiseases,Avillassist in making the detection. (Quomodo
388, ed. Basil.)
coarg. sint qui fing.se ^grot. t. iii,
have

if he

given him

has

of

IMPOSTORS.

PROFESSIONAL

ON

Rhases

w^ere

chapter on
interesting

an

he
impostors,

says, are
in his whole
work.

more

this head.

numerous

could be

than

of them, he

Some

frauds

The

tained
con-

adds, pretend

to

in
and having made
a crucial incision
epilepsy,
the back part of the head, they extract from the wound
thing
somewhich
they hold in their hands, and thus impose upon
it to be believed that
cause
people. Others, in like manner,
of these
they extract a small lizard by the nostrils. Some
films
he says, make
it be believed that they remove
characters,
into
from the eye, by secretly
introducinga small membrane
the eje, and taking it out again. Others manage
to create
a
Others
from the ear with a reed.
belief that they suck water
from the ears
also make
it be believed that they extract worms
teeth.
Others practicea trick by which they obtain the
or
the ranula below the tongue.
credit of extracting
Why should
I mention
those,he adds, who introduce piecesof bone into

be able to

cure

and

wounds

ulcers,and afterwards

extract

them?

He

says, it

for the
impostorsto sound a man
and exhibit
stone, pretendto find one, perform the operation,
into
a calculus which
they themselves had introduced secretly
incisions
the incision.
Others
pretend to cure
piles,make
is not

about

the anus,

the vitreous

something of
There

and

of them

Certain
suck

for these

uncommon

are

some

form

ulcers there

which

did not

afli'ectby scarifications and

humour

from

the kind

which

who

undertake

the

exist before.

other

means

to

while they exhibit

hip-joint,

they themselves

have

to collect all the

introduced.
infirmities of

PROFESSIONAL

246

IMPOSTORS.

[book v.

body into one spot,and then extract tliem ; for this pretended
and
heat
in
raise
violent
an
some
itching
objectthey
of
plished
alkekengi(wintercherry); and having accomplaceby means
this they exact a fee for removing the uneasiness
from
the spot,which
they do by anointingit with oil. There are
the

others who

will make

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
Thus, he adds, they
questionas if it had been brought up.
often do much
mischief,and sometimes are guiltyof culpable
homicide.
their

He

concludes

guard againstsuch

by warning sensible peopleto be upon

vii. 27.)
wretches. (Ad Mansor.

in his account

CoMM.
"

'

he

'

does

of

giveof

operations
surgical
; and

them

are

account

and

his commentator

Galen

dislocations
may

which

but the information

the

which
descriptions

all borrowed

almost

of fractures and

The

[book vi.

ETC.

OPHTHALMIA,

248

from

our

author.

given by Hippocrates

pronounced almost
theysupplyupon most
be

plete
com-

other

is scanty.
surgical
subjects

SECT.

TI.

ON

BURNING

OF

DYSPNCEA,

AND

HEAD

THE

FOR

ELEPHANTIASIS.

ophthalmia,occasioned by a defluxion
of a
dyspnoea,produced by a redundance

In
in

humour

which

is sent

from

OPHTHALMIA,

the head

above,and

recrementitious

chest,and by
partscontained in it,they
down

to the
proves injurious
in this
of the head
middle

lodgingthere

from

to the

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
off of the eschar.
Some
the bone after the falling
by burning
burn

even

the

itselfmake

the bone

manner.

small scale exfoliate from

it,in order

and be evacuated
perspire
the more
theykeep the ulcer open
readily
; and for this purpose
phantiasi
eletime and then allow it to cicatrize. In treating
for some
burn five eschars in the head, one
some
anteriorly
called
the bregma ; another, below this,a little
above the part
above the forehead, at the extremityof the hairs ; another,at
others at the parts called the
the part called the occiput
; two
plates,above the ears, one on the right side and
squamous
another on the left; and thus,by the removal of several scales,
of the collection of
and discharge
they prociu'e the evaporation
in the deep-seated
thick humours
parts of the head, and prevent
the sightfrom being injured. They also apply another
in order to remedy the prime organ in
cautery on the spleen,
of the melancholic humour
the formation
by the eschar formed

to allow the

in the

'

"

'

of the head

to

skin.

Commentary.

CoMM.
'"

humours

curat. Morb.

Hippocrates(deVisu); Aretaeus (de

i,1); Celsus (iii,
23, and vi, 6) ; Ceelius

See

Chron.

(Morb. Acut. i,i,and Morb.

2);
(vi,50) ; Actuarius (Mcth.Med. iii,

Aurelianus

Chron.
ilhases

i,4) ;

Aetius

(Cout.xxvii,1^

24);

ETC.

OPHTHALMIA,

II.]

SECT.

249

(Chiriirg.
i); Mesue (deiEgr.Capitis)
; Aviix, 69); Avenzoar (I,9,
(iii,
1); Haly Abbas (Pract.

Albucasis

cenna

Comm.

17).
Tlie

use

alluded to

of the actual

by

the classicalauthors.

in Dr.

passages

BlomfiekPs
Consult

^'Eschylus
(822.)
(v.193) ;
A

and

Boissonade's

very elaborate and

in the

practiceis often
cautery in surgical

of
practice

See

edition of the
also Gataker's
'

Anecdota

sensible account

surgery

is

collection of these

'Agamemnon'

'Marcus

Grseca'
of the

of

Antoninus'

ii,p. 311.)
(vol.
of the

cautery
givenby Vegetius,(Malomed. i,
use

28.)
whoever was the author of the work referred
or
Hippocrates,
the cauteryto the head
to above, applied
in diseases
very freely
of the eyes and other complaints.
Aretseus
directs us, in cases
of cephalsea
and epilepsy,
to
the bone as far as the diploe,
and afterwards to burn
perforate
it until the dura mater

however, that it is

is

harsh

separatedfrom

the bone.

He

admits,

remedy.

Celsus

directs us, as an
ultimum
in epileptic
remedium
the occiputand
cases, to form issues with a burning iron upon
at the junctureof the first vertebra with the head.
Aetius
as

author.

our

Actuarius
Cselius
cases

The

speaks of burning the

of

He

does the

directs

us

head
to

in
avoid

nearlythe

same

the muscular

terms

parts.

same.

of this practice
in
Aurelianus,however, disapproves

and epilepsy.
cephalsea
Arabians

partialthan the Greeks to

burning the head in these and other complaints. See in particular
whose
is
In
minute.
Albucasis,
cases
description very
of cephalsea
he recommends
the cautery to be appliedto the
but cautions againsttouchingthe bone lest it produce
occiput,
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
zoar,
remedy in the cases mentioned by our author. AvenpoAverful
the unguarded application
of the
however, condemns
burning iron to the head.
Guido de Cauliaco recommends
the cauteryin cases
of hydrocephalus
(ii,
2, 10). Brunus also appliedit for hydrocephalus,
Lanfrancus
(ii,
17.) But see in particular
(III,iii,
18.)
were

even

more

HYDROCEPHALUS.

250

Fabricius ab

CoMM.
'

"

"

[book

'

he
experience

Aquapendente states that from

had ascertained
the good effects

the

cautery over

sutures

of the

skull

asthma, consumption,and
especially
the head to the chest.
He givesa
ii,1.) But
((Eu^TesChiiTirg.
t. iii,
p. \i,c. 6.)

SECT.

III.

ON

in

the most
of

various

all cold

vi.

ample
applyingthe
complaints^

defluxions from

full account
see

De

of the tion.
operaHaen.
(Rat. Med.

HYDROCEPHALUS.

affection is so named
from the peculiarity
hydrocephalic
It occurs
in
of the fluid,it being of a watery consistence.
infants,owing to their heads being improperlysqueezedby
other obscure cause
mid^Yives during parturition,
or from
some
;
and the extravasated
from the rupture of a vessel or vessels,
or
blood being converted into an inert fluid ; or from rarefaction,
the matter
exudingand lodgingbetween the skin and the pericranium
For the fluid is formed either between
the pericranium
and the skin,or between the pericraniumand the bone,
The

or

between

the bone

in which

and

the

meninx.

the fluid is formed

In

between

those
the

cases,

skin

fore,
there-

and

the

there is a soft tumour, all of one

out
colour,and withpericranium,
pain,accompaniedwith an elevated swelling,
havingonlya
it and the fingers,
thin substance
between
intervening
readily
and
its
it
is
seated
form.
"WTieu
again resuming
yielding
the pericraniumand the bone, all the other appearbetween
ances
the
but the swellingis harder, yieldsmore
are
same,
to be felt through thicker
substances,and is
slowly,seems
the fluid is seated between the meninx
more
painful. When
and the bone, there will stillbe a swelling,
but not of so jdeldfelt,
ing a natui'e,nor so easily
onlyit yieldsto the application
of strong pressm'c ; for the bones of infants,being recently
formed, are of a more
yieldingnature ; and this is more
cially
espethe case
when, owing to enlargement of the sutiu'es,
the fluid escapes outwards.
This is readily
ascertained
from
that by pressui'e of the fluid it retreats
the circumstance,
to
the deep-seated
parts. In such cases the pain is greater,the
head is distended,the forehead projects
whole
outwards, the
fixed and shed tears frequently. In these cases
we
eyes are

SECT.

HYDROCEPHALUS.

III.]

251

remove
reprobateany surgicalinterference,although some
pieceof the bone by trepanning,as will be described in

section

on

fluid be

fractures of

formed

between

the

bones

the

skin

of the
and

head.

But

the

if the

pericranium,and

the

incision
transverse
one
swellingbe small,we may make
through the middle. But if the fluid is seated between the
make
is large,
we
pericraniumand the bone, and the tumour
another in the middle ; or if it
two incisions intersecting
one
the form of the
three imitating
make
is stilllargerwe
may
After the operation,
Greek
letter H.
having evacuated the
bind it up, and soak
fluid and appliedsuitable compresses,
we
it with wine and oil until the third day ; after which, having
of
it by the application
loosed the bandcure
may
ages, we
of incarnating
we
pledgets
may scrape
; or, if the bone is long
it Hghtly.
the

Hippocrates(deMorbis,ii,15) ; Celsus Comm.

^^~'
(iv,3) ; Aetius (vi,1) ; Galeni (utaiunt) Isagoge; Antyllus
1 ; iv,2) ; Avenzoar
(I,9, 17);
(apudNicetam); Avicenna (iii,
Albucasis
ix,16); Rhases
ii,1) ; Haly Abbas (Pract.
(Chirurg.
See

Commentary.

(Contin.xxvii; and ad

Hippocratesgives an

Mansor.

ii,25.)
of water

account
interesting

in the

by him, are pain

in the opening of the head and temples,rigor,
fever,double
He
vision,impatienceof sounds, vomiting of phlegm, "c.
and
afterwards purgatives.
recommends
emetics,caputpurgia,
brain,the symptoms of which,

He

also makes

even

directs

us

mention
to

as

described

of hellebore

and

perforatethe skull,or,

and
sternutatories,
in other words, to

trephineit.
Celsus

He recommends
only the hydrocephalusextemus.
to the head, such
stimulant applications
use

describes
us

to

does not succeed,he directs

and if this treatment
sinapisms,
the scalpel.The
to use
us
case, otherwise,is to be treated
and diuretics.
with sudorifics,
like dropsy,
friction,
exercise,
is mostlyabridgedfrom Aetius,who
Our author^s description
lected
Even
when
the fluid is colgives an extract from Leonidas.
it is
within the skull he directs us to let it out, provided
of the suture.
in such quantityas to occasion a separation
tion
in the Collecof the disease,
The account
givenby Antyllus,
He speaks
author's.
our
of Nicetas is nearlythe same
as
as

HYDROCEPHALUS.

252

CoMM.
'"

'

"

"

[book vi.
in which

of the operation
favorably
only in cases
collected externally
to the bone.
ascribed
In the
Isagoge/generally
'

when

the water

the

on

pericranium,

incisions ;
straight

by making two or
it ;
immediatelybelow the bone, to perforate

to evacuate

when
in

three

it

which

fluid is seated

the

between

is

Galen^ it is directed,,

to

the skin

is collected below

the water

but the

membrane

the

and

and
case

the

utterlyincurable.
Rhases borrows his account
mostlyfrom Autyllusand omauthor.
however, he recommends
authority,
Upon his own
He
also approves
of applyingthe
bandages with compresses.
brain is

actual

freely from

boiTows

no
supplies

new

^iews

of

Aetius

practice.A^Tien

Albucasis

the

same

had

that he

describes the

he
much

says

infancy,and

in

temus

hydrocephalusinin every case

it had proved fatal. However,
operationof evacuatingthe collection in

terms

occasion

immediate

death.

as

The

existence

of such

allows

is

lymph,

bone

and

or

pus

been

of it,but
reality

the

described

"We

by

occasioned

the dura

See

The

by

must

external

We

mater.

may

have

been

of
application
to

moxa

evacuate

Larrey
in this

the

was

rare

currence.
oc-

that

collections

tween
injuries
forming be]Modern
pathologists
and

the
pus between
further mention
that the

authorities approve of the cauteryin the

Guido
de Cauliaco (ii,
2, 10.)

late Baron

us

is the

think

earlier modern
case.

frequent

it is of

disposedto

are

author

our

says that

integumentsand the bone.

reahtyof collections of serum

the

the

mentioned, and
scarcely
even
questioned. Van

now

has

case

(Comment. 1217.)

the

mentions

Haly's treatment

sheep.

hydrocephalusexternus

cases

the operator
of blood should

author's.

our

Swieten

warns

evacuation

Alsahara^dus

of the disease in

occuiTcnce

He

the Greeks.

as

wounding an artery,lest the

admit

is collected in

water

only known

to avoid

of

author, and

our

the sutures.

over

the

and

brain, Avenzoar, although in

for the actual cautery,dii'ectsus to apply

advocate

generalno

the

fi'ic-

of the

anterior ventricles

same

further recommends

burning the temporalveins.

Avicenna

the

He

the sutures.

cauteryover

tion and

it

be

pronouncedto

decided

advocate

complaint. Henricus
water
slowlyby making

present
for

the

rects
Regius dia

small in-

ARTERIOTOMY.

lY.]

SECT.

253

cision and

introducinga silver canula. (Animad. Medic. 13.)Comm.

recent
Tliougli
experiencedoes not give much encouragement
to tlie operation,
it sometimes
happens that it is attended with
'

"

"

"

'

success.

Fabricius

givesthe

SECT.

chronic

we
vertigOj

the

cases

the ancients.

as

ii. 22.)

((Euv.Chir.

In

of these

account

same

ON

IV.

ARTERIOTOMY.

defluxions of the eves, and in the affection of

in the practiceof dinding the arteries behind

are

shaven the hind part of the head,

Having,therefore,
and marked
with the fingers
the position
of the artery,which
is easily
discovered by its pulsation,
and then having marked
in lengthwith black ink,
out the line of an incision two fingers
ears.

down

cut

we

must

measure

and

the

to
a

bone.

When

distance of three

then

operateby making a
until blood flow per saltum,and
After

moderate

evacuation

it become

divided,lest

scrapedthe

bone

this does

breadth
fingers^

from

the instrument

artery

strike the bone.

blood,the pericraniumis

inflamed

from

we

the ears,

division of the

transverse

of

succeed

not

the distension

to be

and

ing
hav-

applya wedge-liketent of linen to

the wounds, and accompHsh the cure
by pledgets. But if,after
to scraping
ail,the bone remain bare,we must have recourse
it in like

we

manner.

is mostlyabridgedComm,
description
from Aetius (vi,90),who copiesfrom Severus.
is minutelydescribed by Albucasis. (Chii'iu'g.
This operation
Oui' author's

Commentary.

'

"

ii,2.)

He

behind

the

visible.

directs
ears

The

and

surgeon
and cut

with

shave

rough

head, and

cloth until the

be divided with
to

the bone.

choose,he may

upwards.

the

of the vessels is to

com'se

they are to
down
penetrating

to

us

The

introduce

be

rub

marked

The

with

the
sharp scalpel,

He
the

says,

parts

arteries become

below
scalpel

ink,

incision

however, that
the

if the

vessel,

lengthof the incision is to be two

breadth.
saltum.

the

Blood, he remai'ks,springsfrom
About six ounces, more
or
less,may be

is likewise
operation

mentioned

by A^icenna

an

gers'
fin-

artery per

taken.

iv,
(Cantic.

'

ANGIOLOGY.

254

'
'

(ad Mansor. vii,21) ;

(inCantic.)
; by Rhases
author's by
terms
tbe same
as
our
and is described in exactly
ix,4.)
Haly Abbas. (Pract.
and

CoMM.
'

[book vi.

Averrhoes

V.

SECT.

ON

ON

AND

VESSELS,

OF

SECTION

OR

ANGIOLOGY,

THE

THE

BURNING

TEMPORAL

SAME.

wben the
defluxions,
so
as to occasion
eyes are affected with a hot and acrid defluxion,
with swelling,every one
heat of the temporal muscles
of them.
for the cure
HaA*ing,therefore,
approves of angiology
first shaven the hairs of the temples,and noted the part with
in cbronic

In liemicrania and

our

must

we
fingers,

round

the

ha\dng marked
aside with

use

neck
their

with

must

through,so

must

visible,
the skin

and make
fingersof an assistant,
then cutting
vessel;
quitethrough,
hooks, and exposingthe vessel by

membranous
on
operations
If itbe
it is separated
all around.

used

of the instruments

divide it

we

draw

dage
ban-

the

or

raise it up when
small, having stretched and

may
But

ink,

applya

vessels become

the

with

incision alongthe
superficial
the parts with
and stretching

parts,we

when

and,

means

acute

fomentations, and

warm

course

left hand

our

or

as

in

twisted it with

blind

to be able to seize upon

hook, we
part of it.

large,we must
apply a double hgature under it
other strong
needle,either a pieceof raw flax,or some

if it be
a

sti'aight
opening into
used in venesection,
and takingaway
the vessel with a scalpel
at both
a moderate
quantityof blood,we must tie the ligatures
the intermediate
extremities of the exposedvessel,and cutting
it either immediately,or at the time of
part,we may remove
loosingthe dressings. Some, without di\ddingthe vessels at
all,burn them to a sufficient depth with burning-irons
shaped
must
like ohve-kernels.
After the operation
use
we
pledgets
of drv' charpie,
and put on an oblong compress
with
{splenium)
must
After the removal of these dressings,
we
complish
aca bandage.
the cure
by incarnatingpowders, apphcationson
remedies ; the threads and ligatures
and cicatrizing
pledgets,
dropped out from putrefaction.
havingpreviously
thing; and,

CoMM.

in the fh'st place,making

Commentary.

The

author

of

the

Hippocratictreatise

HYPOSPATHISMUS.

256

Rhases

CoMM.
'

'
"

mended
The

mentions

veterinary
surgeons

direct

the

burnt

inclined to think that it was

are

to

Arcliigenesrecomepilepsy.
(Contin.i.)

temporal veins

cut

out

in diseases

temporalveins and not

by the Greek surgeons

however, that the

will be seen,
a

the

burnt

cut out and

were

operation. It
us

for

vi.

Vegetius (Mulomed. iij16.)

See

the arteries which

in this

tlie celebrated

temporalveins to be burnt

the

of cattle.
We

that

[book

Arabians

portionof the artery; at least

of Albucasis,for he
description

this is

clear in the
states
sufficiently
that the vessel to be secured will be recognizedby its
decidedly
and he fui'ther recommends
to applybeforehand
us
pulsation,
about the head, and not about the neck as du'ected
a ligature
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^sdescription.As Celsus,like our
author,
the neck
directs the ligature
to be appliedround
(cervixante
that his operationremodice
we
lated
deligandaest),
suppose
may
From
his usingthe word venee
to the veins.
indeed no
it indiscriminately
inference can
be drawn, as he applies
to
arteries and

veins.

We

are

at

loss what

to

determine

specting
re-

description
givenby Haly Abbas, for althoughthe
vessel that is secured be called arteria,
the Kgatm'eor stripof
cloth is directed to be apphed round the collum. "Where the mistake
lies in this case
and leave
venture
to conjectm'c,
cannot
we
it to be found out by some
of
to the MS.
person who has access
the original.For our
part we may exclaim with a celebrated
German
Felices
scholar,
Bochartum,
ssepe prsedicavimus
codicum
Plempium, Celsium, Hydium, Casirium,quibus usus
Arabicorum
erat/^ (Sprengel,
Rei Herbarise Historia,
concessus
the

"

"

i,239.)
Fabricius ab

as relating
Aquapendente describes the operation
to the veins (CEuv.Chir. ii,3.)
however, seems
Tagliacozzi,
to refer it to the artei'ies. It thus appears that there is a good
deal of uncertainty
regardingthis ancient operation.

SECT.

This

VI.

ON

HYPOSPATHISMUS.

surgicaloperationderived

instrument

used in it.

We

have

its

name

recoui'se

from

the kind

to it when

of

copious

VI.]

SECT.

and

HYPOSPATHISMUS.

hot defluxion is determined

and

about

ants

passingalongit.

about the

the

forehead

forehead,we

257

to the eyes.

there is

The face is ruddy,

sensation

of

as

worms

HaA-iugtherefore first shaven

or

the hairs

permit the lower jaw to move, and

placewhere the temporal muscles are seen to
and parallel
act, we are to make three straight
incisions on the
each havingthe lengthof two fingers,
and descending
forehead,
to the bone, and being at the distance of about three
fingers'
must

avoidingthe

breadth from
called

another. After the incisionwe

one

and
h}^ospathister,

left templeto the middle

substance

alongwith

from the middle

one

knife
sharp-pointed
be turned

may

to the

extend

ment
instru-

division from

the

all the intermediate

incision,
dividing

the

pericranium
push a spatula
; then we
to the rest,and
applyingthe pointof a
to the first di\dsion,
that its sharp side
so

to the fiesh within the

bone, we

the

applythe

push it as

far

skin,and the blunt one

middle
division,
cutting

the

as

through all the vessels which descend from the head to the
And
eyes, but not comprehending the external skin.
again
we
push it from the middle to the last incision,
cvitting
through
the
of

vessels in

like

After

manner.

blood,having squeezed

twisted tents, we
a

compress
bandage. Next

to

put

soaked

in

are

of the inflammation

account

removed

water,

and

it with

secure

onlythe ulcers,but

not

the

must

we

ears

have
must
we
dressings,
afterwards completethe cure

with wine
the

on

the

sion,and

evacuation

three
coagula, and made
into each di\'ision,
and ing
apply-

one

moderate

the

out

day we bathe
temporalmuscles,and

the

recourse

third
to

and

wise
like-

oil,on

day having
copiousaffii-

with
suitably

tents

out

of basilicon dissolved in rose-oil.

Commentary.

See

Aetius

92) ; Albucasis (Chirurg.

Comm.
(vii,
ii,4) ; Haly Abbas (Pract.ix,7.) This operation
is better described by our
author than
by any of the others. Celsus,
for the relief of
althoughhe describes several grave operations
defluxions on the eyes, makes no mention of it. Aetius barely
'"

alludes to it in

generalterms.
and for that
operation,

abandoned
of it

as

;
II.

in moderate

being an
from which

It must

perhaps,has

reason

times.

operation which

languagewe

may

have been

Even
was

midable
very for-

been

Albucasis

performed by
suppose

speaks
the

that it had

17

tirely
en-

cients
an-

been

'

"

'

PERISCYPHISMUS.

238

givenup

CoMM.
'

'

'

from

our

Haly

autlior.

Abbas

longitudinal

Three

distinctly.

it is

of
description

His

in his time.

[book

describes

the

incisions

at

another are
breadth from one
fingers'
to the bone, then a knife,or
forehead down
three

is to be

introduced

so

as

to diAdde the

incisions,
sparingonly the
longitudinal

VII.

SECT.

ON

vi.

taken
evidently
operationvery

distance

the

of

to be made

in the

such

ment,
instru-

some

parts between

outer

the

skin.

PERISCYPHISMUS.

vessels send a copiousdefluxion to

deep-seated
many
called periscyphismus.
the eyes, we have recourse
to the operation
attended
with such symptoms as these : in the
These
are
cases
When

and
small,
patient's
eyes atrophied
of sight,the cantlii corroded,and the eyelids
weak
ulcerated,
with a dischargeof very thin, acrid,and
the bail's falling
oflF,
hot tears ; there is a deep-seated
pain in the head of an acute
and violent character,and there is frequentsneezing. Having
and avoidingthe placewhere
firstshaved the head as aforesaid,
ginning
the temporalmuscles
play,we make a transverse incision,becision
inThe
at the left temple and ending at the other.
first placeyou

its direction
the

its terminations

have

must

avoid

will find the

little above

being a

coronal

suture.

there

where

Leonidas

the

are

no

forehead,and

directs the

muscles,
we

must

incision to be

the bone is laid

When
along the middle of the forehead.
bare we
keep the parts asunder "^"ithtents and plentyof
may
pledgets,and bind the extremities of the division ; and, as we
formerlystated,bathe with wine and oil. After loosingthem,
made

if the inflammation

is

on

the

decline,we

may

scrape

the bone

by a mode
of practice
calculated to promote incarnation, using the incarnative powders; among
which is that containingof wheaten
flour,p. ij; of colophonianrosin,p. j j and that called the
cephalic,and those incarnatives preparedfrom pumice-stone.
the skin is thickened by a dense
For, when
cicatrix,and the
mouths
of the vessels constricted,
the defluxion is prevented
from being determined
to the eyes as before.

until it begin to

CoMM.

See Aetius

cure

93) ; Pseudo Galen (Isagoge);

(vii,
(Chirurg.ii,5) ; Haly Abbas (Pract.ix, 18.)

Commentary.

Albucasis

incarnate,and accomplishthe

TRICHIASIS.

VIII.]

SECT.

259

It is evident that this

is neither more
less than Comm.
nor
operation
a complete division of the integumentsof the head from temple
it must
to temple; of com-se
have been more
even
dangerous
than the operationtreated of in the last section.
Aetius^Haly
'

'

and

Abbas,

Albucasis

describe it in the

terms

same

as

our

thor.
au-

The

and hypospathismusare
periscj'phismus
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);
eveii
TagUacozzispeaks of them as being cruel and dangerous.
similar in principle,
called the
However, a surgical
operation,
is still practised
in certain hospitals
long issue of the scalp,^^
'

"

of Great

Britain.

See

'Transactions

the

of the

Provincial

Association,^
(vol.
xi.)

SECT.

VIII.

SUTURE

ON
MODES

Distichiasis is

OF

OF

THE

UPPER

OPERATING

FOR

EYELID,

AND

OTHER

TRICHIASIS.

growth of hairs, superadded

preternatural
to the natural
order of hairs of the eyelids
derives its
; and
when
there happens to be a flow upon
originfrom a defluxion,
a

the part of a humour

is not pungent or acrid ; for that
which
it
which is more
otherwise
or
acrid,saltish,
pungent, when
For
the natural series of hairs.
lodgesin these parts,consumes
this state then

we

sometimes

have

to the suture

recom'se

of the

when the eyelid

phalangosis
inclines inward, the phalanx or row of the hairs beinginverted ;
and
the natural
of the eyelid,
when
for relaxation
sometimes
of hairs hurts the ball of the eye.
row
Having placedthe patient
upper

on

and
eyelid,

also for

sometimes

seat, either before

us

or

on

the

upper eyelidoutwards, and, if it has

of them
and
between the index-finger
but

left

hand, we
long hau's,we
thumb

turn

take

the
hold

of the left hand

we
having thread,
they are very
push a
-vvithin
from
outwards ; then
through the middle of the tarsus
of his thread,
the eyelid
with the left hand by means
stretching
with the pointof a scalpel
held in the righthand, having folded
the
out the eyelidand
everted it,behind the thread we make

if

short

under-incision within
from the

irritate the eye, extending

After
to the smaller,along the tarsus.

the hairs which

largercanthus

needle

'

TRICHIASIS.

260

[book vi.

thread,and puttinga small

of the left hand, we
stretch the eyeunder the thumb
compress
broAV upwards. Then
arrangingother small compresses on the

tliissubsection,
havingextracted the

at

behind

to stretch the

the

eyelid
by

used for sutures

scalpel
veruted (shaped like a

of the
the
above

hairs,which

the

skin ; and

we

Then

of them.

means

by means

called
the first incision,

make

verutum

or

short

in their natural

are

stands

assistant who

dart) a

little

state, extending

canthus,and penetrating
onlythe depth of the
afterwards we performthe incision called the lunated,

canthus

from

direct the

extremities,we

canthi

to

to such

skin, and

placeas the former, and carryingit upwards

heightas to comprehend the whole redundant

the

beginningat

same

ending

in like

manner

Thus

it did.

as

the whole

comprehended within the incisions will have the shape of

the angle on
a myrtleleaf,of which
portion,
havingperforated
dissect away the
the right hand with a hook
we
(tenaculum),
the clots with a sponge, we
skin : then washing away
whole
of the incision by three or four sutui'es,
unite the lips
beginning
at the middle, and passingthe needle itselfthroughthe underof wool ; and having cut
The thread should be made
section.
of the thread,not close to the sutures, but
away the superfluity
of three fingers^
breadth,we stretch
as to leave a superfluity
so
of
this remainder
along the forehead and fasten it by means
plasters.But the hairs of the eyelid
any of the agglutinative
skin

be

to

are

Such

freed

is the

the

from

and

common

operation. Some

with

sutures

safe mode

avoid the

of

the

point of

needle.

performingthis sui'gical

dissection of the

skin,and

under-incision,
having stretched

after the

the

fore
there-

redundant

the eyelids,
on
forcepsused in operations
and apply sutures
described
as
they cut it off"with a scalpel,
above.
But if the irritation from the hairs is produced only
it will be proper to confine the operation
by a part of the eyelid,
skin

to

of the

by means

that

part.

layingthem

on

Then
the

to moisten

soaking the
part, we

the

secure

in oxycrate,and
compresses
with bandages,conthem
tinuing

with
dressings

diluted

oxycrateuntil
cuttingaway

the

the
them, and
day ; after which we remove
superfluous
parts of the threads,we anoint the eyelidseither
of the anti-inflammatory
with saff"ron,
collyria,
glaucium,or some
third

such

as

that

inflame,we

formed

applysome

of saff'ron and
one

of the

roses.

But

if the

and
softening
plasters,

sutures

soothe

TRICHIASIS.

VIII.]

SECT.

2(il

of eggs mixed
with milk.
by an injection
I know
slacken we
cut and extract them.
ligatures
person who having made the dissection of the skin
the eye

as

above, did

mentioned

effected the

not

have

to

recourse

When
a

the

certain

of the eyelid,

sutures, but

For when the wound

healingointment.
eyelidbeing somewhat contracted,forced the
with

cure

the
cicatrised,

hairs to incline outAvards.

In like manner,

another person not

cisions,
the two external in-

the dissection of the eyelid,

nor
practising
stretched Avith his
but only making the under-incision,
the fold of the eyehd,two reeds or plates
or by a hook
fingers
of the same
and as broad as for venesection,
lengthas the eyelid,
he twisted a hgatureround
it at both its extremities ; and thus
the whole skin behind not being nourished,and on that account
fell off Avithin ten, or at most
fifteen days
beingdeprivedof life,
so
as to leave scarcely
along with the reeds or plates,
any scar.

Commentary.

of the

eyelid,and other Comm.

of operating
methods
for distichiasis,
see
Hippocrates(deVictu
acut. 66) ; Aetius
71, 72) ; Celsus (vii,
7); Albucasis (Chir.
(vii,
ii,11); Rhases (Divis.
i,30; ad Mansor. ix, 26; Contin. ii,3);
Avicenna
(i,8, 6); Serapion(ii,
iii,
3, 32) ; Avenzoar
7) ;
(iii,
Jesu
HaH
Mesne
Canamusali
(vi,
10) ;
18) ;
(ii,
26); Haly
(ii,
Abbas
ix,19) ; Vegetius(Mulom. ii,15.)
(Pract.
of the operation
The description
givenby Aetius fromLeonidas
that described by our author,we shall
as
being nearlythe same
of it,and merelymake
confine ourselves to an abridgedaccount
of Paulus.
In order
few remarks
to illustratethe description
a
On

suture

upper

'"

to facilitatethe

operation,he

the

recommends

operator to have

assistants instead of one, as directed by our

also recommends
him, in the first place,to mark

two

portionof
him
meant

skin which

to make
an

the

to
requires

be cut out.

under-incision,
by which

incision within

the

He
he

author.

He

Avith ink

the

then

seems

directs
to

have

hairs alongthe tarsus,and

ciliary

it to be
He recommends
extendingfrom canthus to canthus.
made
prettydeep, and even in certain cases suggests the propriety
of making two
above
described
one
as
under-incisions,
in
order
within
the
the ciliary
to
relax
tarsus ; and the
hairs,
other

upon

transverse

hairs,and

the

preternaturalhairs.

incision to be made
then

lunated

one

He

next

directs first a

alongthe eyelidabove the ciliary

beginning and ending like the

"

"

TRICHIASIS.

262

other, after wliiclitlie skin, thus separated,is

CoMM.
'
"

[book

vi.

to be dissected

be united

of five
by means
cisions.
of the insutures, one in the middle and two at each extremity
the same
The other steps of the operation
are
exactly
stood.
be misunderthose described by our
as
author, and cannot
which
Hippocratesdescribes an operationfor trichiasis,
that recommended
Heister thought the same
as
by Aetius,but
is so obscure that we
must
the description
confess our inability
to explainit.
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 anarrhapheor
As the steps
suture, as described by Aetius and our author.
of the operation
described by him are almost exactlythe same
need not dwell upon the explanation
those of Aetius,we
of
as
them.
about
Lest,however, there should be any misapprehension
shall give his directions about it in his
the under-incision,
we
own
hoc,in superiore
language: prseter
palpebrasub pilis
ipsis
incidenda linea est ut ab inferiore partediducti pili
sursum
specsi
levis inclinatio est,solum satis est." Instead of
tant ; idque
five sutures,as directed by Aetius,he recommends
only three.
Albucasis states that there are four modes
of curingtrichiasis.
1. By the actual cautery. 2. By the potential
cautery. 3. By
incision and the sutiu^e,which operationhe describes at great
length. He directs us in the first place to evert the eyelid,
either by takinghold of the ciliary
hairs,or by passinga needle,
armed
with a hair,through the tarsus, and raising
the eyeUd
with it. He then,like the others,directs us to make the underincision within the ciliary
hairs,from the greatercanthus to the
skin of the eyelid,
and unite
smaller,to cut out the redundant
the siu'faces with sutures.
In short,his operationis exactly
the same
He mentions^however,another meauthor's.
as
our
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 unin the last operation,
and
then twistingthe
as
der-incision,
skin firmlyabout reeds or
redundant
small piecesof wood
out.

He

recommends

the

edges to

"

until it mortifies

after which

the wound

is to be cured

upon

generalprinciples.
account
Serapion's

of the

and
operationis defective,

need

BURNING

264

CoMM.

per
'

'
'^

ad
longiira

ociilifasciolam

mensiiram

[book vi.

EYELIDS.

THE

et impositis
prsecides,

palpebramforis versus, ut oculus sine deformitate

et gratiamnatiiralem."
\^suin
recipiat
that
It is to be
remarked
Albucasis, Jesu Hali, and
skin of the eyelid
Vegetiusspeak of cuttingout the superfluous
done by Scarpa.
with a pairof scissors,
as
was
described by
for trichiasis are
All the ancient operations
Guido
de Cauliaco
by twistingthe
(vi,2.) The mode of cure
skin about small reeds until the parts slough is still generally
fold
the
Chinese
The
practisedin China.
grasp
surgeons
fastened at
between
two shps of bamboo, which being tightly
their ends perform the office of a ligature.

fibiilisconsucs

SECT.

IX.

ON

BURNING

OF

THE

EYELIDS

BY

MEDICINES.

probated,
rewith caustic medicines was
burning of the eyelids
in a word, by all the ancients,lest the acrimony of
should prove injurious
the application
to the eyes ; and because
the
extent
the burning was
when
carried to too great an
aftection called lagophthalmoswas
produced,in which case the
be shut,and the vision is apt to be injuredby
cannot
ej'clids
who suffer
in the way.
But since many
everythingthat comes
hairs are not able to endure
from the irritation of the ciliaiy
the
of the operation by suture, we
pelled
comare
name
even
to
from
against our will,to have recourse
necessity,
of that
The
is a composition
biu'uingby medicine.
follo\^'ing
of quicklime,p. ij; of Gallic or common
kind
soap, p. ij;
add
and
These
of aphronitrum, p. iv.
some
thingsbeing
other ley,as
pounded with strained ley,or soap ley,or some
that of figsor of oaks, and being mixed with the urine of a
not come
man
to maturity,
we
apply to the eyelid,
upon
young
the knob
of a specillum,
the pai'ttouched ha^dng the shape
of a mp-tle leaf;and we
burn to the extent comprehended in
the operation
at the first
The
skin being burnt
by suture.
much
of it with a sponge, and apply
we
remove
so
application,
until the
the medicine a second
time, allowing it to remain
applyit a third
part blacken ; and if it does not blacken we

The

time.
we

When

must

the skin is blackened

clean away

the medicine

and

and

the eschar
have

recourse

also
to

formed,

bathing

LAGOPHTHALMOS.

X.]

SECT.

eschar

washing until the

to completethe
proper
and

cure

emollient

collvria.

Commentary.

None

and

265

drop off; after which it will be

of pledgetsof charpie
by means

of the other

authorities describe this

Comj
'"

minutelyas our author,except Haly Abbas,

who e^adently
copiesfrom him. (Pract.ix,71.) Rhases andAlbuhowever, also mention the operation. They direct us to
casis,
burn the part with a preparation of quicklimeand soap, with
caustic lixivia,
the addition of some
or
leys. These ancient
leys,or lixi\ian ashes,appear to have been preparationsof
We
less pure.
need scarcely
remark
that these
or
potass more
have resembled
the caustic paste,now
must
used
applications
of treatment
The method
here described
for forming issues.
the
much
that performedby Quadri
same
as
is,in principle,
A caustic paste very similar to that now
acid.
with sulphuric
used is described by Guy of Caulico. (vii,
1.)
mention
is made
The strained ley,of which
by Paulus,was
the
colata
calx
of Cselius Aurelianus.
as
probablythe same
(Tard.Pass, v, 1.) It appears to have been an impure preparation
of

method

so

cure

of potass with
we

same,

Third

suppose,

with
A

of varix.

by

the

as

of this work.

Book

identical

been

the

the

addition of

lime.

some

mentioned
7rpwroc7raKrov
The calx colata would
seem

Vienna

paste

now

It is the
in

to have

in the

used

ment
treat-

mentioned
compositionfor burning the eyelids,

Hali, contains lime, preparedbeans,nitre,and

Jesu

ammoniac, formed into a paste with the water of soap

of
approve
pure myrrh. Jesu, however, does not much

sal

and
this

of treatment.

method

SECT.

Those
drawn
from

the

the

ON

X.

persons

OR

HARE-EYE.

said to have

are

upwards.
cicatrix

LAGOPHTHALMOS

of

This
a

hare-eyeswho have the eyelids

complaintarises either naturallyor

wound,

and

this

may

have

occuiTcd

from the operations

of the sutui-e or burning
or
spontaneously,
(as just mentioned) having been improperlyperformed; in
moderate
relief can
which
a
even
case
only be accomplished
thick.
when
the eyelidis sufficiently
For we must di\ide the

LAGOPHTHALMOS.

266

[book

the lipswith
and havingseparated
cicatrix^
until the

is

cure

completed,avoidingsuch
to those

bandages

tent,use

vi.

things as

are

very

which

are
having recourse
fattyand
relaxing,such as the juice of fenugreekpoured on the part,
called basiliand the ointment
preparedwith four ingredients
tent.
a
con, appliedon

and
desiccative,

'
'

ii,13) ;
(Chirurg.
(Pract.ix,20) ; Rhases

casis

Celsus

71) ;
(\di,
7) ; Aetius (vii,
Avicenna
3, 3, 12); Haly
(iii,
(Cont.ii,4.)

Albu-

See Celsus

Commentary.

CoMM.
'

directs

to make

us

lunated

of the incision

the horns

to wound

Abbas

incision below

the brows,
eyedownwards, and

being turned
the muscles.

pledget
of lint is to be put into this incision to prevent the edges of it
from
uniting. This simple operationis described in nearly
the same
terms
by Aetius, Albucasis,Avicenna, Haly Abbas,
care

being taken

and

Rhases.
ab

Fabricius

not

Aquapendente

fallen into disuse

had

SECT.

XI.

in his time.

Scultet,(Arsen.de

See

ON

SUTURE

THE

BURNING

under

informs

OF
OF

IT

that the

us

It is

tent

now

or

operation

sometimes

tised.
prac-

Chirurg.Tab. xxxiv,8.)

THE
BY

UNDER

EYELID,

AND

THE

MEDICINES.

is

subjectto the same

complaintsfrom
hairs as the upper ; for,when
the ciliary
largerthan natural,
it is subjectlikewise to phalangosisand
it is everted;and
distichiasis. We must, therefore,
perform the operationof the
in the same
for the upper
suture
but in an
as
manner
eyelid,
inverted order,beginningwith the lunated incision on account
of the obstruction occasioned by the blood,and then making the
the under -incision is to be omitted altogether,
veruted.
But
the lower
because
eyelid,by its natural weight,is readily
The rest of the treatment
everted.
to be completedas in the
of the upper eyelid,
suture
except that the extremities of the
not to be glued to the forehead.
If in this case
are
ligatures
to an
the patientis averse
operation,and prefersburning by
of this process.
medicines, you have ah-eadygot a description
The

CoMM

Commentary.

eyehd

This

section

requiresno commentary.

ECTROPION.

XII.]

SECT.

Xil.

SECT.

ON

EVERSION

OR

ECTROPION,

267

OF

THE

LOWER

EYELID.

causes
Ectropionof the under lid is occasioned by the same
as
lagophthalmosof the upper, only that it does not occur
from relaxation producedby
but arises sometimes
naturally,
of this property, which
have been applied
medicines possessed
the eversion is occasioned
for inflammation ; and sometimes
by
been
the suture
or
burning having
improperlyperformed.
with
armed
double thread,we
a
a
needle,
Taking, therefore,
perforatethe fleshymass, pushing it through from the left
and then by means
of the thread fastened
canthus
to the right,

of its

to both

and

cut

stretch the

we
extremities,

down

upon

it with

time.

skin with the

needle,

scalpel,
removing the needle at
its proper
shape
eyelidresume

Then, if the
and is turned
inwards,this operationwill be sufiicient. But
of the flesh,
if the eversion continue after the removal
we
apply

the

same

and on
the
to the divided eyelid
specillum
;
inside of the eyelid,
beginning at
having made two incisions,
the two anglesof the incision formerlymade, and terminating
in an acute point,and meeting togetherlike the Greek A, we
this substance,
remove
so that its acute
pointmay be below at

the back

of the

the

and

eye,

broad

the

above

at

what

is called

the

tarsus.

taining
separatedparts with a needle contwo
woollen
sutures.
a
thread, being satisfied with
if the ectropionbe occasioned by the operation
of the
But
suture
or
burning we make a simple incision along the first
and having separatedits
cicatrix below the hairs of the tarsi,
fillup the wound
with pledgets,
we
usingthe same methods
lips,
for lagophthalmos (exceptfomentations)until the parts
as

Afterwards

which

have

we

unite the

been

stitched

unite.

74) ; Celsus (vii,

(vii,
7); Albu- Com
casis (Chirurg.
ix,20.)
ii,14) ; Haly Abbas (Pract.
of the treatment
of ectropion
Aetius givesa full account
the disease is occaand Antyllus. When
from Demosthenes
sioned
of the eyelid,
by fungousflesh on the inner membrane
See

Commentary.

he

recommends

us

"c.
misy,chalcitis,

Aetius

to burn

(See the

it down
Third

with

such as
escharotics,
Book.) He describes the

M.

ECTROPION.

268

surgicaloperationin

CoMM.
'

'
'

are

and
scalpel^

When

foUovringterms

very largethey are

the part touched with

excrescences
a

the

like the

wliich unite below

like the upper

untouched.

skin

united

be

to

bv

the

operate upon

burnt

copper

fleshy

the like.

or

wards
after-

letter A, and

triangularpiece,and

or

not

with

by

the

cicatrix,we

external

an

surface

inner

to the

the smaller

canthus

needle

divide the thickened

and

then

with

moistened
directs
out.

put into

be

to

to avoid

us

water,

recommends

appliedwith

from

upon

the

lint is

compress,
bandage. He

until the

drop
ligatures
called

excrescence

encan-

disease

the

When

dissect it out.

to

us

the

needle

pledget of

and
incision,

fomentations

warm

arises
ectropion

When

this,he

cold

flesh.

external

the

down

to cut

are

Then

flesh from

thickened

the

we
larger,

to

are

eyelidin the manner

and
deep incisions,

of the

thread,under

double

tilaginous
car-

When

evelids.

the

at

sutui'e

one

justnow described,only avoidingto make

uniting the edges of the incisions as before directed.
stretchingthe cicatrix with a hook, and pushing a
armed

with

out

eyelid,but taking care to preserve

The
edges of the incisions are then

occasioned

ectropionis

dissected

below, which, he remarks, is

flesh

it the

the

to be

Greek

this lambdoid

out
dissecting

along with

when

"

greater,he directs us to perform an

cisions,
inner part of the eyelid,
making two in-

the

operationupon

is

erersion

the

the

[book vi.

arises from too large a portionof

or
by paralysis,
for entropion,
eyehd havingbeen cut out in the operation

is occasioned
the

curable
It is also said to be in-

incurable.

it to be
pronounces
when
occasioned

he

by the sloughingof carbuncles.

arises either from an operation
Celsus says that ectropion
In the
for inversion
improperlyperformed or from old age.
former

he

case

directs

to make

us

to be

are

When

turned

the

horns

and
jaws (maxillas)

not

to

for

of it

the

eye.

to burn the exold age he recommends

crescence
us
slender piece of iron,and then to anoint it

honey.

Albucasis
as

the

that

it arises from

with
with

to

incision like

that
difference,

this

lagophthalmos,
only with

an

Aetius.

double

describes the

operationin nearlythe

Thus, he

directs

thread,below

the

canthus to the

and
right,

us

to

pass

needle

fleshyexcrescence
it by means
stretching

terms

same

armed

from

of the

the

with
left

threads

cut

to

it out

with

applyingit to

and

to make

then

two

the

269

scalpel.If

broad

he directs
eyelid,

relieve the

us

to take

to
incision,

evert

this incision does

the
the

not

Comm.
"

specillum(radius)
"

eyelidwith

incisions in the inner surface of

'

it,and

the

eyelid

anglebelow, like the Greek letter

Then
this triangular
portionis to be dissected out, and
edges united by a suture with a woollen thread. When

that

so

ANABROCHISMUS.

XIII.]

SECT.

A.
the

they may

meet

the disease arises from

at

an

cicatrixhe directs

to divide

us

it,and

keep the lipsof the wound separateby the application

with
the remark
concludes
of a pledget. He
that,as the
will show his
disease puts on various forms,a prudentsurgeon
skill by restoring
the parts to their natural state.
borrows his description
from Aetius
Haly Abbas evidently
then

or

to

author.

our

operationhere described is very similar to the one

In the days of
by the late Sir William Adams.
practised
cmel and troublecondemned
some.
Fabricius this operation
was
as
The

will be remarked

It

times is

modification of the

XIII.

SECT.

When

but

that

the

ON

operationof

BURNING

irritate the

eye

are

most, three,close to
only one, two, or
approve of the operationcalled anabrochismus.
at

very slender needle,we

hair or a fine flaxen
woman^s
a

pass

modern

described.

now
operation

AND

ANABROCHISMUS

hairs which

the \

WITH

not
one

IRON.

numerous,

another,we

fore,
Taking,there-

throughits

ear

thread,and unite the

(eye?) a
two

mities
extre-

that the thread or hair which

togetherin such a manner
is passedthroughmay have a double loop; and we pass another
such thread or hair throughthe loop,and pushingthe needle
through the tarsus where the preternaturalhairs appear, we
of an earintroduce the hair or hairs into the loopby means
and
di'aw it upwards. And
if the hair of the eyespecillum,
lash
draAv up the loop; but if one
be fixed in it,we
or
more,
of the one at fii'st
fall out,we again,by means
draw
introduced,
the loop,and
down
once
more
a hair
or
introducing
hairs,
if
draw
But
there
is
them
haiislender
upwards.
only one
draw up another of the ciliary
that iiTitates the eye we
haii-s
other glutinous
alongwith it,anointingthem with gum or some
and
substance,
bendingthem until thev unite to the skin.

"

'

ANABROCHISMUS.

270

burning to the operationof anabrocliismus,

preferring
tlie eyelidoutwards^ and with a hair-forceps
dragging

Some
tui'n

the

out

offendinghair,if

if there be

as

some
or
ear-specillum,
placewhence the hair or
no
being thus constricted,

'
'

two,

or

one,

double-headed

hairs

were

three ;

heated,to

removed.

other hair is

or

or
specillum,

small instrument

such

will

We

Commentary.

CoMM.

there is but

they applya

many,

an

'

[book vi.

the

For the skin

produced.

of
give Celsus's description

this

Quidam
aiunt,acu transui
operationin his own words :
debere,eamque transjuxtapilosexteriorem partem palpebrre
mitti duphcem capillummuliebrem
ducentem, atque ubi acus
in ipsiuscapilli
sinum, qua duplicatur,
transiit,
pilum esse
in superiorem palpebrse
conjiciendum,et per eum
partem
et
attrahendum,ibiquecorporiagglutinandum, imponendum
medicamentum
fore,ut is
glutinetur
; sic enim
quo foramen
pilusin exteriorem partem posteaspectet."However, he does
much
of the operation. He also describes the
not
approve
of cauterising
the roots of the hairs, (vii,
7.)
operation
and
Rhases
the
describe
Albucasis,Haly Abbas,
operation
"

the

in much

burning the
such

as

Celsus an.d

roots

of the hairs

that
operations,

is to say, the
of the hairs.

operationis

This

by

Canamusah

instmment.

roots

our

author.

likewise,describe
authorities,

Arabian

the

terms

same

means

givesa

of

the
a

short

auabrochismus

Most

operationof

or
specillum

account

and

of

any

of both

burningthe

described

by the earlier of the modern

The
wi'iters on
mended
composition recomagglutinative
surgery.
for this purpose
consists of
de Cauliaco
by Guido
solved
mastich, frankincense,aloes, sarcocol,and tragacauth,disin the white of an egg. (vi,
ii.)
SECT.

XIV,

ON

HYDATIDS.

hydatidis a fattysubstance,naturally
lodgedunder the
of the eyelid,
in
some
in
which,
persons, more
especially

The
skin

children of
the
the

eye,

more

cause

and

humid
of

disagreeable
symptoms by encumbering
thereby occasioningdefluxions. The eyelids,

under
therefore,

the brows

in

manner;

come
temperament, increases until it be-

becoming

appear watery and cannot be raised

and
if,when we press upon them

272

ADHESION

To

CoMM.

EYELIDS.

OF

this class of tumours

we

may

[book vt.

perhaps refer

the white

rough bodies resemblingchalk-stones^on the inner surface of

which
He
described by Aetius.
the eyelid,
directs us to
are
incision alongthe vertex of
evert the eyehd,and, making an
and applybui'nt
the tumour, to scoop it out Avith an earpick,
extracted
to the pai't. When
wardly
outtriturated,
copper, finely
he recommends
with
a
dressing
tetrapharmacum.
82.)
(vii,
See Albucasis
3, 3, 18) ;
(Chu'urg.ii,10); Avicenna (iii,
and Haly Abbas (Pract.ix,21.) They e^-idently
copy from
his description
author.
Rhases
to borrow
of
our
professes
the operationfrom Antyllusand Paulus.
(Cont.ii,3, 2.)
the name
Pabricius ab Aquapendente,describes under
of
hvdatid,two kinds of encvsted tumours, the

beingof

thick and

of the

He

heavy nature, and the other,an

ancient

modes

described

are

the

Eye, and

similar to those which

upper

XV.

ON

have

we

ADHESION

OF

THE

eyehd undergoes adhesion

lower

tarsus,sometimes

to the

cornea

to the tunica

itself. This

here treated of

EYELIDS.

sometimes

adnata, and

to

to
ear-specillum

the

sometimes

disease obstructs the motions

Wherefore, applyingan

eye.

atheroma.

of

by Scarpa,in the third chapterof his work on

surgeon must be familiar with them.
every practical

SECT.

The

one

operating.
(O. L. ii,9.)
vesiculse aqua plense.(Ch. ii,

approves
Heister incorrectly
calls them

2, 9.) Tumom's

of the

contents

of the

the broad

gin
mar-

of the

it with a hook-like instrument,

or
stretching
eyelid,
free the adhesion with the scalpel
used in the operationfor
we
be not wounded, lest we
taking care that the cornea
pterygia,
giverise to procidentia.After the incision,
havingbathed the
with tents, lest adhesion againtake
separatethe eyelids
eye, we
place,and applvingwool,soaked in an egg, after the third day
we

'
'

recom'se

and

to attenuant

Commentary.

CoMM.
"

have

See

Aetius

healing colhTia.

(\ii,
66);

Celsus

(vii,
7);

Albu-

ii,15) ; Avenzoar
(i,8, 5) ; Avicenna
(Chirui'g.
8,
(iii,
Abbas
Alsahara\ius
(Pract.
ix,
8, 10) ; Haly
22) ;
(Pract.
iv,5) ;
casis

Rhases
The

(Cont.ii);

Jesu

Hali

description
givenby

author's.

(ii,
7.)
Aetius

is

exactlythe

same

as

our

CHALAZIA.

xvi.]

SECT,

2/3

remarks that the disease is the consequence

Comm.
correctly
in the foUo^vHe describes the operation
of neglected
ulcers.
inserendum
deduceuspecillum
ing terms :
Igituraversum
deinde exiguapenicilla
sunt
interponenda,
daequeeo palpebrcc
He
mentions
that
finiatur.^^
loci
donee exulceratio
ejus
Celsus

'

'

"

"

the ^srhite of the

from

them

recommends

; but

specillum(dosde
ointments
saw

never

case

the ball of the eye.

Suitable
applied. Yet he says that he

cured; and states,that Meges likewise

thus

useful

Fabricius

from

give

to

Celsus

of
description

above

the

order to understand

be
may
ancient

it

disease incurable.

thoughtthe
In

than

afterwards to be

are

between

with an averted
cautiously
Fabr. d^Aquapen.),
takingcare
spathule_,
to do

us

eyelidrather

the

to wound

la

dissected

is adhesion

there

when

eve

evelid to be

the

directed

of Tarentum

Heraclides

of the

account

some

it

(qui
specillum. II nous suffit syauvoirque specilliiin
instrument
est le mot Latin de Celse)est un
long et rond, de
sonde
les fistules,
de plomb, duqucl on
on
cuivre,d'argent,
vulen
et 1'autre plusetroit,
ayant un de ses bouts pluslarge,
gaire Italien stilo." (CEuv.Chir. ii.) It was, therefore,a
"

sort of sound.

directs

Avenzoar

goldenrod

or

probe,and
oil of

with

broken

to make

us

then

and

roses

the
to

to the white of the eye he

to make

the

applythe

separationgentlywith
oil of

he says, is difficultto
Of the

other

and

roses

XVI.

The
If it
the

occur

extract

the

on

in like

But

egg

eyehd

manner

then

the latter case,

Haly Abbas evidently

operationgivenby Paulus ; and

Arabians,Albucasis

is

OR

of the

chalazion

TUMOURS

concretion

the external

part

an

cure.

CHALAZIA

chalazion

outer

II.

us

and

additional

RESEMBLING

of inert

Jesu

information.

but similar to
is accui-ate,
description

Hali's

of

and
goldenspatula,

of almonds.

of the
copy the description
Hhases and Avicenna
supplyno

SECT.

advises
a

of

means

AVTien the

oil of almonds.

adheres

to

by
separation
white
the
apply

that of Celsus.

HAIL-STONES.

fluid in the

eyelid.
divided

side of the

having
eyelid,
with
we
a
scalpel,
eyelidtransversely
sucli instruwith an ear-pick,
some
or
18

'

ACROCHORDON.

274

ment^ and

CoMM.
^~^

'

when

the

parated,we unite
some
plaster. But
the

in the

cm*e

them

with

if it be

same

the

large and

is

mcision

[book vi.

suture, and

small

otherwise.

manner

have

se-

to

recourse

the

suture

and

But

if the

chalazion

omit

we

lipsthereof

effect

to appear through the cartilage,

as
so
havingturned
internal,
tract
within,we exeyelidoutwards, and divided it transversely

be
the

it and

use

Aetius

Commentary.
in

some

dii'ects

cases,

to touch

harder

other

the

of

resemble

white

zia,
chala-

of the

he
These
egg.
their fluid contents,
an

the

When

escharotics.

such

recommends

he

the contents

open,

the
and

copper,

says that

and, ha\ang evacuated

burnt
part with a poAvderconsistingof verdigris,

to

us

salt water.

of
injection

an

contents

excision,like

complete

are

author,

our

83.)
(vii,
describes

Celsus
:

"

of

mode

the

incidi

Hsec

"

debent,

operatingwith
si sub

his usual

exteriore

sunt, ab

cute

ness
terse-

manubrio
ab interiore,dein
scalpelli
cartilagine,
ab iutegris
deducenda
7.)
partibussunt/' (vii,
of
the
The
operation given by Albucasis and
descriptions
together
Haly Abbas, if not literally
copied from our author, are al-

parte, si sub

to the

and

Rhases

that

Avicenna
Book

See
and

directs

Fabricius

tumoiu".

fluid contained

Hali

Jesu

of the treatment

most

approve

Third.

the

extract

the

effect.

same

in the

us

is not

to be.
no

identical Avith the

The

here

treatment

lid
eye-

Aquapendente says
is
blanche
(gresle)
de la gresle.'^He
(CEuv.Chir. ii,11.)
'^

chalazion

transparente, en

and

to avert

dicines.
me-

ab

quelque fafon comme

repeats the directions givenby Celsus.
The chalazion is eridently
an
encystedtumour
et

by
the

hordeolum,

of

makes

it

admits

of

Scarpa

as

is such

recommended

soft nature,

as

improvement.

SECT.

XVII.

Acrochordon
canthus

of the

called

cuttingthem

ON

out

ACROCHORDON

eyelidand

encanthis
with

we

ENCANTHIS.

AND

that

seize with

tumour
a

at the

flesh

greater

forceps,and

scalpel,
applylevigatedchalcitis.

PTERYGIA.

xviir.]

SECT,

Commentary.
in the Fourth

The

275
is

of the acrochordon

nature

explained Comm.

Book.

Celsus,like oui* author^directs us to seize the encanthis with

not
to interfere with the
a hook, and
cut it out, taking care
to apply a
us
angle of the eyelid. He then recommends

pledgetsprinkledwith

calamine

of copper ?) between
Aetius
recommends
us

to tie it at its

either

base,and

phate
(sul-

7.)
eyelids,
(vii,

is large,
to transfix it with

tumour

and

the

sutorium

atramentum

or

to

use

with

needle armed

to twist the

if the

forceps,or

thread round

thread,
it.

Haly Abbas evidentlycopy from our author.

Rhases
Avenzoar prefers
tumourwith
septics.
reducingthe fleshy
mentions
that some
recommend
septicsin cases of encanthis,
but he prefersexcision.
After the operationhe recommends
oeris to the part. (Cont.ii.) Jesu Hali dii'ectsus to
squama
it with septics.
remove
(ii,
33.) It will be remarked that our
author's operation
is the same
as that recommended
by modern
Albucasis

and

authorities.

SECT.

This

disease

XVIII.

is occasioned

PTERYGIA.

ON

by

nervous

membrane
(tendinous)

beginning for the most part at the great canthus, and

It proves injurious
to the eye
graduallyspreadinginwards.
both by obstructing
the motion of the ball,owing to the contractions
forwards it
it advances
it produces,
and because when
thin and of a
the pupil. Those therefore which
are
covers
white
colour being easiest to cure, we
operate upon in this
seized upon
and
the
manner
: having separatedthe
eyelids,
instrument, having a small cui'vapterygiawith a hook-hke
ture, we stretch it,and taking a needle ha\ing a horse-hair
and a strong flaxen thread in its ear
(eye?), and a littlebent
transfix it throughthe middle of the pteryat the extremity,
we
gium,
and
bind the pterygium and raise
with the thread we
it upwards,while with the hair we
separateand saw as it were
der
the part at the pupilaway unto its extremity
; but the remainof it at

the

scalpelused

natural

when

the

great canthus
for the

cut

oS" from

the

base

with

lea\dng the
running of the eye

operationby suture,

canthus,lest there be a
Some
stretchingas
away.

flesh of the

it is taken

we

but

aforesaid with

PTERYGIA.

276

[book vi.

thread,dissect away the whole pterygiumwith the instrament

the
to touch
not
called pterygotomos, taking care
cornea.
After

part, we
removal
time.

But

remedies
CoMM.

levigatedsalts to the
having appliedsome
operation,
it some
wool
After the
bind on
dippedin an egg.
of this we
injectinto the eye salt water for a long

the

if inflammation

supervene

we

have

to

recourse

the

described for it.

of the
givesan excellent account
states that the membrane
generally
pterygium. He coiTectly
His description
of the
beginsat the inner angle of the eye.
operationis very precise. The patientbeing properlyseated,
is to raise the membrane
with a sharphook somethe surgeon
what
and
is then
it a
bent at the extremity,
to pass below
with a thread,the two ends of which he is to lay
needle armed
hold of and separatethe membranes
everywherefrom the ball
Celsus

Commentary.

is then

membrane

The

of the eye.

to be cut

out

with

pel,
scal-

He
being taken not to hurt the angle of the eye-lid.
directs us to applyto the part a pieceof sponge, or some
wool,
a
or
7.)
pledgetspreadwith honey. (Adi,
but in the
Aetius also describes the operation
very correctly,
care

terms

same

needle

the

afterwards
here

oui*

as

armed
cut

to

mentioned,

Albucasis

author
with
out

that is to say, he directs us to use

flaxen thread
and a horse-hair,
and
;

the

membrane, using

the

precautions

(^ii,
60.)

recommends

the

same

mode

of

procedure as
directions. (Pract.

ii,16.) Haly givessimilar

(Chirurg.
ix,25.) Both caution us not to carry the incision too near
the use of the scissors,
the inner canthus.
Haly Abbas recommends
and not of the scalpel(inthe translation read forficibns
and not forcipibus.)
likewise recommends
the scissors, (iii,
Avicenna
3, 2, 23.)
Rliases givesdirections for passinga needle
below
the membrane,
and
for cuttingit off.
He speaks of using a pair of
He mentions
that he had seen
scissors.
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.)
Aetius

The

modern

from
principle

methods

of treatment

the ancient.

do not

appear
Scarpaoperates with a

to differ in

pairof

scis-

STAPHYLOMA.

XIX.]

SECT.

277

the scalpel.Scai-paseems
to approve of
prefers
the direction givenby the ancient
authors, not to carry the
incision too far towards the inner angle of the eye.
See also
Chir. ii,18), and Brunus
Fabricius ab Aquapendente (ffiuv.
(Chii\Mag. ii,4.)
; but

sors

Beer

SECT.

Staphyloma is

XIX.

of the cornea, and of the tunica

and being producedsometimes
debility,

incurvation

an

upon

defluxion, and sometimes

in order to restore

it not
but

havingpasseda needle
of the staphyloma,
we
double

thread,from

through

the base
cut

we

by ulceration. We

operate

for that is impossible,

eyesight,
the patient's
deformity. Wherefore
from below upwards through the base
to push another
are
needle, having a

moderate

to

'

STAPHYLOMA.

ON

choroides,arisingfrom
bv

Comm.
'

the

the

canthus

hand

the

next

to the

other,

maining,
staphyloma; and the first needle redouble of the thread,and tie part of the

of the
the

staphylomaupwards and part downwards with the threads,and

then removing the needle we
applywool dippedin eggs. After
the removal

of the

the

eyes with emolUent

until the ligatures
fall off"along with the staphyloma.
injections

Commentary.
oculo

autem

fit : unde

nonnunquam

of

id

the apex

attolitur

summa

sive
aliquibus,

laxatis

et

Grseci vocant."
(jTa(j)vX(oiLia

cure

by

describes the disease

Celsus thus

intus membranis

soothe

dressingswe

the

first of which

author

our

; and

the

is

other

"

In

ipsoComm.
tunica,sive ruptis
similes figuraacino
:

describes two

He

thods
me-

mended
by hgatures,as recomin
consists
cuttingfrom

circular

portionequalin size to a lentil.

in recommending the latter opeScarpa and Guthrie concur
rations,
the merits of which, as they state,have not been generally
appreciated
properly.

Aetius

directs

by
tumour.

threads

our

He

us

to introduce

author, and
is at

then

the

cross

to cut

threads,as
out

great painsin directingus

mended
recom-

the apex

of the

to introduce

and not at rightanglesto one

obliquely,
also recommends
generalbleedingand emollient
(vii,
37.)

another.

the
He

fomentations,

HYPOPYON.

278

'
'

vi.

described in the
is briefly
operationwith the ligatures
ascribed to Galen.
Isagoge/generally
with the
and
Albncasis describe the operation
Haly Abbas
The
author.
terms
as
threads in nearly the same
our
cross
latter_,
however^ makes mention of puncturingthe apex of the
of the ligatures.Jesu Hali gives
after the application
tumour
of the operation.
account
nearlythe same
Although Scarpa condemns in strong terms the use of the
is sanctioned
of treatment
this method
needle and
ligatures,
This operation
of Mr. Travers.
was
approved
by the authority
of by William
of Saliceto.
the descriptions
Scultet explains
givenby Celsus and Paulus,
but they are
(Arsen. de
plain of themselves.
sufficiently
Chirurg.tab. 32.)
phyloma
stathat the ancients appliedthe name
It will be perceived
eases,
different disat least considerably
to two distinct,
or
namely,to enlargement with protrusionof the cornea,
with
ulceration
of the
of the iris connected
and to prolapsus
The

CoMM.
'

[book

'

Heister,Wenzel,

cornea.

in the

same

sense

as

and

other

the ancients.

of
applyit onlyto protrusion

SECT.

XX.

ON

Galenas

oculist of

our

account, which

OF

THE

it

lists
Englishocu-

our

without

the cornea,

ulceration.

EYE.

liver
eyes it will be sufficient to de''
is to this effect :
A certain
"

Justus,cured

time, named
the

Scarpaand

HYPOPYON

of the

Regardinghypopyon

continental writers,use

many

cases

of

pyon
hypo-

head.

Placing them, therefore,erect

a
chair,and graspingtheir head on both sides obliquely,
upon
the pus descending
could see clearly
that we
he shook them
so
downwards
substance,it
; and, owing to the weight of the
unless fixed
remained below, althoughcataracts will not remain
And
again,he says below, oftentimes we evacuate
carefully."
the place
the pus freely
a little above
by dividingthe cornea
This placeis called by
where
all the coats of the eye unite.
and by others the corona."
These are the words
the iris,
some
by shaking

"

of Galen

in his

Avork,

'

On

the

Method

of Cure.^

After

the pus, we clean the ulcer with injections

of honied
of the juiceof fenugreekwith the addition of some

of
discharge

Avater,or

the

honey, and

then

applythe

other

treatment

conformably.

CATARACTS.

280

[book

vi.

and hailstones are

over-compacted. After
gypsum
directed by Galen^ having
tliese circumstances^
as
ascertaining

resemble

but not in the sun,

placed the patientoppositethe light,
the
the sound
bind up carefully
eye, and having separated
of the

other, at the distance

the small

canthus,of

from

wards
part called the iris to-

the

the size of the

about

we

lids

of the

knob

mark
the
then with the point of the perforator
we
specillum,
rate
opeplace about to be perforated
; and if it is the left eye we
left
with the righthand, or if the right eye with the
;
which
is bent
and turning round the point of the perforator,
at its extremity,
we
push it stronglythrough the part which
marked
to an empty place. The depth
was
out, until we come
should
be as great as the distance of the
of the perforation
to the
pupil from the iris. Wherefore, raisingthe perforator
through the
apex of the cataract, (forthe copper of it is seen
transparency of the cornea,)we push down the cataract to the
parts below, and if it is immediatelycaiTied downwards, we
but if it reascends
rest for a little,
we
again.
press it back
of the cataract we
round
the perfoAfter the depression
turn
rator
it gently. After this,bathing with water
and
extract
into the eye a little Cappadocian salts,
and injecting
we
apply
in
the
of
with
soaked
white
wool
rosean
some
externally
egg

oil,and biud it up, and

it may
apartment below

eye, that

not

at

the

time

same

greund,we

order

up

the

sound

lodgingthe patientin

Then

move.

bind

him

to remain

in

state

an

of

perfectrest, and upon a spare diet ; and the bandages are to

be kept on, if nothing prevent, until the seventh
day, after
trial of the sightby presenting
which
loose them, and make
we
him with some
object: but this we disapproveof during the
operationand immediatelyafter it,lest by the intense exertion
the

cataract

loose the

reascend.

dressingbefore

If the inflammation

the seventh

become

day, and

must

urgent
direct

we
our

attention to it.

Commentary.

CoMM.
'

'
'

See

(vii,
7); Galen (Ars Medica,
35 ; Isagoge)
ii,23),
(vii,
53); Albucasis (Chirurg.
; Aetius
Avenzoar
Canamusali
Mesne
(vi);
(de ^gr. Oculi ;
(i,8, 19) ;
de Oculis,
15) ; Haly Abbas (Pract.ix, 28) ; Jcsu Hali (Tract,
3, 4, 20) ; llhases (adMausor.
ix,27, and
68) ; Avicenna (iii,
Cont. ii)
; Vegetius(Mulom. ii,17.)
Celsus

CATARACTS.

XXI.]

SECT.

disease is called

This

281

suffusio
by tlie Latins,and

aqua

by the

'

"

Arabians.
We

Comm.
*

stated in

have

in the Third

Book,

commentary

our

that the ancients

lens is the seat of

were

of the

one

aifections of the eye,

on

that the crystalline

aware

of
species

This

cataract.

opinionis clearlydelivered by Galen, Aetius,Oribasins,

Haly
of
the
that
this
and
others.
As
notion
a
some
Abbas,
proof
will
the
words
of Psellus literally
we
give
generally,
prevailed
is a grievousand
Glaucoma
translated :
incurable affection,
being a certain change of the crystalline
humour, and
"

of its colour to

transmutation

concretion of the

held to be

the

and

The

rare

Celsus

down

as

small,immovable, and

of

iron,and
side,there is

if

to

rule,that when

the colour

hope well

of the

operateuntil the disease has attained

sit

on

an

assistant.

higherseat, while

with wool.
his
not
a

The

sound

and vice

the suffusion is

water,

sea-

be

ing
of shin-

perceivedat the
He

case.

or

forbids

us

to

eye

head is firmlyheld by
patient's
is to be previously
covered up

is affected the
A

versa.

needle

operator must
which

is

use

sharpand

slender is to be

placeintermediate

of the eye, and

needle

the

If the left eye

righthand,
too

of

able.
undeni-

seems

He
proper consistence.
to placethe patient
who is to
oppositethe operator,

directs us
a

mour."
hucrystalline

with

met

degree of lightcan

small

reason

and

other

is sometimes

occurrence,

lays it

suffusion is

then, as Psellus
species
concretion between the crystalline
lens
such a disease,althoughof comparatively

That

cornea.

The

sea-green.
the cornea

fluid between

(Opus Modicum.)
states,was

passeddirect throughthe two coats at

between the temporalangle and the black

towards

the middle

of the cataract.

When

the

has

far enough, which is readily

known
perforated
by
the absence of resistance,
it is to be gentlyturned so as gradually
the cataract below the region of the pupil,
to remove
and
this objectbeing attained it is to be strongly
pressedto 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
in which state they are easier depressed,
and prove less
pieces,
troublesome.

Tlie needle

is then to be drawn

soft wool

smeared

diet,and

to
are
applications
soothingtreatment will

with

the

white

of

be

an

egg,
used.

be proper.

out

and

and
direct,
other

inflammatory
anti-

Quiet, restricted

CATARACTS.

282
CoMM.

Galen, in
does not

his

describe

'

[book vi.

Medica/ alludes

Ars

to

the

but
operation,

it.

tion.
only Greek author who describes the operaeased
Sextus Platonicus,
however^ justmentions that the diswith a specillum.
(De
part is sometimes to be depressed
Medic, ex Animalibus.)
but nearly
of couchingbriefly,
Mesne
describes the operation
directs us to put the
author.
He
in the same
terms
as
our
tion.
patientupon a spare diet,and to bleed him before the operathe
cataract
He recommends
to be careful to depress
us
(aqua)properly.
of Paulus very minutely,
Albucasis
describes the operation
called by him
and
gi^es drawings of the couching-needles,
into the eye
is to be passeddown
almagda. The instrument
to as great a space as the pupilof the eye is distant from the
He says nothingof
end of the black part called the corona.
press.
tearingthe cataract into pieceswhen it proves difficult to dePaulus

is the

He

that he

had

heard

of

certain

oculist

said,sucked out the cataract through a small tube.

seen
adds,however,that he had never
formed
any person who per-

who, it
He

mentions

was

this
works

nor
operation,

had

read

anythingabout

it in the

of the ancients.

be
mentions
that when
cannot
a cataract
briefly
got discussed it must be depressed.He givesdirections to press
it well down, but says nothing about tearingit into pieces. He
recommends
abstinence,and rest afterwards.
retirement,
is evidently
Avicenna's description
copiedfrom our author.
Avenzoar

He

also mentions

that

some

the cornea, and extract by

of this procedure.
much

surgeons
open the lower part of
it. Howevei*, he does not ajaprove

mentions that cataract must sometimes

briefly
con\ailsions come
be removed by a sm'gical
operation.When
after the operationhe directs us to applycastor to the nose.
on
E-hases describes acciu'ately
of couching,exthe operations
tracting,
and suckingout the cataract.
He is the onlyancient
to be
the cataract
author,except Celsus, who recommends
when
it cannot
be got properly
torn in pieces
depressed. He
that the famous
tion
extracmentions
Antylluspractised
surgeon
He also speaks
by openingthe lower part of the cornea.
of a certain surgeon who sucked it out through a glasstube.
of couching,
the operation
Haly Abbas describes distinctly
Canamusali

XXI.]

SECT.

but

CATARACTS.

evidently
copiesfrom

ever^ of

works.

Paulus.

far

283

He

makes

as
as we
can
extraction,
The
of
operation
couching the

no

mention^ how-

in any
discover,
cataract

part of his
is

Comm.
'

minutely

described

by Jesu Haly,but he makes no mention of extraction.

the son
of Haly Abbas.
was
Sprengel,in his
History of Medicine/ refers to Haly

He

'

Abbas
the

as

one

of the ancient

authorities

the cataract;
operationof extracting

the edition from

which

who
but

make

mention

if this be the

of
case

be
they quote (Venetiis,
1492)
different from the one with which we are acquainted.
considerably
of the eye after the
(Lyon, 1523.) Haly forbids examinations
to ascertain whether
has recovered
operation,
or not the patient
his

must

sight.
We

will

of Vegetiusin his own

givethe description
language:
Jumentum
igiturpridietemperabisa 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 ipsafronte paracenterium
inter tunicas oculares subIsedas interius. sed ipsum
ne
jicito,
pupillamtangas, aut aliquid
album
de superiori
parte ubi hypochysis
positaest,capitello
paracenterii deorsum
ad
deprimis palpebraminferiorem subtiliter.
Quod
si depositumfuerit,
non
priusparacenteriumeximas,nisi
clausum
oculum
calido diutissime
solet
penicello
vaporaveris.
enim
resilire. Quod
si evenerit,reprimito,
donee ita componatur
ut resilire non
possit. Cum itaqueintellexeris claritatem
sine illo obstaculo hypochysis,
eximes ferrum, et
tunc
pupillse
"

invenies animal

videre."

but
Sprengelaffirms,

as will be perceived
quitecorrectly,
from the account
of the ancient opinionsgiven above,that it
towards the beginningof the 18th century that it was
was
first
discovered that the crystalline
lens is the seat of the cataract.
Otherwise
he givesan
admirable historyof the operation,
in
which
he does ample justiceto the ingenuityand
inventive
genius of the ancients. (Hist,de la Med. xviii.2.)
Fabricius^s description
is altogetherborrowed
from the ancient
authors, (ffi.
C. ii,16.) Guy of Cauliac,and the other
writers of that age, describe the operation
in the same
surgical
the ancients.
terms
as
Guy mentions the operationof sucking
out the cataract through a cannula, but does not approve
of it.

(VI,2.)

not

'
"

LACHRYMALIS.

FISTULA

284

is
segilops

The
canthus

the

and

LACHRYMALIS,

FISTULA

OR

^GILOPS,

'ON

XXII.

SECT.

[book vi.

between
apostematousswelling

an

the

affection difficult to cure,

of the bodies,and the fear of injuring
it is

; and

nose

an

owing to the thinness

the abscess burst
the eye by sympathy. If,therefore,
the whole
remove
we
protruberanceas far
surface,
bone

and if the

fistulous

it ; but if

we
diseased,

soaked
the eye a sponge
of the flesh,
a
use
fluid

to the

matter

or

and
perforator,
; but we

nose

as

the

cheek,we

Some, after the

are

make

passage
contented with

cision
ex-

for the

burning

and burning down

segilops,

for

the

must

cold water.

in

cauteries

alone,usingthe

be

at

sound, we
scrape
it with cauteries,
applyingto

burn

must

the

incline towards

sore

and if the bone

lay it all open,

must

great

until

course
drop ofl"; and after the burningwe have reof
to lentils and honey,or to the application
consisting
pomegranate-rindwith honey, and other such desiccative
incHne to the canthus,and do not
If the segilops
remedies.
a

of bone

lamina

tend

surface,
then, with a
ptrygium,or one for bleeding,we
the

all towards

at

operationon

lancet

for the

may

dissect

and
the canthus as far as the abscess,
body between
the deep-seated
and have recourse
to moderately
remove
flesh,
Glass
to a fine powder is
reduced
desiccative applications.
in like manner.
and aloes with manna,
desiccative,
wonderfully
of fistula lachrymalis
livered
have deThe rest of the treatment
we
out

the

in the Third

CoMM.

Book.

Celsus

Commentary.

of
us

to interfere with

not

is of not

which

the eye.
us

to

carcinomatous

proceedin

which

is to

the bone

in

it.

He

refers

occurrence

cases

the

that the

nature, in which

uncommon

In recent

abscess,as

remarks

which

are

manner
following

is
fistulee,

to

be bui-ned with

be
a

case

is sometimes
segilops
he recommends

doubt,to lupus,
the inner angle of
this kind, he directs

here,no
near

of

not
:

the whole

laid open
down
red-hot iron,more

of
cavity
to the

the

bone,

if
especially

be carious.

Others,he says, instead of the cautery,

such as atramentum
use
or verdigris;
caustics,
sutorium,chalcitis,
he
these
but
slow in their operation,
things,
adds, are more
and less effectual, (vii,
7.)
When

the bone is diseased the celebrated

recomArchigeiies

FISTULA

xxiT.]

SECT.

piercedwith

it to be

mends

in it with

be burnt

of

givesa
to

us

Book

Third);

mentions

hole is to

Comm.
'

that others

ii,4.)
of

the

first with

cure

if these do not

segilops.He

he
succeed,

medicines

directs

commends
re-

(see

to open

us

and
freely,
apply to the fungous flesh medicines
such as powdered glass,
stone
possessedof strong stypticity,
alum, and the like. A pledgetof lint is to be placedover the
this method
medicines.
When
of practice
does not succeed,
he recommends
burning,and for this purpose directs us to
make
and then to touch
incision in the flesh,
a triangular
the
bone with a heated iron,so as to produceexfoliation. Alum
with turpentineis then to be appliedto the bottom of the
sore,
77.)
(vii,
When
the disease does not yieldto medicines,Albucasis
directs us to open the abscess freely,
to make
outlet
so
an
as

the abscess

for

the

matter, and

he recommends
diseased,
and
When

then

issues from

with

the

bone.

does not

If it is found

it with

to scrape

us

and
applystyptic

to

this treatment
the bone

the

expose

to be

ment,
instru-

desiccative medicines

succeed,he

instrument
triangular

iron

an

directs us
of iron.

to

to it.

rate
perfo-

When

by the openingwe know, he says, that

is completed.
operation
of segilops.
Mesne
For the cure
recommends
the removal
all the diseased
flesh by means
of strong caustics,
such
nose

air
the

of
as

sal ammoniac, chalcitis,

When
the bone is
arsenic,
alum, "c.
he directs us to scrape off the carious part. Some, he
carious,
the bone ; but the operationhad not succeeded
adds,perforate
well in his hands.
same

terms

Jesu

as

He

makes

the others.

Hali approves

mention

of the

cautery in the

(De ^Egr. Oculi, 12.)

of perforating
the
decidedly

also
any suitable instrument.
of the actual cautery. (De Ocuhs, ii,
32.)
He

or
specillum,

Haly
the

Abbas

cautery. We

with
acquainted

directs
have
the

us

to

lay open

mentioned

in

bone

with

'

'

(Apud Galen,

lead.

lengthyaccoxint

attempt

and

He

and melted

Coutin.

full and

285

or
perforator,

iron.

funnel

loc. v; and Rhases

Aetius

slender

red-hot

brn-ned it by means
sec.

LACHRYMALIS.

ably
speaks favor-

the

and apply
swelling,
another placethat he was

lachrymalduct. (Pract.ix,29, and ix, 72.)

It will be imnecessary
to give a particular
of the
accoimt
treatment
recommended
by Avicenna,as it does not differ from
that of Albucasis.
Accordingto circumstances he approves of

MEATUS

286

CoMM.
'

'
'

AUDITORIUS.

[book vi.

the bone, and of applyingthe actual cauteryto it.

perforating
thread
into the lachrymal
He
a
also speaks of introducing
3, 2, 14.)
(iii,
passages and of using injections,
but does
Avenzoar
recommends
compressionand injections,
not describe the operation.He speaks of the matter
passing
it may be
the lachrymalduct,

acquaintedwith
Ehases

inferred that he also

which

from

into the nose,

mention

likewise makes

was

(i,8, 10.)

of the

lachrymalduct.

He

to make incisions down

to the
particularly
it,or to applythe actual cauteryto it. He
bone, to perforate
makes mention also of escharotic applications
arsenic,
containing
of apostema lachryand vitriol. He relates a case
quicklime,
male in which he effected a cure
and friction.
by the ligature
ii,2.)
(Contin.
the bone as recommended
The
practiceof perforating
by
of
and
the
of
the
use
was
Albucasis,
approved by Pott,
cautery
is also supportedby the high authorityof
for this purpose
wise
likewere
Scarpa. M. A. Severinus,Hildanus,and Garengoit,

recommends

us

very

advocates for the actual

to have
cautery. Fabricius seems
understood the disease very well,and treated it in the way recommended
ii,21.)
by the ancients. (CEuv.Chii'urg.
and
Lanfrancus
describe and
Guy of Cauliac,Theodoricus,

appear to have performedthe

of fistulalachrymalis.

SECT.

This
a

is sometimes

for

IMPERFORATE

ON

affection is sometimes

membrane

formed

XXIII.

ancient

MEATUS

we

AUDITORIUS.

into the ear ; and it

blocks up the entrance
and sometimes
superficial
deep-seated.And it is

growth of

may

cure

congenital,
being occasioned by

precedingulceration in the
fungous flesh takingplaceblocks up

the
deep-seated,

try with

some

meatus

the membrane
If,therefore,

is

the

which

in after life by

be

for
operations

attempt

at

which
cure

superficial divide it with

obstructs the opening

is hazardous

slender instrument

the passage.

to divide

; and

yet

it,but ifit

sharp knife,and if necessary

If there
it out.
cut
be a fleshyexcrescence
it may
be
dissected out with the scalpel
used for the operation
in pterygium,
that used for polypus
then
twisted
tent
of
or
a
making
;
we

the size of the meatus

and

it
sprinkling

with

from

linen rag,

we

soak

or
some
levigated
chalcitis^

it in water,

such

powder,

AUDITORIUS.

MEATUS

288

[book

vi.

glassretain 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
ing
a hook^ or
tweezers, or by using powerfulshakby an earpick^
of the

board.

head, while

In like

them

the

manner

through

coveringup
apphed to the ear

it is

outlet to the breath.

or

genth^into
a

Stones

around

wrappingwool

an

bodies

the outside of the reed

in
and

order

that

there

such like bodies

and

If it does

sternutatoryinto the

and

nose

when

it

with

wax

-be

may

we

earpick,and smearingit

auditorius.

the meatus

ing
suck-

frequently
by

glutinoussubstance

some

circular

some

upon

do the like with water

; and

falls into the ear,

when

placed

extract

we

reed

is

ear

extract

with

no

by

tine-rosin,
turpen-

introducingit
troduce
innot yieldwe

close the mouth

and

of these,before inflammation,
yieldto none
convulsions,and dangeroussymptoms supervene, we must bring
it away by a surgical
operation.Wherefore, having placed
the patientin a proper position
turned upwards,
with his ear
nostrils.

base

the

at

make

If it

of the

small lunated

earpickwe

an

the

ear, behind

extraction

completedby

extract

the

the

what

incision,and
the

body

wound
treatment

which

is to

be

is called the
vrith the
is

lobe,we

circular part of

lodgedthere.

sewed

applicablein

up, and
cases

After

the
of

cure

recent

wounds.

Commentary.

CoMM.
"

'
"

See Celsus

(vi,
7);Aetius (vi,
87);Alexander
Trallianus (iii,
6); Oribasins (Loc.Affect, iv,36, 39) ; Galen
(deMed. sec. loc. iii)
(iii,
5, 1, 23) ; Mesne (ii,
7, 8) ;
; Aviceuna
Serapion(ii,12) ; Rhases (ad Mansor. ix, 36 ; Contin. iii);
Haly Abbas (Pract.
ix,31.)
Celsus givesnearlythe same
directions as our author,recommending
wool
round
to use
and
us
a
specillum,
wrapped
smeared
with turpentine-rosin,
hook
a
or
bent, or an
slightly
head.
or
or
ear-syringe,
sternutatories,
shaking the patient's
The

last-mentioned

operationhe

directs

us

to execute

in the

media adherens,
Tabula quoque collocatur,
manner
:
following
homo
capitibus
utrinquependentibus,superque eam
deligatur
in id latus versus, cujus anris eo
modo
ut extra
laborat,sic,
emineat
tabulam
malleo
tum
non
:
caput tabulae,quod a
pedibusest, feritur : atque ita concussa
aure, id quod inest
^^

excidet."

The
as

POLYPUS.

XXV.]

SECT.

recommended

treatment

author^s.

our

by

to Archigenesand
obligations
loc. iii.)
sec.

limits do not

use

of
a

allow of

pieceof

part of the
with

out

ear,

of these animals

instrument,of
reader

other

Rhases

directs

relaxation.

His

us

so

called from
its

resists those

ear

Haly

II.

an

the

recommends

Greeks.
incision

ear, and to put

in order to lubricate and produce

be

bean

or

XXV.

the

that if the

stance
sub-

there

be

pea

tumour
preternatural
to

because, as
seize

on

may

it.

POLYPUS.

ON

it

sea

the

fonningin the
because
polypus,
animal

block

up

nose

it

;
sembles
re-

its fibrils

with

by catchingat

in like manner,
does this affection,
occasioninginconvenience both in
so

these

advantage.

as

of
a swelling
occasioning

would

When

with

remedies

same

tepidoil into

its resemblance

who

externallv,or

failed.

bath

flesh,and

be

tive
substance destruc-

some

translator,
however, remarks

polypusis

to

are

hook.

Mesne

consult

views.

warm

SECT.

in order

with
added, is to be injected

the

to pour

lodged in the
danger of the water

blood

givesa drawing.

he

have

means

other

incision at

Animals

forcepsor

likewise

may

patientinto

The

means

When

an

and wider

below

has been

which

make

to

us

convulsions.

narrow

Serapionalso recommends
Avicenna supplies
no
new

the

our

the extraction
other

among

let
havingpreviously

and

tube

directs

succeed, an oil,to which

do not

when

us

sucking out bodies.

to be extracted with

they are

The

regret

so

for

succeed,he

inflammation

avert

means

turn

he recommends

stone

to be used

do not

sucked

our

our

of which he givesa di'awing. It resembles

forceps,
also
He
ing
drawthe modern
forceps.
givesa
dissecting
also of
hook slightly
bent, which he commends
; and

the under
to

his

theii' hands,

nostrils,

the

breathingand

speaking.
19

'

'

slender

brazen tube

means

are

Comm.

same

also deliver similar

judiciousthat we
gi^nngthem fully. For

Albucasis^s directions

to

the
exactly

acknowledgeshis
Appollonius. (De Comp. Med.
in

Galen, who

author, copy from

is

Oiibasius

and

Alexander

Aetius

Alexander,and
However, Aetius, Oribasius,

directions.

of

289

"

Wherefore

livid and

carcinomatous
are

nature,

of

hard, unyielding,

are

they partake of

as

with

to be meddled

not

are

vi.

but

such

as

to
and not malignant,are
insensible,
operation. Having placedthe person
surgical

friable,spongy,

more

subjectedto a
a seat exposedto

on

polypi which
malignant, inasmuch

kinds

those

somewhat

be

[book

POLYPUS.

290

the rays of the

opened

the

right hand

and

sun,

nostrils

polypus
cut
we
scalpel,having its extremityshaped like a myrtle-leaf,
mity
around
the polypus or sarcomatous
tumour, applyingthe extre-

with

of the

holding

hand, and

left

the

parts where it adheres to the nose.

the instrument, we
bring out the

to the

instrument

Afterwards, turning round

part. And if we see that

is perfectly
cleared, we proceed to the cure ;

separatedfleshybody
the

nasal

in the

passage

its

with

concave

polypus be left behind, we take another

for eradicating polypi, and, with the extremity
instrument
remains
by stretching,twisting,
thereof,we bring away what
burn with cauteries,
and scrapingit strongly. Malignant polypiwe
knob-shaped ; and, after the burning, we have recourse
for burnt parts. After the operation,
to the treatment
having
but

if any

sponged
nose,

part

of

the

and, if the fluid descend

operationwill

pharynx,

the

does

descend,

not

the

upper

not

been

thread

upon

reached

with

the

distance

about

the

of two

a
or

mouth

fleshybodies

are

to

but

the
if it

bones, or

ethmoid

polypus instruments.

moderately thick, like

the

of the

rightlydone

been

have

there

nose,

roof

the

by

it is clear that

parts of the

it at

into the

we
injectoxycrate or wine
parts carefully,

the

which

have

Taking, then,

having tied knots

fingers^breadths, we

cord, and
three

and
specillum,
opening of a double-headed
we
push the other extremityof the specillum upwards to the
ethmoid
openings,passing it by the palateand mouth, and then

introduce

drawing

it into the

it with

both

hands,

fleshybodies.
of a
separate by means
after the third day we
knots the

we

saw

away,

as

it were,

with

the

we
keep the opening
operation,
tent resemblingthe wick of a lamp; and
is left behind
whatever
consume
by the

After the

desiccatime use
like,and at the same
to
to the part.
tive applications
Afterwards, we have recourse
ment
during the whole treatepulotictrochisks,and, if necessary,

trochisk of Musa

we

keep

or

leaden

the

tubes

in the

nose.

POLYPUS.

XXV.]

SECT.

For

Commentary.
cines

291

of the treatment

account

an

refer to section xxiv of tlie Third

we

by

medi-

Comm.
"

Book.

'

treatises,
accordingto
Hippocratic
circumstances,recommends
sawing it out, consuming it with
septics,
tyingit with a hgature,and burning it with a red-hot
iron. (De Morbis, ii.)
to cut
In the
Isagoge'of Galen, it is merelyrecommended
The

of

author

of the

one

'

out

and to scrape its roots.

Celsus,like our author, recommends
the tumour,

instrument

directs

us

to

sharp

apply afterwards

to the

is then
A proper dressing
styptic.
be applied
for cleansing
the sore,
10.)
(vii,
mentions
excision as a proper remedy when
Oribasius briefly

medicines

some

fail.

Albucasis

describes

of
minutelythe operations
Like

the tumour.

sawingout
the tumour

with

hook,

to

thread

is

us

to seize

us

it out.

to scrape it out with

If

slender

such as vinegar,
water,
applystyptics,
thick
with
knotted
it
of
out
The operation sawing
a
also
He
terizing
speaks of cauminutelydescribed by him.

instrument,and
snow.

excision and

author,he directs
pullit down, and cut
our

part remain,he recommends

any

or

with

tent smeared

part a
to

iron, and

of

excision with

the

then

to

part from

which

the tumour

has been

removed.

the process of sawing out the tumour, with

hairs,
to use three horseus
slightdifferences. He recommends

Mesne
some

describes

with knots, are to be introduced

which, beingtied together
end conveyed out
into the nose
with a leaden needle,and one
by the openingsof the palate; and then,by pulhng at both ends,
is to be sawed

the tumour

out.

Avicenna, Haly Abbas, and

and

the process
of a case
history

extracted in

an

to be dressed

The

Rhases

make

mention

of excision

relates the
Rhases
sawing out the tumour.
of polypus,
imusuallylarge,which he had seen
the part
He and Albucasis recommend
hospital.
of

with

green

veterinary
surgeons

ointment.
appear to have depended principally
See Vegetius(Mulom. ii,38.)

the actual cautery.

upon
The method
of curingpolypiof the nose,

by sawing them

out,

servedly
completelyinto disuse,whether deto
venture
not we
or
experience,
cannot, from our own
of it;but he was
decide. Fabricius ab Aquapendente disapproved
with a new
much prejudiced
in favour of the operation
evidently

seems

to

have

now

fallen

'

'

[book

vi.

(CEuv.Chir. ii,24.) Sprengelinforms ns that this method

was
practised
by the surgeons of the
middle ages.
It is described by Brunus
(Chir.Mag. ii.)
other
the
operationdescribed by our
Sprengelthus explains
II se servait d^un instrument
author :
particulier
auquelil
et qui etait garnik I'une
donnait le nom
de airaOiovttoXvitiicov,
de la Med.
de ses extremites
d^un ciseau,KVK\i(7Kog." (Hist,
\iii^
4.) Why does he substitute KVK\i"rKog for KvaOiaKo^?
is
had a chisel (ciseau)at its extremity
That
the instrument
is unwarranted
by
altogether
improbable,and this supposition
the
the context.
end
of
or
concave
KvaOiaKoq means
cup-like
forcepsof

CoMM.
'

PARULIS.

AND

EPULIS

292

his

invention.

own

"

the instrument.

XXVI.

SECT.

ON

MAIMED

PARTS.

lipshave been mutilated,we restore

the skin below,and afterwards bringing
them by first dissecting
the lips
of the wounds ; then remo^dngthe callous pai'ts,
together
and afterwards sewing and glueingthem
together.
the

When

'
"

or

Commentary.

CoMM.
"

ears

Med.

the

This

section is taken

See, also,the

xiv.)

Celsus's observations

'

from

are

too

and

minute

Suffice it to say, that he du'ects the

then united with sutures,
(vii,
9.)

Hhases'
noses

are

directions
to the

same

for the

effect as

(Meth.

Isagoge.'

limits.
and

Galen.

of mutilated

treatment
our

lengthy for our

edgesto be pared,

author's.

ears

and

(Cont.xiv.)Similar

givenby Albucasis. He directs us to make the suture

either with needles,as in gastroraphe,
with a thread. (Chior
rurg. ii,26.)
Celsus has been supposed,but, as we
to
think, incorrectly,
touch on the operationfor the hare-lip.
(vii,
10,6.) See Sprengel
(Hist,de la Med.)
ones

are

SECT.

Epulisis
beside

one

XXVII.

ON

fleshyexcrescence

of the teeth

but

EPULIS

PARULIS.

AND

which

parulisis

forms
an

upon

the

abscess which

gums

forms

or

and

out

the

with

opened only

tents.

common

flesh

parulis we

divide

that

am

aware

used

has

disease

293

raise with

we

lancet

evacuated,the

matter

the

but

incision with

fill the

the

cut

PARULIS.

epuhs,then,

The

the gums.
hook, and

near

AND

EPULIS

XXVII.]

SECT.

forceps
circularly

often

when

for venesection

ceased.

After

and

the operation

gargle with wine, then with honied

the Flowery powder,
water, and afterwards apply to the wound
if mortification
is completed. But
attack
the
until
the cure
do not
and
must
we
yield to the suitable applications,
gums,
burn the part with knob-shaped cauteries.
orders

give

we

Parulis

Commentary.
which

fleshytumour
of

them.

the

To

things

as

allowed

to break

promote
of

applicationswill
at

us

have

is the

forms

he

former

directs

be

For

proper.

apply alum,

desired

efiect he

the

it
a

to

us

first such

either be

may

lancet.

epuHs

"c.,
verdigris,

directs

Styptic

he

and

it

cut

Comm.

fully

treats

apply at

to

us

soft

"

Aetius

gums.

suppuration,after which
itself or may
be opened with

then

Epulis is

gum-boil.

the

on

first to

the

not

to

mends
recom-

if these

off with

24, 25.)
scalpel.(\dii,
Celsus

parulides.

For

ripe,lest
to be

are

the
cut

Haly Abbas
the parulisin
It appears

to

cut

to

it out

with

stypticpowders
actual

us

to

cautery.

time

the

For

28,
Chirurg. (ii,
It is unnecessary

the

other

to

Larger

for the

our

and
to

authorities.

the
it is

tumours

lancet.

and
epulis,

ancient

own

could

if the

part,
be

to open

(Pract.ix,33.)
authorities

for

part, or

cure

boil,
gum-

in

it before

open

bone.

hold

treatingthe epulis. He
forceps and scalpel,and then

See

permanent

of all the

rules

no

to

the

excision

with

that

that

hurt

us

of

(vi,13.)

recommends

the best

lays down

should

entire,

due

directs

figs,and

of

matter
out

length by the name

corresponds to the

remedies, he recommends

decoction

considerable

at

specieswhich

that

other

among
mouth

of both

treats

tumour
we

have

Albucasis
directs

us

apply
again,the
grow
generallyfound

effected without

the

to

cautery.

i, 22. ^
detail

the

treatment

recommended

by

'
'

EXTRACTION

294

TEETH.

OF

[book

vi.

\i
SECT.

XXVIII.

ON

EXTRACTION

THE

OF

TEETH.

Having scarified around the tooth down to the socket, we

must
and
by degrees shake the teeth with a tooth-extractor,
draw it out.
if
But
it is carious we
first plugup the hole
must
with a small tent, that it may
not break when
compressedby
the

instrument.

After

the extraction

we

the

consume

may

"fleshthat is left

it with finely
and
salts,
by sprinkling
levigated
garglesof wine or oxycrate may be used until the

afterwards

completion of the cure.

teeth are formed, those
scrape

fixed

with

unite

the

'

we

those

socket
that

tooth-extractor.

part of it with
remove

may

part of

supernumerary

fixed in the

size,or is broken, we

to them

concave

are

with

redundant

Commentary.

CoMM.
*

unnatural

an

since sometimes

but
gra\ing-tool,

extract

or
projecting

which

'

with

must

we

to

grow

the

down

And
that

as

must

we

not

are

so

tooth

If any

may
scrape away
file. The laminae

may

proper,

appear

specillum, raspatoiy,
a

or

file.

Cselius Aurelianus

of extracting
disapproves
necessity.Herophilusand

of extreme
teeth, except in cases
Heraclides Ponticus,he says, have related cases
operationhad proved fatal ; and in modern times
of such occurrences.
(Pass.Tard. ii,4.)

in which
we

hear

the

times
some-

Celsus directs us, when

the painsof toothache
be
cannot
from the tooth
to separate the
got othei-wise alleviated,
gums

by

free

and

and then to shake it until it is loosened,

scarifications,
forbids us to proceed rashlyto performextraction,
for fear

of

occasioningdislocation of the jaw-bone, or, if

belong to the upper jaw, of hurting the templesor
loose,it is to be taken
a

out

with

and, if eaten, the hole

forceps,

with

lead,to

instrument
the

tooth

prevent

is to be

it from

the

When

the

teeth

to extract
are

tent, or

extraction.

The

lest the
pulleddirect,

is,he adds, considerable

ring
when
the tooth is short and
quently
takes hold of a pieceof bone
us

but

is to be filled with

is fixed sliould be broken.

he directs

tooth

If
eyes.
otherwise
Avith

breakingdming

there

case

hand,

the

the

bone to which
spongy
Of this accident
occm*not

unfre-

long,the

ment
instru-

danger;
its roots
and

broken

carious he directs

and

breaks

it ; in which

piecewith
us

to scrape

pincers.

them, and

CONSTRICTION

296

therefore who
slow

OF

TONGUE.

[book vi.

have this affection

in

are
naturally
distinguished
byand
the
frsenum
speak^
by having

being
size,and that without any
linguaelarger than its moderate
the complaintis occasioned
previousulceration. When
by a
cicatrix it is easily
the patient
is to be
recognised. Wherefore
placedon a proper seat, the tongue raised to the roof of the
frsenum cut transversely.But
mouth, and the membranous
if the curvature
is occasioned by a cicatrix,
transfix the
we
callus with a hook and draw it upwards, and
making a cross
sions
incision free the bent part,taking care
not to make
deep inciof the
difficult to

parts ; for hemorrhages which

stop have therebybeen

relaxingand

'

genitalaffections
denda
venae

water

is to be

"

found

the operation

oxycrate;

or

completed with

applications.

Horum

extrema

est,sub eaque membrana

quae

After

Celsus thus describes the treatment

Commentary.

CoMM.
*

incarnative

cold

been

have

occasioned.

the part is to be washed

with
after all these things the cure

and

'

beginningto

con-

linguavulsella prehen-

incidenda,magna

juxtasunt, violentur

in

habita,ne

cura

et

noceant."
sanguinis
profusione

is

quite similar

12, 4.)
(vii,
Aetius's

plan of

treatment

to

author^s.

our

(viii,
38.)
Albucasis

of the operation. He
gives a similar account
cautions againstopening the artery below the tongue, for fear
this accident occur
of hemorrhage. Should
he directs the
the actual cautery. (Chirurg.ii,
to use
34.)
surgeon
Rhases
recommends
when
the frsenum extends to the
the

so
tongue that it be divided,

However,

of the

one

as

authorities

to allow freedom

quoted by

him

tip of

of motion.

directs

to

us

the frsenum
Avith a thread,which
armed
a needle
pass tlu'ough
is to be tightenedso as to divide the intermediate
He
space.
recommends

this
from

method
the

incision.

dangeroushemorrhage will
below

the

in order

to obAaate

Rhases

result from

fear of

the

himself

states

openingthe

morrhage
he-

that

green

veins

tongue. (Cont.vii,1.)

Avicenna

vi,11.)
(iii,
Haly Abbas

also

recommends

describes very

the fraenum.

the

operationwith

the

ligature,

the operationof
distinctly
(Pract.ix,35 )

ding
divi-

ANTIADES.

XXX.]

SECT.

sometimes

indurated

INDURATED

OR

TONSILS.

called strumee,

glands are

and
inflamed,SAvelled,

when

ears

'
'

ANTIADES^

ON

XXX.

SECT.

Comm.

ne-

ix,35.)
(Pract.

cessary.

the

operationis

tliat the

Alsaliara\ius mentions

As

297

the

so

of

sioning
dried^ occa-

it were,

as

almonds

called
and
of breathing,
of deglutition
are
difficulty
"When
antiades,from theii' being placedoppositeone another.
with
them ;
meddle
not
must
therefore they are inflamed
we
is considerably
the inflammation
but
when
abated,we may
such as are white,contracted,
especially
upon
operate, more
and

have

narrow

and

haA'e

broad

the

person

in the

his

mouth,

while

base.

base, are

to bleed.

apt
the

lightof

and

sun,

are

spongy,

red,

Wherefore, seating
him
directing

to open

and

another

his

holds

assistant

one

which

those

But

head,

the tongue to the lower jaw with a tongue spatula,

presses down
the tonsil with it,
take a hook
we
(tenaculum)and perforate

drawing its
membranes
along with it ; and then we cut it out by the root
with the scalpelsuited to that hand, called ancylotomus,for
such
there are two
instruments, ha\ing oppositecurvatures.
drag it

and

outwards

After the incision of

in the
must

on

one

we

manner.

same

garglewith
come

much

as

cold

he may

can

without

versely
operate upon the other inmay
After the operationthe patient

Avater
use

we

as

or

oxycrate;

tepiddecoction

and
of

if any

rhage
hemor-

brambles,roses,

blood
copiouslywe must
myrtle-leaves
; or if the
give for a garglethe juice of plantainand comfrey,and the
floAvs

and

trochisk from
When

earth, dissolved in crate.

oxythe hemorrhage stops,the parts on the next day
and

amber

the

Lemnian

and starch
be anointed
with
the flower of roses, safi'ron,
may
with water, the white of an egg, or hydrorosatum.
A\ ith milk,or
When
sordes
collect about the ulcers,
we
may use injections
and

from

linctuses made

honey.

Celsus directs

Commentary.

rated to scrape the membrane

if this

or,
or

does

tenaculum, and

with

vinegar,and

Avhen
the

the tonsils

and
finger,

seize the tumour

indu-

are

tear it out ;

Avith

hook

it out ; tlien the Avound is to be washed

medicine
12.)
appliedto it. (vii,
styptic

cut
a

with

succeed,to

not

us

Comm.
'

"

"

298

Aetius

Co^f^^.
'

UVA.

out

directs

the

at

us

[book vi.

to seize the tonsil with

middle.

When

hook

out at the

cut

and

base,he

it

cut

remarks

there is

on

57.)
danger of hemorrhage, (viii,
the patientsit with his
Albucasis directs us to make
the operator'sbosom, and, while an assistant presses

his

tongue, the operator is

to seize the

hook, and drawing it out, to

indurated

it off with

cut

head
down

tonsil with

sharp instrument
a pairof scissors.

resemblinga forceps,
or, in other words, with
He likeAvise givesa drawing of another instrument
which consists
of a lunated pieceof iron fixed to a handle.
He relates
casein which he performedthe operation,
an
interesting
(ii,
36.)
the
called
Rhases, upon
Ancilisius,
authorityof a surgeon
in the barbarous translation of his works, which
probablyis a
corruptionof Antyllus,
brieflydescribes this operation. He
directs
foui'th
make

us

the mouth

to open

part of which

may

be

and

take

off.

cut

hold

of the

the
tonsils,

recommends

He

us

to

the

patientgarglewith vinegar. He forbids the operation

when the tonsils are enlargedand red. (Contin.vii,
2.)
Abbas
and
Mesne
Haly
(Pract.ix,36,)
(de ^Egr. Gutturis,
describe
the
but not so minutelyas Albucasis.
4,)
operation,
Guido de Cauliaco
of Albucasis and
copiesthe descriptions
Haly Abbas, (c.vi,2.)

SECT.

XXXI.

ON

THE

UVA.

The

UAT^ilabeing,as it were, the quill

or
is
often
the
defluxion
from
of speech
seat of

plectrumof the organ

the head, and becoming

enlarged,of a lengthenedform
preternaturally
shape,it is called columella ; but when thick below
is named
called

uva,

from

from

its resemblance

its resemblance

be made

to

to

grape,

column.

as

and
and

slender
round

the other is

it
so

If,therefore,it

tions
evacuayieldto generaltreatment, I mean
and
such
gents,
astrinto
as
by bleeding
pm-ging, nor
topical,
and
discutients,we must proceed to the
repellents,
it bring on
lest,by its constant
operation,
irritation,
coughs,
and
suffocation.
even
as
are
sleeplessness,
Such, therefore,
what
contracted,round, not of a lengthenedshape,bloody,or someblack,we must decline operatingupon ; but those that
not very bloody.
are
slender,
long,small at the extremity,
loose,

cannot

to

"

"

"

UVA.

XXXI.]

SECT.

must

whitish,we

but
them

upon

for the inflammation

only take

must

the

of

much

as

away

for

size ;

its natural

exceeded

as

uva

We

subsides.

soon

the

operate

299

of

tirpation
complete ex-

to the parts about the

of it proves greatlyinjurious
Wherefore, having
chest, and occasions the loss of voice.

placedthe patienton
him

to

gape
or

purpose,

drag

it

wide,

seize with

we

the

tenaculum, upon

common

downward,

seat in the rays of the

and

cut

forcepsadapted

for this

part and

the redundant
instrument

Avith the

it out

and directed

sun,

called

operationfor the
the operationthe same
of the upper
suture
for angiology. But
things are to be done as are recommended
the fear of the
of the patient,
or
since often,from the timidity
by medicines,
attendingthe treatment
hemorrhage, or the success
sume
he declines the operation
by instruments, we may rather conof a caustic medicine.
Wherefore, taking
it by means
or
some
such, we are
the caustic used for burning the eyelids,
called staphyloof the instrument
it the hollows
to fillwith
caustos, and directingthe patientto gape wide, and getting
with a tongue spatula,
we
the tongue pressed down
open the
of the uva
and grasp Avith it as much
instrument
sufficiently
must
medicine
off" in the other operation. The
cut
we
as
down from
neither be of too liquida consistence,lest it run
fore,
the uva
improperly,and burn the adjoiningparts (and,thereto swallow
direct the patientnot
during the whole
we
operationof burning),nor very hard, that it may soon act upon
the extremityof the
if from
And
one
the uva.
application
staphylotomus,or

uva

become

use

it

the

again. Dm-ing

which

is melted

flow from

the

mouth.

falls off"about

and

with

down

time

the whole
bent

the

water.

But

portionsof

the

or

fourth

after this

appliedaround the neck, and

garglesand liniments.

may

in

the

the

hour,

one

burning,

soft wool

direct

patient

medicine

the

and
operation,

from

the

saliva

day. After
with

must

we

that the

dead

part becomes

tonsils,
soothing fomentations

to be

if not

of its action

having wrapped the index-fingerround

we
wipe the parts about the uvula, or

garglewith

the

forwards, in order

The

the third

in

but
sufficient,

will be

black,this

sit with his head

must

scalpelused
eyelid. After

or

patientto

also that

the oil of camomile

in like

manner

tow,

we

may

on
are
use

PHARYNX.

300

Commentary.

CoMM.
'

'
"

[book vi.

It appears from the

excision of the uvula was
sometimes

treatises that
Hippocratic
performed in earlytimes.
(Prognost.de Morbis, ii;De afiect.)
Celsus recommends
with
the operation
not
to meddle
us
when
the uvula is red and
for fear of hemorrhage;
enlarged,
but when
it is slender,
sharp,and white,or when it is pale
and thick below, but slender above,it may be extirpated
out
withdanger. For this purpose he merely directs us to seize
it with a forceps
and cut it out. (^di,
12.)
upon
Galen
describes fullythe operation
by medicines,but says
nothing of excision. (De Med. sec. loc. vi.) Aetius describes
the operation in nearlythe same
author.
He
terms
as
our
directs us to grasp the enlargeduvula with a forcepsand cut
it off,using afterwards
some
44.)
astringentgargle, (viii,
Oribasius briefly
mentions
the operation,
which
he directs to
be performed with extreme
circumspection.(Med. Collect,
xxiv,10.)
Albucasis describes the operationsimilarly
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
is proper
of it. He givesa
as
cines.
drawing of an instrument for the operationwith caustic medi(Chirurg,
ii,37.)
Avicenna's description
is to the same
but not so circumstant
effect,
directs us
to perform the
9, 15.) Mesne
(iii,
operationwith a heated scalpelof gold.(De ^gr. Guttm-is,3.)
Rhases
states that when
the uvula
is enlarged,
but is not
the
red,
tions
operationmay be performedwithout danger. He menthat some
preferredthe actual or potential
cautery,but
that he preferredexcision.
but not distinctly,
He describes,
instniment for applyingthe caustic medicines.
He states
an
that loss of the entire uvula impairsthe voice and
exposes the
lungs to danger from cold. (Contin.vii;and Divis. i,49.)

SECT.

XXXII.

ON

Thorns, or
swallowed
such

as

can

THORNY

the bones

in
be

SUBSTANCES

of

and
eating,
seen

we

are

FIXED

IN

THE

PHARYNX.

other substances,
often
or
fishes,
are
fix in different places. Wherefore,
to extract

with the

forcepsfor

that

LARYNGOTOMY.

XXXIII.]

SECT.

which

those

but

pm'pose;

301

Some
are
differently.
manage
ought to be made to swallow large

of

must

of lettuces,or
thread

about

piecesof bread
a small
pieceof

in the

down

lower

are

morsels, such
others

; but

direct

clean soft sponge

into

and

pus

the

the thorn

to bind

us

and

is

fingersor
is

which

then

fall out

of its

own

give it

to

thread

to

the

thorn

Leonidas
those

as

converted
If

accord.

we

see

swallowing,before digestionhas
the stomach, and cannot
perceivethe substance
fixed,we may order him to vomit by pushing the
the thing
the throat,for sometimes
feathers down
that are
fixed will be brought up with the matters
the

patientat
taken placein
which

the stalk

as

takinghold of the
in order that
draw it up, and to do this frequently
get fixed in the sponge and be brought up.
may
orders
suppurativecataplasms to be applied,such
be
in order that the part may
from raw
barley-flour,
patientto swallow, and

the

gulletwe
patient

opinionthat the

of

time

vomited.

Our

Commentary.

from

Aetius.

Albucasis

author^s

directions

mostly taken

are

Comm.

(viii,
50.)
repeats

our

author's

and
directions,

further

commends
re-

instrument
an
they fail,to introduce
tract
made of lead,which he givesa drawing of, and either to exthe substance
(Chirurg.ii,38.)
or
push it downwards.
is recommended
A similar plan of treatment
(de
by Mesne
9, 43) ; and by Alsaharavius
^gr. Gutturis); by Avicenna (iii,
of food sticks to the oesophagus,
a morsel
(Pract.xii.) When
us,

Alsaharamis

back, which

when

directs that

person

should be

will facihtate the descent

SECT.

The most

the

famous

ON

XXXIII.

surgeons

have

of it.

struck

on

the

(6.)

LARYNGOTOMY.

also described this

operation.

of cynanche (as we
In cases
will
Antyllus,therefore,says,
we
entirely
disapproveof
explainunder the head of Dietetics)
the incision is utterly
because
this operation,
unavailingwhen
of the trachea ?) and the lungs are
all the arteries (thewhole
and
about the mouth
affected ; but in inflammations
palate,
"

and

in

cases

of indurated

tonsils which

obstruct the mouth

of

[book

LARYNGOTOMY.

302

hav^e

it will be
unaffected,

the trachea is

windpipeas

the

vi.

proper to
in order to avoid tlierisk of suffocation.
to pliaryngotomy,

recourse

in the operationwe
slit
engage
it is dangerousto di-videthe
open a part of the arteria aspera (for
whole) below the top of the windpipe,about the third or fourth
we
"When, therefore,

this is a convenient

ring.For

and
as beingfree of flesh,
situation,

placedat a distance from the part which

head backwards,
is divided.
Wherefore, bending the patient^s
to make
to bring the windpipebetter into view, we
are
as
so
of the rings,
that it
two
incision between
so
as
a
transverse
is divided,but the membrane
which
may not be the cartilage
be more
If one
timid in operating,
one
connectingthe cartilages.
because the vessels

are

first stretch the skin

may

remoAdng the

vessels

with

hook

divide

and

it,and then,

in the way,
of Antyllus. We

make

aside,if they come

the words

the

judge that
the windpipehas been opened from the air rushingthrough it
from
the voice being lost.
After
with a whizzing noise,and
has
of the suffocation
the urgency
passed over, we pare the lips
These

incision.'^

of

the

incision

have

then

are

so

to

recourse

cartilage.Then
fresh

We

incarnants.
we

should

meet

throat from

CoMM.

we

wounds, but

Commentary.

to

as

make

sutures,but
use

the

if it does
must

with

them

the

wish to commit

Aretseus

again,and

the skin

only,without the
applications
proper for bloody or
sew

not

follow the
case

surfaces

raw

of

unite

must

we

plan

same

person

who

treat

it with

of treatment

had

cut his

if
own

suicide.

makes

mention

of this

operation
such
terms
as
casionally
practisedocproves
in his time.
He, however, does not approve of it,
of angina. (De Curat. Morb.
Acut. i, 7.)
at least in cases
Cselius Aurelianus
says that Asclepiadesperformed the
of cynanche ; but he himself disapproves
of
operationin cases
mention
further in this
it. (De Morb. Acut. i, 7.) We
may
placethat Avicenna,Avenzoar, Haly Abbas,Mesne, and Rhases
of the operationin urgent
express themselves rather favorably
of cynanche. From
the circumstance mentioned
cases
by Pollux
of cynanche,that it mostlyattacks children,
inclined to
we
are
that it must

in

think

of the Greek

the

crouji

by

been

it.

authorities,
except om* author,have left
it
of the operation. Psellus,however, mentions
description
None

that the ancients meant

have

[book yi.

ABSCESS.

304

flammatio
symptoms of inbeing diminished, from the swelKng assuming a
sharp point,and from pus being felt under the fingersupon

and
redness,pulsation,
present),

other

the

in that
if the abscess be superficial,
especially
we
case
proceedto the operation. But if it is not felt to
may
is elevated to a point,
the touch, nor
owing to its being deepseated,we must attend to the other symptoms before operating.
more

pressure,

It is to be

understood,however, that before

the conversion

to

completed,we sometimes open abscesses when they are

of their being near
jointsor ^ital parts,
unripe,on account
some
necesa ligament or
lest,by their continued putrefaction,
by it. And Hippocratesdirects
saiy part should be corrupted
before they are completely
to open abscesses about the anus
us
In opening
the intestine.
ripened,for fear of their perforating
pus

is

them

the natural

but observe

manner,

the incisions in the

not, in all cases, make

must

we

lines

"

same

face; and
taking as much

as

on

the

the

the head, and

care
as
on
growth of the hairs
incisions are
not to occasion deformity. Straight
as
possible
"

to be

in the

made

in the muscles

legs,as

and

tendons

and

avoided,takingcare
of their safety
by sometimes making a straightincision and
into the abscess,according
to the
one
sometimes
a transverse
of each

circumstances
make

\atal

and
arteries,

nerves,

thinner

di\ddingthe

convenient

for the escape

raised up

to

must
we
vitality,
a
mp'tle leaf,or

cut

is much

out

pointedwe

open
sinus,if the part is

only make

such

make

they are largerwe

parts,and those which

we

more,
most

are

the

When

of the matter.

some

circular is unfavorable
not

small

are

swelling

point,unconcocted,thin,and devoid of

of

to be

"UTien the abscesses

case.

incision,but when

one

always

parts are

to

or
pieceeither like a triangle,
other angularfigm-e,
because

cicatrization.

Those

and
by a simpleincision,
fleshyand the skin proper

incisions into the

part

as

when

for

which
we

like
the
ai'e

find

we
uniting,

will allow the matter

discharged
; but if it be thin and veiy devoid of flesh
make
length; and after
a simple incision along its whole
we
this simpleincision,if the parts on each side appear thin and
off. After the operation,
must
we
not fleshy
ha\dng
pare them
and
if
be
if
abscess
the
first sponged the part,
small,
only one
but if it
incision has been made, we may use a simplepledget,
draw through them
and there be many
we
be large,
incisions,
to be

ABSCESS.

XXXIV.]

SECT.

filletwhich

been

cut

be

cau

out

extracted
easily

fillit in like

we

take

placewe must
the bleedingcontinue we
which
powdered clialcitis,
when
the

the

305

cold water

may

part is gangrenous

and when
with

manner

use

we

lint. If

also have

part has
rhage
hemor-

oxrcrate,and

or

the

sprinkleupon

may
and

the

part finely
often

to

recoiu'se

flaccid. In

if

winter,and

when

soak oblongpledgets
in wine
may
and oil and applythem ; and in summer,
when the parts are
soak these appUcations
in water and oil,
in
we
or
fleshy,
may

parts

the

are

nervous,

cold wine

same

and

we

oil,and bindingthem, on

the

following
third day,

fluids ; but on the

day we may bathe with the same
and spongedthe parts,we
use
havingloosed the dressings
may
the application
called tetrapharmaconon
and
if
a
pledget,
there be no
inflammation
present we may
apply the same
for the preservation
wash
of the pledget
flammation,
; but if there be inmust
we
cataplasm,havingfirst
applya digestive

pom-ed water
we

eff'ect the

may

Sinuses
has been

are

parts. "When

cure

to

the Fourth
Celsus

is

the

All the authors

Book
more

procure

may
resolution.

matter

is collected

not

abates

sinuses.

quoted under

Before

incisions in the
to

this head

layingdown

of abcesses.

surgicaltreatment

which

the

on

be consulted.
may
than usually
prolixin

harden, he du'ects us to make

in order
a cuppinginstniment,
to

inflammation

the

nation.
by promoting suppurationand incarbe cured by agglutinative
remedies,as

said,in the Fom'th Book,

Commentary.

for

the

on

remove

Comm.

the rules

the

abscess

skin,and

apply
flammation
of in-

symptoms

any

in

present,or, in other words,

Sometimes, however, as he explains,

have been

in

in which
cyst (tunica),

to be

supposedthat the contents of

When
by a cupping instrument.

the abscess

seldom

the

it is

case

be

can

moved
re-

ripensit is
armpits,or groins;
pus

proper to let it out if seated in the

when the collection is superficial,
it is
nor
or in the flesh ; and
the
to applycataplasms until
better,as he prudentlydirects,
pus
to

make
open

nervous

because

an

itself. When

it is

judged necessary

abscess,he recommends
us, if not
part, to perform the operationwith a

seated

an

small

longeropen.
II.

openingfor

opening made

Abscesses

in

in

nervous

this

red-hot

iroii,

will remain

manner

parts are

in

to

be
20

opened

ABSCESS.

306

with

CoMM.
"

it

are

made

the

making

to

be considered.

as

small

is livid

this

In

cure.

biit

two

three

or

case

are

be

size of

be

to

ai*e

when

the

off to further

cut

made

is to be

vi.

require larger

necessary'

must

opening

an

and

openings

sinuses

large

it sometimes

diseased

or

the

general

In

sometimes

incision, the form

an

possible;

as

incisions, and
skin

In

scalpel.

'

"

[book

of the

shape

the pus is evacuatedj if in the armpit

myrtle-leaf. AVhen
of
out
or
pledget is to be used, but a sponge
groins,no
other
wine
is to be applied. In
places,a little honey is first
above
these
be used ; then
to
aggUitinativemedicines
; and
a
squeezed out of wine. {\i\,
likewise,if necessary,
2.)
sponge
is
of
abscesses
The
treatment
fully explained by Galen.
abscess
is slow
an
(Therap. ad Glauc. ii.) He dii'ects us, when
of ripening,to make
scarifications in it,and
wards
aftersuperficial
to apply a cataplasm of barley-meal.
of

directions

Aetius^s

author^s, but

author, he
like

directs

to

us

sores

additional

Little

make

the

healing;

authorities.

all

the

dangerous

if the
prostration,especially

remarks,

Like

our

the

animal

author, he

ripe,unless

seated

spiritswill

forbids
near

the

us

to

anus,

at

obtained

or

from

the

once,

lest it

along

abscesses

with
until

is

produce
;

the

A-ital part.

some

the

abscess

patientbe weak

escape

open

are

Aphrodisiensis.

its contents

to

cular
cir-

of this fact

causes

is to be

large,not
he

our

that

aware

directs us, when

Albucasis

evacuate

well

were

and

infomiation

to

precise. Like our

incision long and
naiTow,

Alexander

and

similar

whole,
and

ancients

Cassius

fullyexplainedby
other

of

slow

are

minute

The

myrtle-leaf.

so

quite

not

the

upon

are,

for,
pus.

they are
(Chirurg.

ii,40.)
that
if an
Haly Abbas justly remarks
in an
prematm-ely,the lipsof it remain
But
when
prevent the sore from heahng.
or

ligaments,

treatment

upon

he

advises
the

whole

not

to

does

wait
not

abscess

be

indurated
seated

until

state, and
near

it is

difier from

opened

our

nerves

ripe.

His

author's.

(Pract.Lx,8.)
The

method

of

opening abscesses,by

is described

in the

Fourth

means

Book,

18.

of caustic applications

STRUMA.

XXXV.]

SECT.

SECT.

XXXV.

STRUMA,

ON

30/

OR

SCROFULOUS

GLANDS.

The

ing
choeraSjor scrofula,is an indm'ated gland,mostlyformin the neck, armpits,and groins,
either
derivingits name
from a Greek word, signifying
of rock, or from swine,
a species
because they are fruitful animals,or because swine have swellings
of the neck.

The

part of the neck, or

consist of one,

two,

like the
which

strumse

either side of

on
or

formed

are

it,or

the

painfulto

medicine, are

of

carcinomatous

and

the anterior

on

both, and they

on

all contained

more,

in their proper membranes,

meliceris. Those,therefore,

steatoma,atheroma,and

are

either

touch, and

malignant nature,
it is obvious

that

are

on

to

they do

the

of
application

be

considered

not

as

readilyyield

surgical
operation. But such as are mild to the touch
and the seasonable
be operated
of medicines,may
application
To such as are superficial
and incline towards
upon in this manner.
the skin we
a
use
simplesection,and free them from the
the skin with hooks we flay
surroundingbodies,and stretching
the lipsof the incision,
said in describingthe operation
as
we
of angiology,
and by degreesremove
them entirely.But such
as
are
larger,having transfixed them with hooks, we raise up,
and dissecting
must
we
away the skin from them in like manner,
free them
from
the surroundingbodies,avoiding in
entirely
If any
the carotid arteries and recurrent
nerves.
particular
divided vessel obscure the operation,
include it in a
we
may
the base
when
cut it asunder, if not large. And
or
ligature,
of the scrofulous tumour
into a narrow
out
runs
point,we
and introducingthe index fingersearch
may cut it away readily,
them
in
if there be any other strumse
lyingthere,and remove
the same
if we
But
manner.
suspect that a largevessel or
to

vessels
need
so

situated

are

not

cut

that it may

when

we

if cut

at
are

once

to

may
size of the

skin,having

cut

be

we

of the scrofulous tumour,

base, but include it in

the

in
spontaneously

effect the

we

the

from

fall off

may

away

incisions

it out

at the bottom

may
made

cure

by

the

unite the

direct,and

pieceswithout

we

ligature,
danger,

of lint ; but
application
lipsof the incisions. The
if there be nothing redundant

But, if owing to
immediatelysew them up.
scrofulous swellingthere be a redundancy of
we
may
away a part of it like a myrtle-leaf,

STRUMA.

308

have

sutures, and

to

recourse

[book
the

use

applicationsfor

vr.

recent

wounds.

referred

authors

all the

See

Commentary.

CoMM.

in the

to

34th

'

"
'

relates

the

Med.

Meth.

Aetius

gives a long
His

the

such

neck

are

operating
intention

than

incision,he
in

the

with

be

author, make

discharge of
Celsus

blood

he

the

of the

the

with

be

skin

is to

incision

base

from

of the

not, like

When

ligature.

simple

the

the

does

He

gitudinal
lon-

separated

but

this

incisions

lips of

is to

In

jugular

and

large, the

the

in

tumours

is small

scalpel;

recommends

nothing

says

if

great caution.
of

the

tumour

skin

the

fingersand

mention

any

speech,

but

avoid

make

treatment

dictated.

of

myrtle-leaf,and

with

cut

the

sufficient

hooks,

the

with

is to

be

of

form

the

stretched

tumour

will

the

to

to

When

the

on

us

nerves

rather

us

transverse.

says,

struma

the

surgeon,

speech. (See

covild have

cautions

arteries, and

of

dissectingout

for

he

neck,

loss

Leonidas

experience alone

as

ignorant

an

i, 6.)

from

extract

recommends

he

which

Affect,

directions

the

on

veins, carotid

being

Loc.

septic applications.

or

occasioned

nerve,

and

xvi;

in

case

recurrent

of scrofula.

cut

incision

unfortunate

an

by cutting

be

Book.

briefly recommends

Galen
He

Fourth

of the

section

our

is

there

styptics,(xv,5.)
by

treatment

surgicaloperation,

(v,28.)
Haly Abbas, Avicenna,
of

approve
terms

large

as

vein

describe

author.

Albucasis

our

at the

of

it,and
which

allow
the

of the

it to

tumour

ointment

incarnants

and

them

with

to

the

tumour
out

red-hot

Arabian

operation

directs

in much

consume

recommends

the
to

same

there

when

us

the

is

apply a ligatureround

to

fluid,he

When
us

to

corrupted flesh

be

used.

ordinary treatment,
iron.

authorities

by putrefaction.

detergents are

resist,the
a

drop
are

apply an
tumours

burn

bottom

of the

most

excision,and

its root, and

contents

and

he

W^hen
directs

the
open
; after
fulous
scrous

to

ON

XXXVI.

SECT.

also

These

AND

ATHEROMA,

STEATOMA,

MELICERIS.

but differ from

abscesses,

tlie class of

belongto

309

respect,that those which

scesses
properlycalled aband contain an
of an inflammatory
are
nature, painful,
and corrodingfluid;neither
are
they surrounded by a
membrane
tunic.
or
They differ from one another,in

in this

them

acrid

proper
much
as

from

made

The

steatoma

touch, and has

is,as

steatoma

is in the

atheroma

its

is like

meliceris is like

fluid in the

the

while

of

The

base.

narrower

the sensation

touch

in the

suet ; that which

corn;

are

another
thus.
from one
them
distinguish
may
is harder than the others,is unyieldingto the

You

honey.

is contained

that which

as

like
implies,

name

pap

ETC.

STEATOMA,

XXXVI.]

SECT.

soft

to the

meliceris conveys

and
body, is slowlydiffused,

soon

as
shape. We
operate upon them
upon
the
and
rest
scrofulous tumours, by incision,
dissection,
sutures,
the membrane, lest
of the treatment, only avoidingto wound

its

again to

returns

its fluid contents

lest

be

pouredout

part of it should

complaintat
as
parts about joints,
if the

manner,

such

Commentary.

We

of these tumours

Galen
to

are
or

to cut them

Celsus
open

the

to wound

have

their
out.

directs us,

cyst and
the

the cyst be

scrofulous

with

not

to

sew

up

in

like

If any

the

wound,

septicappHcations.

of
givenan explanation

the nature

Comm.
'

Book.

"

in all these

cure

"

cases

of them,
contents, produce putrefaction
The steatoma, he remarks, beingof a solid

by an operation.(Meth. Med. xiv.)

to
steatomatous
tumours,
extirpating

onh^
in

evacuate

cyst of

does

tumour

part of it be left behind.

that the indications of

be remedied

nature,can

in the Fourth

states

discuss

or

the remainder

consume

and
operation,

behind, which often occasions

the wrists,ankles,and the moveable

left it will be better

thing be

but to

whole

obstruct the

be left

of the

renewal

and

its contents

the others.

; but

Should

recommends

the whole

or

not

part of

unavoidablyleft behind,he directs suppurative

applications
to
After the operationhe directs us
to be used.
and an aggluunite the lipsof the wound
tinative
by a clasp(fibula)
medicine,
6.)
(vii,
is very fullylaid
The surgical
of these tumours
treatment

'

down

CoMM.
'

"
"

[book

ANEURISM.

310

by Aetius,in

tion is

so

limits.

but Ms

descrip-

to it within our
narrow
long that we cannot do justice
Like Celsus^he directs us to avoid wounding the tunics

suiTOund

which

Leonidas

from

extract

an

vi.

and

atheroma

the

mehceris

; hut

states

that

of the steatoma.
He judiciously
this may
be done in the case
directs the skin to be cut in the form of a myrtle-leaf,
(xv,7, 8.)
in the fii'stplace,to

directs us,

Albucasis

in order to ascertain the

found

are

be

to

of its contents.

nature

recommends

fatty,he

prick the tumour,

to

us

"VMien
it

cut

they
out
by

making a crucial incision,and removing it with its cyst if

he directs us to dissect
the cyst is wounded
possible.When
it out in pieces,
and to endeavom*
to leave no
part of it behind.
of various instruments, namely, scalpels,
He
gives di'awings
for dissecting
out these tumours,
tenacula,and perforators,
45, 46.)
(ii,
dii'ections for the
E/hases and Avicenna
givevery judicious
those

thev scarcelv differ at all from

of these tumours, but

treatment

and

of Aetius

opening the cysts of

but if any

author.

our

the

part remain

They

atheroma

recommend

and

they direct

us

us

to avoid

if possible
meliceris,
;

to

destroyit by septics.

(Contin.xx"vii.)

SECT.

is

Aneurism

XXXVII.

ON

ANEURISM.

fingers,
baring its originfrom blood
anastomosed
an
artery having become
"

is called
when
the

the

an

skin

Such

substance
Thus

that lies

affections

; but, if

over

"

it is

neither

wound

but
cicatrized,

unites

of the same,
the wound

in

is blocked

up by
the pulsationof arteries
nor

recognisedby
in so far,the
tumour
disappears
forms it returningback
into the arteries."
them from one
another in this
we
distinguish
are

compressed,the

which

Galen.

and

aneurism; it arises also from

artery remains, and

flesh.

yieldingto the
and spirits.Galen
says
tion
the affece. dilated)
(i.

soft to the touch

tumour

But

of an arteiy appears longer,

way : That formed fi'om anastomosis
is deep seated,and when
sort of
a
pressedupon by the fingers,
sound
is heard ; whereas
noise is heard in the cases
no
arising
from

rupture,and these,moreover,

Those
superficial.

therefore which

are

more

form

rounded, and

in the

feel

groin.
ai'mpits,

ANEURISM.

312

unskilful

CoMM.
'
''

artery at the

an

opens
from

in

surgeon

'

[book vi.
the

arm,

he says, either
proceeds,

It

time.

same

of

vein at the bend

opening a

blood and spirits.

and its contents
are
rupture or dilatation,
of a smaller
or
are
a swelling
sj^mptoms of an aneurism

The

without change of colour,free fr'om pain,of a spongy

largersize,
and
softness,disappearingupon the pressure with the fingers,
returningagain when
they are removed; this last symptom

from dilatation. But

characteristic of aneurism
beingparticularly
when

it arises from

the blood becomes

wound

coagulated. With

he declares that aneurisms

be interfered with
the

he directs

arm

us

to

the treatment,

regardto
and

in the neck

head

ought not

to

of

the disease arises at the bend

but when

equallysoft,as

is not

the tumour

proceedin

the first placehaving marked

the

armpitto the fore-arm,we are

four fingers'
breadth below
or

the

In

followingmanner.
of the

course

to make

artery from the

three
simple incision,

armpit along the inside of

the arm, Avhere the artery is most
superficial
; and having laid
the surroundingparts,to seize
it bare and separated it from
the artery with a blunt hook
and bind it with
two
ligatm'es
;
the

after which

it is to be divided between

filled with

fine

frankincense,and

bound

it.

The

be

over

them, and

opened without

Avouud

pledgetof

suitable

swellingat the bend of

any fear of hemorrhage.

the

the

arm

then

may

the

When

hut

coagula

the arter}^
from which the blood was
away
dischargedis to be seized with a hook, secured and divided

have

been

cleared

like the former

after which

is to be filledwith fine

the wound

and suppuration
frankincense,
promoted, (xv,10,)
Albucasis treats of aneurism
in the followingterms.
an
artery is dinded, and the skin heals over it,a tumour
is the

happens from

consequence,
the wound
of

and
a

the

vein.

thing

same

of

Aneurism

When
quently
fre-

sometimes

arteryis

an

characterized

in the situation of an
by a deep-seatedtumoiu'
when pressed
artery,the swellingsubsiding
upon by the fingers,
and being attended
with a hissingsound.
When
it arises from
the Avound of a vein it is round
and exposed. He
adds, to
if seated in the armpits,
groins,
open such tumours, especially
and
from

neck

would

be

fatal mistake.

dilatation of the artery,we are

and
having dissected a^ay

parts,to pass below it

to make

the
needle

arises

the aneurism

When

cision,
inlongitudinal

artery from
armed

with

the
a

rounding
sur-

double

ANEURISM.

xxxvii.]

SECT,

and
tliread,

to tie the

threads

313

iu

placesas recommended
Comm.
in angiology. The
is then to
part between the two ligatures
be divided and the blood evacuated.
Suppurativeapplications
then to be made^ until the ligatures
fall out ; after which
are
suitable ointments
to be applied. If the disease arise from
are
the openingof a vein,we are to grasp as much
of the
as
possible
in
the
tumour
hand, to push a needle through it armed with
double thread,when
the aneurism
is to be firmly
a
bound with
the threads in the manner
described in the operationfor staphyloma.
When
out
danger is apprehended from the falling
two

"

"

of the

threads,we

another

thread

by

to introduce

are

under

the whole

the first needle,and

aneurism

is then

like

letter X.

another

needle

armed

with

at the

tumour

to tie the threads

opening made
four places. The

in

to be cut in its

ated,
middle,and its contents evacuwhen
the superfluous
skin is to be removed, and a compress
and oil applied. (Chirurg.
dippedin mne
ii,49.) The
threads which he speaksof are meant
to decussate one
another

the

This

is somewhat
pai-tof his description

obscure.
We

need

exactlythe

remark
scarcely
same

as

Ilhases borrows

our

that the

operationof

Albucasis

is

author^s.

his account

of aneurism

from

and
Antj'llus
Paulus.
The operation
of Antyllusconsisted of tyingthe artery
above and below the tumour, and then evacuating
its contents,
in the hams,
7.) He states that when the disease occurs
(xiii,
with it,but that
groins,or neck, it is dangerousto meddle
when
seated in the extremities it is easily
cured.
All the cases
in which
he had
known
the arteryto be opened duringthe
performanceof venesection had terminated in aneurism, except
in which a cure
effected by compression. (Cont.xxviii.)
one
was
Haly Abbas directs us when an artery has been Avounded in
the parts about it,and havingapplied
to dissect away
lileeding,
a

silk thread

each

on

in the middle.
a

plan of

When

side of the
an

aneurism

wound,
takes

to diAdde

placehe

similar to that recommended

treatment

the

artery

recommends

by Albucasis.

(Pract.ix,45.)
Avicenna

Alsahara\dus

and

Alsaharavius

directs

bleedingat the

us

to

w^hen

do not
an

describe

artery has

attempt a cure by means

and tightbandages.(Pract.xxix,11.)
arm,

the

been

operation.
opened in

of compresses

"

'

'

BRONCHOCELE.

314

vi.

perceivedfrom the foregoingaccount of the practice recommended

by Aetius^ that the ancient surgeons were
of the
aware
advantages of securing the artery above the
John
of the aneurism, as practisedby the late Mr.
seat
had recourse
to two ligatm-es
Hunter, and that they actually
directed by Mr.
in the manner
Abernethy; but that they
and evacuated its contents,not
afterwards opened the tumour
to trust to the absorbent
having yet learned from experience
It will be

CoMM.
'

[book

'
"

of the

powers

inguinalanem-isms

and
axillary,
as

incurable

; so

of

ha\ing so

far

abandoned
boast

and

Greeks

It will likewise

system.

that modern

surgery
the

improved upon

aneui'ism

(Hist, de

la

the
Vigo was
by compresses

of
practice

the

Med.

and

conceived

the idea of

styptics.This,however,

accident which

after the

him,
curing

to

is not

above, Galen, Rhases, and

compresses and bandages to prevent

recommended

Alsaharavius

According

xviii,
3=)

first who

operationfor

the

mentioned

exactlytrue, for, as
aneurism

edly
undoubt-

Arabians.

aneurism.
de

may

rotid,
ca-

times

in ancient

were

historyof
Sprengel givesan interesting
John

that

be remarked

commonly givesrise

most

to it.

large round
there

matical.

are

The

it is

which

The

abandon

dangerousto

described

meddle

with, as

the

other

is the

to the

symptoms
aneurisms
most

case

of

cially
espe-

size of the arteries.

we

The

by Celsus.

but
by caustics,

of

judge of from
hopeless,like all
we

described for strumse,

we

'

"

the inner

neck, owing
in general,
operateupon like steatomes
manner
avoidingthe vessels,in the same

steatomatous

Commentary.

CoMM.
"

as

of the

and
distinguishing
as

from

the neck

appellationof bronchocele, of
and the aneuristhe steatomatous
varieties,

two

with those

on

the

aneurismatical

aneurism, and

BRONCHOCELE.

forms

tumour

it obtains

parts,whence
which

ON

XXXVIII.

SECT.

cure.

surgicaloperationfor

bronchocele

is

He

be evacuated
says that its contents
may
that the knife is a more
expeditious
process

For this purpose

he dii'ectsus

to make

singleinci-

SECT,

GANGLION.

XXXIX.]

sion doAvn to the

cyst,and

to dissect it from

When
parts with the jfingers.
recommends

us

Aetius
chocele

and

The

its

the

surroundingComm.

be

cyst cannot

removed

he

"^"^

"

'

destroyit with caustic medicines, (vii,

13.)
Albucasis gi^^e
t
he
of
account
bronexactly same
to

author.

our

as

315

alludes to the

Juvenal

prevalenceof bronchocele
the peopleat the foot of the Alps. (Sat.xiii,
among
162.)
of the water,
Pliny attributes it to the corruption
{xi,37.)
Rolandus_,Guy of Cauliac,and other of the earlier modern
poet

authorities, direct
cross

us

to

blow

tumour

bv

of two

means

setons.

SECT.

the

remove

ganglionis

XXXIX.

round

GANGLION.

ON

of

tumour

violent

from
tendon, arising

most
about
exercise,
being
frequently
and.
the partsabout a jointwhich are much
wi"ists,
ankles,
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
pressedupon it has a dull feeling.
It is not deep-seated,
but takes its originunder
the skin,and
or

formed

the

moved

be

may

forwards
arms,

backwards.

or

and

forehead

and

Those

the

part be

we

operate upon

if the

by

cannot

extremities it is not

danger lest
or

but
laterally,

then

which

safe to cut

mutilated.

means

any

But

form

in the

legs,

out, for there

those

is

about the head

by dividingthe skin
be small, seizingthem
But
out by the roots.

tumours

be forced

with

pel,
scal-

with

flesh

if they are
forcepsand cuttingthem
transfix them
with hooks, and remove
them
secting
we
larger,
by disthem
from the skin,and unitingthe lipswith sutui'es,
to fresh wounds.
completethe cure by the treatment
applicable

Commentary.

Book, and

We

mentioned

have
the

treated

of

ganglionin

the Fourth

Comm.
'

principalauthorities on the subject.

Hippocratesand most of the others forbid gangliato be opened.
the head, to Avhiclilikewise he applies
The hard tumour
the
on
described by our
safelybe removed in the manner
name,
may
Albucasis repeatshis directions. (Chirurg.
author.
ii,50.)
Abbas
recommends
discutients at first,
and if these
Haly

'
"^

VENESECTION.

316

'
'

the desired

have not

CoMM.
'

hard

body

so

as

effect we

to break

its

[book
to strike the tumour

are

strikingthe tumour
lead on it,and excision.

pieceof

bindinga
practisedhe

directs

it.

SECT.

with

When

not

painsto extirpatethe cyst or

(Cont.xxviii.)

XL.

ON

for the sake

be overlooked

is the evacuation

by
of

VENESECTION.

The

first objectthen

fulness

that fulness of blood is of

of blood.

twofold

known

to

be
may
it must
distinctions,

of its technical

us.
a

hammer,

excision is

Although the mode of performingvenesection be

everybody,yet, in order that no part of surgery
omitted,and

to take

us

surrounds

tunic which

with

cyst, (ix,10.)

recommends

Rhases

vi.

in venesection

It has

been

shown

with regard
first,
in which
to the strength,
althoughthe veins do not appear full,
those affected soon
become
weak
and
case
enervated,nature
it were, the load; and second,
not being able to support, as
with regardto the containing
is seen
in the parenas
vessels,
chymatous
a

parts,in which
able to

nature

although the strengthseems

case,

support the fulness without

burst,and

of
spitting

stress,the vessels

blood

times
some-

other

discharge
takes place. Plethora then as
regards the strengthmay be
ascertained from the heaviness upon
the body ; and plethora
of the veins from their distension and
from
their appearing
full.

In

both

evacuation

cases

if

or

is

some

indicated;and, therefore,

bleed

the first
on
necessity
require,you
disease,waiting only for the digestionof the
thereof
stomach, or the complete sanguification
But

to in

must

if

on

has not

venesection

account

any

been

attack

food
in
had

of the
in

the

the

liver.

recourse

the

beginning,and has been postponed until after the

seventh
day,there will be no improprietyof bleeding even
then
when
necessity
requiresit,and the strength does not
coutra-indicate.
to ascertain

the

But

that there

and,
intestines,

evacuated
suck

by

an

in the

when
be

not

if there

emollient

about
a

to let blood

great

be, the bowels

lest
clyster,

putridmatter

it is necessary
obstruction of faeces in

the

ought

be

tines
veins of the intes-

of the excrements.

the abstraction of blood from

first to

the presence

Those

quiring
re-

of a disease

we

VENESECTION.

XL.]

SECT.

bleed

may

at

Those

who

must

be

not

seventieth
And
whose

as

practisedbefore

the

make

the evacuation

from

the

body,but

In

from

for the

regard to

after the

bleedingthose

the

oppositeparts,but

must

we

in

that in

generalthe arterylies

chronic

below

inner

vein called the alar ; that below the middle

one
there is a nerve
the
called
whereas
also
the
;
upper one,
is free from

all risk.

humeral, but in

those

is

both

in
applicable
around

In

diseases of the

below

the

muscular

some

another

upon
divide
one

its breadth

for

it

largerincisions

those which

head
alar.
must

we

part of the

fulness of the vein, we

"

neck, the

Wherefore

cases.

friction of the hands

whilst

persons

inflammations

recent

us.

adjoining.We abstract blood from many parts of the

from the inner part of the elbow.
more
But
especially

it is to be recollected

band

bleeding

age,

fourteenth,nor

avoid

must

strengthis reduced.

fever,
operation.

urgent necessitycompel

some

we

continual

blood,not from the presence

will find the spring
preventive,

With

year,
the whole

of particular

acme

of

of the year.

unless

upon

if it be

evacnation

but
disease,

the fittestseason

But

the fittest season

means

requirethe

of any

avoidingonly the

any season^
in fevers.

paroxysms
morning is by all

the

31 7

(median)
humeral,

the
open
The
median

we

tie
and

arm,

the

narrow

havingby

producedthe necessary

but only along

transversel}^

than

this

are

difficultto

heal,

occasion
inflammations
very narrow
by
t
he
the
thicker
fluids.
of
When
we
obstructing passage
expect
to have to abstract blood again on the second,third,
and sometimes
are

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.
be determined
The quantityof the evacuation must
by the
of
and
the
magnitude of the disease.
strength the patient
there is a humeral
and the matter
When, therefore,
plethora,
is in

state

of

patientdoes

not

to

inflammation,we are to make our evacuations

deliquium animi, providedthe strength be firm,and the
a

stomach.

swoon

Wherefore

deliquiumanimi

before

from
many
a

an

overflow of the humour

at

the

sufficient evacuation

the deliquium
must
and, therefore,

of the evacuation.
and

the

commencement

be

If there is

strengthis weak,

we

upon the
fall into

has taken

place,

sure
judged of from the meafor much
ation,
evacunecessity

must

husband

the

evacua-

VENESECTION.

318

[book

vi.

tion^and making the firstabstraction in small quantity,bleed

have recourse
to
a third time, if required. We
again,or even
the body is in a plethoric
general evacuation not only when
of the magnitude of the
account
state (as Galen says),but on
the general system is in a moderate
state with
when
affection,
regard to the humours, as we do also in hemorrhage from the
nose
or
elsewhere,when
althoughthe dischargedo not proceed
in
order
bleed
from
the oppositeparts
from plethora,
we
also in violent inflammations,as
to produce revulsion ; and
so
in colics and affections of the kidneysfrom calculi,
ophthalmies,
and

other such

pain of
cases

parts occasion

the inflamed
the

general system
bleed

must

we

m-gent attacks

and

acute

defluxion

heat

to the
particularly

In such
superfluities.

be free from

and

age

and

though
it, al-

upon

the
proportioning
sparingly,

more

taking into

for the

of the

constitution

the season,

ation
evacu-

patient,

country,and habits

of

and

also

the

When
affected.
there is a strong inflammation
person
and hepatitis,
is opened, as in pleui-isy
the vein which
it

near

will be most
and

account

to wait

proper

and

mddier

ifit was

brighter
; or

powers,

reasons,

which

pulse (foryou

either from

you may
will find

in every case
before this takes

it either

unequal

and
contra-iudicate,
mild.

But

if the

change takes

of the

none

as

to

strengthand

of the blood
from

it will not
if

sunk

patient^s
by feelingthe

the

also
failing
mahgnity of

remit,but

of these

the

striction
con-

circumstances

be in the vigom'of age, we may

patient
if the atmospherebe
place,especially

if the flow of blood

has taken
and

for sometimes

strong. But

continues

wait until

stream

strengthis sunk), or

indicates that the

the infiammation

have

to

the
magnitude,or indistinct,

not

the weakness

ascertain

the

before,it turns

such

Yet we
must
being over-heated.
the change,but sometimes
give over

place;for two

colour

formerlycrude,

was

black from
wait for

in

is different from

heated,if it
natm-al,since being excessively
itbecomes

blood

the

change of

in inflammation

Blood

consistence.

the

stop before

place (thishappens from

sufiicient

tion
evacua-

fear,deliquiumanimi,

tightan appHcationof the bandage),we

attend to each of these causes, rousing from
must
deliquium
with strong-scented things,
slackeningthe bandage when too
tight,and a coagulum may be dissolved by pouringin oil,or
by rubbing it with the fingers. The rest of the apparatus for
coagulum, or

too

VENESECTION.

320

CoMM.
'"

'
"

"

[book vi.

old men,
and pregnant women
that cliilclren,
might
discovery
be safely
bled,the operation
having been anciently
proscribed
the authority
of Celsus,
in all these cases.
Yet, notwithstanding
the prejudice
to
againstbleedingyoung and old persons seems
have
for it will be perceived,that our
prevailed,
generall}^
author,copyingfrom Galen, forbids persons to be bled before

seventy, except in urgent

after

fourteen and

that his

mentions

Averrhoes

However,

cases.

Avenzoar

countryman

had

bled

relates
; and
years old with great success
certain persons who had been bled
further that he had known
directs us to judge of a
at the age of eighty. Celsus properly
a

only three

child

is

that there
between

lean

blood,and

fat most

therefore,who

When

strength,and

age.

(See also

Arist. H. A.

iii,
19.) Those,

best,and the corpulent

depletion
of the body,therefore,
is to be
strength

the veins rather

the

also

lean bear

it. The

from

estimated

flesh.

are

from

suffer most

advanced

or

He

his

acutelyremarks
difierence between
a fat,and
a strong body and
and a weak ; for that a lean body contains most

his tender

from

not

from

venesection

endure

to
ability
patient's

than

the

generalappearance.
disease indicates evacuation,

of the

nature

from

strengthappears ill fitted to bear it,he advises us first

to givewarning of the danger,and then to abstract blood ; for,
satins est remedium
he adds,
nullum.'"
anceps experiri
quam
In generalhe forbids venesection
when
the stomach
is loaded
with impm'ities
all the ancient
this rule of practice
; and upon
we
ample
believe,
authorities,
Thus, to givean exagree with him.
from the Arabians,Averrhoes
famous
physician,
says, our
and the

"

Abumeron
had

Avenzoar,

states

to until the

recourse

emptied of

blood

body

practiceis

Celsus

that the second

fittest time
the very
man
as

onset

is

of

may

little attended

or

thii'd

fever,which
whole
affected

sometimes

ought

not

to be

for the veins being

pui^ged,
superfluities.
(CoUig.vii,1.)

He

blood.
abstracting
the

venesection

too

now

outright. Upon
to the
as
near
possible

that
The

for

venesection

the crude

attract

This rule of
holds

that

he
he

day

of

In

disease

general
is the

forbids

says

is

approves
part. He

act

to.

bleedingupon
enough to kill a
of letting
blood
admits,however,

by producingrevulsion.

operation,he remarks, althougheasy to a skilful person

performed by an unskilful one, as
may
prove dangerouswhen
the arm
after
In securing
a nerve
or
arterymay be wounded.

VENESECTION.

XL.]

SECT.

he directs us
tlie operation
soaked

in cold water,

Galen
he

was

very

Erasistratum

to bind

partial.They

de curatione per
of great attention as

those of

in

to which
venesection,
are

De

venae

venesectione

These

works

He

more

deserving

are

he mentions

pint,the

abstract of them.

nearly the

to have

appears

taken away in the course

of a
in a case
of haemoptysis.Now
half

observations and
judicious
delivered at so great length

great quantities.Thus

than

in Roma

containing
many

author.

our

tion
opera-

adversus

Erasistrateos

but which
are
practice,
venture
we
even
can
scarcely
upon an
of treatment, however, are
principles

His

Comm.

compress

fever,and
the

same

abstracted blood

haAdng

seen

six heminse

hemina

being

six lib.
at

once

somewhat

quantityabstracted must

have

ceeded
ex-

three

inculcates that venesection

pints.He strenuously
revulsion,and as a proofof this
proves useful by occasioning
he instances the beneficial effects producedby opening a vein
of the arm
in cases
of epistaxis.He
practisedbloodletting
in cases
of dropsy,as we
have mentioned
under
occasionally
that head.
he thinks prejudicial
in
Bleedingfrom the arm
of

cases

it

amenorrhcEa,as

the

of

causes

determination

the

better than such

persons bear depletion
venesection is not to be performedwhen
in the stomach.

heat

cold do not

or

from

the

artery, that

He

bear

states

directs

us

with Celsus that lean

as

fat j and

are

there

are

that

undigested

in extreme
persons
mentions
that in bleeding

bleeding.He
there

is

lies

under

the

nerve

to

that

basilic vein

of blood

he
therefore,

body, and,
parts
upper
rather to bleed at the ankle.
He agrees

matters

danger

of

wounding
but

median;

that

the

the

opened without danger.

Oribasius gives an
dissertation on
interesting
venesection,
of Herodotus,Antyllus,
condensed from the works
principally
and
Galen. (Med. Collect, vii.) Antyllus directs us when
two fingers
going to bleed at the elbow to applya ligature
broad round the arm, so as to producea swelling
of the veins ;
and remarks
that they are mistaken
who
affirm that the same
efi'ectmay be producedby applying
the ligature
below,for that
cephalic
may

be

the veins will not

When
II.

going to

then

swell,even

bleed at the

'
'

sectionem.

rules of
that

'

de venesectione adversus

and

as

the wound

on

10.)
(ii^

three treatises on

wrote

321

when

ankle he

the

is fomented.

arm

directs

us

to

applythe

31

322

CoMM.

VENESECTION.

aljove the
ligature

knee

to

put

[book vi.

tlie limb

the person walk about.

When
he ad\dses us to slacken the
readily,

the blood

make

openingin

the

into hot

water^ and

does not

bandage if too tight;

the vein be covered with

the

skin,to

flow
or

if

the

turn

until the opening of the vein and of the

positions
When
skin correspond
; and if it be too small,to enlargeit.
he
fear retards the flow of the blood it will be of advantage,
of it. When
to hear the sound
says, not to allow the patient
it stops from deliquiumanimi he ad^dses us to lay the patient
in a recHningposture on a couch ; to promote vomiting,and to
and by aromatics.
to the extremities,
rouse
by tightligatures
into all

arm

clot of blood obstructs the vein he directs us

When

it out,

or

to dissolve it with

whether

body, occasioned

the

of the

the nature

oil

by

the

and

frictions.

coldness

of

temperature of the air,or

disease,
prevents the

fomentations

When

vinegar.

or

to squeeze

flow of

When

blood,he

mends
recom-

piece of

fat

or

up the opening of the vein, he says there is no

the obfor it but to cut it out or push it aside. When
ject

flesh blocks

remedy

is to

sudden

produce a

largeincision in the

vein,but

small

one

us

when

to

make

it is intended

re\Tilsion.

to procure

According

Freind

to Drs.

who
is the first authority
far

jugulars.As

Aetius's account
less

directs

he
depletion

as

and

Milward, Alexander

recommends
know

we

of this

Trallian

bleedingby openingthe

this statement

subjectis similar

is correct.
to

but
author's,

our

10.)
copious,(iii,
in like

Actuarius

which
venesection,
reader.

He

our

manner

limits

has many

judiciousremarks
prevent us from giving to

forbids venesection

increased,and

when

any

natural

on

the

secretion

is

this is in

generala very proper rule,although,

and Avicenna
Galen
remark, profusesweatingsare someas
times
remedied by bleeding. Bloodletting,
he says, is contraindicated 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
Avenzoar

have

We

Ai'abians.

mentioned, however, that

approvedof venesection

of lifethan
Avicenna

the

Greeks

with

importancewhich

his

had

at

Averrhoes

later and

and

earlier period

permittedit.
customary accuracy collects everythingof
been
previously

written

on

the

subject.

VENESECTION.

LX.]

SECT.

323

hardlyany addition to the ancient stock of infor- Comm.

We
venture upon an abstract of his immation.
can
scarcely
portant chapteron phlebotomy. We may justmention that as
rule he approves of bleedingafter any accident. He
a general
disapprovesof bleedingboth at the onset and the crisis of
he holds
In constitutions requiringbloodletting
disease.
a
in which
for it. Even in cases
that springis the best season
in some
there is a deficiency
of bloodybut there is congestion
in order to
particular
part,he permitsblood to be abstracted,
wards
the patient's
strengthbeing recruited afterproducerevulsion,
the colour of the blood is
by a nourishingdiet. When
is to be
amount
a larger
dark, and it is thick in consistence,
makes

but

'

'

abstracted than when

the

it is thin and of

and

He

food

or

fat obstructs

pushed aside,but

not

author, ancient

No

lightcolour.

He

makes

kindles up a
bleedingsometimes
forbids the bath immediatelybefore the operation,
of
When
exercise immediatelyafterwards.
a piece
the flow of blood,he directs that it should be gently

importantremark,

fever.

performingvenesection

that

cut
or

(i,4, 20.)
modern, has described the modes

out.

in all

parts of the body more

of

accurately

jugularvein he describes
in much
the same
practised
by veterinary
way that it is now
benr at the point,
a sort of scalpel,
sm-geons, namely,by placing
the instrument
which he calls fossorium,
upon the vein,and striking
such body. He givesdrawings
Avith a hammer, or some
of variously-shaped
lancets for opening the veins of the arm.
ii,97.)
(Chirurg.
The
reader is also referred to Haly Abbas for a copiousaccount
and the cii'cumstances under which it
of the operation,
he says, when
the
be performed. It is contra-indicated,
may
Albucasis.

than

the

it to be formed
perbe
after seventyyears of age, providedthe patient
even
vigorousconstitution. (Pract.ix,2.)

bowels

of

Bleeding from

are

loaded with vitiated faeces. He

allows

Hhases, with admirable judgment,condenses

tion
all the informa-

and mixes it up with his

by precedingauthorities,
supplied
diately
own
personalobservations. He forbids us to givefood immeafter bleeding,
as the empty veins will absorb the chyle
which
will prove a pabulum of
before it is properly
digested,

disease. For the

when

same

the stomach

ing
he, like the others,forbids bleedlest they should
is loaded with crudities,

reason,

'

CUPPING.

324

be

CoMM.
'"

"

"

absorbed,and carried

'

lie directs

menses

to the

instrument
of
an

the

the disease is

When

ankle.

inflammation^ he recommends

oppositepart,

revulsion

acute

attack

from
fully

but when
the

it from

to take

advises

he
affection,

clrronic

an

to abstract blood

us

to procure

as

so

vi.

system. In retention of the

saphena,or to applya cupping

the

over

to open

us

[BOOK

it is

part affected.

in bleeding
prudentprecaution
who is intoxicated,to apply two bandages about the
a person
attendants to restrain the bleeding,
and to have proper
arm,
cases.
which
is often difiicult to stop in such
(Ad Mansor.
He enjoins,
as
xx^dii.)
(Coutin.

vii,21.)

veterinary
surgeons

The

diseases of

of the

in the treatment
bleedingfreely
practised
cattle.
Vegetius,the great authority

bled their cattle

that many
mentions
persons
subject,
He adds,however, that the ancient
every year, in the spring.
and
more
prudent authorities disapprovedof indiscriminate
depletion.(Mulom. i,22.)

on

this

XLI.

SECT.

We

not

must

have

ON

CUPPING.

ment
cupping at the commencestate,
body is in a plethoric

to

recourse

the
when
nor
complaints,
the generalsystem has been evacuated, and when
but when
defluxion any longer to the part, and especially
there is no
mining
and deterof removing, dislodging,
there is a necessity
when
something outwardly. Dry cupping then dissipates
of

flatulence,stops defluxions

to the

part,and stopsit again,when

stomach,

determined

attracts

to

blood to

part,if applied

oppositeparts; and it also occasions a translation from

and on the whole produces
the deep-seated
parts to the surface,
evacuation of the spirits.
metastasis of the fluids,and an
a
But
cupping with scarifications facilitates the evacuation of
it manifestly
the ofi'ending
bringsfrom the deepcauses, which
seated parts; for it produces the dischargenot only of blood
if appliedwith much
but of the other humom*s, and especially

to the

heat.
are

if

And

we
fleshy,

instrument
recourse

to

we

wish

must

but

first

if the

the abstraction from

to make

apply the cupping

first have
must
we
fleshy,
swelled
the parts becomes

scarifyand

part is

dry cupping,and

not

when

parts that

then

XLi.]

SECT.

CUPPINa.

and
scarify
up, we
wish to make
but
but
incision,

one

if

applythe cupping instrument

small

if we

the

have devised

by

equal lancets together,so

three incisions,
but
a

simple lancet.

glass,in
be

may

order

seen

we

wish

to

must

be

Others

that the

we

And

thinner

sistence
con-

if of

evacuate

coagulated
regulatedas to the
Some

for this purpose,

by joiningthree
that by one
it may
application
duce
proconsider

we

have

it

used

to

inconvenient,and

cupping

quantityof

as
attraction,
being able

those

we

but those made

is of

the thickness of the skin above.

instrument

an

blood

If

several.

but
superficial
scarifications,

thicker,deep-seated.When
blood, occasioned by a blow,

depthof the incisions

make

must

we

again.

be satisfiedwith

must

we

contained

will make

we

evacuation

wish much

apprehendthat

we

325

blood

of copper

endure

instruments

which

have

use

of

is evacuated

more

powerful

stronger fire,whereas

of

But
such as draw out the
glassare apt to break.
blood by suckingwith the mouth
through horns,evacuate less,
but do not dry,like those appliedwith fire. If
necessary,
when
about
the
to apply
we
are
cupping instrument,having

placed the limb

for if
upon

erect

an

apply the lamp

we

the

whereas

in

skin

there

with
is

the

fasten it to the

posture,we

above

when

flame

burns

side

lying,the wick falling

in a painfulmanner,

for this.
Sometimes
the size
necessity
of the instrument
is proportioned
to the
part on which it is
that account
there is a great variety
of cupon
applied
; and
ping
instruments
with regard to smallness and greatness of
size.
For the same
those which
made
with longer
are
reason,
necks and broader bellies are possessed
of a stronger power of
We
avoid applyingthe cupping instrument
attraction.
must
the breasts,
for sometimes
near
they fall into it,and swelling
render the removal
and
in that case
difficult,
greatly,
sponges
out of hot water
the cupping instrument,
to be appliedround
are
which

fall off

we

make

must

no

it relax.

On

this mode

its determination,the
altering
full of information
It appears

if

with

even

this it do not

it.
perforate

Commentary.

so

But

that

that

the

our

of

blood, and
abstracting

records

of ancient

of

surgery are
lies in selection.
only difficulty

father of

medicine

practised
cupping.(De Articulis,
49,

and

and

his

de Medico,

successors

6.)

Comm.

32(i

CUPPING.

Celsus mentions

CoMM.

being made
were
a

of
at

open

t\YO kinds

horn,and
end and

one

largeropeningat

of cloth
mouth

was

set

then

was

and

fire and

on

of

tlie one
cuppinginstruments^

the otli"5rof copper.

Those of copper
shut at tlie other.
Those of horn had

end

one

[book vi.

smaller at the other.

thrown

fitted to the

into the copper

body and pressedon

piece

and

one^

its

until it fastened.

In

applyingthe one made of horn,the air was exhausted

by suckingat the smaller end, which was then covered up with
wax,

and

in this state it would

fasten to the

part. He

remarks

that when

is applied
the part to which the instrument
had been
blood is discharged,
but otherwise nothing
previouslyscarified,

but

spirits.He

instrument

is to

constitution
a

safer but

th.at the

states
remove

use
principal

local affection

any

of the

when

the

cupping
general

is sound.
less

Upon the whole, he considers it to be

efiicacious remedy than venesection.
Cupping,

he adds, is to be had

to

recourse

in chronic

in
diseases,

order

corruptedmatter which may be seated in a part ;

and in acute, when the strengthwill not allow of venesection,
(ii,
11.)
According to Galen, cupping is useful after evacuation,but
when
there is plethora. In inflammation
does not answer
of
he forbids cupping at
the brain and its membranes, therefore,
to

remove

any

and

the commencement,
until the defluxion is
; and

evacuated
is to

In
to the

move

stoppedand the

states

and

also in inflammation

that

the

determine

he
general,

but
part aflected,

advises
to

the

of other

parts,

has been

generalsystem
eases
objectof cuppingin such disthe inflammatory
wards.
outparticles
not
to
us
applythe instrument
adjacentpart,with the view of

wise
producing revulsion,de hirud. revids. cucurb.,"c. He likeof leeches.
He recommends
account
givesan interesting
it is wished to abstract much
their tails to be clippedoff when
of a few leeches. (Ibid.)
blood by means
Oribasius is the ancient author who discusses this subject
at
indebted.
the greatestlength,and to him Paulus is principally
that cuppinginstruments
made
of glass,
He mentions
are
horn,
Those
of silver,
he says, are to be rejected;
those
or
copper.
best
of copper are in most
generaluse ; those of glassanswer
when
wish to see the quantityof blood that flows into the
we
instrument ; and those of horn are to be appliedto the head

because

copper

ones

are

diflicidtto

remove

and

timid
besides,

and
mies^ cynanclie,

CoMM.

in

ARMPIT.

THE

BURNING

323

[book vi.
for amenorrhoea,

manner
especial

an

'

'
"

when

it is

The

the breasts.

appliedto

Avicenna
subject,
especially

this

of them

Arabians, although some

other

Rhases

information.

fullyof

treat

ditional
Rhases, yet givelittlead-

and

speaksof apphdng a glassor a

off the blood after leeching. He

cuppinginstrument to draw
Before
givesa full account of the different kinds of leeches.
the part with blood and
applyingthem, some, he says, smear
off he
When
with milk.
some
they are too long of falling
He recommends
salt upon their mouths.
directs us to sprinkle
herbs. (Cont.
them
to be kept in a vessel containingwater
blood after the
it is wished to abstract more
xxviii.)When
leeches have
with

fallen

hot water, to

W^hen,

recommends

Avicenna

to the
us

part.

applya

to

For

XLll.

In dislocation at the

either

the

this purpose

head

to

deprivedof

BURNING

ON

jointof

of the

arm

the

likewise directs

Albucasis

their skins.

THE

ARMPIT.

shoulder,it sometimes

falls out

over

and

over

happens
again,

humidity,or because
prevalenceof too much
In this case
is paved to it by its frequentoccurrence.
have
to burning. Wherefore, the patient
recourse

from

the Avay
then
we

to

us

of beans

mass

SECT.

that

stop the discharge,

gents,
apply galls,lime, or other astrin-

contrary, it is wished

the

on

off,Albucasis directs us to foment the part

to it.
rub it,and applya cuppinginstrument

the

back, or on the sound side,the skin at the

inner part of the armpit, where
the dislocation mostly takes
two
place,is to be stretched between
fingersof the left hand,
of a slender
with hooks, and burnt with heated cauteries,
or
and oblongshape,until the cautery, being pushed through to
the other side,occasion the formation
of two eschars at one

being laid

on

his

application.And
havingpassedthe
another

eschar
the

reach

if the distance between

head

not

burn

is considerable,

specillumthrough them,

we

the middle

on

each

side of the middle

one

at the

We
they,so as to form a quadrangularfigui'e.
and
deeperthan the skin,because nerves, glands,

as

make

tery
by burning down until the causpecillum. And Hippocrateswishes two other

in

eschars to be formed
distance

of

them

same

must

other

PRETERNATURAL

XLiii.]

SECT.

substances, which

The

treatment

be

may

pounded

Afterwards

of eschars.

329

inflammation

to

treatment

appliedwith

of leeks

means

give rise

may

lie below.

the

FINGERS.

turbance,
dis-

conducted

salts,and
we

and

mav

the

by

rest

of

the hand

use

cautiously.
Hippocratcs(as stated by our author)re- Comm.
the recurrence
for preventing
of discommends
this operation
location at the shoulder-joint
: it is minutelydescribed
by him.
(De Artie, xi.) Albucasis describes the operation,but it will
of it. (Chirurg.
be readily
understood from our author^s account
i. 27.) It is described in Hke manner
by Haly Abbas. (Pract.
ix. 73.)
CoMMExTARY.

'

"

XLIII.

SECT.

PRETERNATURAL

ON

HAVING

SIX

the hand

fingersare formed in
near
thumbs, and sometimes

the

ON

PERSONS

FINGERS.

Preternatural
near

AND

FINGERS,

the

sometimes

little finger,
but

Of preternatural
fingers,
rarelybeside any of the others.
and
others have bones in them, and
some
are
whollyfleshy,
sometimes
bones,
they have likewise nails. Of those ha^-ing
from
theii*
lation
articuderive
a
common
some
a joint,
ha^^ng
origin
arise from the phalanx,
with some
other finger
and
some
;

Now

motion.
for

we

But
is

on
more

The

motion.

no

the

excision

others

sometimes

of those which

are

fleshy is

have
easy,

fingerall through.
scalpelthe preternatural
those which have their originfrom a jointthe attempt
arise from the phalanx we
difficult. Of those which

cut

with

first cut

must
to

have

these

and

the bone

remove

it

the

away

itself we

either

by salving;

cicatrize them

as

flesh

and

mentioned

all around

to

the bone, and

chop it through with

in

by

the
us

treatment

with

we

regardto

as

or
chisel,

scrape

and

the wounds

of bones.

Commentary.

(Cant,i,2,)allude
our

Galen
the

(de Difi*.Morb.

4,) and

Avicenna

growth of fingers.
preternatiu'al
terms
as
Haly Abbas describes the operationin the same
author. (Pract.
ix,39.) Rhases repeats our autlior^s deto

Comm.

'

EMPYEMA.

330

CoMM,
'

'
'

[book vi.

of tlie metliod of treatment, and also mentions that of

scription
Antyllus,which, however, is little or nothing different from

Thus, he directs us first to make

is to be
to the bone, which
the soft parts down
author^s.

our

tinants.

When

he directs

us

between

united,and

to be

the skin is then

part

sawn

treated

across

with

fingergrows
supernumerary
the separationcautiously
; and
contains

or
fingers,

bone,

agglujoint

from

the

to make

two

the

incision of

an

if it grows

forbids it to be

he

amputated.(Cent,xxiv.)
Albucasis's
from

taken

of

account

author.

our

fingersis evidently
preternatural
there is a
ii,91.) When
(Chirurg.

adhesion of two fingersto one

another,he du'ects
preternatural
and introduce a pledgetwetted in
us to divide it with a scalpel,
the oil of roses, or a thin plateof lead between them, until the

partsheal. (Ibid.)

SECT.

XLIV.

The

THE

ON

OPERATION

effectual

most

OF

remedy

BURNING

which

FOR

has been

burning. Wherefore, the parts are

applyingthe root of the long birthwort soaked
is

empyema

eschars,one of which we must

of the clavicles,
having stretched
small

ones

carotids ; two
third and

the

on

each

back,

the

another
one

side of the

and

the chin

not

very

the

at

and

by

in

the

ribs to the

and

two

from

the

back,

the
as

fifth and

the

of the

of the

to

between

the
at

as

junction

mammse,

the mouth

middle

oil,so

remote

another

cautery,heated
the

to be burnt

between

spine,higher up than
Others,
superficial.

knobbed

interstice between

above

for

upwards;

the

others

two

little backwards

behind,

having passeda
the

ribs ;

fourth

of the sternum, and

three

skin

of considerable size below

sixth,inclininga
and

from

little distance

the

discovered

between

make

form

EMPYEMA.

middle

stomach,
and

eschar

Leonidas

two

in the
says,

in the

fire,
through
abscess,have carried

Some
have dared to operate
burning down to the pus.
them
by making a transverse incision,or one a little
upon
obliquelyin the skin,between the fifth and sixth ribs,then
with a knife the membrane
perforating
liningthe ribs,and
thus evacuating the pus ; but they and those who burn with
iron to a considerable depth either occasion immediate
death.

EMPYEMA.

XLiv.]

SECT.

tlie vital

evacuated

spiritbeing

331

witli the

or

pus,

occasion

curable
in-

fistulce.

Galen

Commentary.
the chest

tbe

operation of burning Comm.

Vulg.)
do not
yield to ordinary
cautery to be appliedin this
'

for

phthisis.(De Morb.
phthisicalcomplaints,which

In

manner

One

chin,another

under

the

the

on

throat,two

scapulae. They

is removed,
Aetius

is to be burnt

eschar

with

redhot

each

upon

to be

are

"

'

"

the

recommends

treatment, Celsus
the

mentions

kept

iron under

breast,and
until

open

the

two

cough

(iii,
22.)
directs

to burn

us

the chest

and

neck

much

in the

recommended

by our author, (viii,

73.)
This operationis described by Albucasis,who
ing
givesa drawof an
for performing it expeditiously.
instrument
(Chirurg.
i,26.) See also Rhases (Cont.ix.)
such an
Haly Abbas recommends
operationas that described
He
directs us to do it,not with
by Celsus and our author.
same

manner

as

the

iron,but with

The

(Pract.ix, 74.)

of the

root

use

long birthwort

of the

root

cautery is also mentioned

lochia)as a
narius,by the

way,
has

which
sentence

where

not

seems

led him

to

into

with

of the birthwort

by

have

smeared

Aetius.

been

mistake

(aristo-

3.) Cor(xii,

aware

in

oil.

of

this circumstance,

the
translating

it is mentioned.

practiceof burning the chest in chronic diseases of the

lungs is strongly advocated
by Caillot. (Elemens de Physiologic,
It
tried
Dr.
in
his
was
own
i.)
by
Mudge
person
M.
with
Dr.
Good's
of
(See
Medicine,'
great success.
Study
ii,786.)
Our author, it will be remarked, disapprovesof paracentesis
This
and
thoracis.
described
in
operation is recommended
of the Hippocratictreatises. (De Morbis, i,and ii.) It is
one
in the
also mentioned
Rhases
likewise
Isagoge'of Galen.
it in brief terms.
mentions
(Cont. iv, 3, and x.) Rhases
directs us to open the chest by a small orifice,
that the matter
be
He
mentions
that Galen
mends
recomslowlyevacuated.
may
burning the chest,and also the operationof paracentesis
The

'

'

in such

cases.

CANCER.

332

XLV.

SECT.

[book vi.

ON

CANCER.

swelling,
rough, unseemly, darkish,
ulceration
and sometimes
(which Hippocrates
painful,
called also concealed cancer),and if operatedupon, it becomes
with ulceration,
for it derives its origin
and sometimes
worse,
from black bile,and spreadsby erosion ; forming in most
in the female uterus and
especially
parts of the body,but more
is

Cancer

uneven

an

without

breasts.
the

the veins stretched

It has

crab

(cancer)has

Wherefore,

the

treatment

entlydelivered by
womb

has been

parts and

such

its

are

all sides

feet,whence

of in

Book

the Third.

simplyaltered

the

as

it derives

of it bv medicine

in the Fourth

us

treated
as

on

from

has

; and

But
their

its

been
cancer

animal
name.

sufficiof the

since

putrid

natural

state

in the womb, indeed,it is neither

requireamputation,cancers
nor
expedientto operate upon ; but of those of the
possible
external parts,and
have now
of the breasts,
to
we
especially
Some, then, have consumed
explainthe surgicaltreatment.
the whole redundant
matter
by cauteries ; but others first make
excision of the whole breast,and then burn the place.But
an
Galen approves only of the excision,
writingthus of the operation
If ever
to
:
cure
cancer
an
by
operation,
you attempt
evacuations
the
melancholic
])eginyour
by purging
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
restrain it,but squeeze the surroundingveins so as to
speedily
force out the thick part of the lilood,
and then cure
the wound
"

like other ulcers. ^^

Such

are

the words

malignant and putrid ulcers,such

be treated in the
and the like,must
CoMM,

Commentary.
with

as
same

of Galen.

And

other

phagedtena,gangrene,
manner.

Hippocratesforbids

the surgeon
from interfering
that is to say, with such as have not
that if healed the patient soon
dies,

occult cancers,

ulcerated, remarking
whereas, if let alone,he may

live

long time. (Aph. vi,38.)

remarks
that even
if
Upon this his commentator, Theophilus,
the disease is eradicated by cutting
or
burning,many untoward
symptoms follow,and the strengthof the patientdoes not
stand out. (Ed. Dietz. ii^506.)
a

SECT.

CANCER.

XLV.]

333

truly,the general result Comm.

He
of treatingcancer.
method
of every known
says, some
corrosive applications,
some
burning ii'ons,and others
use
of no avail,
but medicines
the scalpel;
are
cut it out with
moves
burning only exasperatesthe disease,and excision only refor the disease immediatelyreturns,
the part affected,
(v,28.)
Galen's sentiments
are
partlyexplainedby our author. He
states,that the disease is curable only at its commencement.
it has attained any considerable magnitude,he says, it
When
admits of no
operation
; and when
remedy without a surgical
there is danger of hemorrhage,
is cut out all around
the tumour
give rise to the disease
which, if restrained by ligatures,
may
to
in the neighbouring parts,whereas, if cauteries be used
inconsiderable danger may
burn the roots of the vessels no
the \ital parts.
to
result from
their application
near
so
(Therap.ad Glauc. ii; Meth. Med. xiv ; (Isagoge.)
of the
Aetius givesfrom Leonidas the followingdescription
mammae.
Laying the patientin a
operationon cancerous
incision into the mammse
he says, I make
an
supineposition,
above the cancer, and immediatelyapplya cautery until an
another
eschar be producedto stop the bleeding.I then make
and
incision deep into the substance of the mamma,
again
ing
burn the parts, and so proceed first cuttingand then burnin order to restrain the bleeding.In this way
alternately,
there is no
danger of hemorrhage. After the amputationis
completed I againburn the parts until they are quite dry.
and the
for the sake of the bleedings,
The first burnings are
last with the intention of eradicatingthe disease, (xvi,
45.)
in
described in nearly the same
This operation,
words, occurs
Soranus.
(61.) He says, when the disease is scrofulous the
burning may be omitted. (Ibid.)
Celsus

we
describes,

fear but

too

'

"

"

Avicenna

mentions

that

after

the

excision of

cancerous

required. And yet,he adds,

there may
be danger from the burning provided the part
affected be near
(iv,3, 2.)
any vital organ,
incision into a cancerous
Rhases
an
says, that they who make
part merely produce ulceration thereof,unless it be so
and the
removed
seated that the disease can be completely
(Ad Mansor. vii,9.) In another
parts aftei-wards burned.
part the actual cautery may

be

'

"
'

he

work

CoMM.

BREASTS.

MALE

334

himself

expresses

seated in the
the

allow

raammse

until all the

the

evacuated^and says nothing of

ix,13.)
Albucasis

says

he

that

He

never

vi.

excision and

operationwhen

the

extremities.

or

to bleed

part

favorablyof

rather

burning.(Contiu.xiii.)
Haly Abbas approves of

[book

the

cancer

recommends

melancholic

us

humour

is
to

is

cauteryor ligatui-e.
(Pract.

saw

of

case

cured

cancer

and

recentlyformed. He directs
is attempted,
to cut out the tumour
the operation
by
us, when
the roots, and if the hemorrhage from any vein be profuseto
ii,53.)
stop it by the cautery. (Chirurg.
of excision,
Serapion expresses himself rather diffidently
(v,24.)
of scirrhous breast distinct
Soranus
gives a full account
unless

from

the tumour

the

small

was

He

cancerous.

that when

the

whole

chest,the excision

to the

adheres

and

scirrhous

states

breast is

of the sound

to be

attempted; but when

only the extremityof the breast, or only the half of it is
hardened, he approves of amputationwithout burning,there
{66.)
being no danger of bleedingin this case as in cancer.
the

partsfrom

XLVI.

SECT.

As
so

at the

in like

diseased

extent

; but

below

the

MALE

ON

of

season

manner

ought not

THE

FEMALE.

breasts of females swell up,

males
also swell to a certain

pubertythe

those

for the

RESEMBLING

BREASTS

of the

part they subside

again. In some
creasing
incases, however, having acquireda beginning they go on
Wherefore, as
owing to the formation of fat below.
it is proper to
has the reproachof effeminacy,
this deformity
made
incision
a lunated
operate upon it. Having, therefore,
parts by

most

breast,and
sutures.

dissected

But

if,as

away the
in women,

skin,we
the

unite

breast

the

incline

downward, owing perhapsto its magnitude,we make in it two

that
lunated incisions,
so
meeting togetherat the extremities,
and dissecting
smaller may be comprehendedby the larger,
the intermediate
skin,and remo\dng the fat,we use
away
But if,through mistake,we
should
in like manner.
sutures

the

cut

and

away

too

we
little,

applythe remedies

must

again

remove

for fresh wounds.

what

is

redundant,

burn

hooks, we
cautery

so

through by

it

to form

as

there

that

so

tlie skin wliiclilies

stretched

Having

OVER

BURNIXG

ON

XLVIIl.

SECT.

eschars

two

In

bui'ned eschars

"

de Affect.

and

Aetius

over

the

this

spleenwith
long ignited

do three times

we

formed

spleenthe Coan surgeons

de Afiect. intern,
(Hippocr.

the side affected.

on

SPLEEN.

of diseased

cases

'

"

THE

altogether.Eut
trident-shaped
cautery formed

by using a trident or
eschars at one
apphcation.

Commentary.

CoMM.

and

six eschars

be

may

[book vi.

of
application

one

Marcellus
six

STOMACH.

THE

OVER

BURNING

330

5.)

directs

either with the actual

the eschar

to burn

us

cautery or with caustics, (x,12.) The ancients used an issue

paste,very like the modern, preparedfrom potass. See above

15, 1) ; and
Albucasis
Guido

of

process

so

i,32) ;
(Chii-urg.

side in

at the

make

with iron but

bodies
spongy
with
the
use

order that

mouth

CoMM.

time

with

barbarians.
without

by

the

of the stomach

Commentary.

called

They

burning
only one large

others

But

and

of the

fonn

Some

skin.

oaks

course
re-

cauteries,forming
and the other two
cartilage,

substances
on

have

knobbed

of the stomach.

forming

moderns

the depth
triangle,

the

the

stomach

ensiform

of the

eschar at the mouth

STOMACH.

THE

OVER

with

some

"

of

cases

BURNING

burning,

being the thickness

some

of the
description
scirrhous spleen,
(ii,
2.)

burning the

ON

(iii,
(Pract.ix,76);

xx.)
(Contin.

Rhases

repeats Albucasis's

eschars,one
below, so as to

in

and

de Cauliaco

three

for

manner

Greeks

the

as
practice
Haly Abbas

same

chronic defluxions of the

to

"

like

in

XLIX.

In

the

recommends

Avicenna

iscse.

do not

The

burn

iscse are

walnuts,being mostlyin

allow

and
cicatrizing,

the

ulcers

rather

to

I'emain

stimulate them

therebyoccasioned,the
great diaphoresis
may

be freed from

Galen, and
Hippocrates,

the defluxions.

Celsus say

nothing

DROPSIES.

L.]

SECT.

about

is similar

account

in

to burn

ua

affections of it.

author's.

our

He

Aetius^s

calls the

iscee the

Comm.
'
"

"

(vii^
91.) They are
likewise by Haly Abbas^ who
says they are called
the Persian language.(Pract.
ix,77.) Albucasis

mentioned

directs

to

of walnuts,

wood

of the

medullarypart
ducanum

in

the stomach

burning over

337

i^28.)
(Chirurg.

with iron.

L.

SECT.

ON

DROPSIES.

their varieties and

dropsical
swellings,
from one
another,and
they are to be distinguished
causes, how
their treatment
in the Third
by medicine,havingbeen explained
Book, and it havingbeen there shown that ascites alone falls
under
the provinceof surgery, we
are
now
going to givean
make
the
of it. Wherefore
must
account
we
patientstand
The

formation

erect ;

the

be

if that cannot

or

if he be

or

of

then

operation
entirely.If

give orders

must

that this cannot

weak

so

done,we

to the assistants

be

the

done,we
be

man

standingbehind
the swelling
to

push downwards
knife or lancet,if
takinga sharp-pointed
line of
in the perpendicular
the intestines,
hands

three
trium

and

breadth
fingers^
far

as

affected we
or

if the

as

the

peritoneum.

make

must

spleen,on

in that

our

the

it

But

incision

on

right,for

we

to be seated ;

standingerect

we

to press with their

the

the

pubes. Then
dropsyis among

the

navel,and about

divide the

we

abandon

must

if the liver be

hypogasprimarily

the leftside of the navel ;

cision
innot make
must
an

to lie. And
part on which the patientis disposed

havingdissected with
lies over

distance from

him

cause

the

divide the

it,we
until the

instrument

pointof the instrument the skin that

cision
peritoneuma littleabove the first into

comes

an

After

empty space.

throughthe incision of the abdomen and peritoneum

like
those
of
a copper
tube,havingan opening
writingabstract
the
fluid
in
and
this
must
to
we
by
proportion
pens,
and
the strength
the
the
then removing
tube,
pulse,
; feeling
we
(forit will stop immediatelyfrom
stop the flow of the fluid,
the alteration of the incision,)
we
and, for the sake of security,
tliiswe

introduce

introduce

rietes alone
and

twisted tent into the incision of the abdominal

;

recruited
II.

and

havingplacedthe

him, we

may

next

man

in

recumbent

pa-

posture

day againevacuate throughthe

22

'

[book vi.

DROPSIES.

338

to his strength
proportionate
; and
until very little be left,avoiding,
by all
thus, in like manner,
For some
evacuation.
a sudden
ignorantpersons having
means,
with the fluid have immediatelykilled
evacuated the vital spirit
for the sake of greater security
ha^dng
the patient. Some
fluid
the
evacuated a small quantityof the
operationso as
by

tube

quantityof

small

fluid

powers of the system from its great load,procure

discharge of the remainder by hydi-agoguemedicines, by

to relieve the

the

burying the patientin heated sand, by insolation,abstinence

from
givingdesiccative food; and they have recourse
liquids,
and hypothe stomach, liver,spleen,
likewise to bm-ning over
gastrium; and make five eschars about the navel,some by slender
or
cauteries of iron^and others by those substances called iscse,
And

like material.

other such

some

many

by this method alone, sometimes

to at all.
having been had recourse
cured

declares
Hippocrates

that the sudden

evacuation of the matter

in

fatal.

'

'
"

in

Commentary.

CoMM.

water

dropsy,proves

fluid with

without

one

of his

been

rather

paracentesis

Aphorisms,

in empyema,
or of the
speaks of evacuatingthe

He

called

instrument

an

have

which
rpuTraiTpwyXrjTr/piov,

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 operationof paracentesis
seldom

that he had

burning. He states, however,

recovery take placeafter the operation.

instead of

generaluse,

in

was

seen

Med.

Meth.
(See in particular
alludes

Aristotle
work

on

'

the

to

Thessalus

very much
had
which

and

and
of

of his

mentions

that

Evenor, and
Erasistratus,

but that Asclepiades,

paracentesis,
He himself approves
of it.
Soranus
disapproved
all the objections
the operation,
and answers

been

of the remedies.
a

conclusion

of Animals.'

made

to

it.

and
of breathing,
difficulty

that

the

advocates for

were

Themison,

near
paracentesis

Generation

Cselius Aurelianus

xiv.)

He

sudden

agrees,
evacuation

says, it relieves the fulness

prepares the parts for the action

He

however, with
of the water

the

other

is attended

rities,
authowith

8.)
danger. (Pass.Tard. iii,
of the operation. Some, he
givesa good description
breadth below the navel
performit at a spot four fingers'

Celsus

says,

L.]

SECT.

DROPSIES.

in the left side

skin
the

do it at the

; some

and then

perforatethe

operatorto

be careful not

339

navel

abdominal

; and

some

burn

parietes.He

to wound

vessel.

The

the

directs

Comm.
'

"
"

size of

the

he says, should be the third part

pointof the perforator,
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
healingtoo
He speaksfavorably
soon.
unless the patient
of the operation,

be much

debilitated,

Aetius and
mention

the

most

15
(vii,

; also

ii,10.)

of the medical authors

and
operationof paracentesis,

subsequentto Galen,
approve

of it.

recommends
Vegetius,the veterinary
paracentesis
surgeon,
for the dropsyof cattle,
the swelling
is not removed
when
by
purging.(Mulom. iii,
25.)
Avicenna
himself
rather unfavorably
of paracentesis.
expresses
He says, it ought never
to be attempteduntil every other remedy
has proved ineffectual,
of
and unless the strength
the
be
and
he can
endure
abstinence from
patient good,
exercise,
is
of the operation
drink,and restricted diet. His description
taken from Paulus. (iii,
14; iv,13.)
in very brief terms, (iv,
Serapionmentions the operation
7.)
Albucasis^s description
is very minute
the
whole,
; but, upon
littledifferent from our author's as to the placeof the incision
the instruments
with which it is to be performed. After
or
has been made
in the manner
directed by our
the perforation
the introduction of a canula made
of
author, he recommends
silver,
copper, or brass,and having a small hole at the bottom
and
water

skin

three

in its sides

at first.

will

He

he advises

adds,that when

us

to evacuate

the canula

onlv half the

is removed

the

opening in the abdominal muscles, and

therebystop the discharge. The remainingpart of the water
is to be removed
afterwards,accordingto the strengthof the
ii,54.)
patient.(Chirurg.
Haly Abbas does not in generalapprove of the operation.
it performedbut once, and then
He mentions,that he never
saw
it did not save the patient. He adds, that Galen relates that
he only knew
in which it had proved successful.
of one
case
He directs the incision to be made three fingers'
breadth,straight
cover

the

EXOMPIIALOS.

340

beloTT the

CoMM.
"

"

"

'

is to

navel, that

if the

spleen,in

right. (Pract.ix^41.

the

however, is scai'celv at all different from

He

directs

the

sit on a
patient
with a largeneedle

He

bench.
below the

directs

us

; but

peritoneumhigherup

of copper, is then

canula,made

We

and

compress
to make

the incision

to make

the

if from

right.
us

to

nected
con-

liver,on
the

Like

the

make

that of the skin.

than

into the ing.

openadnses
to
us
operationhe

to be introduced

pulsesink during the

dischargeof the water. (Cent,xix.)

If the

stop the

author.

onr

the collection is

navel,when

disease of the intestines

the

of

that

the
the left side ; or if from the spleen,on
other authorities
noticed above, he directs

opening of

-ohich,
operation_,

recommends
abdomen, and, if possible,

the sides of the

with

the

the assistants stand behind

to make

us

in the left side,

it to be made

of
description
givesAntyllus's

Rhases

vi.

in the linea alba ; but if the

say,

liver is diseased he recommends

or

[book

have

in

mentioned

notes

our

Book

on

Third, section 48,

approvedof scarifications at the

advocate for
ankles.
It appears that Archigenes also was
an
this practicein dropsical
cases.
scribed
deand hydatidsthereof are
correctly
Dropsy of the womb
It seems
to be now
agreedthat the dropsy
by Soranus.
of largehydatid. (120.)
in this case is a species
Hippocratesand

that

SECT.

LI.

Protrusion

ON

Aetius

OR

EXOMPHALOS,

takes

of the navel

OF

place when

THE

the

NAVEL.

peritoneum

the omentum,

intestine,
or
prolapsed;
down upon the navel,someinert fluid falling
times
sometimes
an
from a collection
and sometimes
of the flesh,
from hypertrophy
from the rupture of a vein or
of blood there,proceeding
from

there is rapturedand
and

PROLAPSUS

as in aneurisms
ai-tery,

; and

sometimes

the collection consists

be
blood,but of spirits
only. If,then, the omentum
protruded,there appears a swellingat the navel,which is free
soft to the touch,without pain,and uneven
from discoloration,
;
not

of

but if it is intestine in addition to the afore-mentioncd

there

is

symptoms,

pressedby the
borborygmi; and it is

inequality,the tumoui*, when

gi'eater
"

sometimes
fingers,disappears,

increased

by

baths and

Avith

straining.If

its contents

be

fluid.

EXOMPHALOS.

LI.]

SECT.

the tumour

is equally
not
soft,

diminished

nor

to the

livid ; but
be

increased

hy

pressure, and is neither

dition
If it consist of blood,in ad-

to
yielding

it.

swellingis
the tumour
hypertrophyof flesh,

afore-mentioned

if it arise from

and
harder,elastic,

341

symptoms,

will continue

of the

the

size. Those

same

a certain
by flatulence are attended with softness,
We
when
tapped, and disappearanceupon pressure.
Having placedthe man
operate then in this manner.

erect

posture,we

order him

he retains his breath

of the navel with

at the

will
sioned
occa-

sound
must

in

time

same

an

that

nence
then, having marked the whole promiblack ink,we are to layhim on his back,

the tumour

dissect around

and

to press down

more

with

agreeablyto
scalpel,

the

must
the middle with a hook, we
marking; then, stretching
for
applya thread or stringaround the part which is dissected,
thus it Avillbe preventedfrom falling
down, when secured with
a knot.
Then, at the top,having opened the constricted tumour,
lest
and search carefully
introduce
the index-finger,
must
we
or
part of the omentum, be included
any fold of the intestine,
loosen the
must
in the ligature
we
; and if intestine be included,

fold of the

draw

may

thread,and push it inwards,but

it out, and

cut

off"what

if it is omentum

is redundant

of

we

it,securing,

in the way;
thread,any vessel that may come
and then taking two
needles,containing a plam thread, we
through the scarified part in the form of the Greek
pass them
mentioned
the doubles of the threads,
as we
letter X, and cutting
as

is proper, with

for

aneurism,we

constriction with the four heads.

make

After

have become
putridand
by the ligatures
we
completethe cure by dressingthe part with
dropped ofi*,
hollow.
pledgets,and strive to make the cicatrix particularly
the part concerned is the intestine
when
Such is the operation
the

or

bodies

secured

omentum.

But

if

or blood occasions
or
fluid,
flesh,

having divided
then

removed

whatever

the middle

the

plaint,
com-

and
circularly,
peritoneumat the
But
applications.

of the tumour

lies external to the

perform the cure by incarnative

we
exomphalosarisingfrom aneurism,or the presence of flatus,
of aneurism.
like other cases
abandon
must
as
hopeless,
navel,we

abstract of the Comm.

givesan interesting
but as it difl'ersbut little
opinionsupon this subject,
shall not dwell very particidarly
author's description,
we

Commentary.
ancient
from

our

Celsus

GASTRORAPHE.

342

CoMM.
'

it.

upon
'

through the

tumour

part by pressure

make

or
staphyloma,

substance,
the

so

of the

the ages of

and

seven

to

remove

the

lapsed
proits base ; after
medicines
the
or

ligatureround

be

hernial tumour

that it is

omentum,
intestine,

fourteen,and when

of
description

the

or

is attended
operation

be

onlyto

forbids to interfere with

He

says, first

is protruded,
but this he thinks

apply a

danger,and

some

to be enabled

as

intimates,hoAvever,that the

He

water.

he

of

destroyedby
part
whether
he adds, will be sufficient,
operation,

This

cautery.

and

Some,

is to be

outer

the contents

The

rules.

two

the

producemortification

to

vi.

by passing

threads,in

two

sufficientmerely to return

it will be

as

unnecessary,

state.

between

with

armed

whatever
greaterfacilitj^

with the

with

tlie disease either

cure

incision in the tumour,

an

which

to

us

needle

described for

manner

the

directs

He

[book

performedbetween
bodj^is in a healthy

the

scirrhous tumours,

(vii,
14.)

Albucasis is very
author^s. (Chirurg.
ii,
53.)

operationgivenby
effect

as our
minute,but is to the same
like
in
to pass a needle,armed
recommends
us
Rhases,
manner,
it by a
with two threads,through the tumour, and to secure
crucial knot.
He, Avicenna, and Haly Abbas evidently
copy

author's

description.
first described by Celsus,
The operation
with the ligature,
as
was
revived,with very slightmodifications,
by the celebrated
seldom practised.
Desault,of Paris,but is now
our

SECT.

LII.

DOWN

WOUNDS

ON

DESCRIBED

ALSO

IS

How

wounds

of the

intestine

can

done

WORKS

THE

the wound

OF

FALLING

GASTRORAPHE
GALEN.

to be treated is next

peritoneumare

The

to

the

how

the

cause

what
the

surroundingair; so
heating. Wherefore, having

is the

measure

But

But
that

be

either to evacuate

former

accomplishit.
By removing

inflation of the intestine.

the

WHERE

OMENTUM,

be necessary

enlargethe wound.
one

FROM

ON

AND

small,so that the prolapsed

being distended with air,cannot be restored to

place,it will

Aided

PERITONEUM,

OR

If then

be considered.

its

THE

INTESTINE

THE

OF

OF

may
which

cure

or

better,pro-

this be most

is this ?

soaked

flatus

occasions

probably
the

Congelationof
performedby

is to be
a

soft sponge

in hot

GASTRORAPHfe.

344

soft is itself first broken.

needle too
of the
taken

lipsof

the

near

which

remainder

the

manner,

same

remains

rupture

if too much

But

narrow.

is

vations
obser-

These

ununited.

vi.

passingthe

wound, occasions often

is too

of the skin

in,much

the

In

[book

more
of all ulcers,but are
apply to the treatment
we
to be observed in gastroraphe
; and, as aforesaid,
especially
of the peritoneum
must
as to the adhesion
act, forming a conjecture

with the

abdomen,

the circumstance

from

seldom adheres ; or, as

beingmembraneous
togetherthe partsof the same kind ; that
and abdomen
to abdomen.
to peritoneum,
thus

in

from

the side of the abdomen

and

through

the

same

manner

nearest

is to say, peritoneum
Or, it may be done
must

pass
without

us, from

it above ; then
passing both
must
again turn the needle from

we

do,by bringing

some

above,we

as

that the latter

lipsof

needle

inwards,

the

neum,
peritoinwards

without

and againturningit from

peritoneum,
men.
within outwards, pass it through the opposite
part of the abdoand vulgarone,
This
differs from the common
mode
inasmuch
is passedthrough the four lipsat one
as the needle
and
perforation,
exactlyconceals the peritoneum within the
The
those
formed of the
abdomen.
are
applications
proper
wounds ; but in
materials as the applications
for recent
same
some
order that no vital part may
be affected sympathetically,
hot oil,
and the whole
tender wool is to be dippedin moderately
armpitswrapped in it. It will
space between the groinsand
oil.
be better,also,to evacuate
the bowels by a clyster
of warm

through both lipsof

But

if any

the

of the intestines be

dark

wounded,

austere

wine, in

if it be permore
tepidstate, should be injected,
forated
especially
cured,
quitethrough. The largeintestines are easily
but the small ones
with difficulty,
and the jejunum is utterly
a

incurable,fi'om the multitude of its convolutions and the magnitude

of its vessels,
and owing to its coats being thin and
it receives all the bile in an undiluted state,
nervous
; besides,
and

is nearest

stomach

because
are

more

to the liver.

under

and

fleshy
partsof the
succeed,not only

may attempt to cure, for we may

these parts are thicker,
but because curative
we

to
appliedto them, OAving
readily

parts,however, about the

affected

the

mouth

medicines

by
of the
exquisite
sensibility

are

The

their situation. The

of the stomach

only in

mouth

medicines

and

oesophagus
; and

passingdown

of the stomach

is

an

the

obstacle

to

GASTRORAPHE.

Lii.]

SECT.

the

of wounds

cure

the
peritoneum,

of it.

345

Wlien^

from

rupture of the

and either becomes

livid
prolapsed,
the part anterior to the black portionmay be included
or black,
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 readilyescape when cast off
by the suppurationof the wound.
omentum

is

of gastroraphe
here givenwill Comm.
description
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
that eTriydarpiov
is used in this
explains

Commentary.

The

'

'

sense.

Celsus

of

he

of a somewhat
different method
givesa longdescription
performinggastroraphe.He uses two needles, (vii,
16.)
Several modes
of performingthe operation
scribed
are
minutelydeof a case in which
by Albucasis. He relates the history
gastroraphe,
(ii,
practised
87.)

Halv Abbas

recommends

the

warm

bath, to facilitatereduc-

which
he directs,
performinggastroraphe
is similar to the suture
now
practisedupon dead bodies after
dissections. (Pract.
ix,43.)
of gastroraphe. He speaks
K/hases describes various modes
with the stringof a harp. (Cont.
of performingthe operation
of the ancient harp were
made of the
xxviii.)That the strings
proved from the followingpassage
guts of a sheep is clearly
in the Odyssey of Homer
:

tion.

The

method

of

Kai aoiSijg
iTTiffTd/iivos
avtjp ipopfiiyyog

i)qOT

tTcivvffCfsvkojInl koWotti xopSiji',

pijidicog
ivcFrps(piQ
u\l/ag
tvTipovoiog.
a.[i(poTepa)^fi'

OSvc. "f.

The

modes

described by
gastroraphe
commented
by Van
upon

of

Galen

and Celsus

are

Swieten
explainedand
(Comment,
ab
and
Fabricius
Chir.
cccxi),
ii,53.)
Aquapendente. (CEuv.
by
A completehistory
of the operationis givenby Sprengcl.(Hist,
de la Med.
Pare
xviii,
21.) Ambrose
performedthe operation
exactlylike Galen.

'

DEFICIENCY

346

SECT.

TV hen

LIII.

PREPUCE.

DEFICIENCY

ON

is

OF

OF

[book

THE

vr.

PREPUCE.

deficiencyin tlie skin of the penis,

in order to repairthe deformity,have attempted a double
some,
surgicaloperation; sometimes
cuttingthe skin all round above
of the penis,in order that by this solution
at the commencement
of continuitythe skin may
be drawn
downwards
until the
with a scalpel
glans (as it is called)be covered ; and sometimes
dissectingits inner surface from the root of the glans,and then
drawing it downwards, and surrounding the glans with a soft
sion,
ligature; but a piece of cloth must be interposedat the incithere

in order

to

small

prevent

adhesion

an

glans. Antyllus approves

but
gives a full description,
it is rare

outline,because

of this

most

that this

the

Commentary.
''

Cutis

ipsam

circa

condat

coles

ad

iter,vel

vinculum

circulus

venae

linamenta

eoque

licto

cicatrix

exiguo urinse

Rhases
then

to

directs
draw

to

us

the

put

prepuce

(Cont.xiv.)

This

for

See

phimosis.

Fabricius

reader
ab

is much
section

will

find

ut

latitudo

circa

illam

in orbem

cavetur,

cura

Eo

facto,

pubem

velut

increscat,et id

caro

id debet

esse

itinere.^'

having previouslydissected

The

magnaque

to

follows

extenditur, donee

dantur,

sit,cinctum

brief

submit

to

ibi sunt, incidantur.

supra

he

the functional

operation as

inclinatur,nudaturque

pleat: satisqueveiamenti
donee

nudatur
quse

which

with

glandem
: deinde, juxtapubem,
; ibiquedeligatur

vel urinse

cutis

the

prehenditur et

donee
tergus inciditur,
ne

describes

Celsus

the

surgicaloperation is required,

complaint neither occasions any defect of

such deformity that one
would
choose
nor
office,
the hazard
of it.
of an operationon
account
CoMM.

of

content

the

as

to

prepuce

method,

been

have

we

of

im-

plagaeprsestat. Sed,
:

in medio

tantum

re-

(vii,25.)
proper

pieceof

it,and

over

it from

the

the

same

seciu'c

it with

parts below,
as

our

the

lead upon
a

glans,
ligature,

if necessary.

author^s

operation

Iv.

operation described
Aquapendente. (ffiuv.Chirurg. ii,61.)
the

ancient

by

PHIMOSIS.

LV.]

SECT.

SECT.

LIV.

347

OR

HYPOSPADIjEUM,

ON

IMPERFORATE

GLANS

PENIS.

In

glans is

children the

many

is situated

the meatvis

part called canis^at the

the

under

at birth^but
perforated

not

mination
ter-

they can neither make water

glans. Hence
to the pubes^nor
forwards unless they draw up the member
be injecteddirect into the
cannot
procreate^as the semen
the complaint occasions
In addition to these defects,
uterus.
no
ordinarydeformity. Wherefore, the simplestand least
dangerousmode of operationis that by amputation. Having
in a supineposture,we have to stretch
then placedthe patient
the glansforcibly
with the fingersof the left hand, and then
to amputate the glans at
with the point of a scalpel
we
are
but caning
the corona, not making the amputationobliquely,
of

the

it were,

it,as

round,

all

so

that

eminence

an

may

appear

in

since a hemorrhage
resemblingthe glans. And
if possible,
takes place,
we
stop it by styptics
frequently
may
slender
to burning with
have
must
but if not, we
recourse

the

middle

cauteries.
of this

mention

deformity.
(De Comm.
(De Fab. Hom. v, 22.)
usu
Partium.) See also Theophilus.
transcribes our author^s description.
The
Albucasis evidently
is called finiscapitis
author
canis (kvwv)by our
part named
makes

Galen

Commentary.

"

'

virga in

translation of

the

translation of
to

author

is

have
to

Haly Abbas.
the

seen

term

appliedby

kvwv

virile.

part of membrum

appliedby Galen
(Meth. Med. xiv. 16.)

member.
genital

de Cauliaco

directs

make

to

introduce

and

suitable instrument

us

to

ber
remem-

proper

word

part of the

opening with

an

canula

in the

any other medical

Perhaps the

is

'Iqgent, [voq,which
Guido

Albucasis,and finiscoronce
ix. 44.) We
do not
(Pract.

of lead

or

wood.

(iv,2.)
sect.

There
SO

covers

are

two

the

LV.

causes

ON

of

glansthat

PHIMUS,

phimosis;
it cannot

OR

PHIMOSIS.

for sometimes
be

the prepuce

retracted; and

some-

'

PHIMOSIS.

348

times when
last

drawn

behind,it

from

either

adhesion

an

from

by

be

brought forward^which
paraphimosis. The firstvariety

cannot

is properlycalled
species

is occasioned

[book vi.

cicatrix formed

flesh.

Eut

the

in the prepuce, or
second
varietytakes

place in inflammations of the genitalorgans when the skin

being brought back, the glans swells,and it cannot longer
allow of being drawn forward.
If it is the firstspecies
of phimosis
it
in
this
After
we
manner.
operateupon
having
may
and
the
drawn
the
placed
patientproperly,
forwards,
prepuce
and having fastened three or four hooks into its extremity
and
giAdng them to assistants to hold,we direct them to stretch
and

it ; and

open

lancet

or

divisions at the inner

another.

divide
the

if the

adhesion

be

from

distant from
parts direct and equally

The

at the
prepuce
the mouth
of the inner

contraction
the

external

divide the prepuce

from the internal parts with
sharp knife in three or four places,
making the

we
cicatrix,
a

then

formed

by

But

prepuce.

the

if

one

glansis double, wherefore we

part; for having thus opened
enabled to rewe
are
tract
cicatrix,
preternaturaladhesion of the

flesh of the internal parts occasion the phimosiswe may make

scarifications in all the flesh,
drawing back the prepuce and

scrapingaway

the

fleshyprominencesbetween the incisions,

and afterwards applya tube of lead to the whole glans,having
the tube having its openwrapped it in dried paper (papyrus),
ing
the same
for
the
of
everywhere ;
thus,by
application the
tube, the prepuce, when brought forwards again,is prevented
from
forming adhesions,beingkept separate by the lead and
the paper wrapped round
it ; for by gettingswelled Avith the
moisture

it separates the

whether
or

one

operate upon

we

from

take

But
or

to

the

yet formed

direct incisions

Commentary,

Celsus

Subtcr

phimosisoccasioned by

summa

ora,

adhesions,we

may

make

and havingbathed
circularly,

the prepuce

"

we

may

do

of
operationfor deficiency

tepidoil,draw
CoMM.
'

if it has not
more

This

more.

cicatrix,
adhesion
of flesh. But if the compreternatural
plaint
take place,and become
hesions
paraphimosis
chronic,adplace,and the complaintis incurable,unless one

submit

to

still

called

choose

skin

prepuce.

three,four,
with much

outwards.

describes the

operationas follows

cutis inciditur recta

linea usque

ad

CIRCUMCISION.

LVii.]

SECT.

349

atque ita superiustergiis relaxatum, cedere retro Comm.

potest. Quod si parum sic profectumest,aut propter angustias,
frsenum

"

'

forma cutis ab
protinustriangula
tergoris,
inferiore parteexcidenda est,sic ut vertex ejusad fraenum,basis
sit. Turn
in tergo extremo
superdanda linamenta sunt alia
que medicamenta
quse ad sanitatem perducant. Necessarium
cicatrix sit,conquiescere
: nam
autem
ambulatio,
est, donee
reddit."
atterendo ulcus sordidum
(vii,
25.)
for keepingthe preof the operation
Our author^s description
puce
of
leaden
the
from
a
tube, is
glans,by means
separated
mostlytaken from Galen. (Meth. Med. xiv,16.)

propter duritiem

aut

must,

or

from

found

part

one

it is

far

as

with the

add of the

glans,

place.
deavouring
be, en-

as

may
pointof

scalpel,
pletely
glanscom-

but,

glansto

contrariwise

united, than

the

to the other takes

it adheres

to which

GLANS.

about

to free the
especially

rather

must

THE

TO

previousulceration

more

the prepuce,

we
difficult,

which

with

PREPUCE

separatethe adhesion

polypusknife,and

THE

therefore,dissect around,
to

of

adhesion of the

an

prepuce,

We

OF

there has been

When
or

ADHESION

ON

LVI.

SECT.

if this be

the prepuce

for the prepuce,

disengagementof

being thin,is readilyperforated.After the

the adhesion,a thin cloth,dippedin cold water, is to be placed
between the glansand the prepuce, that no adhesion may again
and the parts are to be healed with some
take place,
astringent
wine.

Albucasis

Commentary.

describes the

operationin exactlyComm.
'

the

ii,56.)
(Chirurg.

terms.

same

LVII.

SECT.

We

do not

to
conformity

has become

treat
a

at

heathen

black

from

ON

CIRCUMCISION.

present of those who

rite,but
some

''

circumcised

are

in

of those in whom

affection of the

the prepuce
privypart. In

such cases, it becomes

necessary to cut off the blackened portion
all around ; and afterwards we must
have recourse
to the squama

[book vi.

THYMI.

350

with honey,or
seriSj

to

and
pomegranate-rind

of those

which
applications

there be

made

are

hemorrhage, we

must

tare, in the form

pledget.

upon

lunated

use

if

And

which
cauteries,

the stoppage of the

good purposes : I mean
But if the whole glansbe
bleedingand of the spreadingsore.
consumed, having introduced a leaden tube into the urethra,
water
to make
direct the patients
through it.
we

contribute to two

See

Commentary.

CoMM.
'

'

similar

ii,57.) Albucasis
(Chirurg.
the operationon boys, as a

"

descriptionin

describes the mode

that he
a

was

performing
religion. He

and
scissors,

directs the prepuce to be cut with a pairof

the manner
allowed to bleed freely. From
himself

of

Jewish

rite of the

Albucasis.

in

the

which

there can
the operation,
respecting
Jew, and it is equallyclear that our

be

he

part
presses
ex-

doubt

no

author

was

Pagan.

Aquapendente
(CEuv.Chirurg.ii,64.) Guido
Fabricius

ab

describes

similar

de Cauliaco

directs

operation,
to draw

us

the prepuce forwards,and cut it off; after which the bleeding

is to be stoppedwith powders,or the cautery, (vi,
2.)

SECT.

LVIII.

ON

THYMI

OF

THE

PENIS.

Thymi are fleshyexcrescences, 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
and
it will be proper to pare away with the edge of a scalpel,
the part with chalcitis; but when
malignant,the part
sprinkle
If there be thymi on
be burned after they are removed.
must
both sides of the prepuce,
must

attempt all at the

not

cut off the prepuce,

internal,
and, when
Some

external.
off with

which

we

healed,we

of the moderns

effect

cure

bm'n them

Albucasis

copiesour

ii,56.)
(Chirurg.

Wlien

the tumour

attempt the
by cuttingthem
with

hair
horse-

cautery.

description.
malignantnature,

author's
a

off the

next

with the cold

is of

should

we

first cut

must

may

some

'
"

is thin ; but

and by bindingthem
pairof scissors,

Commentary.

CoMM.

we
external,

time, lest by mistake

same

they are

; as, in like manner,

'

internal and others

some

CATITETERISM.

352

the

CoMM.
"

'

further account

catheter,to givesome

and
complaints,
with regard to

Galen

states

retentive and

of the

the

opinionsentertained by

the

functional

that

the

possessedof

is

bladder

of which

vi.

of these

causes

the

offices of the

both
expulsive,

an

[book

physiologists
urinary organs.
a
faculties,

two

arise from

muscular

power ; that the retentive resides in the neck of the

kind of powers ; but that the
and is of the voluntary

bladder,

expulsive
being of

involuntary
powers,
kind as the peristaltic
of the intestines. When
the same
faculty
it is by suspendingthe
a person,
then, makes water voluntarily,
that is to say, of the
vesicae,
voluntaryaction of the sphincter
retentive faculty
of the bladder,whereby the expulsive
or
staltic
periand
the
into
of
the
contents
action,
are
brought
powers
He
bladder are
properlyadds, however,
thereby evacuated.
that this involuntary
or
expulsivefaculty
may be assisted by the
surround
action of the voluntarymuscles which
the bladder,
the recti muscles of the abdomen.
Retention of urine,
especially
the class of natural

belongsto

arise from

therefore,mav
The

facultyis
expulsive
of the

to accumulate

commonly lost,either

most

its contents

bladder,as
far,or from injuryof

it with nerves.
supplies
of urine proceeds from

be

the loss of either of these

when

too

bladder may

or

Rhases

the

remarks

faculties.
from

distension
over-

have been allowed

marrow
spinal

that when

which

retention

debihtyof the expulsivefaculty,the

evacuated by merelymaking pressure above the

pubes.
retention of urine arising
from derangeAccordingto E-hases,
ment
of the retentive faculty,
that is to say, from its no longer
flammati
being under the control of the will,may be occasioned by insuch as a fleshy
tumour
by some SAvelling,
formingin
the meatus
or
urinarius,
by the presence of some
foreignbody,
such

as

times

stone,a clot of blood,or the like.

to this

either

means

of the

He

alludes several

in the passage, by which he probably

tumour
fleshy
an
enlargementof the prostategland,or stricture

urethra.

He

calls it

very

intractable

case.

For

fuller

and opinions
expositionof the ingeniousspeculations
stated above, see
Galen
iv,4); Rhases
(De Locis Afi'ectis,
(Contin.i and xxiii.)
Celsus
The

tube

describes very
or

the operation
of
accurately

he says, should
catheter,

male catheter

oughtto

be somewhat

be made

catheterism.

of copper, and

bent,smooth,and neither

the
too

CATHETERISM.

Lix.]

SECT.

353

The lengthof the largest

small for the passage.
Comm.
should be 15 inches^of the middle-sized 12, and^
female catheter should be 9, and
of the smallest 9 ; the largest

largenor
male

too

catheter

'

patientis to be laid on his back,

and the surgeon
standingby his right side,and holdingthe
in
his
left hand, is to introduce with his rightthe catheter
penis
it reaches the neck of the
into the urinarypassage ; and when
bladder,the instrument
along with the penis is to be bent
the smallest

evacuated

The

and introduced into the bladder.

downwards

he

6 inches.

the catheter is to be extracted.

remarks,is

and is discovered
shorter,

protuberanceabove

When

is

the water

female passage,
sort of mammary

The

by a

which

the

to describe the clitoris.

he evidently
means
vagina,by
The operation,
he adds,in this case

is

less difficult,(vii,
26.)
is mentioned
operation

The

but
authorities,
Albucasis

none

recommends

of the

of
injections
It is

Avicenna
describe it

of silver.
from

having the

copper

count
ac-

author.

our

instrument

an

His

for throwing
inflamed.

bladder of

ram

ii,59.)
(Chirurg.

and

Serapion mention

minutely. Haly

sit and
is

Paulus.

into the bladder when

oil and water

or

fullybut

made

catheter

givesa drawing of

tube of silver

attached to it.

describe it

borrowed
evidently

is
operation

describes and

He

Aetius and other of the Greek

by

of them

to pour

Abbas

with

operationbut

directs

and

water

warm

recommended
evidently

the

us

oil upon

view

The

connected

not

make

the tient
paThis
penis.

to

the

of

producingrelaxation.
described
very properly

are
ordinarystepsof the operation
ix,45.)
by him. (Pract.
and
E-hases givesa fuller account of catheterism,

therewith,than

do

any

all the circumstances

other ancient author.

the
forbids the catheter to be introduced when
very properly
at the neck of the bladder.
retention arises from inflammation
He

{Ad Mansor. ix,73.)

which
operation,

firstgivesAntyllus's
of the
description

He

accurate, but similar to

is very

the
He recommends
us, before attempting
instrument,to put the patientinto a warm

hot fomentations
the

instrument

to the

parts.

with oil

or

thick

He

II.

bath, or

then directs

mucilage,and

until it arrives at the under

into the passage

penis,when it is to be

author^s.

our

introduction of the

us

to

apply

to lubricate

to introduce it

extremityof

gentlypushed upwards in

the

the direction
23

CALCULUS.

3J4

navel^turning it to

of the

CoMM.
'

'
"

openingsof the catheter

obstructed
by clots than
that he

Serapionand

and

there

be

ofl^the urine

that there

danger

The

case

be

urgent,
of the

ancients

with

of the wound
to have

seem

the side of the

fancied that

it

was

catheter

See Alexander

of the
It is
when

syphon.
singularthat they
Galen, as we have
that the

the action
is

in this

should

evacuation

suspendedor
adopt the

overcome.

notion

out,

the

upon

fallen into this

above, had

of the bladder

of its expulsive
powers

some

principle
(Prob.ii,59.)
Aphrodisiensis
case

have

mentioned

acted

to

necessary

of the catheter with wool, or

fillup the internal ca\-ity
drawn
when
such substance,in order to produce a vacuum
that the
belie^^ing

to

bladder,
canula.
Both add, however,
not closing.(Cont.
xxiii,
2.)

perineum into

*ind to draw
is

inflamed,if the

is

is retention

there

aggravate the spnptoms, it -may be proper

incision in the

an

that when

apprehendthat the introduction

to

reason

would

catheter
make

the bladder

and

the

itself to the passage.

of puncthe operation
turing;

mention
says

it

to be
they are less likely
tions
extremity. He also menof using a ductile
practice

accommodated

Rhases

the bladder.
of the urine

in the

Rhases

accordingas

as

in the

^hen

another

or

that it is best to have

states

in its sides

of lead which

instrument
Both

He

sometimes

was

side

one

obstruction.

encounters

[book vi.

whenever

mistake,

explained
clearly
is accomplishedby
its retentive faculty
so

wise
surgery likethat the cavity
of the instrument
requires
The

earlier writers

to be

on

filled up with wool. See Guido de Cauliaco

describe stricture of the urethra under
the names
cosis and

caruncula

(An. Med.

in meatu

See

44.)

SECT.

The

urinario.

2.) They
[xi,
of hypersurHenricus
Regius

of the

cause

LX.

formation

ON

CALCULUS.

of stones, and

tliat in children

they are formed most readilyin the bladder,and in adults in

the kidneys, all this haA'ing
been
explainedin another place,
we
now
proceed to the method of performinglithotomy,but
shall first give the symptoms of stones lodged in the bladder.
then void mine
The patients
of a watery consistence with a
sandy sediment; and from constant itchingthe member is now
"

CALCULUS.

Lx.]

SECT.

3.55

relaxed and

again stretched in an uncommon

degree,because,
the
irritation,
owing to
thej are perpetually
handlingit,more
in the case
of children.
When
the stone falls into
especially
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,
of the softness
account
on
of their bodies

old

men

are

difficultto

of their bodies do not

readilyheal

have

chance

intermediate

an

who

have

larger stones

habituated to the

recover

; and

because

cure

ulcers

the intermediate

of recovery.
best because

inflammation,whereas

And

again,those

thev have

those who

ages

become

have smaller

with

recover

for the oppositecause.

These things
difficulty
first have rewhen we
we
course
proceedto the operation,
sometimes
ants,
of assistshakingthe patient,
by means
sometimes
by making him jump from a height,in

being so,
to

and

order that

the

bladder.

We

stone

have

be forced down to the neck of the

may
then to place him
in an erect possitting
ture^
his

with his hands under

be forced down

thighs,in

order that the bladder

small

If then we
ascertain
space.
bv feelino-externallv that the stone with the shaking has fallen

may

down

to
;

perineum,Ave proceedimmediatelyto
descended,we
left hand well oiled,or,

the
the

anus,

and

with

tion
opera-

introduce the index

must

if

the

an

adidt,the middle

in a supinedirection
fingers
for the stone, and, bnnging it down
search with them
dually
grafix it there,pushing it
to the neck of the bladder,we
when
with the finger
or
so fixed ; and havinggiven
fingers

also,into

out

but if it has not

fingerof
we

the

into

the

the bladder with his

du'ections to the assistant to press down
hands, and orderinganother assistant to raise the testicles in
his

righthand,

and

the other side from

the other to stretch the

that upon

which

called

perineum

the incision is to be

to

made,

the
lithotome,and between
and the testicles,
anus
not, however, in the middle of the perineum,
the
make
towards
left
but on
an
one
buttock,we
side,
cutting down dii'ectupon the stone where it
obliqueincision,
that the external incision may
be wider, but the
so
protrudes,
internal not largerthan justto allow the stone to fall through
it.
Sometimes, from the pressure of the fingeror fingersat
we

take

the anus,

the

with

instrument

the stone

incision is

starts

made, without

out

readilv at the

same

requiringextraction

time
; but

that the

if it does

CALCULUS.

356
not start out of itselfwe

[book

vi.

itwith the

called the
forceps
After the removal of the stone,havingstopped
stone-extractor.
and aloes,
the bleeding
of frankincense
comfrey,misy,
by manna
and
and such like styptic
presses
havingdippedwool or compowders,
in wine and oil,
dages
we
applythem ; and also applythe banfor calculous diseases,
namely,that havingsix legs. But if
of hemorrhagewe
there be any apprehension
must
press
applya comwhich

been

had

must

extract

in

soaked

oxycrate,or

water

and

rose-

placingthe patientin a reclining

posture,bathe the
dages,
parts frequently.After the third day,having loosed the banand oil into the wound, we may
and poured much
water
dress it with the ointment called tetrapharmacon
on
(basilicon)
them
and
of
the
o
ften
account
a pledget,
on
removing
dressing
If inflammation
must
come
acrimony of the urine.
on, we
and fomentations proper for it.
have recourse
to the cataplasms
into the bladder oil of roses, oil of caalso inject
And we may
momile,
oil,and

or

butter,unless

if the

inflammation

some

prevent.

In

like

become

otherwise malignant,
or
spreading,
suit the applications
When
must
to the state of it.
the
we
ulcer is freed from inflammation
loose the dressings,
we
may
and use
of the belly.
to the groinsand bottom
diachylonplaster
During the Avhole time of the treatment, the thighsmust be
bound
with the other
which contributes
to the cure
together,
remedies.
If the stone, being small,fall into the penis,
and
manner,

cannot

be

sore

voided

with

the

urine,we

the prepuce
extremityof the glans.
may

draw

stronglyforwards,and bind it at the

We
must
next
round the penisbehind
apply another ligatui-e
the member, making the constriction at its extremitynext
the

bladder,and

then

make

an

and

incision down

the stone,
upon
stone, and undoing the

bending the peniswe ejectthe

clear away the coagulafrom the wound.
The posAve
ligatures
terior
i
s
lest
should
the calculus
retreat backwards,
ligature applied
and

the

in order that,Avhen untied,after the

anterior,

extraction of the stone, the skin of the prepuce

and cover
the incision.

CoMM.
'

Commentary.
cient

We

will

now

may

slide backwards

attempt to explainall the

an-

of lithotomy.
descrijations
in his Oath binds his pupilsnot to perform this
Hippocrates
but to leave it to those who
made it their business.
operation,

CALCULUS.

Lx.J

SECT.

357

branch
a separate
was
It appears then that in his dayslithotomy
describes
of the profession.Celsus is the earliest author who

Comm.

although it is probablethat he merely explained

lithotomy^
of which
in Alexandria, the surgeons
of operating
the method
in performingthis operation.
cityhad acquiredgreat celebrity
He forbids the operation,
except after every other remedy had
in children between

failed ; and
and in the
a

spring.

diet beforehand

spare

to the

stone

directed

is about
operation
walk, so as to bring

the

to

to be

down

is to be ascertained

bladder,which

of the

neck

the ages of nine and fourteen,

The
patientis to be kept upon

when

and

is to be

performed,he
the

of

season

Then
a
strong and
by introducinga fingerinto the anus.
experiencedperson, sittingon a high seat, is to take the
his buttocks
being placed
secure,
patient and hold him
in and
the assistant's knee, and his legs being drawn
upon
if the patient
But
his hands placedon them and held there.
each side,
one
on
assistants,
be strong he is to be held by two
another,and they are to be
seats placed beside one
upon two

directed to press upon his shoulders with their breasts,so as to

to be at
other assistants are
Two
the bladder.
force down
risk of the former two losingtheir hold.
hand, to
the

prevent any
is to introduce
his nails,
gentlyfirst
surgeon having pared
index and then the middle
fingerinto the anus, whilst with

the

righthe

The

of the

shape

so

pressure

secured

is to be

the stone

down

makes

a lunated
"arranged,

bladder

the

near

; then

the curvature
transverse

neck

hook

rough
taken

on

out

is of

the neck of the

over

?)

even

by

bladder,the

of the
the

tock
(left
?) but-

incision is bent round

under

which

the

stone.

When

the

(at

skin,another

the neck

is to

be

semi-circular

but

it may
it is
if large,

for

that

the stone

out by the fingers

and drawn
;
propelled
crotchet made
be extracted by a hook
or

This

pressed
being properly

matters

the openingbeingsomewhat
urinarypassage dilated,

largerthan
to

the

part where

of the incision

the

it is to be

inclininga littletowards

incision is to be made,

opened,and
be

to the

down

anus

that

at

These

incision is to be made

of the incision

horns

considered,and

its exit.

to favour

as

the abdomen, and in this way

upon
Tlie
of the bladder,
at the neck

is to be

stone

form,

smooth

is small

purpose.
externally,and

By the help of it the stone is to

attention beingpaid to the shape of
dexterously,
the inside.

'

"

be
it.

'

in the

tlie litliotomistwas

that Ammonius

mentions

He

CoMM.

[book

CALCULUS.

358

practice
so large

'

^
"

the

breakingdown

of

be extracted

that it could not

He

bladder.
the

case

stone

that the

states

The

be necessaiy.

pieceswhen it was
without tearingthe neck of the
is seldom
requiredin
operation

into

largeit may

be

that if the stone

but
females_,

of

vi.

to be introduced

are
fingers

times
some-

into the

of males, and then, if the

vagina,as they,are into the rectum
incision is to be made under the left edge
an
patientbe a girl,
(of the labia pudendi?); but if in an adult female,a transverse
incision is to be made

on

both

urethra

the

sides between

and

pubis.

OS

above is but

The

which, it

passage in Avhich he describes the

placeof the incisions. " Incidi super vesicae cervi-

and

cutis

juxtaanum

cem

debet,cornibus
resima

qua

givethe

shall

AVe
form

culties.
considerable diffi-

with

admitted,is attended

be

must

description,

Celsian

the

abridgmentof

an

ad

coxas

plaga lunata usque ad

paulum :
spectantibus
sub

est, etiamnum

plaga

cervicem

vesicae

deinde

parte,

altera

cute

ea

transversa

donee urinse iter pateat,

plagafacienda est, qua cervix aperiatur;
calculus sit."
Sprengel
sic,ut plaga paulo major, quam
renders
the words
cornibus ad coxas
spectantibus
paulum
"/'
but cox(B
dont les angles regardantles aines
signifies
by
the buttocks,or
but the nates,A-iz.,
properlynot the groins,
1.) In the English translation
perhapsthe hips.(Celsusviii,
of the
Memoirs
of M. Foubert^s
paper on Lithotomy,in the
these words
French Academy of Surgery,^
are
more
coiTcctly
"

"

"

'

rendered,

"

the extremities of which

directed towards

measure

in his edition of

the

incision must

thighs."

Celsus, proposes

supposes that Celsus

"
hinc liquet,
cornua

understood

to be made

the

some

Dr.

to read

the

be in

coxa

however,
Milligan,
by which he
coxam,
He

sinistra.

adds

sinisut hodiernse,
coxam
plagseCelsianse,
tram
as
respexisse.""We are inchned to adopt this conjecture,
author
it makes
the Celsian description
agree with that of our
all of whom
and his Arabian copyists,
direct the first incision

towards

plaga est," must

any

we
signify,

of the incision where

middle

reads

left nates.

''

qua

proper
We
may

strictior ima

The

the
suppose,
the two
horns

plaga est,"but

from MSS.
authority
to remark
be permitted

that the

words

"

qua

curvature

unite.
we

M.

resima
in

the

Foubert

suspectwithout

advantagesof

the

CALCULUS.

360

of
ternallj

CoMM.
'

'
'

start

the size of the stone.

out, the

[book vi.
If the

seize upon

operator must

does not

stone

it with

then

or
forceps,

than one
having a lunated extremity. If there be more
and then the others
stone, the largestis to be extracted first,
the stone is large he directs
When
removed.
be easily
may
with a forceps. His directions respecting
it down
to break
us

hook

afterwards

the treatment
the

stone

sticks in the

are

similar to those

urethra

of Paulus.

he recommends

us

to cut

When
down

is likewise
of the operation
on
women
description
circumstantial.
but more
similar to our author's,
Having
introduce
to
dexterous
or
some
midwife,
got a
proper person
her fingerinto the rectum
or
vagina,and press the stone down
first a small incision
left hip, the operator is to make
to the
it
over
by the help of a sound or specillum,
it,and afterwards,
for the stone. (Chirm-g.
is to be enlarged
so as to allow a passage
ii,60, 61.)
is nearlythe same
Avicenna's description
as that of Albucasis,
upon

but

His

it.

not

so

minute.

He

directs

the

surgeon

to introduce

gina
patientbe a male, but into the vaand to push the stone
who
is not a virgin,
if a woman
outwards,so as to make it protrude. He is then to cut down
to the size of the
it,making an incision proportionate
upon
the incision must
not be
stone ; but if the stone be very large,
and
of the same
made
size,but it is to be graspedin a forceps
If
inflammation
after the operabroken into pieces.
come
on
tion,
him to have recourse
he recommends
to clysters,
the warm
and a pieceof cloth dipped in oil of
bath, and venesection,
and some
roses
vinegaris to be apphed to the part. The bad
symptoms after the operationare said to be violent painin the
tion
prostrapart and under the navel,coldness of the extremities,
at
of strength,loss of appetite,
and,
last,singultusand
xix,1, 7.)
dischargesfrom the bowels, (iii,
involuntary
The description
Abbas
givenby Haly
being nearlythe same
need not be noticed here but very briefly.
that of Albucasis,
as
He prefersperformingthe operationin infancy,
but permitsit
For the reason
to be done at all ages.
assignedby our author
he
states that recovery is most
likelyto take placewhen the
he directs the surgeon
troduce
to instone is large. Like the others,
either the fore-finger
alone,or it and the middle finger
into the anus, behind the stone, and to push it outwards,and

fingerinto

the anus,

if the

SECT.

Lx.]

then

the

between

operatoris to
the testes

towards
the

CALCULUS.

the left side.

it will

stone

in the
fingers
a

it^making the incision

yet not in the middle,but

Comm.

upon

the

anus^

When

the

sometimes

is carried

incision
from

down

start out

to

the

If inflammation

extracted.

come

he

on

mends
recom-

apply a cataplasm,and to throw into the bladder

an
of oil of roses
and of camomile,or of
injectionconsisting
melted butter. (Practic.
ix,46.)
Rhases
from
of
gives
precedingauthors several descriptions
but as they closely
resemble
lithotomy,
our
author's,we shall
treat of them
In his first description
onlyin a cursory manner.
he
directs the surgeon
to place the patientwith his hands
to

us

fastened to his ankles

the
he

recommends

him

and

draws

as

does not descend

stone

rectum

so

push

the

up

to press down
so
properly,

to introduce

it outwards

testicles the

one

the bladder.

or

externally,
into the
fingers

more

then

and

When

to be felt

as

operator is

to

while
make

assistant

an
a

transverse

but internally
(oblique
?) incision,larger externally,
only of
such

does

size

not

as

out

come

and

to allow

the

stone

to pass

readilyit is to be

out.

If the

extracted with

stone

ment,
instru-

an

the

hemorrhage checked Avith a compositionof aloes,

vitriol.
When
the patientis a child he reana
frankincense,
commends
the operator to place him upon
the knees of an
and to make
so
as to force
assistant,
pressure on the abdomen
down
the bladder.
He
when
forbids the operation
the stone
be brought down
cannot
to the neck of the bladder.
When
the stone is largehe directs it to be broken
into piecesbefore
extraction.
His next description
is taken from the celebrated
diff'ers at all from the preceding
Antyllus,but as it scarcely
When
the stone
shall merely select a few remarks.
one, we
is smooth, round, and small, he directs the surgeon
to push it
down
of the bladder by means
of a fingerintroduced
to the neck
into the rectum, and
after which

the stone

after the

patientin
"c.

or

bath

if it be

is to be

medicated
summer,

it is ascertained

in

forced

incision down

an

upon

it ;

When

pain supervenes
placethe
with
mallows,
camomile, linseed,
and
there
to
be any
disposition
vessel filledwith strong vinegar.
a

he
operation,

hemorrhage,to placehim
When

to make

that

out.

recommends

there

are

him

to

clots of blood

in

the

'

'

pressure of the
it is to be seized upon with
; but otherwise,

anus

forcepsand

down

cut

and

361

"

CALCULUS.

362

'
*

vr.

the urine,he directs the surgeon to introobstructing

extract
them
duce a fingerby the incision,and
gradually.
is
author
His next
from
named
an
Sarad, whom
description
in
of
his
he frequently
other parts
works.
He directs
quotes
and push
the operator to introduce a fingerinto the rectum
the stone
outwards to the left side of the perineum,removed
about the size of a grainof barleyfrom the raphe (daramj, and
bladder

CoMM.
*

[nooK

then

make

to

afterwards
from
the

incision

an

He

of the operation
account
very circumstantial
author called Athuriscus.
He particularly
directs

operatorto make
seldom

incision in the left side of the

an

of the

the neck

to open

the bladder

unites.

When

minute

givesvery

of

wound
is

perineum
the body of

largehe

mends
recom-

strong pincersand break

it and

another,and

the stone

sticks in the

stone
a
pieces. When
behind
tie one
ligature

glans with

bladder,as

to seize it with

liim

He

of the bladder.

givesa

another

and

into the neck

to

then

urethra

secure

to

cut

directions about

the removal
especially

directs him

he

the prepuce

before

down

the

upon

to

the

stone.

the after treatment,

of any

the passage.
(Cont.xxiii.)
of lithotomyappears
The
practice

it into

to

clots which

have been

commending
re-

obstruct

reckoned

the Arabians, for Avenzoar

disreputable
occupationamong
mentions
it as an
and
operationwhich an upright"
respectable
would
not witness,far less perform,(ii,
man
2, 7.)
As there are some
doubts regarding
the form of the incisions
in the ancient methods
of performinglithotomy,
will now
we
of the Arabian
translators. Stephanus
givethe words of some
Antiochensis,the translator of Haly Abbas, has the followingwords

"

Inter

testes

finde et

anumque

non

in medifi via sed in

sinistri lateris parte ab intestinis,

et ab
sitqueperalhlafissura,
ab interioribus non.^^ The translator of Albuexterioribus larga,
casis expresses

himself

et testiculos et

anura

sectio transversa."
translator

"

tem

The
terms

in

non

The

Cave

malum, commissura

super

translator of llhases
:

Scinde

medio, ad

super

in

quod

eo

veritatem

cadat

expresses

lapidem

cum

sit

quum

est locus

ipsum (lapidem?) scissuram

ut

inter

of Avicenna^s

commissuram

super
secundum

est

latus natis sinistrse: fiat

the words

scindas

ne

ad transversum, studendo

"

Finde

"

followingare

enim

Amplius fac

talis.

thus

mor-

tenden-

scissura in collo vesicaj.^'

himself

in

instrumento

the

following

cainadun

et

TESTICLES.

Lxi.]

SECT.

363

fieri transversa, et sit exterior

scissura debet

larga et

caro

in

interiori vesicae stricta."

notwithstandingall this we
the incision was
obliqueand not

they all follow,directs

and
[Xo^oq),
the

answer

No

well.

so

transverse

make

to

us

inclined

are

clear that

it is further
purpose
of these

'
'

Yet

whom

Comm.
'

the

that

author,

our

incision

oblique

would

one

not

be put in

dependence can
The

translations.

barbarous

for

transverse

think

to

languageof
obscure.
Casiri justly
StephanusAntiochensis is particularly
authors "as being
characterizes
the translations of the Arabian
Hisp.Arab, i,266.)
perversiones
potiusquam versiones." (Bibl.
is deThe
with scarcely
scribed
ancient operation,
any alterations,
by the earlier modern writers on surgery. See Brunus
ii,17) ; and Guido de Cauhaco (Chir.vi,2.)
INIagna.
(Chu'urg.
and push
They direct us to introduce a fingerinto the rectum
the accuracy

"

the

outwards

stone

; then

the left side of the

on

make

to

incision down

an

recommends

Brunus

raphe.

upon
a

it

tudinal
longi-

incision.
of lithotomyis still
that the ancient operation
It appears
with greatsuccess
by the native doctors of Ilindostan.
practised
'

See

Transactions

Medical
the

on

Mr.

iv.

Celsian

and

An

boy

SECT.

of thirteen

LXI.

in
a

PhysicalSocietyof
point,related in the
valuable
In

ON

THE

saw

commentary

the

lithotomy.
year 1827
it performed in Tyre by an old

of
description

the traveller

Madden

piloton

Medical

case
interesting
Gazette' for Feb. 7,1845,forms

vol.
Calcutta,^
*

of the

years of age.

PARTS

ABOUT

The

THE

case

did well.

TESTICLES.

of the operations
on
to the understanding
contributing
of the parts about the
shall premise a description
we
herniee,
stance,
testicles.
The testicle itself is a glandularand friable subThe
substances
for the productionof semen.
formed
As

called

and cremasteres,
parastatse

are

processes

from

the

brane
mem-

descendingalongwith the arterial

spinalmarrow,
is injected
into the
vessels in the testicles,
by which the semen
pudendum ; the spermaticvessels are veins from the vena cava
and by them
passingto the testicles in a convoluted manner,
or
the testicles are nourished. The tunica vaginalis
(erythroides
and anterior
nature j at the convex
elytroides
?) is of a nervous
of the

TESTICLES.

364

part not adhering,but

and

posterior
partsunited
coat.
to the testicle,
derivingits originfrom the peritoneal
This part,where it is united to the testicle,
theycall the posterior
The darti are membranes
adhesion.
connectingthe external
skin to the tunica vaginalis,
beingunited to it at the part where
behind

it is united
forms

which

at the

[book vi.

the

to

external

an

concave

But

testicle.

coveringto

that

wrinkled

skin

the testicles is called the

scrotum.

'

'

'

Cclsus

CoMM-ENTAKY.

CoMM.

with the

parts connected

of
description

similar

givcs a

The

testicles.

the

testicles themselves,

and
possess no sensibility
says, consist of medullarymatter
of their own, but experienceviolent pains and inflammations

he

from

groinsby

the

each

of

covered

by a
by
elytroides
of

dartos

descend
thin

of modern

white

the Greeks.

the

veins

two

nervous

stronglyto
by the Greeks.

them.

called cremasters

Above

inner

by

and

They hang
the

it is

blood, called

part,and

to be the cremaster

and
anatomists.)The veins,arteries,

vaginalis

nerves

is called
muscle
are

rounded
sur-

to
(By these he seems
fascise from the aponeurosisof the external
meant
have
oblique muscle.) All these parts are covered by an external
called the scrotum,
investment
18.)
(vii,
Buffus Ephesius says that the scrotum
is a loose substance
in which the testicles are placed,
ternally
being in particular
fleshyexit consists of two
tunics,the external being
; that
corrugatedand called dartos,and the internal being called
the
connect
?). The dartos and scrotum
erythroides
(elytroides
testicles to the parts above, but the erythroides
?) is
(vaginalis
surrounds
the
united to and
testicle itself. (De Corporis
Humani
partium appellationibus,
ii.)
Oribasius describes the cremasters
as
being two muscles
descend
from the groins and surround the tunica vagiwhich
nalis.
is
similar
to
ex
(Anatomica
Galeno.) (This
very
of them.)
Cloquet^sdescription
down to us
has come
Theophilus's
description
imfortunately
very incomplete.(De Fabrica Hominis, v, ad finem.)

by

many
the

small membranes.

are

stronger tunic which

at its lower

(Thisappears

These

be the tunica
a

from

Greeks, A^dth

arteries.

coat, without

(Thismust

anatomists.)

modern

adheres

nerves

which

surrounds

which

the membrane

HYDROCELE.

Lxii.]

SECT.

ON

LXII.

SECT.

365

HYDROCELE.

collected about the parts which are enveloped

fluids
by the scrotum, and occasioninga marked swellingthere,has
lected
obtained this appellation.The fluid is,for the most part, colaround
the testicle,
in the tunica vaginalis
at its anterior
inert

An

but

part;

the affection is

to the tunica

some

into

by

inert

an

blow,

contents.

and
testicles,

such

or

sanguineousor

of the

of nourishment

substance.

serous

But

is a

parts,the

is converted

if it is occasioned

feculent substance

symptom

common

weakness

as

for the purpose

watery

The

surgeons call this affection

If the complaintis formed

adnata.

precedingcause,

brought there

blood

ternally
ex-

vaginalis.Often,however, it is collected

in the proper tunic of the

hydroceleof the tunica
from

formed
sometimes, though rarely,

constitutes its

without
permanent swelling

under
cumstances
pain about the scrotum, not disappearing
any cirwhen
the collection is
compressible
yet somewhat
it is large. When
when
the
small,but not at all compressible
the swellingis globular,
fluid is collected in the tunica vaginalis

but somewhat
is not

egg ; and

oblonglike an

to be felt as

in these

cases

surrounded

being evervwhere

the testicle

with the fluid.

to the tunica vaginalis,

externally
When
it is
is felt as through a small intervening
substance.
and
in the adnata, being everywhere circumscribed
formed
of another
testicle.
the swellinghas the appearance
globular,
is of one
colour and transIf the fluid be watery,the swelling
parent
and bloody,it appears red or livid ;
; but if it be feculent

that which

But

if these

and

is collected

symptoms

that
be sure
may
upon it in this manner.
unless the patientbe
you

bench, and
folded,and to the

upon

and
an

shaven

parts of the scrotum,

hernia.

Having
a boy, we
lay him
applyto his buttocks

the

pubesand

in
a

We

operate
scrotum,

supineposture

cloth several times

sponge of considerable magnitude,

at the left side of the patient,
we
sitting
givedirections to

assistant

to the other

the

in both
appear
there is a double

abdomen.

scrotum

sittingat

his

side,and

to

Then

rightside
draw

taking

up
a

to draw

the

the

genitalorgans

skin of the

we
scalpel

scrotum

divide the

to

scrotum

from
the pubes, making
its middle to near
longitudinally
divides
and parallel
incision straight
to the raphe which

the
the

HYDROCELE.

366

into two

scrotum

the

the apex

where

extending the incision down

is in the adnata,we
make

parts,and

vaginalis. When

fluid

having dissected the

the

with
it is

into

vessel the whole

some

Afterwards, Antvllus
wounds

incarnative
state

pass
a

uses

the moderns

but

mode

and

have

recourse

otherwise

there

are

cremaster

and

two

hernias

about the loins.

we
fluid,

we

may

cut

parts, with hooks.

the treatment
to what

for

recent

is called the

testicle is found

be

in

inclosed
separately

cut, and the testicle removed.

the incisions
twice,directing
scrotum

its ance,
appearhook, and

diseased,the vessels Avhich

to

are

of the

most

If the

or
putrefaction,
alongwith the cremaster

when

the incision

for hydrocele

thinnest

sutures

of treatment.

of

the
ligature,

knife

or

its
vaginalis,
especially

the

away

to the

divide it through
we
vaginalis,
in that
a lancet for bleeding,
more
especially
charged
separatedfrom the testicle; and ha^"ingdis-

laid bare the tunica

part where

makes

the incision with

darti with

and
scalpel,
middle

adnata

of the tunica

the lipsof
separating

and

[book vr.

operatein

the

same

in

And
manner

both

sides at the parts of the

After these things,
haWng introduced
on

probethroughthe incision below at the extremity

of the scrotum, and elevating
make
the scrotum
we
an
upon it,
incision with a sharp-pointed
scalpelin 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 havingsponged away the clotted
blood, we introduce wool dipped in oil through the incision
down
to the testicle ; and externally
we
applyother pieces
may
of wool dipped in wine and oil to the scrotum, hypogastrium,
groins,
perineum,and loins ; and applyinga compress three times
folded upon them, and bindingthem with a six-legged
bandage,
and other proper bandages,Ave placethe man
in a reclining
for the sake of ease,
posture, puttingwool under the scrotum
and
cations.
spreadingthe soft skin under him to receive the embroWe
bathe with warm
oil until the thii'd day, after
which
having loosed the bandageswe must use the ointment
tetrapharmaconon a pledget,
having changed the oblong one.
Afterwards we may again applythe embrocations
flammatio
proper for inthe head

of

until the seventh

to the medicine

cleaned

and

dav, after which

we

have

recourse

called motophylacion. After the ulcer has been

moderatelyincarnated,and

the parts have

been

'
'

the

out

be

assertion

if this

but

correct

which

in

passage

of the

mention

lie makes

that

affirm

CoMM.
'

[book

HYDROCELE.

368

he

but
accurate

our

as

as

mode

been

not

of

able

cure

find

to

so.

of the

account

the

He

author's.

have

we

does

gives a very distinct

his
description of

Aetius

seton

vi.

is

operation

mostly

trusts

of hydrocele,

nature

by

no

means

so

astringent and

to

applications,(xiv,22.)
the
describes
Albucasis
operation in nearly the
of making an
His
Paulus.
operation consisted

desiccative

as

swelling and

the

in

the

nearly

timid

patientbe
the

used

instrument

for

in

testicles.

operation by
adds,

submit
either

to these

with

will

He

dropsy.

water

incision

those

to

He

to

water

tapping

operation the

after this

the

choose
the

let out

similar

Paulus.

as

do not

and

may

surgeon

that

terms

same

of the

coats

are

also describes

He

author.

our

recommends

he

dressingswhich
by

the

dissectingout

terms

same

in

The

mentioned
the
that

cautery
if the

operations^

scalpel or

the

states^ however,

collect

again. (Chirurg.

ii,62.)

briefly describes

Avicenna

then

ancients.

the

The
"

ima

rod

the

open

medicines

and

tumour,

dressings. This

the

escharotic

(Pract. ix, 47.)

the

He

of

iron,

tunica''

tunica

and

of

albuginea

Sprengel gives
(Hist, de

cutting out

tunica

Celsus, and

translation

an

adnata

the

"

Albucasis,

of modern
excellent

la Med.

of

of

speaks
of

called
of

operation

also

He

membrane

Arabian
the

to

prefer to

describes

hydi'ocele.

slender

opening

the
the

to

cut

its

out

treatment,

applicationsused

also describes

the

cess
pro-

burning. (Pract. ix, 79.)

Rhases
for

us

apply incarnative

to

moderns

he. adds, the

of

directs

Abbas

tunics,and

by

strong

or

of

xxii,i, 6.)
(iii,

membranes,

Haly

operation

cauteries

applying

and

tumour,

the

punctui'ingthe
the

burning

its tunics.
in

scrotiim

part with

(Cont. xxiv.)

translation

our

is the

panniculus proprius" of

and

seems

to

be

the

same

the
as

anatomists.

history of

18, 8.)

the

operation of hydrocele

SARCOCELE.

LXiii.]

SECT.

AND

SARCOCELE

ON

LXIII.

SECT.

connected

by

the

OP

THE

TESTICLES.

in any part of the bodies which arc

scrotum, it givesrise to the disease called

arises either from

This

sarcocele.

testiclebeingattacked with
from

TOPHI

flesh is formed

When

or

369

blow,

or

obscure

some

defluxion and

after the

of the
swelling

Its consequences
are, a
the swellingis of
hardness ; when

for hernia.
with

sharppains.

are

patientas

and

case,

complaintis

if the

place the

going to operatewe

When

in the former

; and

manner

same

operation
colour,

a scu-rhous nature, it
it is malignant
sensibility
; and when

is devoid of colour and

there

the

becomingindurated,

unskilful treatment

from

cause,

make

incisions in like

the

occasioned

by

the

growth of

divide the dartos and tunica

we
to the testicle,
tumour
fleshy
the testicleand bringin like manner
ing
; then stretching
vaginalis
the
cremaster
of
the
we
it to the outside
separate
vaginalis,
and cut the
the
round
tie a ligature
vessels,
from the vessels,
the testicleafi'ectedwith the fleshy
cremaster ; then we remove
be formed
tumour
tumour
a foreign
as
body. But if the fleshy
vided
about any of the coats of the testicleor its vessels,
having diand the membranes
the scrotum
lyingunder the flesh,
Buc if the postetumour.
dissect out the whole fleshy
must
rior
we
with
afi'ected
be
sarcocele,
having
?)
process {"epididymis^^
the
testicle
dissected all the surroundingparts,we remove
along
for the testicleto continue without it.
with it ; for it is impossible
If tophibe formed about the testicleand the tunica vaginalis,
from sarcocele and hydrocele
by their
theymay be distinguished
and are to be operated
hardness,and inequality,
resistance,
upon
a

as

sarcocele.
Celsus describes and

Commentary.

recommends

the

same

operations.He directs us to divide the nerve by which the

testicle is suspended (the cremaster
?),then to tie the veins
below
and
arteries at the groinwith a thread,and cut them
the
is formed between
the ligature.When
a
fleshytumour
the
to cut it out. (vii,
coats he recommends
us
22, 23.) When
parts are

indurated

Albucasis
to
II.

he forbids

directs

tie the

us

to

us

to meddle

separatethe

and then
vessels^

remove

with

cremaster

them.
from

the

sels,
ves-

the testicle from the

24

Comm.
'

'
"

After

out.

oil and
the

who

adheres

which

tumour

the

to

directs

testicle he

the

of

fleshy

other Arabians

The

it

to cut

us

is to be filledwith

wound

the
operation

(Chirurg.ii,63.)

wine.

rose-

of

treat

of Haly Abbas,
less minutely,with the exception
operation
describes it exactlyas Albucasis. (Pract.
ix,48.)

PNEUMATOCELE.

AND

the vessels about the scrotum

When

called

condition,they are
vessels of the
named

CIRSOCELE

ON

LXIV.

SECT.

tlie disease consists

When

surrounding parts.

CoMM.
"

[book vi.

CIRSOCELE.

370

testicles be
The

cirsocele.

collection attended

darti

simply varices,but
in

varicose

symptoms

with

or

of it

are

if the

varicose
nutrient

state, the affection is

are

obvious.

and somewhat
swelling,

botiyoidal
shape,and accompaniedwith

in

There

is

of
cui-ved,

relaxation of the testicle.

in running,
inconveniences,especially
walking. We may operateupon it thus. After

It also occasions certain

and
exercising,

puttingthe patientin a convenient posture,we must lay hold

and push the cremaster
of the scrotum
to the under part ; it is
from the vessels,
slender,
firmer,
beingmore
distinguished
easily
firm
feels
and
also
the
and elastic,
as beingstrong
pain
patient
;
and
is
with
it
connected
the
moreover
penis.
pressure,
upon
by our own
fingers
Having secured the vessels in the scrotum
and stretching
them strongly,
and those of our
we
assistant,
the vessels ;
the pointof a scalpel
direct upon
press obliquely
having transfixed the partswith hooks and dissected what
lie under the skin,and havingexposedthe vessels,
as mentioned
and that for aneurism,and pushing
of angiolog}'
in the operation
through them a needle having a double thread, and cutting
tie the ligatures
round
the vessels
the loop of the thread,we
the varices arise and where they terminate,and make
where
a
then

incision
straight
the blood

in the intermediate

collected in the tumour,

until
suppurations
out

of their

own

the

we

with
ligatures

accord.

the vessels which

noiunsh

operationshoidd

be

the

space.

Haring evacuated

applythe

treatment

the vessels themselves

for
fall

Leonides

few of
a
says, that when
the testicles are in a varicose state this

performed,but that when all are aff'ected,

testicle should be cut out along with them, lest being deprived
of its nutrient vessels it should decay. Pneumatocele

CIRSOCELE.

Lxiv.]

SECT.

371

of aneurism, Leonides forbids us to operateupon

being a species
be restrained from
it for fear of a hemorrhage,which cannot
takingplaceat the time ; but, there beingtwo kinds of it,the one
nourish the testicle,
occasioned by the four vessels which
and
the other by the arteries of the darti and scrotum
fected,
being afthe moderns
refrain from meddling with the latter,
but
them
We
from one
other,
andistinguish
operate upon the former.
inasmuch
that which arises from the arteries is easily
as
made
whereas that
to disappear
upon pressure with the fingers,
the nutrient vessels of the

from

We

trouble.

imam

ipsum

irons,which
are

sub

"

Comm.

Venfe

ima

If the varicose
it with
the veins

the middle

it with

fingeror

they

to be

are

When

the

cut

below, and

out, and
of

thread above

the

sharp
in

dressings

When

tunic,an

the handle

afterwards to be tied with

are

suitable

groin,the tunic drawn

in the

and

themselves,but

cicatrization.

producing

is upon

tumour

slender

alone. Then

them

situated above

are

separatedfrom

to burn

us

to burn

appliedfor

be

is to be made

place.

thread.

appliedto

to be
as

varicose veins

then

directs

are

manner

to

veins

each

conglomeratsequea superiore
tunicam
vel
implent,vel mediam

scrotum

etiam

he

scrotum

cirsocele,
taking up

intortse

eseque

great length afterwards.

such

with much

or

tunica,circa testiculum ner18.) He describes the operation

ejus,increscunt." (vii,

the

at all

Celsus thus describes the cirsocele :

interdum

vumque
at

for

as

securingit with

Commentary.

parte, vel

it

operateupon

of the veins and

intumescunt

not
testicles,

the

incision
the veins

The
scalpel.
and

below

testicle restored to its

disease is situated above

the

third tunic

Then
(tunicaalbuginea?)the middle one must be cut out.
three veins are in a varicose state they may
if only two
be
or
at the groin and where
tied,as above directed,
theyjointhe

testicle and
the

cut

internal

remedy
directs

coat

the

but
us

out.

to

secure

and

When
the

the

disease is situated between

he
testicle,

says, there is no other

removal of the testicle. For this purpose he
the arteries and veins with a thread,divide

them, and then to cut the nerve by which

19 and 23.)
(the cremaster?). (vii,

pneumatocele.
our

author

was

It
an

must

be

aneurismal

obvious
varix

the testicleis suspended

He

does

that the
or

not

treat

of

pneumatoceleof

erectile tissue.

We

see

ENTEROCELE.

372

CoMM.
'
'

the animadversions

for
good reason, therefore,

no
'

makes

Med.'

Meth.

'

Albucasis

pass

them, and

to

with

of

make

to

cordingly
ac-

sect
to dis-

the feculent
to be

them, and

to

cision
inlongitudinal
fluids which they

di'essed with incar-

he directs
disease,
testicle altogether.
(Chirurg.ii,64.) He

the

involved in the

are

the operation
saw
performed for
says he never
but that the ancients operatedfor it in the same

cirsocele.

he

surroundingparts,to

thread,under

is afterwards

If all the vessels

remove

then

says
He

it,directingus

the

double

to evacuate

wound

The

contain.
nants.

but
dangerous operation,
performedby the ancients.

and below

above

in

us

it was

as

needle,armed

tie them

Isagoge'of Galen,

'

gives our author's account

congeriesof vessels from

the

Heister

(xiv.)

considers it

will describe it

which

(See Surgery.)

noticed in the
is briefly
operation

This
and

of it.

his account

upon

[book vi.

pneumatocele;
manner

as

for

(66.)

and recommend
pneumatocele,
carminative applications
to it ; but they do not describe
the surgical
operation.
of Paulus.
(Pract.
Haly Abbas borrows the description
ix,49.)
Rliases treat

A^.dcenna and

SECT.

LXV.

Enterocele

ON

is

of the

ENTEROCELE,

descent

of the

OR

INTESTINAL

HERNIA.

intestine into the scrotum,

peritoneumwhich
of the peritoneum.
takes placein the groin,or from sti-etching
occasioned by
Both these,I mean
are
rupture and stretching,
previousviolence,such as a blow, a leap,or loud crying,but
is connected with relaxation
in particular
that from stretching
and other weaknesses
of the body. The common
symptoms of
both are a marked
swellingin the scrotum, which is increased
heat, retention of the breath,and other exertions ;
by exercise,
and its symptoms
are, that it goes
up slowlyupon pressure,
and that while the person afi'ected
and quicklyfalls down again,
and

with

is occasioned

it lies in

either from

recumbent

rupture of

the

posture it remains

The
placeuntil he stands again erect.
often brings on
regionof the scrotum

retention

in

its proper
of faeces in the

dangerous symptoms

SECT.

ENTEROCELE.

Lxv.]

373

of
pain,and sometimes with rumblinfj
The
wind upon pressure.
peculiar
symptoms of hernia from
distension are, that it does not occur
suddenly,but gradually;
from
that
that it fallsdown occasionally
any ordinarycauses;
the protruded
the swelling
equable and deep-seated,
appears
intestine being surrounded
by the peritoneum. In those from
rupture the descent at first is sudden, and happens only from
seated superviolence ; the swellingis very large,and appears
ficially
immediatelyunder the skin,owing to the intestines
alone
having burst through the peritoneum. If the omentum
tion
falls down to the scrotum in rupture of the peritoneumthe affecbut if intestine descend along with it,
is called epiplocele,
be contained in the
it is named
epiploenterocele
; and if water
it receives an appellation
tunica vaginalis
compounded from all
with

for it is attended

the three.

neither

But

these

nor

the

intestinal hernia

from

for surgery, but

rupture of the peritoneumare proper subjects
in the following
we
operate upon enterocele alone from distension,

placingthe patientin a recumbent posture,

tant,
assisand gettingthe skin in the groin stretched by an
make
we
incision,
cuttingas in the operation
a transverse
but
make
the incision not transverse
of angiology(butsome
then having transfixed it with hooks we stretch
longitudinal),
for the
out the incision to such
a
degree as to afford room
testicle to pass through; then passingthrough the inner skin
to the size of the wound, and
of hooks proportionate
a number
and fat with a blind hook or scalpel
the membranes
dissecting
the peritoneum is everywhere
When
cut them
across.
we
at the back part of the
the index-finger
laid bare,introducing
free the posterior
the darti and peritoneum,
between
we
scrotum
?); and then with the righthand doubling
process (epididymis
its extremityto the inside of the scrotum, and at the same
the peritoneumin the left hand, we bring the
time stretching
tunica to the incision,and
testicle with the vaginalis
give
manner

directions to

after

assistant

one

to

stretch the

whilst
testicle,

we,

posterior
process, ascertain by the
of intestine be comprehended in the

havingcompletelycleared the
fingerswhether

fold

to the belly
must
and if so we
;
press it down
vaginalis,
thread
doubled
needle
then we take a large-sized
containinga
mity
at the extreand we
of ten pieces,
pass it through the middle
of the peritoneumclose to the incision ; and cutting the

tunica

ENTEROCELE.

3/4

double
another

four

make

we

that

so

of

After
the

fingerof

at the

removing

introduce

than

the

the

neum
perito-

pieceswe

have

one

over

secure

free passage

applyanother

we

two

scrotum

the

to favour

discharge,

applyembrocations

and
oblongpledget,

an

bind

we

and
occasioned,

part of the

at the lower
we

X,

vi.

distant from
breadth
fingers'
leave about the size
we
making these ligatures
peritoneum,and cut off the whole all round,
cision
then making an intime
the testicle,
same

farther out, less

ligature
the former.

be

inflammation

to it lest any

letter

vessels may

of the nutrient

none

layingthem

and

againtwistinground

and
securely,
it

piecesof them,

of the Greek

in the form

[book

bandages as for hydi'ocele.We

I
there laid down.
as
applications
and

the other

also make

must

have

known

of oil

not

some

skilful
un-

after the incision into the tunica vaginalis

who
surgeons
the
extremityof it with heated cauteries for fear of

bm'ut

after the
These
operation
hemoiThage, as would appear.
bathed their patientsin a long wooden
trough
straightway
until
the
seventh
this
hot
as
water,
day,repeating
containing
often as five times during the periodof a day and a night,
for
with children ; and it succeeded wonderfully,
more
especially
fell
free from inflammation,and the ligatures
they remained
out speedily
along with the parts. In the intervals between
the bathingsthe afore-mentioned
embrocations
were
apphed.
Another
alreadymentioned,
surgeon, in addition to the means

rubbed
COMM.

into their back at the time pepper

Celsus

Commentary.

child,to
with

make

attempt,

an

bandages.

recommends

In

intestine has fallen

in the

us,

tritnrated with oil.

if the

first place,to

advanced

more

ages, if a
if attended with

and
do-\vn,

patientbe
effect a

cure

largeportionof

pain and

ing,
vomit-

which

arise from retention of the fseces,

symptoms generally
it is clear,he says, that the knife is not applicable,
and that the
is to be remedied

case

bv other

means.

He

recommends

vene-

and spare
section in the arm, the tepidbath,warm
cataplasms,
diet ; but he disapproves
of pui'gatives.This is his treatment
of

hemia.
strangulated

resolved upon,
to the middle

the

tunic

tunic

from

an

with
operation

incision

an

separatedwith

When

the

ha^dngbeen made in the

(tvmicavaginalis
?),the lipsof

assistance

all the

of

small

hooks, while
membranes

is
scalpel
groindown

the

it

are

the sm'geon

to be

frees

fascia?).
(external

ENTEROCELE.

376
CoMM.
"

[book vi.

distension of the

or

peritoneum. Sometimes,he says, fseces

prolapsedbowels, and being retained give rise to

get into the

"violent and

fatal

sometimes

When

symptoms.

going to operate

reduce the
the patient
to make
directs us, in the first place,
Then
incision is to be made
intestine if reducible.
an
along
he

the whole

lipsof

and hooks are to be fixed in the

testicle,
to enlargeit,and allow a passage for
so
as
membranes, then, below the skin,are to be

skin of the

the wound

the testicle.

The

{sifac
completelythe tunica vaginalis
is
then
be
introduced
The
between
to
index-finger
album.)
the tunica vaginalis
and the second coat (tunicaalbuginea?)
so
dissected,

so

The

operator is afterwards

adhesions

raise

and

and
take

it up

whether

examine

now

to

adhesions

free the

to

as

to expose

as

any

if so, it must

large needle

back

at the

part of the testicle.

to

separate the testicle from

to

the

external wound.

He

the
the

vessels

nutrient

not

Another

inflammation.
the distance

mav

of less than

applyingthese
peritoneumis to

After

two

the

be

armed

with

cord

of ten

truded,
pro-

then

threads,
skin

the

of

be cut,and
the
as

neum
perito-

that the

will obviate

be able to reach it,which

is to be apphed afterwards at
ligature
breadth from the former.
two fingers'
about a finger's
breadth of
ligatures,

left,and

around, and the testicleremoved

then to be made

must

portionof intestine remain

be replaced. The operator is

ha"vingintroduced it behind the tunic under

testicle (tunica
?) its extremities are to
vaginalis
threads arrangedinto four pieces. With
them
in a crucial form, so
is to be tightly
bound

and

all its

at the lower

the rest

is then

along with
part

so

as

it.

to allow

to be cut

all

An

incision is

an

outlet for

dipped in oil is to be applied

Sometimes, he
afterwards,and bound as formerlydescribed.
after the
adds, the cautery is appliedto the timica vaginalis
incision for fear of hemorrhage.(Chirm-g.
ii,65.) He describes
by burning in another place,(i,47.)
minutelythe treatment

the blood

Avicenna
other

and

matter.

recommends

Wool

the cauterv, but does not

describe the

is evidently
taken
operation.Haly'sdescription

author.

from

our

(Pract.ix, 50.)
that
correctly

hernia

latation
arises from digenerally
of the abdomen
of the passage which leads from the cavity
to the testicle. In ordinarycases, he says, there is no
rupture of the peritoneum. He states that the contents of the
Rhases

states

BUBONOCELE.

Lxvi.]

SECT.

hernial tumour

377

either intestines

are

The

omentum.

or

omen-

Comm.
'

commonly found in ruptures.

turn,he
lines the whole intestines and
He
says the peritoneum {sifac)
he givesa subfrom whom
sequent
surrounds the testicles. Antyllus,
addsjis the intestine most

extract, states in like

several of the

ment

dites est infiniment

de la

Med.)

that

it

The

was

''

of Rhases

Sprengelsays

Sa

there

entirelytaken

from

propre-

celle des Grecs."

(Hist,

givesof ruptures is,

Rhases

which

account

correct

theorie des hernies

a
preferable

but

doubt, very

ation
relax-

the

between

passage
testicles. This

no

arises from

and
cavityof the abdomen
opinionregardingruptures is maintained
authorities quotedby Rhases,
(Contin.xxiv.)

of the

by

scends
peritoneumdei. e.
elytroides,

tunica

the

affirms that hernia

vaginalis.Antyllusalso
the

forms

testicles and

the

to

that the

manner

is every reason
of
the works

to

suppose

the

surgeons.
The operations
practised
by the ancients for the radical
but

hernia cannot
and

'

'

appear to

yet the danger attendingthem

have

must

and

cure

of

hazardous

been less than

is

extremelycruel

us

Greek

quently
supposed,otherwise they could not have been so fregenerally
Faabout two centuries ago.
performedas they were
that a celebrated rupture
bricius ab Aquapendente mentions
doctor of his time

patientsat an
prudentlyrecommends
200

in extreme
the

cases,

partsby
The

SECT.

LXVI.

average
us

and
of

means

ancients

him

informed

never

ON

every

he used to

year.

operate upon
Fabricius, however,

performthe operationexcept
in generalwith supporting
content

not

to be

that

to

truss.

operatedto

BUBONOCELE,

relieve

OR

hernia.
strangulated

INGUINAL

HERNIA.

cele
bubonodistension commences
from
as
arising
the peritoneum being stretched the relaxed
; for at first
ease,
the groin,and forms this disintestine is protrudedas far as
in this manner.
After
the ancients operatedupon
which
breadth
making the incision to the extent of three fingers'
in the groin,and removing the
the tumour
across
transversely
and fat,and the peritoneum being exposed in the
membranes
middle where it is raised up to a point,let the knob of a probe
Enterocele

[book vi.

BUBONOCELE.

378

applied,
by wbich the intestines will be presseddeep down.
The prominences,
then, of the peritoneumformed on each side
another byof the knob of the probe are to be united to one
toneum
sutures,and then we extract the probe,neither cuttingthe peribut curing
nor
anythingelse,
nor
removing the testicle,
But
since burning
for fresh wounds.
it with the applications
is preferred
in cases
of bubonocele
by most of the moderns it
of this operation.
account
will be right for us
to give an
let him cough
After the man
has undergonemoderate
exercise,
the
and
strain to keep in his breath; and when
violently
swellingappears at the groinwe mark Avith black ink or coUyin a triangular
rium
the placethat is to be burned
figure,
making its transverse line above in the situation of the groin,
be

and

also make

we

mark

in

the

middle

of the

triangle.

posture we first applyto

patientin a recumbent
cauteries heated in the fire,
the mark
in the middle nail-shaped
with gamma-shaped
afterwards
burn the sides of the triangle
with cauteries
and
afterward level the triangle
(F) cauteries,
assistant duringthe whole proan
cess
shaped like tiles or lentils,
of burning wiping away the ichorous dischargeswith a
habit of body the
of a moderate
and in those who are
rag;
burning should be carried to such a depth as to touch the fat.

Having

But

laid the

in those

who

lest by mistake
those who
before

we

are

lean

should

must

we

burn

the

not

attend

this mark

to

peritoneum;

nor

againin

for in them
the fat appears
and fatter,
grosser
fore,
sufl"cient burning has taken place. We
must, thereare

guided as to its extent by a skilful conjecture.

After the burning,having triturated salts with leeks we
apply
the inguinalbandage shaped like
them
to the eschar,and use
the Greek
letter X.
On
the following
days we complete the
with the dressings
for eschars,
such as lentils with
cure
fitting
honey, and the like.
be rather

CoMM.

Commentary.
is moderate

in
two

out ;

Celsus

size,to

make

directs us, when

one

lines to be made,

the

he
incision ; but if larger,
so

that the middle

may

commends
re-

be cut

advised in certain
the testicle,
as
then, without extracting

the veins are to be

prolapsedintestines,
and tied where
they adhere to the tunics,and
below the knots, (vii,
24.)

cases

tumour
inguinal

of

bound

together

afterwards

cut

CASTRATION.

Lxviii.]

SECT.

379

and the actual Comm.

speaks of astringentapplications
of the incision and suture, (iii,
cautery,but disapproves
22, 1 .)
The
of the suture and burning are described by
operations
Albucasis (Chirurg.
ii,67, and i,47) ; by Rhases (Cont.xxiv);
and by Haly Abbas
dently
(Pract.ix, 52, and ix,80.) They all eviAvicenna

'

"

from

copy

"

"

'

author.

our

of crural
Garengoit affirms that Paulus has made mention
hernia^but we agree with Heister that this is a mistake.

SECT.

ON

LXVII.

RHACOSIS,

the skin

When

about

RELAXATION

OR

the

OF

THE

SCROTUM.

is relaxed without

scrotum

the

rhacosis is formed, being a most

being aflFected,
Leonides,havingplaced the
unseemlycomplaint. Wherefore

bodies within

in

man

recumbent

direct
scalpel
the lipsof the
a

scissors

effected

board

some

with

was

external

or

But

sutures.

to

three

with

them

redundant
hard

some

skin with

the redundant

transfixed

off what

upon
wound

off the

posture, cut

and having secured

scalpel,
the cure
by the treatment for

skin,and

united

Antyllus,havingfirst
four ligatures,
cut
or
sharp-pointed
pair of

the

or

skin with

recent

parts with sutures,

wounds.

of the two modes Comm.

description
of perfonningthe operationis copiedby Albucasis. (Chirurg.
ix,53.)
ii,68) ; and by Haly Abbas (Pract.
Our

Commentary.

author^s

"

"

SECT.

ON

LXVIII.

CASTRATION.

objectof our art being to restore those partswhich are

of castrastate to their natural,the operation
in a preternatural
tion
But
since we
sometimes
are
professes
justthe reverse.
compelledagainstour will by persons of high rank to perform
shall briefly
describe the mode
of doing it.
the operation,
we
of performingit,the one
There
two ways
are
by compression,
That by compressionis thus perand the other by excision.
formed
still of a tender age, are placedin a vessel of
: children,
The

hot

Avater,and

the testicles are

then

when

to be

the

parts

squeezedwith

are

the

softened

in the

until
fingers

bath,

they dis-

'

[book vi.

CASTRATION.

380

and, being dissolved,can no longer be felt. The

method by excision is as follows : let tbe person to be castrated
with the testicles
be placedupon
a
bench, and the scrotum
graspedby the fingersof the left hand, and stretched ; two
in
one
straightincisions are then to be made with a scalpel,
appear,

testicle; and

each

dissected around

when
and

of connexion

bond

cut

the

testicles start

out,

havingmerely left the

they

are

to be

very thin
vessels in their natural state.

the

between

up

to that by compression
preferred
; for those who
them
have had
squeezedsometimes have venereal desires,a
certain part, as it would appear, of the testicles ha\ing escaped
the compression.

This method

'
"

We

Commentary.

CoMM.
"

is

have

of
given Celsus's description

the

operationin the 64th section of this Book. Albucasis describes

the operations
by compressionand by excision. In the former
the testicle is squeezedby the operator while the patientis
In the other the spermaticcord is to be
seated in hot water.
first secured with
a
ligatureand then the testicle cut out.
ii,69.)
(Chirurg.
Thev

are

Abbas.

Haly

likewise described

(Pract.ix,54.)

The

nearlv the
castration

same

of

terms

the

bv

inferior

(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
animals

was

with

is mentioned

in

customary
a

to make

by

Aristotle

capons

by burningthe

testiclesof cocks

It appears from Juvenal that the surgeons

often called upon
to perform castration. (Sat.

red-hot iron.

in his time

were

vi,1. 370.)

Abulpharagiuslikewise mentions that the performance

of this operation
constituted at one time an importantpart
of the surgical
practicein Bagdad. (Dynast,ix.) But the
the operation
as beingdangerous
Emperor Justinian condemned
and

often fatal.

Sprengelgivesan interesting
histoiyof castration. One of
the most
of
importantpointsin this operationis the mode
authorities afifinn that no bad
t}dngthe cord. Some modern
result from puttinga ligatiu'e
round
the whole cord,but
eflPects
this practiceas bringingon
others condemn
convulsions
and
All admit the difficulty
tetanus.
of securingthe artery separately.

NYMPHA.

Lxx.]

SECT.

SECT.

LXIX.

ON

This affection derives its

one

HERMAPHRODITES.

from

name

combination

of the

sions
Aphrodite(Mercury and Venus,) and occaThere beingfour varieties
to both sexes.
great deformity
in men
and
it^accordingto Leonides ; three of them occur
In men,
in women.
sometimes
about the perineum and

Hermes

names

of

381

sometimes

and

about

the middle

of the

scrotum, there is the appearance

pudendum with hair ; and in addition to

in which the discharge
of urine
these there is a third variety,
In
from a female pudendum.
takes placeat the scrotum
as
there is often found above the pudendum and in the
women
of a man^s privy
situation of the pubesthe appearance
parts,there
there,one like a penis,and two
being three bodies projecting
of

female

like testicles.

The

third of the

male

varieties in which

the

through the scrotum is incurable ; but the other

bodies and
three may be cured by remo\ing the supernumerary
the part like sores.
treating

urine

is voided

Albucasis
Avicenna

Guy

section of

author

is

copied by Comm.
ii,70) ; and by Haly Abbas (Pract.ix,55.)
(Chirurg.
mentions this monstrosity,
20, 2, 43.)
(iii,
briefly
This

Commentary.

our

'

"

of Cauliac and Brunus

describe it in the

same

terms

as

the Arabians.

SECT.

LXX.

ON

EXTIRPATION

OF

THE

NYMPHA

AND

CAUDA

PUDENDI.

large
?)is excessively
nympha (clitoris
insomuch
and presentsa shameful deformity,
that,as has been
have had erections of this part like men,
women
some
related,
and also venereal desires of a like kind.
Wherefore, having
and
dant
in
the
a supineposture,
woman
seizingthe redunplaced
portionof the nympha in a forcepswe cut it out with a
taking care not to cut too deep lest we occasion the
scalpel,
complaint called rhoeas. The cauda is a fleshyexcrescence
from the mouth
of the womb, and filling
the female puarising
dendum,
and
like
sometimes
a
even
tail;
projecting
externally
it may be removed
in the same
manner
as the nympha.
In

certain

women

the

"

"

'

'
'

That

Commentary.

CoMM.

as
anciently

the

nympha

and

clitoris were

is evident from

teims

synonymous

[bookvi.

ETC.

THYMI,

382

used

lluflus Ephesius

(De Partibus Hominis); Soranus

than
con, ii.) Martial,in more

(c.6); and Pollux (Onomastione

place,makes allusion to
with an enlargedclitoris. Aetius

connected
practices

unnatural

says that it is

small

muscular

substance

situated

of the alse

pudendi above the meatus

enlargedit is
preternaturally

adds,that when
Like our
author,he directs
a

forcepsand

the

excision

urinarius.
to be

missure
com-

He

amputated.

of the tumour

with

off the

protuberance,
takingcare not to carry
He recommends
far.
to apply a sponge
us
wine or cold Avater,with suitable
astringent

cut
too

squeezed out of

us

to take hold

at the

an

account
of the cauda
our
as
dressings. He gives the same
author, (xvi,
103 and 104.) It was
from the
a tumour
arising
itself.
Albucasis merely transcribes our
author's
uterus
count
acof these operations.
Avicenna
ii,71.)
(Chirurg.
briefly
recommends
the
to remove
us
enlargednympha by medicines
22 ; i,24.) It would appear that this operation,
or the knife, (iii,
like circumcision,
is stilloften practised
in the East.
The chaptersof Soranus, in which
these operations
were
treated of,are unfortunately
wanting.
On
of
the
gery
extirpation
enlarged clitoris see Heister^s Surcauda
flower
5, 147). The
pudendi was probablythe cauli(ii,
of the os uteri described by late authorities
excrescence
on
midwifery.

LXXI.

SECT.

ON

ABOUT

The

thymus

white, for
clusters of
and

the

THYMI,
THE

is an
most

the hemorrhoids
sometimes

them,

when

women,

with

And

we

the

more

these

FEMALE

excrescence

PARTS

OF

HEMORRHOIDS

GENERATION.

sometimes

red, but sometimes

part without
The

thyme.

AND

CONDYLOMATA,

pain, and resemblingthe

condylomataare rugose protuberances
;

resemble

pour

forth

those
blood.

about

the anus, and, like

Such
in
excrescences

broughtinto view and exposed,are to be seized

forcepsand cut out with the point of a half-spatula.
then to use
fissilealum.
For
are
or
pounded galls,
in
do not approve of ligatures
distinguished
sm'geons

cases.

IMPERFORATE

384

PUDENDUM.

[book vi.

incision,
simple adhesion only,it may be separatedby a straight
made
with a scalpel,
for operating
fistulse. But
upon
if it is an obstruction,
having transfixed the connectingbody,
a

whether
and

it be

divide with

membrane

with
flesh,

or

hooks, we

stretch it

for fistulse; and having stopped the

scalpel
such applications
desiccative without
as
are

hemorrhage with
being stimulant,we

have

then

to

recourse

such

medicines

as

tent covered
applyinga priapus-shaped
promote cicatrization,
in which
with some
medicine,in those cases especially
epulotic

operationis performed upon

the

in order that the parts may

which

in the

at

the

unite

not

of the uterus

mouth

deep-seated,
the phiraus
is operatedupon

very
again. And

manner.

same

Aristotle makes

Commentary.

CoMM.
"

is formed

not

part

mention

of

imperforate

'
'

vagina. (De Generat. Animal, iv,4.) Aetius treats of these

diseases at considerably
greater length than our author,but
is nearlythe same.
his practice
Upon the whole the amount
of his directions respectingthe treatment
is,that when the
obstruction is occasioned by a membrane, it is to be divided
and
the lipsof the incision prevented from
adheringby the
introduction of suitable tents ; or, if it is a fleshy
body, it is to
be dissected out, and the parts separated
by a pieceof sponge
tents,
or
operationis described by Sora(xvi,
96.) The same
nus.
(219.)
The

method

same

of

treatment, however,had been previously

casioned
by Celsus. Thus, when the obstruction is ocrecommends
he
to divide
us
by a simplemembrane,
hke
the
letter
it by two
incisions
transverse
X, takinggreat
to wound
the urinarypassage, and
then the memnot
care
brane
When
is to be cut out.
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
sect
or
hook, to disit out, and introduce
soaked
an
oblong tent (Xtj^uviWoc)
and applyexternally
wool
moistened
with vinegar.
in vinegar,
The dressings
the third day,and the sore
to be removed
are
on
the wound
is lieaUng,
treated upon generalprinciples.When

recommended

he advises

us

ointment
Albucasis

to introduce
to

leaden

tube

prevent adhesion,

makes

mention

of

smeared

with

some

able
suit-

(vii,
28.)

singularsubstitute

for the

ABSCESS

LxxiiT.]

SECT.

leaden tube recommended

ut

consolidetur

non

OF

by

Celsus

"

SS.i

Coeat

alia ! !"

vice

locus

WOMB.
mulier

The

omni

die

advice is

same

Comm.
'

and b}^Alsabaravius,
gravelygivenby Rliases (Cont.xxii),
who,
have formerlystated,
was
as
we
as
probablythe same
person
Albucasis.
the obstruction arises
(Pract.
xxv, 2, 19.) But when
from a fleshy
of
to make
us
use
tumoiu% Albucasis recommends
the leaden tube. (Chirurg.
ii,72.) Alsabaravius dii'ccts us to
the obstruction by corrosive medicines or with the knife.
remove
Rhases briefly
describes the phimus,and directs us to perforate

it with

instrument

an

moistened

Haly

in

either from
or

from

the

states

that obstruction of the uterus

natural,that

is to say,
He
the effiectsof ulceration.
a

midwife

other

to introduce

then

tent

wine.
styptic

some

Abbas

iron,and

of

clear away the

convenient instniment.

congenitalimpediment,
recommends
with

obstruction
The

arise

may

Arabians

us

to make

or
scalpel

any

very delicate

were

to perform surgical
operations
allowingmale practitioners
about the genital
ix,66.)
(Pract.
organs of Avomen.

in

SECT.

OF

THE

the abscess is situated at the mouth

When
that it can
recourse

ABSCESS

ON

LXXIII.

be
to

operatedupon,

incision,nor

bodies which

surround

not

to

it have

of the

be in

until the disease be

increased

has

inflammation

must

we

WOMB.

womb, so as
haste in having

and
ripened,

its utmost, and

become

the

the

vascular

attenuated,
owing

to the

In

the
operating,
should be placedon a seat in a supineposture,having
woman
from
and her thighsseparated
her legsdrawn up to the belly,
likewise be brought down
to her
another.
Let her arms
one
The
legs and secured by proper ligaturesabout the neck.
operator,sittingon her right side,is to make an examination
The
to her age.
with a speculum proportionate
person using
with a probe the depth oi the
the speculum should
measure
of the speculumbeing
woman^s
vagina,lest the stalk (fistula)
too long it should
happen that the uterus should be pressed

importance

upon.

of

If it be

the

uterus

in

ascertained

the

that

system.

the

stalk is

largerthan

the alse pudendi,

to be laid upon
are
compresses
The
that the speculummay
be placedupon them.

vagina,folded
in

order
II.

the

25

'
^

ABSCESS

386
is to
(fistula)

stalk

part, and

tlie

OF

WOMB.

[book

inti'oduced,having

be

speculum

is to

be

lield

by

vi.

at the

screw

upper
the
but
operator,

the

assistant,so that the laminse of

by
When
be distended.
the stalk being separatedthe vagina may
be
thin (which may
the
abscess is exposed, if it be soft and
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
into the incision,or rather external to the opening
introduced
into
the woman^s
vagina,so as not to produce compression.
And
externallyto 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
and having
of warm
oil or water, or of a decoction
of mallows
;
the tent gentlyinto the opening,
wiped the parts, we introduce
tetrapharmacon, either alone or with
spread with the ointment
clarified honey ; its strength, however, ought to be reduced
is to be

screw

with

butter

covered

with

be

may

be

If

thrown

it is

decoction

the
up

with

the

an

of

mouth

of the

Commentary.

uterus,

we

external

got cleansed

to

are

subside

and

be
the

with

an
difficulty,
of
or
honey,
healing process

iris,of birthwort,

ear-syringe.

must

parts

inflammation

promoted by the calamine

applied upon a pledget. But

and

CoMM.

The

roses.

cataplasmsuntil
clean.

injectionof
may

the

oil of

or

become

sore

turned

The

ointment
if the

decline

diluted

abscess

be

with
within

wine
the

operating.

similar

of the method
of opendescription
ing
abscesses in the vagina is given by Aetius.
(xvi,85.) The
in comprehending his description
author's
only difficulty
or
our
arises from

oiu*

unacquaintance

with

the

construction

of the

of them

cient
an-

or
dioptrse
specula. Drawings
are
in
the
of
and
Scultet.
Albucasis
given
by
(Arsenalde
surgery
One
of
tab.
the simplestof them
consists
of two
Chirurg.
18.)
laminae
or
platesso united that by turning a vice or screw
they
distance.
Albucasis
separatedto the proper
evidentlycopies
author's
our
description.(Chirurg.ii,71.) The account
given
is quite similar. (Pract.ix,57.)
by Haly Abbas

of several

sorts

LXXIV.

SECT.

We

have

Third

Book.

the

EMBRYULCIA.

Lxxiv.]

SECT.

ON

AND

EMBRYULCIA

be not rectified by
parturition
must
proceedto the surgical
Avhether
a probableconjecture

If the process of
there laid down^ we

means

we

will survive

woman

operate ; but if not,

to

are

in

operation. Those
and
lethargy,
rouse,

not

or

loss of muscular

if roused

or

loud

by

if she may
decline
must

be

and

;
we

dying

EMBRYOTOMY.

of difficultlabours in the

described the treatment

after having formed

operation^
the

387

state

are

motion

saved,then

attemptingthe

aflFected with

they

cries,
they return

difficult to

are

coma,

feeble answer,

and

have
Some
convulsive
state.
again sink into a comatose
subsultus
to food.
or
tendinum, or insensibility
contractions,
The
but obscm'e and
pulse is found to be greatlyinflated,
of these symptoms.
have none
feeble. Those who are to recover
in a supine posture,Avith her head
Having placed the woman

her thighsare to be kept elevated by women

depressed,
each
on
side,or by certain assistants ; or if they are not at
hand, her chest is to be first fastened to the bed by ligatures,
that when
the foetvisis pulled the woman's
so
body may not
follow,and diminish the force of the pulling. Then the ate
must
introduce the
we
pudendibeing separated
by an assistant,
rather

left hand

lubricated

with

some

substance,the fingers

unctuous

of the uterus, and dilate it,

being contracted,to the mouth
it with oil,we
seek
and
having got it relaxed by lubricating
for the most
convenient
place for fasteningthe hook (embryof the
ulcus) The most convenient placesin presentations
.

head

are

"

chin, the

the roof of the

eyes, the occiput,
and
the parts about the sides
clavicles,
the

chondrium

; and

the middle

be held

in the

fixed

to the

it

on

to

one

but

and

there

of the

hypopubes,

ribs,or, again,the clavicles. The hook is to

righthand, and its curvature graspedwith the
is to be gentlyintroduced with the left hand,

some

cavityof the

to it in
not

and

the

of the

fingers,and
and

the bones
presentations,

in feet

mouth,

order

of the afore-mentioned

And

uterus.

that

side. Then
also from

ought to be

another

beingpushed
places,
is to be appliedopposite

pullingmay be straightdown and

to pullgently,
not only straightare
forward

the

we

side to side,as in the extraction of teeth

no

relaxation

of the

pullingin the in-

EMBRYULCIA.

3S8

tervals.

or
introducingthe index-finger

Then

besmeared

with

must

and

the
the

When

it all around.

lubricate

vi.

fingers

more

womb

of the

the mouth

fat between

impactedbody, we

changed to a part above,

When
extracted.
until the foetus is completely
a
so
on
presents,and is so impacted that it canuot be returned,

hook

hand

must

we

pullit
when

far,and

so

off at

fall down

slip,and

it may
not
fallen down
it is properly
it

that

so

The

shoulder.

the

hands

two

when

be

must

cloth round

wrap

cut

it
properly

down

comes

and

be

[book

into the

thing is

same

done

to be

in like manner,

and

vagina;

it should

body does not

come
along,we must amputate at the groins,and then endeavom? to turn the rest of the body. If the impactiontake
place owing to the head being largerthan natural,if it be a
hydrocephalousfoetus,we must open its skull with a polypusknife concealed between
or
a needle,or a sharp-pointed
scalpel,
when
evacuated ; but
in order that it may
the fingers,
collapse
if it be a naturally
largehead, we must open the skull in like
when

the

feet

and

manner,

break

and
bone-forceps,

take

its bones

down

with

tooth-forcepsor

tracted.
they ought to be exj)roject
lias been delivered,
an
impediment

if the bones

If,after the
should

rest of the

the

down, and

come

placeat

head
the

clavicles

the

parts about

chest,the

cavityof the thorax with the

its fluid
when
same
instrument,so that the thorax may collapse
contents
are
discharged;but if it do not collapsev,e may
should

be

di\ided down

to the

divide the

clavicles and

extract

them, when

collapse. If the bellybe inflated,

owing to
evacuate
must
child,or its being dropsical,
we
the intestines in the

same

parts
we

womb
and

are

must

cut

it and

draw

the head
off',
the

down,

retreat

left

of the

death

with

its contents

and

making
If,after

backwards
and

hand,

we
belly,

or

and

if the

must

division

the

is

mouth

other

retained,
of the

be

to the cavityof the womb,

open, push up the hand
havingfound the head,bringit down with the fingersfixed

in the

mouth,

when

tliere is inflammation

must

it

its contents.

evacuate

introduce

the

will

In presentations
by the feet
way.
of the
be easily
rectified at the mouth

the wrong
direction may
womb.
But
if the foetus stick at the chest
wrap a cloth about
in the same
manner,

thorax

the

use

no

and

extract

but
violence,

by one
at

or

two

the

hooks

mouth

lubricate the

fixed in it ; but
of the womb

partswith

we

unctuous

EMBRYULCIA.

Lxxiv.]

SECT.

389

and have recourse

fattyapplications^
cations,and cataplasms,in order that
in
dilated extraction may be accomplished
if they can
Cross
above.
presentations,

and

treated

the whole

the

of the
the

ah'eadyhad

none

is

There

along with

of the foetus ;

of it directs us,

the

manner

be

rectified,
may

methods

; but

parts of it be

is

described
be

if not,

extracted

to the treatment

recourse

come
liemoiThage

in

left behind.
for
have

on, you

curious treatise

commonly pub-

of

Hippocrateson the
mentioned
by Erotian

it is not

when

the

of the

generallyadmitted

now

mouth

of it described.

the works

but,as

the

within, and

If

uterus.

when

asunder

have

must

management

Commentary.

it is

that

we
operation

inflammations

lished

be cut

foetus must

pieces,taking care
After

the afore-mentioned

accordingto

emliroliip-baths^

to

not
arm

Comm.

extraction
.

and

Galen,

genuine. The author

and
presents,to pull it down
to be

the head is to be
shoulder-joint
; after which
and
cordingly.
accomplishedacbrought to the proper position
delivery
and
This is not now
the generalrule of practice,
to deliver in this way,
once
compelledby necessity
yet we were
assistant had been foiled in all our
after we
and an intelligent

amputate

at the

attempts

to turn

the child.

We

have

known

of similar

cases

of other surgeons ; and, in fact,this

happening in the practice
of procedurewas
advocated
method
latelyby a sensible writer
in the
Edinburgh Medical and SurgicalJournal.^ The author
to bring
treatise in question recommends
of the ancient
us
but if this be
down
the head
in its natural state,if possible,
He directs us to give
to break it down.
found impracticable,
'

for drink
Celsus

white,sweet, undiluted

wine.
of this

account
givesan interesting

practiceis deser\ingof

much

He

consideration.

his

subject,and

I'ecommends

is unnatural, to turn the child either to

position
that deliveiy
the feet ; adding,afterwards,
the head
or
may
feet.
the
In
be
arm
generally accomplishedeasilyenough by
he approves of turning to the head, that is to
presentations,
the

us, when

sav,

in

cases

the head
fastened
its

be

when

is at

it is ascertained that the foetus is dead.

hand,

smooth

hook

with

small

pointis

If

to be

the eye, the ear, the mouth, or the forehead, and

is to be thus dragged down.
This, however, must not
at

body
attemptedAvhcu

the

mouth

of the

womb

is not

properly

EMBRYULCIA.

390

dilated.

CoMM.
'

foetus,and

the

let out, and

it is to be

child lie

If the

and

across

In

allyperformed.
the neck
the

the

fluid,

with

body brought down with a hook.

the position
be got rectified,
cannot
at the armpit,and extraction gi'adu-

extreme

asunder,and
head, for fear

and

the

is to be inserted

the hook

with

of the foetus is distended

the body

When

foetus.

directingthe instiaiment

left in

the

employed in draggingdown

is to be

righthand

The

'

'

[book vr.

he

cases

the

extract

of its

recommends

to

us

cut

parts separately,
beginning

being left

in the uterus.

Should

accident occur, howerer, he directs us to get the belly

compressedso as to force the head down to the os uteri ; after
such

an

which

it may

be extracted with

the

us, when

foot cannot

other

protrudes
," after

which

one

sticks at the

the breech

foot presents,and
the

child is dead.

the

giverise

He

be

which

described

manner

one
cases.) When
os
mends
uteri,he recomfound, to separate

body of the child

leg found and brought down.
is only recommended
practice

be pushed up, and the other

may
It is to be recollected that this
Avhen

of such

(Smellierelates histories

.above.

in the

hook

the

adds, that other difficultiesmay

of performingembryotomy, (vii,
necessity
29.)
has
Aetius
an
interesting
chapteron the Extraction of the
Dead
His
of Philumenus.
Foetus, copied from the works
of embryotomy is similar to our
author^s.
He
description
directs us
hooks
to apply two
to certain parts of the head,
such as the eye, mouth, and
chin,and thus to drag down the
he advises us to
body. If the head is large or hydrocephalic,
it and

open

be too

which

its contents

evacuate

largefor the passage,

the bones

If

to the

of the

skull and

the instrument

obstruction

belly,he

directs

When

arm

an

or

us

and if even

he recommends
them

remove

is to be fixed and

the

to

take
delivery

us

with

it is found

to break
a

to

down

after
forceps,

the foetus dragged down.

placeat

their contents

to evacuate

then

both present,he recommends

the chest
in like
us

to

or

the

manner.

amputate

at the

the
can

If the child come

down
shoulder-joint.
doubled,and
cannot
be got rectified,
he adrises us, if the head
position

be

reached,to break down

its

bones, and

then

extract

the

other parts accordingly

; but if the legsare
got at most easily
and cannot
be brought down, they are to be amputated at the
and then the
hip-joint,
body is so impactedin

head
a

will be

doubled

got delivered.

state

that it cannot

When
be

the

moved.

CoMM.
^"^^

"

'

[book

SECUNDINES.

392

vi.

be
cannot
the delivery
when in footling
presentations
hip-joint
is preternaturally
the head
otherwise accomplished. When

large,he directs
to

do

in like

so

placeat
resemblingthe

when

obstruction

any

instrument

of any

mention

no

and

ix,57.)
forceps.(Pract.

modern

SECUNDINES.

THE

OF

RETENTION

ON

LXXV."

SECT.

makes

He

its contents

evacuate

Avith the chest

manner

it.

takes

it and

to open

us

Often, after the removal of the foetus,the placenta(whichis

When
also called the secundines)is retained in the uterus.
the mouth

rolled into

and

is dilated and

of the uterus

ball in

part of the uterus, the extraction

some

if

But

to

in like manner,

the hand

and
j-ield

the

uterus

fundus

and

grasp them

be moved

mouth

shut

in

the

But

the

stomach, we

CoMM.

hand

figsare

Commentary.

We

have

in
practice
Hippocrates^
suspendingweights from
us,

not

when

same

and

much

and

the end
the

and

drop

disorders

which

placentaconsisted

of the umbilical

placentais

even

placethat

in another

retention of the

not

an

alarmed,

be

fumigations,
among
approved.

mentioned

migation
fu-

if the

If

aforesaid.

suitable

use

dried

in

cord.

cast off

soon

after

child,to draw down the umbilical cord gently

not to break it. The righthand
with the left hand, taking care
is then to follow it up to the secundines,and their veins and

the

dehveryof

the

the

be used ; and
may
is to be introduced

fetid smell affects the head

must

Celsus directs

to

of

mouth

dissolve into sanies and

putrefy,

and

cardamum

pot

placenta,as
need
be extracted,one

extract

to

since

If the

recourse

the

in this way it cannot

for after a few days it will

off.

the
dilate,

of the womb

attempt made

have

must

we

aromatics

with

troduce
in-

pullthem

strengthis not sunk, sternutatories

If the

treatment.

we

and

they

as

must

with great
nor
prolapsus,
gently,at first from this side
for thus they
more
strongly,

their adhesion.

be freed from

be found

uteri

the

that,and afterwards somewhat

will

extracted

for fear of

down
along,not straight
but they are to
violence,
to

the secundines

they adhere

is to be

anointed

and

warmed

The
left hand
easy.
and
introduced into its cavity,

is most

present.

placentaseparated,

the

SECT.

being separatedfrom

membranes
be

SECUNDINES.

Lxxv.]

along with

extracted

393

the

womb, the whole

coagulatedblood

whatever

are

to Comm.

be in

may

'

"
'

29.)
(vii,
of the subject
Our author merely abridgesa fuller account
24.)
(xvi,
givenby Aetius from the works of Philumenus.
of using sternutatories,
the ancient practice
jNIoschion reprobates
and fumigations,
and of suspendingscales or
pessaries,
sometimes occasion
weightsfrom the cord,because these means
the midwife, if the mouth
of
hemorrhage. He recommends

the uterus,

be still open, to introduce her left hand, and to take

hold of whatever part of the placentapresents: then, if it does
the womb

not

adhere

is not

to the

fundus

separatedit

the

When

gentlyhither

moved

is to be

\aolence.

without

uteri it is to be extracted

mouth

of

the

but if it

and

uterus

thither
is

tracted,
con-

which
liquorsand injections
of the womb.
for inflammations
are
(SectionHv.)
applicable
of securingthe umbilical cord after deliveryis
His method
nearlythe same as that now adopted. After the child has been
allowed to lie on the ground for a few minutes, two ligatures
round the cord,the nearest beingfour fingers
to be applied
are
from the belly
or
; it is then to be cut with a scalpel
any shai"p
of usinginstruments
of wood, glass,
He disapproves
knife.
or
reeds, and hard crusts of bread, as practisedby the ancients.
(Ixv.) He directs lacerations of tlie perineum to be treated by
composed of wax, oil of roses, litharge,
applpng ointments
ceruse, and alum, with suitable bandages. (Ivii.)
is most judicious,
and
of Soranus in these cases
The practice
at the present day. He
be improved upon
such as can
scarcely
but when
the
of all Ndolent attempts at extraction,
disapproves
placentacannot be got otherwise removed from the womb, he
advises her

he

to

use

those

of introducingthe hand well lubricated to extract the

approves
the mouth
of the womb
He directs us when
eentlv.
secundines
is shut

to open

with the fingers

in
possible
called
case
now
incorrectly

it if

is the

This

ner.
gentleman-

the

hour-glass

contraction.

repeatsthe directions givenby Paulus and Aetius,

Avicenna
but

to have

seems

the uterus

as

considered

painful,and,

the introduction
in

general,an

of the hand

unnecessary

into
ration,
ope-

21, 2, 16.)
(iii,
Albucasis

follows

our

author^s

(Chirurg.ii,78.)
practice.

'
'

Abbas

Haly

CoM.M.
'

with

oil of

adds, that
ix,59.)
Rhases
after

to
delivery

uterus

when

us

sneeze,

woman

do

not

and

if

nails,and having introduced

so
pullcautiously

to

well lubricated

if it still adhere

secundines

the

the

make

pare the

retained,to
the

when

directs

the hand

vi.

extract

the

it is to

be

side,and not pulled straightdownwards.

not extracted,it becomes
putrid.(Pract.

side to

He

[book

like,into the uterus, and

separated
; but

it be

from

to introduce

us

the

or
violets,

placentaif
moved

directs

HIPS.

THE

BURNIING

394

as

not

to

come

they are

away
still

the hand

into

give pain.

When

to throw
us
they cannot be removed in this way, he recommends
of the
to promote putrefaction
into the Avomb
so
as
injections
tained,
placenta. In another place he mentions, that when long reand
off
in
the placentaputrefies
comes
(Cont.xxii.)
pieces,

LXXVI.

SECT.

in the

ox

of the

HIPS.

THE

BrilMNG

also the

shoulder, so

getting
hip-joint
fore
dislocated from a collection of humours
burning. Whererequires
takes
Hippocratessays : AVhen dislocation at the hip-joint
ischiatic disease,
the leg wastes, and
placefrom long-continued
is to
lame unless burnt."
the patients
are
Biu'uing,therefore,
the jointis
be performedmore
at the place where
particularly
As

case

"

humour
will be dried up, and
for thus the redundant
dislocated,
the part being condensed
by the cicatrix will no longer be able
the Inu-ningshould be carried
to receive the bone, wherefore
to

considerable

burning;

the knee

of the ankle

CoMM.

behind

one

little above

depth.

in the

The

moderns

in the hollow
on

the

form

of the

outside,and

three

eschai's

buttocks, another
third

on

by
a

the outside

fleshypart.

recommends
to burn the parts
us
Hippocrates
with crude flax. (De Afiectionibus.)The
hip-joint

Commentary.
over

the

author

of another

Hippocratic treatises

directs

bony partswith fungiand the flesh with a red-hot

(De Affect. Int.)
of Archigenes,
recommends
Aetius, upon the authority

burn

the

of the

in this

with

us

to

iron.

ing
burn-

irons,the roots of fuller^s herb and birthwort, or with goat'sdung, (xii,

3.)
of ischiatic disease,
Cselius Aurclianus,in cases
speaksof formcase

issues

ing

eschars

395

by the actual
hip-joint
with which
potentialcauteries,
to have

burnt, appear

were

and
he

potentialcaumentions

been the ashes

of

Comm.

that

"
'

herbs,that

to which quickof the caustic alkali,

lime
impure preparations
sometimes
added.
They must, therefore,have been

is to say,
was

nearlythe

same

that

some

burned

with

piecesof

the skin in

folded and

the calx

as

cum

He

use.

root of fuller^s herb

states,
;

others

the letter T ; that some

raised
transfixed it with heated irons ; that some

shaped like

fold and

fungi,and

laid

kali of modern

part Avith the

the

iron

it with

burned

the

on

others with

which

have

we

pieceof

part. (Pass.Tard.

the fullest account

But

HIPS.

the

over

His

teries.

THE

BURNING

Lxxvi.]

SECT.

v,

linen

cloth

1.)

of the ancient modes

burning the hips for diseases of the jointis that which is

tion
Menascribed to Dioscorides.
Euporiston,^
givenin the book
of burningwith goat^sdung,
of the methods
is there made
of

'

and

Avith wool

smeared

Some, it is said,form

Avith oil.

ball

clay,and, having laid it on the place,applyto it a burning

staff as long as it can be borne.
Others, haAdng stretched the
transfix it with a heated styleor
skin over
the affected joint,
with shavings
writingpen. The Libyansperfonnedthe operation
The Marmaridse
and elaterium.
of the lote tree, sulphur,
are
of the Avood of olive trees.
said to have done it with green pieces
of which they
used a leaden tube,the extremity
The Parthians
smeared
Avith dough, in order to prevent the oil in the inside
of fortyor
to the number
from escaping; then hot cauteries,
Avere
introduced,and the burning continued as long as it
fifty,

of

could
cool

be well
the

the

tube

endured.

face with
was

not

Care

meantime

in the

cold Avater; and

it

was

was

attended

over-filled with oil, lest it should

taken

to

to, that
run

over.

i,242.)
(Euporist.

minutely the process of burning Avitli

red-hot irons. (Chirm'g.
i,43.) Haly Abbas in like manner
and to keep it open
directs us to burn an eschar over the joint,
Albucasis

for

describes

considerable time.

(Pract.ix, 81.)

mentions
that he had seen
(apudXicetse Collect.)
Asclepiades
in Avhicli dislocation had taken placeat the hip-joint
two
cases
.

without
states
course

cases,

any accident. The editor of this work, Anthony Cocchi,

such case
in the Avhole
that he had met Avith only one

practice. We
hoAvever,are by no means
of his

need
of

remark
scarcely
rare

occurrence.

that

such

FISTULiE.

396

SECT.

LXXVII.

ON

[book

FISTULjE

AND

us
present occasion requiring

The

FAVI.

of fistulain ano,
in the first placeof

to treat

be

it will not

vi.

improperto givean account

fistuhe in general. A fistula then is a callous sinus,attended
with little or no pain, and forming in most
parts of the body.
in abscesses not properly
healed.
The
It generally
originates
and therefore insensible,
callus is compact and white,the flesh dr}',
the
neither vein nor
nerve
passingto it. Sometimes
charge
filled with a discharge. The dissinus is dry and sometimes
constant, and

is sometimes

of it

mouth

or

crooked

considerable

; but

caution

size,or

them

if crooked

lum), or

made

we

must

the sinus
in which

manner

those

as

by

time

bone, sometimes
it is either
Those

many.

all,or with great

at

made

When

of

there

on

straight

therefore

one

the

in this
a

two
a

of its

openingswe
out
injectioncomes

skilful

manner.

sound

(specila

very
the smallest of

tin,and
are

and

specillumof

with

to the examination

trust

and

double-headed

of copper.

not

at another

may be operatedupon
if they be straight
with

with

flexible nature, such

those

with

the others

first examine

We

on

the
intervals,

largearteries,or nerves, or tendons of

the pleura,or any important part, are

upon

to be meddled

either not

orifice or

one

at

up, and

impoi'tant
part ;

either

has

tha,t terminate

shut

time

one

other

some

or

nerve,

at

the fistula terminates

Sometimes

open.
a

being

sometimes

or

orifices,

more

but
specillum,

ascertain from
whether

it be

jecting
inthe
one

if there be several fistulse. After

fistula with many
or
orifices,
and naiTow,
it is to
the examination,if the sinus be superficial

by

is to be

off"with

cut

the nails

or

the

deep and

far

as

we

it with
not

can

pointof

is not

caustic

hot irons.

medicine

If

diseased,we

otherwise

of

scalpel. If it is

or

also broad

If it is not

away.

must
cut
we
straight,
make
and
incisions,

the

dundant
re-

superficial,

off"the callus all around

as

if any part remain, destroy

if the callus be large,and do

slough by burning it
Avith a bone, and if it
the fistula.terminate
need only scrape it,but if it is carious,
or

yieldto medicine,we

with

to be dissected

parts are
but

and the callus

specillum,
or
scalpel,
properly-shaped
pared Avitli

the introduction

be distended

the
corrupted,

must

whole

form

diseased

portionis

to

be

cut

FISTULA.

Lxxvii.]

SECT.

397

and if necessary we
bore a
perforators,
may
hole with a wimble
?) whether the bone be diseased
(trephine
If a bone project,
only to the diploeor as far as the marrow.
it ofi\ Taking,
after a transverse
must
saw
we
as
fractui'e,
two
bandages, v,e applythe middle of the one to the
therefore,
and get it kept stretched by an assistant ;
bone itself,
projecting
of wool, we
to take in
the other being thicker,or formed
are
the
and applythe middle of it to the flesh under
like mann.r,
bone, and taking its ends below, we give directions that the
flesh below be retracted by this band lest it be torn by the teeth

out

with counter

of the
When

accomplish the sawing.

vital part is situated below, such as the pleura,spinal
the Hke, in cutting
or
sawing the bone, we must use
and

saw,

any
or

marrow,

called

the instrument

is to be

in the

sawn

is to be
if diseased,

such
be

taken

is denuded

out

of flesh a]l

for bones

manner,

parts all around

the

ofi*;and

sawn

But

entire.

which

if the

around, it
gaged
disen-

are

incarnate.
possibly
bone near
a
joint,

often,if the whole

the

If

cannot

extremityof

or
ulna,radius,tibia,

the

as

same

like manner,

In

we

them.
meningophylaxfor protecting

the other

from

manner

diseased,but

is not

the bone

this

in

like,be

head

of

bone,

diseased,it is

of the

to

thigh-bone,or

tempt
spinebe diseased,we must not atfor fear of the adjoining
them
arteries.
to operate upon
in every particular
tion
We
must
proceedin this manner
case, attenof
and connexions
proximity,
being paid to the situation,
of the disease,
the strengthand
the afi'ectedparts,the extent
of the patient. The favus being a fistulous sinus with
powers
be subjected
to the same
operationand
a milky dischargemust

or
pelvis,

treatment

vertebra of the

as

fistula.

For

Commentary.
crates

we

refer to

our

of the

account

an

notes

on

the 49th

practiceof Hippo-

section of the Fom-th

Book.
Celsus states that if fistulpe spreaddeep,are

are

operationrather than by
he recommends
medicines. Wherefore, if it spreadtransversely,
to introduce a specillum,
or
sound, and cut down upon it.
us
out and
to be followed
But if it is crooked,its bondings are
numerous,

they are

open

in the

the end

of the

cut

same

to be

manner.

cui'cd

crooked,or

by

an

When

all the callus

fistula,

the

operator has readied

is to be cut

out, and

the

Comm.
'

^"^

FISTUL.^.

398

'

'
*

the fistula terminates

"When

tions.

by claspsand

secured

wound

the

lipsof

CoMM.

[book vr.

agglutinative
applica-

Avith

rib he directs

pieceof it lest it affect the

us

to

adjoiningparts.
he pronounces
to be highlydanabout the abdomen
gerous.
sores
recommends
He
by
us^ however, to attempt a cure
making an incision,and unitingthe edges of the wound by
sutures,
4.)
(vii,
out

saw

lavs down

Aetius

our

author.

skin, he

directs

fistulffias
the

he

downwards

nearlv^the
When

ulcer

terminates

of it.

(xiv,55.)

with

rules for the treatment

same

the sinus

lay it open.
to cut off the

us
a

bone

to

"When

it penetrates

callus ; and
the

remove

of

transversely
along

runs

to

us

ad\ises

lous
Fistu-

when

diseased

the

lamina

of fistulce at great
treatment
surgical
in inculcatingthe necessity
of
length. He is very particular
and of removing any piecesof diseased
making free incisions,
bone which may happen to be found at the bottom of the sore.
of fistulous ulcer in the thigh,to cure
He relates a case
which
he removed
large piecesof bone, sawing it down as far as the
of his saws
Some
are
marrow.
constructed,
very ingeniously

Albucasis

and

one

delivers the

of them

is not

unlike

the

saw

introduced

into the tice

pracHe enumerates

of surgery by the late j\Ir.Hey, of Leeds.

from healing
nine causes
which prevent sores
; and

they appear
shall briefly
mention
to be of some
we
practical
utility
of blood in the body ; 2, cawhat they are : 1, a deficiency
chexy,
bad coudition thereof; 3, fungous flesh,
which
or
vents
presordes in the
the union of the edgesof the sore ; 4, much
other bad
ulcer ; 5, putridity,
or
qualityof the fluids ;
any
state of the
6, improper applications
; 7 and 8, the pestilential
of the placewhere
the patient
atmosphere and the insalubrity
resides ;

9, a diseased bone.

present,the
the

When

none

of nature
restorative principle

of any

solution

of

of these

as

causes

are

will of itself effect

ii,88.)
continuity.
(Chirurg.
Ehases givesextracts from Antyllus,
and many
other authors,
this subject,
of treatment
but as their principles
much
on
are
the same
those delivered b}'Paulus, we
need not
as
occupy
much
with an abstract of them.
forbids
room
to
us
Antyllus
the fistula is situated in the groin or funthe knife when
dament.
use
it is not judged expedientto have recourse
When
to
of his Arabian
one
an
operation,
authorities,
Aaron, recoracure

400

FISTULtE

and

to have

ANO.

[book vi.

terminated

examination

upon

in

we

intervenes between

only deeplyin
find that a scalyor

the

fundament, and

the

membranous

index-fingerand

the

if

substance

extremityof

the

Avith the head

of the
sound, we must
perforateit violently
sound, and forcingthe sound through the rectum, we must
again,as formerlydescribed,cut asunder the intervening
parts

with
in

the
scalpel
; or, having perforated
with

ano

the

and

common

and

after the

instrument

instrument
with

space

surroundingparts,which
called staphylagra,
one
or
we
forceps,
unskilful

an

patienthas

manner,

had

out

the

for
the

at

edge of

incision,having taken hold

mostly consist of callus,with

around, avoidingthe sphinctermuscle

in

falciform

divide all the intermediate

so

the instrument
the

we
fistulse,
bring the

operatingupon
anus,

of

sharp part

of the fistula

bottom

have

wounded

for

cut

them

out

of
a

all

cuttingdeep

some

it, from

which

the

involuntary
dischargeof faeces. Those who
avoid a surgicaloperationmay
from timidity,
be treated Avitli
the ligature,
recommended
as
by Hippocrates.For Hippocrates
directs us to pass a raw
of five pieces,
thread,consisting
through
the fistula by means
of a probe having a perforation,
or
a
double-headed
and to tie the ends of the thread and
specillum,
tightenit 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 sprinkledwith the detergent
such powder,and
in.
drawn
or
some
powder called psarum,
insert a thread into the opening of the falciform instruSome
ment
for operations
and
on
fistulse,
pass it through in the
manner
described,which I think ought not to be done. For
in addition
venience
by avoidingan operation,
they incur the inconof a slow recovery.
With regard to blind fistuhe,
Leonides says :
When
the fistula is deep,and penetrates the
whether
from
sphincter,
beginningin the fundament, or arising
in the sphincter,
after the examination
a distance and
terminating
an

"

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-specillumis to be passed through it,and
pushed deep into it,and cutting down upon it where it presents,
the whole
a

fistula is to be

spathulafor operatingupon

diAdded

fistula?."

with
We

or
semispathula

having

met

with

FISTUL.E

Lxxviii.]

SECT.

this state
this

of the

mode

cavityof

of

IN

have
disease,

found

because
operating,

the fistula. For

it

ANO.

401

it

to practise
impossible

could

we

situated between

was

sphinctertowards the rightside,and the dilator

the operation.But having dilated the wrinkles
a

certain

fissure

discover

not

appeared among

the

the
and

anus

rather obscured
about

them, being

it

as

the

anus

the

were

defluxion of the fistula,

for the pus passed out by it we
to
saw
of the specilluminto the fistula by it,which
pass the head
served

as

right hand
substance

of the
director;and havingpassedthe index-finger
and having found a certain thin
to the sphincter,
between
the fingerand
the sound, by
intervening

pressingthe

sound

bottom

which
fistula,

with

of the
the

whole

(I

that

fingerthe

of the
the

mean

one

so

was

head

substance

made

now

to
violently

the

the
we
perforated
finger,
turned upwards ; and passing

of the

between

situated

the

outwards, the
of the

mouths

to favour

as

divided

by us,)we

instrument

with

the

fistula,
and
defluxion,

scalpeland

cut

out

the sound.

Hippocratesdescribes minutely the apoli-Comm.

with the ligature,
in his work
De Fistulis.'

Commentary.

We

the

or

nose,

'

cure

mention, however, that Kiihn and Sprengel do not

admit this among
the genuine treatises of Hippocraces,
although
Littre also,though with some
they allow that it is ancient.
has rejected
it from his list of the genuineworks of
hesitation,
must

that it was
Hippocrates. And
yet, considering
such by Galen and Erotian,it seems
bold in any

received
modern

as

critic

to refuse its claims.

Celsus

the

hkewise

the
distinctly

method

of

process, he says, is slow but free from pain.

eschaexpeditedby smearing the thread with some

of

means

many

sinuses

The

same

with

thereby exposed are

to be

drink,

of

thing,he adds,may

scalpelguided upon
mouth,
open by one

straightfistula

diluent

to

tied

nature, with

accomplished

specillum(sound).When

he

and
scalpel,
be

be

with

directs
then
a

us

the

thread.

liberal allowance

to cut

others
The

we
II.

open

being
diet is

of water

for

(vii,
4.)

Aetius
as

apphang

ligature.The

It may
be
rotic ointment.

by

describes

from Leonides,a full account

of fistulsein ano,
gives,
to
in another place. He recommends
us
have explained
26

402

iutroduce

CoMM.
'

'
*

IN

FISTULiE

to pare

and ha^dng cut

specillum,

the

away

Actuarius

cautions

callous

[book vi.

practiceas

same

Albucasis
author.

Med.

the cautery, or

Haly

Abbas

also states

the

he

to circumstances

See

as

of the

approves

our

knife,

apolinose.(Chir.ii,80.)
describes only the operationby the incision.
ani be woimded, it will octhat if the sphincter
casion

not

putrefy.

the

whole

other

no

See

(Pr.ix,60.)
and

ano

as

also Rhases

A^-icenna

18,
(iii,

bristles of

or

ancient

of the

of fistulee in
efficiently

so

sphincterani

the

(Ad Mansor.
ix, 80; Cont. xxviii)
;
Avicenna
twisted
hairs
1, 18.)
prefers

treated

He

the others.

rules of treatment

same

irretention of the faeces.

they will
Upon

it,

iv, 6.)

delivers nearly

According

fistula upon

lest the

againstmaking large incisions

(Meth

the

open

11.)
parts of it. (xiv,

of the

approves

be wounded.

He

ANO.

hog,

authorities

as

has

Paulus.

operationin SprengeFs
such
de Vigo trusted to septics,
John
History of Medicine.^
arsenic and the aegyptiacum.Ambrose
Pare approved of the
as
excellent

an

of

account

the

apolinose and

incision.

the
Guido
Brunus

the

with

one

de

of the

for the

advocate

an

the apolinose
practised

with

other

silk

one.

of the
ligature.
Rogerius approve
Theodoricus
preferthe actual cautery,but describe
of this country have now
The
generally
surgeons

and

rejectedthe
learned

and

Cauliaco

others.

The

was

Camper hkewise
leaden
thread,the

cautery. Foubert
"

Severinus

and

methods

with the

followingaccount
Harduin

will

operation. We

fifteenth section.

"

serve

ligatureand

of

the

to illustrate

overlooked
Quid

ancient

sit

our

it in the

the

cautery.

specillumby the
author's description
commentary

specillumVarro

on

the

explicat(Lib.5

de

Lingua Lat.) Quo oculos inunguimus quibusspecimus (hoc

Grsecis fxriXr]
dicitur.
Aetius
est, aspicimus),
specillum est.
Serm.

8, 14,

cum

instrumento, quod
sjjecillo

Instrumentum
nerum

Une
the

fistularum

parvum
^'iam aut

ac

melam

teres, quo

Grceci

utuntur

appellant.
ad vul-

profunditatempernoscendam.
sonde
de chirurgien.^^(Ad Plin. H. N. vii,54.) If
the same
the ^ujX'/
^'* the
as
however, was
KOTTo'ptoi',
cillum,
speaut

it

was

cuttingupon.

evidently used

for

cutting

with

as

well

as

for

HEMORRHOIDS.

Lxxix.l

SECT.

SECT.

The

LXXTX.

HEMORRHOIDS

ON

PILES.

OR

is rendered

of hemorrhoids

existence

403

manifest to

us

by the

to the operation
must
we
proceeding
with the Adew
of evacuatingat the same
use
frequentclysters
the anus, of
of the intestine,
time the contents
and, by irritating
rendering it more
disposedto eversion and protrusionof the
laid the patienton his back in a clear
gut. Having, therefore,
we
light,if we are to use the ligature
pass a very thick thread

dischargefrom

Before

them.

with this
of the hemorrhoids
each
lipsand secure
blood (for
ligature,
leavingone as an outlet to the superfluovis
of the ligatui-e,
so
Hippocratesdirects.) After the application
round

the

dipped in oil and the bandage

order the patientto remain
we
quiet,
anus,
the bowels with tepid oil and honied
water, and
of bread
of crumbs
and
a
we
use
cataplasm made
that has

usinga compress
adaptedfor the
and

treat

afterwards

saffron ; and

after the

been

fallingoff of

the hemorrhoids

the

trization
cica-

promotedby wine. Leonides has not recourse

and held
but
to the ligature,
having seized the hemorrhoids
used for operations
the
time with the forceps
them for some
on
off with a scalpel.After the operation
uvula he cuts them
we
the plasterof
and
starch with chalcitis,
must
or
use
manna
is to be

with
sponge
it
to burn

burnt
order

the instrument
have

Durnt

faustinum, in

the trochisk called

pitch,and

the cavityof
completely. Others by filling
with caustic medicines,
called staphylocaustes,

hemorrhoids

like

scirrhous uvula.

Hippocrates directs us to pass a needle

armed
with a very thick thread through the hemorrhoids, and
afterwards to be
tie them
with it. Septic applications
are
Commentary.

made

(De Yictu

to them.

Acut.

The

67.)

us
Hippocratictreatises recommends
burning with red-hot irons. (De Hsemorr.)

of the

Celsus

directs

to tie it with
over

it

livid,when

us

when

thread

where

it

of

cure

is

hemorrhoid

joinsthe

anus,

them

and

by

narrow

to

apply

until it become
squeezed out of hot water
sponge
it is to be scraped off with the nail or a scalpel.

Sometimes, however,
and

the base

'

of another

author
to

Comm.

retention

he

of urine.

says, the ligatureoccasions great pain

If the hemorrhoid
be large and its

'

HEMORRHOIDS.

404

'

broad, lie

base

CoMM.
'

"

out

there

^"hen

thread,

be

to

When

time.

one

dissect it

secured

he

hemorrhoids

many

and

with

ad^ises
there

not

us

is

charge
dis-

stopped by the applicationof a

to use
us
day after the operationhe recommends
and catalapsms.(vii,
30.)
of

approves

cutting

operationminutely.
and
hook, grasp it firmly,
is to be raised and

cut

round

bound

off

directs

He

off.
a

To

describes

pilewith

tkread,after

which

it

bleeding a piece of

stop the

thread

and

seize the

to

us

it with

bind

with

hemorrhoids,

is to be introduced

dressingsand bandages are

Suitable

anus.

part is

the

all at

the

sponge

hook,

vi.

it is to be

blood

The
sponge.
the tepidbath
Aetius

to seize it with

are

them

operate upon
of

us

its base

little above

to

directs

[book

into the

to be

then

apphed.

(xiv,6.)
of treating
'Isagoge'ascribed to Galen, the method
is particularly
commended.
hemorrhoids
by the ligature
Albucasis
prefersexcision and burning,but if the patient
of cure
he approves
of having
will not submit to these methods
to the ligature. Excision is performedby seizingthe
recourse
with a hook and cuttingit at its base, after which
hemorrhoid
is to be made.
The ligature
is applied
some
stypticapplication
with a needle armed
by transfixingthe base of the hemorrhoid
directions
with a thread. (Chirurg.
ii,81.) He givesparticular
about the process of burning, (p.i,37.)
the

In

hemorrhoid

the

When

is internal Rhases

having laid

and

hold

the

anus,

He

also describes the process

as

by

other

the

authorities.

Aricenna

of

to

tumour

tying them

(Contin.xxiv.)

in the
The

us

to evert

cut
same

directions

it out.
terms

given

quite similar.

are

Abbas

Halv

of the

directs

recommends

excision

or

the

ligature. (Pract.

ix, 61.)
Fabricius

makes

speaksof

but

Upon

the whole
fi'om

Theodoricus
and
makes

them

the

the

mention

of all these

of
application
he

appears

to

the

methods

of treatment,

cauteiy as being dangerous.

have

entertained

great apprehensions

(CEuv.Ch. ii,94.)
stoppingthe dischargeof piles.
and

Brunus

recommend

the cautery,
excision,

Theodoricus
also
ligature,
accordingto circumstances.
of applications
mention
for consuming
and
drying

up.

CONDYLOMATA.

Lxxx.]

SECT.

SECT.

LXXX.

405

AND

EXCRESCENCES,

OR

CONDYLOMATA

ON

FISSURES.

Condyloma
from

that

of the

excrescence

to be

wrinkled

preceding inflammation

but when
then, it is called an excrescence,
first,
callous,
condyloma. These also,like the former,

it becomes
are

either from

anus,

alone

At

fissure.

or

being
parts of generation,

the female

on

situation

differs in

fundament

the

on

hold of with

taken

forcepsand

cut

out, and

the

pally
completedwith escharotics. Fissures are occasioned princiof
slow
and
granulatingowing to
being
by hard faeces,
ulcers by paring
be converted into recent
their callosity,
must
when
with the nails or
them
a
they may be made to
scalpel,
granulateby proper applications.

cure

with

loma

briefly directs

Celsus

Commentary.

forcepsand

it out

cut

fungous flesh arise it is to be

by

kept

down

us

to seize the

the roots.

condy-

Should

Comm.

any

seris.

with the squama

30.)
(Adi,
Aetius
author.
the
and

gives a
The

he

skin

of these

account

condyloma, he

soft wrinkled
callous

fuller

says,

about

recommends

the
us

to

is

anus.

take

affections than

tubercle which

it becomes

When

hold of it with

our

forms

in

hard

forceps

by the roots. Old fissures he directs us to treat

(xiv,
3.)
by paringtheir edges and applyingsuitable dressings,
See
is recommended
The same
treatment
by the Arabians,
Haly Abbas (Chirurg.ix,62) ; Albucasis (Chirurg.ii,81, 82) ;
Rhases
(Contin.xxiv.)
and

cut

it out

SECT.

In

new-born

ON

LXXXI."

children the

IMPERFORATE

anus

ANUS.

is sometimes

found

forate,
imper-

If possible,
then,
by -a membrane.
but if not,
the membrane
rupturedwith the fingers,
and accomplishthe
cut it with the pointof a scalpel,
must
we
an
And
since often in adults,owing to
wine.
with
cure
ulcer not properlycured,a stricture takes placeat the anus,

being blocked

up
is to be

we

must

break

it with

convenient

instrument, and

treat

it

[book

vi.

troduced
wedge-shapedtent inlest conbe completed,
traction
until the cure
into the anus
is
tent
should again take
place. The Avedge-shaped
anointed with some
healingointment.

properlywith

to be

CoMM.

VARICES.

OF

EXCISION

406

distinct terms,

very

ing
author^s account, recommend-

copiesour
evidently

openingto prevent adhesion.

tube

leaden

directs

in like manner,

Haly Abbas,

or

to

us

pieceof

canula

ii,79.)
(Chirurg.
make
an
opening

sponge.

EXCISION

THE

ox

LXXXTI.

SECT.

and introduce

divide the membrane,

or

of lead into the

and introduce

operationin

this

(p.164.)

to break

us

some

or

describes

Soranus

Commentary.

Albucasis

leadj

of

pipe

63.)
(Pract.ix_,

VARICES.

OF

in the
sometimes
occurring
in the hypogastric
regionbelow the navel,
temples,sometimes
in the legs. For
in the testicles,
but more
sometimes
especially
the most
part it derives its originfrom a melancholic humour.
for those of the testicle we have alreadydescribed
The operation
and those in the leg may be operated
Avhen treatingof cirsocele,
varix is

The

dilatation of

vein

making
upon in a similar manner,
where
the inner parts of the thighs,
below

this, as they

di\dded into

are

more

difficult to succeed

man,

and

we

are

to direct him
we

lyrium,to

the extent

extended, we
a

is distended

skin, lest
the wound

crooked

to

man

we

the

from
ligatures

the

blind hook, and

writingink

or

col-

incision upon the mai'k with

greater depth than the thickness of the
make

yvith.hooks, and
like
specilla,

the vein becomes

breadth
or
a little more,
fingers^
in a recliningposture with his leg
ligatureabove the knee ; and where

divide the vein

we

bare

and

laid

not

the

of three

applyanother

but
scalpel,

are

part of the thigh,

the upper
about,and when

its situation with

to mark

are

having placed the

the vein

they
ramifications,

many

in
for

arise ;
they generally

Wherefore, haA'iugwashed

with.

to walk

those

attempt upon

apphed a ligatureround

distended

and

the

those

an

and

ha^^ngseparatedthe lipsof

dissected
used

vein, and

away

in the

freed

the membranes

for hydrocele,
operation

it all

around,

thigh, and having raised

introduced

under

it

with

needle

we

loose the

the vessel with

having

double

CoMM
'
^

to hurt

taken

not

below

it ; and

the

there

hooks, and drawn

The legbeing in
above,

31.)
(vii,

interval

same

at

of the

one

then

torn

out.

lipsof the
plasterapplied
agglutinative

an

remarked

author

our

makes

of it.
disapproves
the same
varices in exactly
but

of treatment

He

that

of the treatment

mention

also makes

cautery, (xiv,84.)

actual

the

introduced

performedwherever

hook^ and

next

vi.

cleared of the varices,the

It will be

author.

our

as

at the

asunder

cut

describes the excision of

Aetius

by

the

this way

of this method

mention

be

to be

is then

to be done

to

united, and

are

[book

this has been

When

towards

to be

wound

terms

thing is

same

varices^the vein is

are

liook

blunt

above.

mentioned

as

it);

VARICES.

OF

EXCISION

408

described
varicose veins is briefly
operationof extracting
Albucasis
describes accurately
in the
'Isagoge^ of Galen.
He says there
the different modes of operatingupon varices.
of performingthe operationwith the knife,
methods
two
are
The
former
that is to say, by incision or
by extraction.
the upper
is done by applyinga pieceof fillet round
method
the knee, and
part of the thigh,and at the inferior part near
and evacuthen opening the vein in one, two, or three places,
ating
The

in it

the blood

limb

the

is then

be bound

to

In

up.

first to be made
the veins are
to swell
performingextraction,
by puttingthe limb into hot water, applyingfomentations,and
incision is to
taking strong exercise ; and then a longitudinal
made

be

in

it, either

at

afterwards to be dissected
with

at the

manner

blunt

from

three

of

placesif required.At last,it

and

drawn

is to

be

Afterwards

out.

applied.
vessels

tortuous

he

When

pended
sus-

vein is to be laid bare in like

in

breadth,and
fipgers'

is to be cut

asunder

dipped

varix

recommends

vein is

The

ankle.

neighbouringparts and

wool

the

the

or

the

The

hook.

distance

knee

the

in wine

consists

us

to

at

of

dissect

more

the ankle

and

rose-oil

congeriesof

it out

entire.

(Chirurg.ii,92.)
inculcates the same
Haly Abbas
briefly
considers
(Pract.
ix,64.) Avenzoar

treatment

the

as

casis.
Albu-

complaintnearly

incurable.
pru'ge, and
also approves of

lihases directs us, in the first place,to bleed and

then

to

expose

the vessel

or

cut

it out.

compression.(Cont.xxviii.)
It is related that the operationhere

He

described

was

performed

AMPUTATION.

Lxxxiv.]

SECT.

tlie celebrated Caius Marius.

upon

Pliny (H.

N.

been

have

xi,104) ;

SECT.

The

have

We

LXXXIV.

SECT.

on

the

Sometimes

fractured

the
as

bones
a

not

to

off ; before
be

must

fidlyof

is

mortified,but
large veins or

Book.

subjectat

the

all the

to

internal

some

doing which
But

are

arteries

cut
are

at

once

the
known

foot,having
corrupted, either
or

external

some

required

parts

first to

Comm.

EXTREMITIES.

hand

themselves

divided.

time

as

unless

part Avhere

sary
neces-

surrounding

this is done

sawing, there

for the

be

it is

cause,

from

or

means,

since,when

to

the parts

hemorrhage taking place,Leonides

divide

Fourth

this

THE

OF

by

putridowing

considerable
of

treated

bones

been

them

of it in the

account

such
extremities,

from

saw

beingprincipally
accomplishedby

AMPUTATION

the

to

GUINEA-WORMS.

'

that

having become

OR

'

mortified,so

having

being

and

DUACUNCULI

have

without

Book.

Fourth

of the

it.

given an

Commentary.

it

to

as

OMM.

ingeniousAurelius
(V. Mangeti Bib. Chir. xvi.)

of dracunculi

treatment
we

he

THE

ON

it is mentioned

submitted

that the learned

perform

to

LXXXIII.

medicines,

C
(Tusc.Disput.ii.)
It
to
seems
(inMario.)

Plutarclius

that

appear

used

Severinus

See Cicero

painfuloperation,since

very

It would

bound.

and

liis fortitude

of

proof

end

409

first,

is danger

properlydirects us
they are completely
not

many

situated,down

nor

very
to the

as
possible,
quickly; then to saw the bone as expeditiously
have
lest
the
Avhich
been
linen
cut
to
a
they
parts
applying
rag
and
then
be torn by the sawing and occasion
having cut
pain,
through what remains, to applyred-hot irons to the vessels and
of lint, and to
stop the hemorrliage thereby with compresses
rations.
apply proper bandages with the dressingssuitable to suppu-

bone

AMPUTATION.

410

^"''

"

'

tatiou to

be

Galeni Comment,

t. v, p.

those

at

unless
safety,

the

fever supervene

on

650, ed. Basil.)Hippocratessays

performedat

be

excision may

foot,and

patientbe

cut

and

with
ankle, and generally
continual
off by fainting,
or

day. When
gangrene attacks a
is to let the parts drop off",
practice

persons

thus

femur.

is seated in the

fracture

the hand

the fourth

remarks, many

he

jointsof

the

plete
com-

and

of the wrist

fractured limb, his rule of

and

vi.

Hippocratesand Galen recommend

ampuperformed in generalat a joint.(De Articulis,

Commentary.

CoMM.

[book

even

recover,

When

gangrene

when

the

comes

on

being precededby fracture,he directs the soft parts,as

at the
to be removed
as
soon
they have lost all sensibility,
nearest
jointbelow, and the surgeon is to wait until the bone
of the thigh
the bone
also separates. He
says he had seen
thus separateon the eightieth
day ; in that case the limb below
the twentieth day. In a
removed
had been
at the knee
on
the
of gangrene
similar case
of the leg,the bones separated
on
of the extremities to
sixtieth day. He pronounces
gangrene
formidable in appearance than in reality.He recombe more
mends
without

mild

should be

limb

anti-inflammatorytreatment, and that the

laid in an elevated position
as
long as there is

and

hemorrhage. Violent attacks of dysenteryare apt

to come
on, but do not generally
prove obstinate. (De Artie. 69.)
It would appear from Thucydidesand Lucretius that it was
not
in the days of
of gangrene
to amputate in cases
uncommon
of the Plague of Athens.)
Hippocrates.(See their Descriptions
fear of

any

In
of the

have

been

is to be sawed

removed

brought over

directs

sound

the

flesh,between

bone, which

the

Celsus

of gangrene

cases

from

make

to

us

an

incision

and

corruptedpart, down to
across, and after the asperities

end of the

bone, the skin is to be

scription
degivesus no particular

the

33.) He
(vii,
amputationof the

the stump,

extremities. We
however, of
turn,
of Architherefore,to the celebrated fragments of the works
and Heliodorus, preservedin the collection of Nicetas,
genes

publishedby

Cocchius.

Grseci,Florent. 1756.)
(Chirurgici

Archigeues beginsby statingthe

to be had

recourse
some

to

amputation. They

intractable disease,such
cancer,

inflicted

by

circumstances

certain

callous

weapons,

and

as

tumours,
the

like.

require

are, the presence

gangrene,
and

which

of

necrosis,
putrefaction,
sometimes

Before

wounds

attempting

the

operationhe
strengthwill

recommends
enable

consider well if the

to

us

it. The

to endure

him

411

Comm.
patient's

then

operator must

the vessels which

sew

or

to be

it,and

poiu'edupon

habit

of

jointsis not
body, a circular

draw

up

the skin

down

to

scrapedand

the bone
red-hot

with, and to direct

the bone, tlie tendons

irons

are

anointed

obviate the

limb, to

to be

full

After cutting

retracted,and

danger

from

states

jaw-bone

discharged,

appliedto
are

to

in order

oil,doubtless

old

of iris and

be
to

tetanus.

that

limb

requireto

may

or
gangrene
any other cause
In the extremities,
then, he

be

amputated

that occasions

owing to
of it.

the

salt is to be

the

parts about

the

cerate

Heliodorus

of

applied,and a double compress laid on

the blood proceeds. Having loosened the

and

with

are

blood is

much

part from which

band, a cataplasmof leeks,bread, and
stump;

as

to be

are

the

the

Amputation

incision.

the

When

sawn.

such

put round

is to be

band

bled.

to be

are

to be attempted.In

the

near

some

the death

remarks, amputation may

performedwith less danger; but above the knee or elbow

the danger of hemorrhage from the great vessels being wounded
for
is very considerable. Some, he says, from too great anxiety
cut through all the bodies
(thesoft parts?) at one
despatch,
be

and
incision,
the

then

limb

is not

But

the bones.

saw

with

unattended

this method

danger, as

of

many

ing
remov-

vessels

"
time.
Wherefore," he adds,
pour forth blood at the same
"
better first to divide those parts of the
it appears to me
the anterior part of the
there is least flesh,
limb where
on
as

leg,and

then

to

is to be

described.
be

sawing

In

When

External

put

on.

and

in order
the bones

sawing

of the bones

the other

sawed

are

part

operatingin the manner

plateof the saw ought to

the

that the

the

in the tice
pracof the limb

of

then

the bone

myself am

may

partswhich

be
main
re-

pel,
straightwayto be cut through with a scallargepledgetsappliedalong with suitable compresses.
to be
suitable bandages are
with
to these, sponges

undivided
and

across, and

sawn

appliedeven,

even.

the bone

applyinga ligatureabove

of first
which

saw

After

hemorrhage is
dressings'."

are

the
over,

third

or

fourth

suppurationis

to

all
day, when
be promoted by

fear

of

suitable

'

'

pass to the parts; in certain cases

ligatureis to be appliedround the whole limb, cold water is

tie
a

AMPUTATION.

Lxxxiv.]

SECT.

"

In

CoMM.
*

^~'

[book vi.

AMPUTATION.

412

down

to

is there

us

have

come

the

tremities.
ex-

operationof sawing off the bones

such generalterms
as
givesus no

of

the

extremities,but in
what

in

which

works

of amputationof
description

any

mentions

Avicenna
the

medical

other of the Greek

no

it

manner

formatio
in-

performed, (iv,4, 4, 10,

was

11, 12.)
is

complete. A
mence
operationis to com-

givenby Haly Abbas

description
The
limb, he says, is amputated thus.
The

first

with
of

is to be

limb

cutting the

must

you

sawn,

veins
be

time

mean

should

retracted

being

across,

sawn

Albucasis
as

the

if the
In

itself be

arm

like manner,
all

the knee.
two

cases

In

bandages

below
are

fore-arm

to

the
be

in the
; when

to the

is to

bone, which

fleshyparts in

of

hnen, lest the

bleeding and
portionof the

flesh remains

the veins

arteries

and

pain;

hand, he recommends
in the

forearm,at

the
saw

when

the
divided
un-

to be

are

suitable

of

tification,
mor-

When

to amputate

us

the elbow

; and

he
affected,

with

the case to be hopeless.

pronounces
he proregardto the lower extremities,
nounces

incurable in which

the disease is seated

performingthe operationhe
around

the

limb, the

so
by two assistants,
fleshy
parts are then

as

to

to be

is afterwards

off.

to be

with
cut

us

and

to

above

apply

the other

These

the latter

put the skin upon

divided

directs

above

one

place at which it is to be cut

the former upwards and
pulled,

the bone, which

except

ought first

you

the

disease is seated
at the

then

bone

great arteries and

no

piece

of the

death

bleedingis stoppeda pledgetwith

to be applied.
ix,65.)
(Pract.
representsamputationas necessary in cases
indicated by the smell and discoloration.

When

bandages is

putrid.

the
possible,

with

whatever

is to be cut, and

burned.

But

occasion

and

them

tear

is

bone

quicklyas

as

across

sawn

the

sawing the

down

situated,
cuttingthem

are

of

process
be wasted
or

part of the flesh where

divide that

whole

through the

cut

to occasion

as

interruptthe

the flesh of the limb

to

not

the bone

when

then

dischargeof blood take place

flesh at once, lest an immoderate

arteries so
from
the veins and

patient and

and

skin,

more

the

bandages
downwards,

stretch ; the

largescalpeldqwn

out,

or

sawed

across,

to

and

during this part of the process a pieceof linen is to be applied

around all the fleshy
parts,to prevent them from beinginjured

SECT.

AMPUTATION.

Lxxxiv.]
Should

413

hemorrhage occur duringthe operation, he directs us to applythe cautery^ or a styptic

powder ;
to
and after the operation
he recommends
the
us
limb
bandage
the

by

in

sawing.

suitable manner,
the
case, from which

until the

his

strengthmight
learned

attacked

the
he

upon which he
cut it off in the

hand,
would

this he refused to do, for fear that the man^s

but

manner,

relates

practiceis rendered

own

that
appliedto Albucasis,requesting
same

He

'

spreadingmortification in
himself,and was cured for
ankle-joint
had

who

disease next

The

is healed.

stump

timidityof

very apparent. A person

the foot,cut it off at the
the time.

Comm.

any

be able to endure

not

that the

had

man

cut

the

operation.He

off his whole

wards
after-

hand, and had

ii,89.) The historyof this case proves

(Chirurg,
of the Arabians, in the
decidedlythat the operative
surgery
self
days of Albucasis,must have been very defective ; this he himfranklyconfesses,for he declares that all knowledge of this
of it had been preserved
art had been lost,except what vestiges
whose descriptions,
he comof the ancient authors,
in the works
plains,
We
had been mutilated and corrupted.
tion
men(Prefatio.)
in
which
that
the
his
in
time
order
this,
ignorance
prevailed
be used as
not be imputed to all precedingages, nor
may
may
an
argument againstthe genuinenessof the extracts from the
works
of Heliodorus and Archigenes,
givenabove.
remarks
the sawing of
makes
Rhases
on
some
interesting
wards,
He directs us to stretch the flesh upwards and downbones.

recovered.

with

piece of cloth,so

of the teeth of the

When

saw.

that it may not

it is necessary

in the way
rib or
to saw
a

come

he recommends
or organ,
importantmembrane
to protectthe soft partsfrom the saw.
to use
us
a plate (tabella),
the bone connected vnth a jointis diseased,he directs
When
the os brachii,or tibia,
is
to extract it at the joint. When
us
a

bone, near

any

diseased,he recommends
meddle

with the head

us

to extract

of the femur

or

it

entire,but forbids

the vertebrae.

to

In another

opinionthat when a jointis swelled,

of white swelling?)
it will be
and the bone diseased, (incases
imless the whole diseased portionof
to effect a cure
impossible

placehe

declares

it as

his

(Cont.xxix.) From these passages it is

quiteobvious that the ancients practisedexcision of the bones
author
of joints. See also what
our
says on this subjectin
A
the seventy-seventh section of this book.
Cooper br a

the bone

be cut

out.

'
"

PTERYGIA.

414

CoMM.

could

Listen
such

recommend

not

[book

plan of

bolder

treatment

vi.

in

cases.

writers
Tlieodoricus,Guy of Cauliac,and the other surgical
in the footstepsof the ancients,
of that age, follow closely
to
the mortified part is near
When
of the Arabians.
especially
a joint,
amputationat it. In other cases they
they recommend

direct

to make

us

parts,to

an

the bone

saw

incision between
with

fine saw,

the

sound

and

to

and

the dead

stop the bleeding

cines,
medistupifying
before
or
such as opium,hyoscyamus,mandi'agora,
cicuta,
of introducin
Pare has undoubtedlythe merit
the operation.Ambrose
in amputhe use of the hgatm'e into modern
practice
tations,
ancient
be
the
to
only
and, in fact,Archigenes seems
ever,
We
have
it in such cases.
shown, howwho mentions
authority
in another place,that the ligaturewas
freelyused by the
with

heated

for

ancients

SECT.

iron.

Theodoricus

recommends

stoppingbleedingfrom

PTERYGIA

ON

LXXXV.

wounds.

excrescence
pterygiumis a fleshy
and
beingcommonly
part of the nail,

about

The

and

those

But

toes.

formed

in the feet arise most

accident,whereas, those

THE

ABOUT

in the hands

the

NAILS.

nails,
covering
largefingers

in the

from

commonly

arise from

whitlow,

an

the

one

For, the
being neglectedand turningto pus.
being allowed to remain, corrodes and corrupts the root of
the
the whole of it,but generally
nail,and often destroys
is left at the root of
half,while a portionof it uncorroded

the

nail, and

inflammation

pus
the

the whole

sometimes

root

is left uncorroded.

smell
Sometimes, too, it corrupts the bone,when a disagreeable
swelled
arises from it,and the extremityof the fingerbecomes
livid.
and
They are to be treated,then, by cutting
appears
and
of

remainingpart of the nail with the point

and then bui-ning
both the ulcerated and cut part
scalpel,
and
cauteries. For, the pterygiumis a spreadingdisease,

removing
a

with

all the

whole

stop unless burnt, so that, if neglected,it aff'ectsthe

finger. If,while the nail and bone remain sound, the

inner

angle

does

not

of

flesh,it occasions

portionis

to

the

nail

sink

inflammation

be raised upon

piercethe adjacent
the irritating
; and in this case
thin probe, or some
such
thing
down

and

CLAVI,

41G
to the

down

fleshyexcrescence,

[book

ETC.

another
it is called^

as

vi.

is

body

shootingout through the

plaint
division of the nail,whence
painsagaininvade, as in the comnail
under
the
flesh
the
call paronychia,
owing to
we
being compressedby it. Wherefore, one may see the patients
lowing
immediatelyrelieved from painby this section. On the foldays we may gentlyraise the divided part of the nail,
the nail,and then again,as I
and press the sanies from under
The
rest
flesh below.
to the
said,applythe nail as a cover
of the fingershould be soothingand disof the treatment
formed

the nail

the flesh below

from

cutient.'^

'

'

"

recommended,

here

treatment

and

Avicenna

Commentary.

CoMM.

fact, gives the

Rhases, in

Rhases

authorityof

the

upon

plan of
Galen.

Galen.

of

words

very

of the

approve

(Cont.

xxxvi.)
Albucasis
have

of

case

and
venesection,

to

recourse

the

us, in

directs

then

bruised
make

to

nail,first to
a

transverse

ii,91.)
{oblique?) incision through it. (Chiriu'g.
See

of the terms

confusion

sixtieth section of this Book

in the

remarks

our

transverse

and

obliqueby

the

on

the translators

of the Arabians.
The

by Haly Abbas.

is recommended

treatment

same

(Pract.

ix,67.)

LXXXVII.

SECT.

The
a

clavus is

nail,and
lameness

the clavus

CLAVI,

or

all

parts of the body, but

soles of the feet and

in

ACROCHORDONES.

AND

MYRMECIA,

callus,white,resembling the head of

round

occurringin
the

on

and

ON

the

toes, occasioningpain

walking. AVherefore,having scarified

corn,

and

taken

hold

cially
espe-

more

of it with

around

forceps,we

cut

it out

lancet for
or
by the roots with a sharp-pointedscalpel
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,spreadingdeep at the base,and, if
sensation like the bites of ants, and being
a
rubbed,occasioning
in all parts of the body,but more
formed
in the
especially
hands.

Wherefore, some,

among

whom

is

Galen, advise

us

to

the

around
scarify
such

it down
do the

so

to

as

to
forceps,

cut

chordon

is

for the

most

like

it out

risingof

small

the

part round, and

It is

so

Having

eagles,and
the root.

Others
moderns

it with

hanng

called

base

narroAv

so

its resemblance

from

the

stretched out

may
who

as

to

to the

protuberancethen
tie

thread

what

or

this and

consumed

with
protuberances

afore-mentioned

is called the

cautery.

Commentary.
towards

We

the end

refer the

have

reader

others he directs

of wine

?),or
(potass

acrochordon, he

of
treated fully
already

of the Third

in the

and

Book

for further information

Celsus recommends
The

feather,
to push

scalpel.The acrofree of pain,callous,

surface,
with

corns

cut it out ; or, otherwise,we

may
hair round it. I have known
many

we

hard

we

cold

of

The
copper or iron tube.
around
it,and, having seized
scarify

appear to hang.
end of a cord.

all the

stalk of

the

myrmecia from

the

thing with

same

417

geese, and

fowls,of

remove

satisfied to

are

rayrmeciawith

of okl

those

as

ETC.

CLAVI,

Lxxxvii.]

SECT.

us

us
a

these diseases Comm.

Fourth,

says, when

cut

of alum
out

and

leaves

or

no

corn.

the lees

sandarach.

The

behind.

roots

{V,28.)
recommends
burning for the cure of
particularly
either with
be accomplished
clavus and myrmecia. This may
iron
is prefei-red,
an
If the former method
fire or hot water.
is to be heated red-hot
to the size of the corn
proportionate
and
appliedto it,and the burning carried to such an extent
as to occasion
suppuration.In the other method a fimiiel of
of a ^oilture is to be applied
or
iron,or else the quill
copper
filledwith boiling water.
and
then
By these
to the corn,
be eradicated. (Chirurg.
i,55.)
he says, the corn
may
means,
and
Rhases
(Cont.
See also Haly Abbas
(Pract.ix,12)
difference
the
xxxvi.) Khases does not state very distinctly
between the myrmecia and acrochordon. He speaksof scraping
at the base ; but
them
out with a hard pen, and of tyingthem
Albucasis

upon
a

forcepsand
Avicenna

applya
II.

of
he approves
most
them
out.
dissecting

the whole

recommends

caustic medicine

us

to cut

to the

taking hold of
out

the

clavus

them

with

and

then

7, 4, 14.)
part, (iv,
27

'

'

this head.

on

merely to shave the cla\Tis

such as
to remove
by caustics,

mixture

to which

"

WEAPONS.

418

That

ON

LXXXVIIl.

SECT.

EXTRACTION

THE

is declared

of surgery

OF

is

of weapons

extraction

the

[book

by

the

"

The

We

of medicine

man

Who

Poet

in worth

can

the weapons

knows

to

with

excise,and

Homer,

he

when

shafts

either

are

of

bones, and

and

reeds, too,

as
lance-shaped,

are

some

the barbs

without

apply."
like
War-

of weapons.
another

in

material,
material,then, as

In

of reeds ; and

the heads

selves
them-

iron, copper, tin,lead,horn, glass,

of wood

or

and

such

differences

are

Egyptians. In figure,inasmuch
some
angled (as triangular),
pointed

the

round, some

are

or

of

made

especially
among

some

and

of wood

made

are

\ie,

soothingsalves

first describe the different kinds

must

found

warriors

many

instruments, then, differ from one

figure,size,number, mode, and power.

as

partment
important de-

says

the

"WEAPONS.

most

vi.

some

have

barbs

three

and

barbed
are
points; some
of the barbed, some
have

backwards, so that in attemptingto extract

fasten in the parts; and some
forwards,so that

turned

them

they may
have them
when
thing: some
pushed they may do the same
in
divergingin oppositedirections like the forked lightning,
order that whether
pulledor pushed they may fasten in the
missiles have their barbs
united by a hinge,
parts. Some
which
prevent the weapon
being expanded in the extraction,
out.
from
as
They differ in size,inasmuch
being drawn
breadth
in size,and some
small
three fingers^
as
are
some
are
are
as
one
finger,which are called micca in Egypt, and some
between

intermediate
are

simple

of iron

are

and

some

inserted

them.

In

number,

compounded.
in

For

inasmuch
certain

as

small

some

pieces

them, which, in the extraction of the

deep-seatedparts. In mode, as
to a
sharp extremityfixed to a tail and some
have it carefully
inserted in the shaft,and
shaft ; and some
that in the extraction
so
some
they may separate
carelessly,
In power, as some
not poisoned
and leave the head behind.
are
and some
are
poisoned. Such are the differences of weapons.
We
now
proceedto treat of the extraction,both in cases of
remain
weapon,
have the
some

those

who

have

concealed

been

in

wounded

in

war

and

those

not

in

war.

WEAPONS.

LxxxYiii.]

SECT.

419

and involuntarily,
under whatever circumstances,
voluntarily
materials
and
of whatever
they may be composed.
There
from
of extractingweapons
two modes
are
fleshyparts;
either by pullingthem
them
forwards.
backwards, or pushing
When
is fixed superficially
the weapon
the extraction is made
Avhen it is lodgeddeep,
by pulHng it back, and in like manner
but the oppositeparts,if wounded, would occasion danger from
hemorrhage or sympathy. It is to be pushed forwards when
lodged deep,and the interveningsubstances between it and
the oppositeside are
of small size,and neither nerve, bone,

"whether

thing is an obstacle to the division. Wlien a

any such
is wounded, the mode
of extraction is by pulling;if,
bone
nor

of the weapon

head

the
therefore,

immediately; but, if

extraction

be

it is

get the wounded

posture

; or, if

examination

drawn

of the weapon
with the hands,

it is to be

If the head

sound.

out

part is mostlymade

by

extraction

of

has

And

oppositeside,and
it

to be

the

placedin

examined

with

it is
flesh,

When

or

by layinghold

it has fallen

we
off",

make

the

sometimes

head

if the

And

in which

make

fixed in the

we

make

it is found

incision in the flesh

an

it in the first place,if the wound

around

thus

same

or a root-extractor,
or
tooth-extractor,
for extractingweapons,
or
any other convenient

means

instrument

instrument.

of wood.

pocrates
Hip-

says

of the pendage,
apshaft,if it has not fallen off. This

is called the

which

an

thus

the

make

put himself in the

wound, and
be done, he is

this cannot

to it,and
possible

the nearest

to be

he

when

as

sight,we
hid,we must,

to

person
received
the

in

do not

of the weapon
to
impossible

admit

has

extract

the instrument.

passed to

it by the way

we
entered, havingdi\aded the partsopposite

it throughthem, either

drawing it out

in the

the

extract

mentioned,

manner

itself,
pushing it either by
the shaft,or, if it has come
instrument,
away, by an impellent
takingcare not to divide a nerve, vein,artery,or any important
the weapon, we
if,in extracting
part, for it would be disgraceful
or

make

we

do

should

the weapon
the

hole with

more

has

mischief
a

the weapon

than

which
tail,

probe,having introduced

instrument
it has
appear

and

fixingit,we

If
the weapon
itself had done.
with
is ascertained by examination
the female

part of the impellent

forwards, but if
push the weapon

shaft,the male part. And

to have notches,
so that other

if the head
small

when

piecesof

extracted
iron

might

WEAPONS.

420

he

inserted

probe,if

jieldto

is laid

apply a

make

must

bare, we

tube about the

manner.

same

do

incision in the adjacent

an

the like lie there,and when

it without

extract

barbs, so

the

which
oppositedii'ections,

importantvessel or

parts,if no

in the

them

in

has barbs

again with

examination

an

exti'act

we

puUing,we

our

the weapon

make

we

find them

we

if the weapon

And
not

them,

in

[bookvt.

trouble.

Some

they draw

that when

the

out

If the wound
not be torn by the barbs.
the flesh may
weapon
does not become
inflamed,we may use sutui'es,and heal it up
the inflammatio
Uke a bloody wound
we
remove
; but if it inflame
may
If the
and the like.
by embrocations, cataplasms,
cut off"all the flesh
be poisonedwe
must, if possible,
weapon
is known
which
has imbibed the poison,which
by its being
and as
altered fi'om the sound flesh,for it appears pale,li-^dd,
dead.
it were
They say that the Dacians and Dalmatians touch
with elecampane, called also ninum,
the pointsof their weapons
and

it thus

when

that

becomes

mixed

with

the

blood

of the

fatal,althoughit is eaten by them

make
fix in a bone, we
with impunity. If,again,the weapon
trial with the instrument, and, if flesh prevent the extraction,
cut it oft',
or
we
separate it ; but if it be lodged deep in the
be
bone
(which we know
by its being so firm that it cannot
the remaining
shaken with a considerable
force)we first remove
wounded

it proves

animal

with

part of the bone

if it has
If

weapon.
the
as

be

phines
tre-

thickness, and thus disengagethe

considerable
weapon

bore it with

cuttinginstrument, or
lodged in

importantpart, such

any

brain, heart,throat, lungs, liver,stomach, intestines,

kidneys,womb, or bladder,and fatal symptoms have already
shown

themselves,as
we

the extraction

decline

must

the

would

attempt, lest while

expose ourselves to the reprobationof

result be dubious, we must make
the

warning of

the

has formed

in

danger.

occasion

For

we

do

much

tion
lacera-

good

no

ignorantpeople.But

we

if the

attempt, ha^dngfirst given

in many

cases,

when

abscess

an

vital

taken
part,recovery has unexpectedly
and periplace; and the lobe of the liver,part of the omentum
toneum,
and
away,
open

and

the

whole

yet death

uterus

are

said to

have

been

the consequence.
And
the windpipeintentionally,
in cases
of angina,as
under

then

some

as

it

not

was

the head

is,occasions

of

Laryngotomy.

To

taken

we

often

we

tioned
men-

leave the weapon

certain death,and exhibits the art in an

WEAPONS.

Lxxxviii.]

SECT.

421

Avhereas by extracting
it
liglit,

inhumane

might possibly
life. It is not difficult to ascertain when
a
save
an
important
of the
part is wounded, this being discovered by the peculiarity
and situation of the parts. When,
symptoms, the discharges,
therefore,the
intense
there

membranes

pain of

the

head,the

is abenration

wound

of the brain
eyes

are

we

wounded, there is
the tongue red, and
fiery,
are

if it is attended

of intellect;but

with

with loss of
strength,
charge
speech, distortion of the countenance, A-omitingof bile,a disof blood from the nostrils,
evacuation of a white and
an
pultaceousfluid by the auditoryforamen, and of ichor,if it can
find a passage by the wound.
has penetratedto
If the weapon
is left for it,the
the cavityof the chest,and sufficient room
the heart is wounded, the weapon
breath passes out.
When
if in a cavity,
but
as
appears at the left breast,and feels not
as

of the

fixed in another

motion
vnih

in

there is

there is a throbbing
body, and sometimes
dischargeof black blood if it can find vent,

coldness,sweats,
short time.

is prostration
of

brain,there

deliquium animi, and

the lungs are wounded,

death

and

When

if the

follows

opening

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
be

blood
large,a fi'othy
sufficiently

the weapon
the diaphragm is wounded
things. When
appears
with
lodged about the false ribs,there are large inspirations
pain,sighs,and heavings of the parts about the shoulder-joints.
of the
wounded, the nature
be
injurywill be apparent from the discharge,if the wound
sufficiently
large,or if the weapon be extracted,or if the shaft
from the stomach,
be broken
internally
; for chyleis evacuated
If the viscera of the abdomen

are

the intestines ; sometimes

the bladder
intestine protrudes. When
and

fceces from

discharged. When
itself is
the

skull,as

bones
does

wounded,

will be

of the head.
not

moderate
rib with
In

the

like

come

out

membranes
we

the omentum
is wounded

of the brain

or

an

urine

or

the

is

brum
cere-

the weapon
by trepanning
presentlyin fractures of the

extract

described

is lodgedin the chest,and

If the weapon
of a
it is to be extracted by means
readily,
a
space, or by cuttingout
called meningophylax.
of the instrument

incision in the intercostal

the assistance
manner,

seated parts are

when

the

wounded,

stomach, bladder, and

if the weapon

come

out

other

deep-

it is
readily

WEAPONS.

422
to be extracted

without

the

and

wound,

wounds.

In

wounds

described may
weapon

or

and

be

[book

afterwards

of the

had

; but

ado

more

if

not, we

must

vi.

large
en-

the

dressingsfor fresh
as
abdomen, gastroraphe
formerly
use

to, if necessary.

recourse

But

if the

such as the internal

lodgedin any of the largervessels,
pits
jugularsor carotids,and the largearteries in the armand
if
the
extraction
threaten
rhage,
a
groins,
great hemorboth sides,
on
they are first to be secured with ligatures
has

then

the extraction

fastened to
fore-arm

another,such

one

to

is to

the

other

another,if the

weapon

both parts,we

are

be
as

made.
the

If

the

to

arm

parts of the body, or

(asa spear) do
hold

to take

if

of

not

parts have

chest,or

the

feet to

been
the
one

penetrate through

the weapon

and
externally
but if it has passed
affected,
wood
through the middle, we

only one part were

through both, having sawed the
in the most
extract each part singly,
convenient direction. But
since often stones
the
or
sharppoints of rocks, or piecesof
the
lead,or
like,are lodgedin the body, either being impelled
with force from a sling,
or
happening to be acuminated, they
to be
known
are
by the swellingbeing hard and irregular,
and
but
by the solution not being everywhere straight,
and
largerthan common,
having the skin bruised and livid,
and the pain being attended
with a sense
of weight. They
to be dislodged
of suitable instruments,
are, therefore,
by means
or
scraped out with the concave
part of a specillumor of an
ear-specillum
adaptedfor wounds ; or, if they can be apphed,
a tooth-extractor
be used for pulling
or
a root-extractor
may
them out.
In many
instances weapons
lodged in the body lie
and
time
a
concealed,
healed
long
after,when the wounds
are
the
part having suppuratedbursts,and the weapon
up,
drops
extract

as

out.

CoMM.

Commentary.

Hippocratesconsidered the extraction of

to be one
of the most
weapons
important departments of
It is to be fullylearned,he
surgery.
says, only by attaching
oneself to a foreign
(De Medico.) He makes
some
army.
r
emarks
the
his
on
treatise
De Capitis
interesting
subjectin
'

Vulneribus.'
We

must

now

attempt

interesting
chapter on

to

the

give an

abstract of Celsus's very

Extraction of Weapons.
Every

WEAPONS.

424

CoMM.
*

instrument

an
'

"

tion.

extracted

leaden

balls,stones,

skin^and

whicli lie givesa

which

of weapons

class

are

the

breaks

by Diocles^of

invented

Another

[book

is buried

descrip-

sometimes

must

vi.

be

any such thing which

In all such cases
the

or

within.

M'ound^he says, must be enlargedand the body extracted with

which
of
increases the difficulty
a
forceps. A complication
arises from the. weapon
extraction
being lodgedin a bone, or
between
to be

with

bones

two

about

moved

forcepsand

It

out.
pjilled

to be

the

at

joint.

until

When

lodged in

loosened,when

extracted

in the

rarelyhappens

placewhere

it is

same

the bone

is to be

that

way

be

cannot

do not

means

moved
re-

bone, it is

until it be shaken
other

perforatedwith

grasped
tooth is

fixed in the

it is

trephine. When

from
ceed,
suc-

the

jointbetween two bones, the two members

about the wound
of cloth,
to be Avrapped
round with strips
are
leathern thongs,and therebyseparatedby pullingin oppoor
site
which
the
them
will
between
be
means
directions,
by
space

body

is

lodgedin

When

lodged.

it is to be

that the weapon

but if it remain
in this way;
iron instrument
struck Avith some

bone

slackened,and

then

When

the

be done

must

which
person

with

the weapon
be removed
culty.
without diffimay
had
been
poisoned,these things
weapon
all

possible
despatch,and the remedies applied
used when
a poison has been
swallowed,or a
from which
stung by a serpent. The wound

are

has been

been

weapon
what is

has

An

entered

extracted

other

requiresno.

than

treatment

for ordinaryinjuries,
applicable
(vii,
5.)
Albucasis borrows mostlyfrom our author the account
which
he givesof the construction
of weapons
and the symptoms occasioned
the
wounds
which
inflict.
He
also
relates
by
they
of
from
some
wounds.
cases
interesting
recovery
very severe
arrow

by

Albucasis

at the root

behind

his

ear

of

man's

and

the

nose
man

having sustained any injuryto the eye. He

which
had lodged deep below
large arrow
and
a

in this

barbed

arrow

enlargingthe
lodged in
mortal

also the

case

sight

Avhich had

Avound,

man's

and

was

lodgedin
the

man

not

and

extracted

Avas

recovered

without

extracted

another

the

eye
impaired. He

the throat of

recovered.

of

Jew

extracted

Christian,
by

An

arrow

had

belly,so that, at first sight,Albucasis considered

the case
as
hopeless;but, after thirtydays, as no
had
symptoms
supervened,he enlargedthe Avound and
a

WEAPONS.

Lxxxviii.]

SECT.

He

extracted the weapon.

lodgedin his back

seven

the

years

knew

woman

wound
her

healed, and
his

lodged in
him

the

had

been

below

out

the Avound

He

buried

Lad

his

in the

that

he

of

nose

her

Comm.

an-ow

buttocks.

'

He

and
belly,

who

man

an

interval of

an

afterwards

healed

relates

got

after

lodged in

arrow

never
weapon
He knew
a

face,and

trouble.

much

which

an

wLo

mau

healed,but

came

inconvenience.

any

saw

; the wound

weapon
who had

425

the

occasioned

had

an

arrow

up, and never

extracted an

prince,after

gave
arrow

making

various fruitless

He then
attempts for the space of four months.
of weapons,
delivers generaldirections for the extraction
rowing,
boras usual,very
a weapon
freelyfrom our author. When

cannot

readilybe got extracted

mater

is not

at the

time, he recommends
us
to let it alone until it become
loosened by the putrefaction
of the
impacted in a bone, he directs us
surroundingparts. When
either to move
it about until it is loosened,or to perforatethe
bone with a trephine. When
lodged in the cranium, it is to
be removed
in like manner
with a trephine,
provided the dura
be

interfered

for
injured,
with.

When

part of the body where

he

directs

if it is wounded
a

are

must

case

not

is

weapon

there

the

no

lodged deep in any

large nerves, veins,or

and
the
extract
enlargethe wound
parts about it must first
; but if it has barbs,the fleshy
weapon
be carefully
separatedto prevent them from being torn. "UTien

bones,

weapon

body

to

fastened

another,he
then
in

leave it for

If the
directs

with
the

us

or

to

concludes

turn

part which

projects,
accomplished. If

it round

so

he recommends
sutfice,
be extracted

it may

without

as

to

us

to

culty.
diffi-

or

is to

recommends

be

as

to

adapt itself to

extracted.
us, if

When

to
possible,

the form

of

the

is
weapon
out the flesh

cut

lodges in the breast,belly,

bladder,
weapon
be felt with a probe,he du'ects us
to cut
a

can

cautiously
upon
He

not

so
extremity,

it. When

side,and

does

to

us

part of the

one

be broken
Avooden part of a weapon
off,
applyto the head an impellentinstrument

M'hich

poisoned,he

advises

off the

easilybe

may

days,when

shaft

concave

body

around

few

to cut

us

extraction

if that

attaches

limb, or

directs

bone, he

loosen it ; and

he

through

passes

and

to

us

it,taking care

with

ii,96.)
(Chirurg.

not

to wound

vein

and
givingdrawingsof forcipes

or

nerve.

impellents.

'

WEAPONS.

426

givessensible directions
they are so similar to

Rliases

CoMM.

but

cases^

need

not

upon
to introduce

us

it.

those of

author

our

too

small,he

recommends

vi.

of these

management

forcepsto the iron head

opening be

If the

it out.

for the

that

If the size of the wound

them.

dwell

directs

he

[book

we

permit,
and
us

draw
to

large
en-

has

nearlypassed through the

limb, he advises us to push it out at the oppositeside. Thorns
and such like sharpthingsare to be removed
by the application
of extractive plasters.
(Ad-Mans, vii,25.)
Avicenna
givesa literal translation of the present chapter
of Paulus, and
interest,
suppliesnothing additional of much
(iv,4, 2, 10.)
The
but like that of
account
givenby Haly Abbas is fall,
Albucasis.

He

had

been

arrow

the weapon

When

mentions

lodged

were

dischargedby

adds

that

relate

others

although the
ix, 15.)

liver

rules for the

The

doricus

and

all the

the ancient authors,

It
account
as

it

be

would

in this
be

can

the

in

he

the

the

wound,
cases

had

seen

in

which

had

an

althoughfaeces

patient recovered.
recovery took
been
wounded.

He

place
(Pract.

laid down by Theoextraction of weapons

earlier authorities are mostlycopiedfrom

(i,22.)

naturally
expectedthat we
placeof the surgery in the

learned

in which

cases

and
intestines,

omentum

or

from

of Eustathius.
methods

that

should

give some

heroic

ages, as far
and the mentary
Com-

the poems
of Homer
The Commentator
remarks

that three

of

1
mentioned
are
:
extracting
by Homer
Aveapons
By evulsion or pullingthe weapon backwards,as in the case of
Menelaus.
iv,214.) 2. By protrusionor pushing it
(Iliad,
of Diomedes.
forwards, as in the case
(Iliad,
v, 112.) 3.
By enlargingthe wound and cuttingout the weapon, as practised
Patroclus
in
the
of
case
by
(Iliad,
xi,218.) He
Eiirypylus.
further remarks
that it appears to have been a common
practice
with the mouth; and, he adds,that this method
to suck a wound
stillin use
barbarous peoplein his days. (IHad,
was
a
among
used in the Trojan war
iv,219.) The weapons
were
swords,
stones
flung by the hand or by a sling,
spears or javelins,
hatchets or axes, as used by the Trojanson certain occasions
Eustathius
xii,590), and arrows.
(Iliad,
remarks, however,
.

that there

would

appear

to

have

been

very

few bowmen.

In

FRACTURES.

Lxxxix.]

SECT.

427

his

Commentary on the Odyssey he states that poisoned arrows

Comm.
in
but
for
w
ild
were
never
beasts.
employed
only
killing
war,
We
believe
that
of
iron
no
(Odyss.i, 260.)
were
weapons
used
in the war
of Troy, and that they were
all made
of
(See Jameson's Mineralogy, iii.) Little transpires
copper.
from Homer
with
In one
regardto the internal treatment.
place (Iliad,
xi_,
638) mention is made of a mixtui'e of wine and
cheese ha\ing been givento a wounded
warrior,which practice,
Eustathius
given rise to a varietyof conjectures.
says, had
Some
supposedthat the wound in the case referred to was so
proper
sHght as not to render the administration of stimulants im'

"

others

But

many,
lived

believed that the loss of blood had

to call for the

great as

so

rather

he

of wine

use

of

adds,were

to

been

support the strength.

opinion that

in the heroic

men

temperatelythat their constitutions readilybore

occasions,which in after ages were
things on extraordinary
reckoned to be of too inflammatory
This explanation
a nature.
is advocated
by Athenseus.
(Deipnos,i.) In the Odyssey,
mention
is made
of a hemorrhage being stoppedby incantation,
ages

so

which

shows,

incantations

Having
have

these

ON

mean

to

give

the

the

on

they hold an
fleshyparts

DIFFERENCES.

the

of fractures and

the

dislocations ; for

placebetween

bones,

and

fleshy
parts,
relate to the

And

surgery.
of the bones

fractures

intermediate
and

of those which

departmentof

fractures,
beginningwith
because

THEIR

AND

account

the treatment

and

the heroic ages.

on
surgical
operations

an

also fall under

as

remarks, that amulets

FRACTURES

described the

next

bones, I

ancient

as

LXXXIX.

SECT.

we

were

Eustathius

as

of
the

because

of
first,
the head,

operations

the

cranium

overtops all the other parts. In generalterms, then, a fracture

is a division of a bone, or rupture, or excision of it,produced
external

by
A

bone,

in unguem,
is
natim

violence.

differences of fractures

The

then, is said to be fractured

polentatim,and
a

transverse

one

are

many.

raphanatim,scandulatim,
A fracture rapha-

actionem.
per defr

through the

and

is called also cucumeratim

and

cabbagesbreak

and

in this way.

thickness of the

bone,

caidatim,because cucumbers
Scandulatim

is

longitudinal

"

'

428

FRACTURES.

fracture

of

and

its

at

bone.

extremitylunated,
is

Polentathn

fracture

of

also called nucatim

hj some

of

away

bone

is taken

is removed

The

who

have

treated

fracture at

and

bone

Defractioor

with

into

arundatim.

small

tearingof

pieces; and it is
pracisiois when part

the

skin,

so

that

part

the differences of fractui'es.

are

followingis a

of fractures

vi.

part straight,

one

it is also called

is wanting. These

and

Commentary.

CoMM.

is

In unyuem

[book

list of the ancient authors

dislocations

and

Hippocrates
Capit.; Officina Medici);
:

(deFracturis;de Articuhs; de Yulner.

Galen
(Comment, in eosdem, Meth. Med. vi.); Celsus (viii)
;
Oribasius
(de Machinamentis, "c.); Nicetse CoUectio ex
Chirurg.Grsec. ; ApolloniusCitiensis (Scholiain Hippocrat.
Dietz); Avicenna
(iv,5, 23) ; Rhases (ad Mansor. vii,26 ;
DiA-is i,140; Cont. xxix); Averrhoes
(CoUig."\dij
36) ; Avenzoar
Q, \) ; Haly Abbas
(ii,
(Pract.ix, ad finem.)
Hippocratesdoes not make use of the technical terms explained
by our author in this section,and Galen hints that he thinks
ed.

his Master

Galen
that

himself to words generally

understood.
confining
defines only a few of these terms.
He calls

did better in

of fracture in which

kind

the end

of

bone

at

an

culation
arti-

is

taken
A transverse
cibruptio{a-n-ayfxa.)
entirely
away,
fracture with a completeseparationof the broken portions
is called a fracture caulatim (jcovArjSoi'.)
A longitudinal
division
entire separation
of the parts is called
attended with an
not
He thinks the later writers on
scandulatim
the
((rytSa/crjSov.)
the
had
of
such
who
introduced
terms
use
as
subject
raphanatim
".nd polentatim(aX^trr^Soi')
had refined
{pacpain^^dv)
mentioned

All the terms

of

by

our

author

occur

too much.

in

Soranus, preservedin the collection of Nicetas.

in the
of very elaborately
in the same
collection.

also treated

contained

fragment
They are

fragmentsof Heliodorus,

and elegance,avoids
perspicuity
all technical terms
much
as
as
possible. He thus defines the
varieties of fractures.
A bone, he says, may
be splitlongitudinally
like a pieceof wood, or it may
be broken
transversely
and its ends may
be blunt or sharp,which
last
or
obliquely,
be easily
made
to
varietyis the worst of all,as they cannot

Celsus,who

unite
and

with
nerves.

was

studious

the other

of

parts, and

Sometimes

are

the bone

apt

to wound

is broken

into

the

muscles

and
fragments,

HEAD.

xc.J

SECT.

iu certain bones

Comm.
separated entirely
fragment is occasionally

'

bone.

tlie broken

from

429

''

A^acenna^ Haly Abbas, andAlbucasis,

Arabians^ especially
Albucasis
remarks, that
adopt the terms used by our author.
The

recognised
by the derangement of the
and the crepitus
produced
pieces,by theii*projection,
of

the fracture
broken

is

bone

He says, however, that there

pressure.
upon
without derangement or crepitus.

SECT.

XC.

then,a fracture
particular,
cranium, sometimes
simpleand
The
external violence.
by some
In

BONES

THE

OF

FRACTURES

ON

OF

in the head

be

may

is

fissure

HEAD.

THE

division of the

complex, occasioned

sometimes

of fractures

differences

of the

a depresan
incision,an expression,
sion,
fissure,
A fissure,
arched
an
fracture,and, in infants,a dent.
or
deep, when
then, is a division of the skull,either superficial
the inward bone is not removed out of its place. An incision,

head

or

these

are

is a division of the skull with

slash,(ey/coTTj))

the affection

i. e.
deasciatio,

as

if done

division of

of

downwards

call

off some
An

hatchet)
.

pression
ex-

the meninx.

says, is

fractured

division

with

An

arched fracture

sinking
its natural
position
Galen
as
{Ka/uaouyaig),

of the

skull attended

with

fractured

the

towards

of

from

bone

bone

parts,like

also the

enumerate

it occasions

owing

death.

in expression. Such

fracture,but
capillary

An

to

the

is his

edges

opinion.

it is

very

therefore,being
the symptoms of it not being obvious,

eludes

fissure which

often overlooked

as

of the

elevation

around
piecesin the middle,and depression

of the sound

narrow

of

bone

is a division
depression
(ty-yiawjito)

Some

by

refraction

into many
parts,Avith a sinking
of the brain.
the membrane
of the fractured piecesupon
is

down

be broken

(ifthe injuredbone

bone

the fractured

the

and

senses,

indentation

is not

division of

bone,

and, therefore,such an injuryis not properlycalled a fracture,

wardly,
but is,as it were,
a
protrusionand bending of the sktdl inas
forming a hollow without a solution of continiiity,
when
struck

of copper,
There
the outside.

vessels
on

made

for either the bone

or

are

is

the
two

raw

hide

of

ox,

an

different kinds

depressedthrough

of

are

dentation,
in-

its whole

FRACTURES.

430

that often

thickness,so
brain takes

it is

place,or

sometimes

or

[book

of the membrane
of the
separation
throughpressedupon by the skull out

indentation

the

ti.

does

aflfectthe

not

skull

through its whole thickness but only its outer platedown to

also add that by reperthe diploe. To these differences some
cussion,
fracture of the crawhich happens,say they,when
a
nium
takes placeopposite
to the part which received the blow.
in a mistake,for what
But they are
happens to glassvessels
does not, as they say, happen here; for,this happens to them
from
their being empty, but the skull is full and otherwise
strong.
struck,as

other parts of the head

many
fall,and a fissure of the skull takes

in

solution of

forms

in

it,and
to

appears

have

when

But

of the skin,an
continuity
being opened,this fissure

them

and

oppositeside ;
If

mentioned.

been

to have

occasioned
be

this is to

then,
fracture,

blow

the

by

the

in the

occur

afterwards

which
discovered,

like

cured

out
place with-

abscess
is

been

fissure first
is discovered

head, it

by the sharpness,weight,hardness, or violent

body which struck it, and by the symptoms

of the

the person who

supervene
upon
loss of speech,and sudden

been

has

the

on

struck,such

force
which
as

tigo,
ver-

more
prostration,
particularly
if it be a fracture with depression,
or
contusion,or expression,
the internally-arched
or
fracture,
owing to the compressionof
the brain.
It is also discovered by its appearances
to the
senses

ascertain

the

or
division,

make

an

occurrence
a

only

kinds
a

very

narrow

considerable

with

an

of fracture

and

one,

we

it

If then

we

be

no

if there

by

the

it be

sight,or

any
it will readily
be apparent, but
which

skin

we
suspect a fracture,

ascertain

instrument.

fissure
capillary

narrow

division of the

readilythereby; but

incision in the skin and

by probing it
other

be

for if there

eludes

the sense,

of the
if it is

having

black liquid
medicine,or the common
poured on the part some
writingink, we scrape the bone, for the fissure appears black,
and we
must
go on scrapinguntil the symptoms of the fissure
if it extend
desist
must
to the membrane
we
disappear
; but
from the scraping,
and
endeavour
the
to ascertain whether

membrane
if it

separatedfrom

remain, the inflammation

the

pus

has

the bone
of the

patientgets graduallyfreed

appears

concocted.

But

or

remains

wound
from

if the membrane

fixed.

continues

the

For

rate,
mode-

fever,and
has

the

separated.

FRACTURES.

432

[book

vi.

which have certain eminences

projectinga
abaptistie,
them
from
little above the point that prevent
sinkingclown
to the membrane^ and
Ave
remove
then, by using the chisels,
if possible
with
the fractured bone not at once, but by pieces,
bone forceps,
the fingers,
otherwise with a tooth forceps,
or
or
The space between
such instrument.
some
or
or
hair-nippers,
the perforations
should be as great as the breadth of the largest
and its depth should be until it is near
head
of a specillum,
called

sm-face of the

the inner

(trepan?) do

of the bone

suit the thickness

with

the

perforator

Therefore,in

touch the membrane.

not

that

bone, taking care

size of the

the

order

to

perforator,

But
preparedfor the purpose.
previously
should
if the fracture extend only to the diploethe perforation
of the bone, ha^-ing
After the removal
be earned
farther.
no
after the cutting of
that remained
cleared away
any asperity
the bone with a carvinginstrument, or the extremityof a perforator,
using the meningo-phylaxas a protector,and bringing
and spiculse
which
the small bones
remain, we
carefully
away
This
of
the
is
the more
the
dressings.
application
proceed to
time the easiest and least dangerous
and at the same
common,
it with a sort
of operating
of performing
mode
; but the method
of incisor called lenticular is greatlypraisedby Galen, being
after the part has been scraped
performedwithout perforation
all round with hollow chisels {kvkXlgkoi).Wherefore
he says
thus :
If you have once
laid bare the place,
then applyingthe
which
has a projection
lar,
at the extremity
like a lenticuincisor,
blunt and smooth, but sharplongitudinally,
when
you apply
several

ought

to be

"

the

part of the lenticular

broad

by strikingwith
we

requirein

half

operator were

onlywith
adhere

to

and

more

the

for the
not

the broad

For

divide the

we

trouble.

And

mode

of

all that

even

if the

be wounded

tact
being in conand if anything
lenticular,

behind

the

instruments

chceuicides

be done

by
as

the moderns

we

described

that

so

as

mode

bad

of

is

impossible

free from

danger

operatingwith

or

one,

for fissure.

removes

it follows the incisor,

operatingmore

expeditious."But
called

nium
cra-

have

membrane,

itself,
dividingthe skull;

another

is condemned
may

the small hammer.

operations;
asleep,could

without

knife

to discover
or

meninx,

part of the
the cranium,the round part of the lenticular

its adhesion
or

such

to the

modioli
and
The

the
same

saws

(trepans?)

operation
mode

of

HEAD.

xc]

SECT,

remoAdng

bones

cranium.

of
you

will be

in
applicable
regardingthe amount

But
Galen

in order.

are

When

the other

thus
wi'iting

informs us,

fractured bone

433

it is

to

do,

must

we

well knowing
termination,

extraction
requiring

:
plainly

"

I will

bruised
greatly

entu'e,but if certain fissures extend

they appear

of bones

be removed

to

that

no

fractures of the

What

parts

explainto

now

it is to be taken

fi'om it

farther,as

out

times
some-

them
to their
pursue
will result from them

not

harm

if

After the operation,

everythingelse be properlydone."
havingdippeda simplelinen rag of the size of the wound in oil of
in like
a
as
roses, we
lay it over the membrane
cover, and
ha\"ing
dippeda small ball of wool in oil of roses, we put
manner,
it over
the aforesaid rag, and then havingmoistened a doubled
in wine and oil,or in the same
oil of roses, we
applyit
compress
that they be not too heavy for
to the whole wound, takingcare
the meninx.
then have recoui'se
We
to a broad bandage,
which
also must
but so as merely to preserve the
not be made
tight,
matory
pledgets. And the regimen is to be what is called anti-inflamfor fevers,frequently
and such as is applicable
bathing
After the third day loosing
them
with oil of roses.
the membrane
for
and spongingthe part we pm^sue the treatment
applicable
and the anti-inflammatory
recent wounds
; sprinkling
upon the
until it incarnate,
meninx
of the powders called cephalics
some
and sometimes
scrapingthe bone, if it requireit,on account of
for the sake of incarnation itself.
certain projecting
or
spiculse,
recommended
And
we
applymedicines of the ingredients
may

for wounds.

of the
inflammation
the membrane
operation

On

the

above

the skull but likewise

hardness, and

obstructs

of the

membrane
is

inflamed, so

as

not

only to

after
rise

skin,and is attended with

of the
natural pulsatorymotion

above

the

Often

brain.

the

symptoms, or
brain,in which case convulsions and other severe
inflamed either
It becomes
death,for the most part supervene.
of some
from the imtation
sharp projecting
pieceof bone, or
from cold,or from eating
or
from the weight of the dressings,
too

much,

or

from

If then
or, if it is

wine,
di'inking
the

cause

some

other

cause

be obvious it is to be

not, it will be proper

againstit,either by havingrecoiu'se
II.

or

to

not

parent.
ap-

removed,
speedily

strenuously
venesection,if nothmg
to contend

28

[book vi.

FRACTURES.

434

and
rose-oil,

mallows, or

the

is also

viscera also

The

auditorius.

cataplasmsare
and
else

mentioned
of linseed with the afore-

barleyflour,or

raw

anti-inflammatoryoil

of the whole

taken

vrith.hot

decoction and the grease of a fowl ; and irrigations

the head and occiput,and some
to be poured upon

wool

with

embrocations

warm

must

part -^rith the decoction of marshof linseed,of camomile, and such like,
of fenngi-eek,

bathing

cataplasmsof

and

'We

for inflammation.

it, or to a diet suitable

prohibit
also use topical
remedies,sucli as

be

to

not

are

poured into the meatus

able
but suitto be neglected,
is to be

And care
appliedto them.
into warm
body, puttingthe patients
be

to

baths

If the inflammation continues and nothing

anointingthem.
Hippocrates directs us to purge them with choprohibit,

lagoguemedicines.
On

blackness

of the

the meninx

When

meninx.

turns

black,

three

dicines
brought on by meit by applying
which have that propei-ty,
we
may remove
along with the
parts of honey with rose-oil upon pledgets,

other

suitable treatment.

if the blackness

be

and
superficial,

has been

if the

But

blackness

has

and
if deep-seated,
more
particularly
spontaneously,
must
with other dangerous symptoms, then we

using them,

appearances

indicate

on

be attended
refrain from

dissolution of the

had his skull trephineda

person who
from
The fractiu'e was
after the accident,and recovered.

natm'al
vear
a

for these

come

I knew

heat.

and

weapon,

having

an

was

situated

the

on

outlet,the meninx

was

bregma, and the discharge

therebypreservedfree from

injurj^

'

"

Hippocratesvery properlylaysit doAvn as a

of the head are to be considered as trifling,
ride that no injuries
since wounds
aff'ecting
only the integuments will sometimes
of fissures,
prove dangerousif neglected. He treats distinctly
Commentary.

CoMM.
""

'

cranium, which is an excellent

Our limits,however, will not
arrangement of these accidents.

contusions,and fractures
allow of

In fractures

wine.
especially

of rpv-rravov

',

appear

of his modes
explanation
the head he forbids liquid
cations,
applicalls the trephineby the name

enteringminutelyinto

our

of treatment.

would

of the

He

of

an

It
raspatory {^varrip)altothat his objectin applyingthe trepan was
and

makes

mention

of

HEAD.

xc]

SECT,

435

he had
preventive
getlier
; that is to say, that
operationin order to prevent inflammation
the

brain,and

that

not

to

remove

contusions

severe

the

without

sweUing of

eflPeetsof them.

fracture

and

to the Com

recourse

and

He

fissures

holds

are

more

dangerousthan

attended with depression

and considerable
injuries
of the fractured portions,
and it is in the former
separation
class of cases
that he recommends
trepanning. When the bone
is broken into several pieces,
he says it stands in no
need of the
which
he describes
trephine. One of the varieties of fracture,
with surprising
accuracy, is the separationof the bones at a

It,he adds, seldom requiresthe use

He
remarks, that couM^ilsions often occur
of the head, and that the convulsions
injuries
sutiu'e.

side to that

in wliich

the

of the

trephine.

in consequence
of
in the opposite
are

injuryof the brain

of erysipelas
of the

is seated.

He

face supervening
givesan excellent account
it to be treated with
upon injuryof the head, and recommends
his work
On Injuries
of the Head'
cholagogues. Altogether,
with the subject,
and we
need
bespeaksextensive acquaintance
'

have httle hesitation

valuable relics of
that concussion
to say,

pronouncing it

antiquity. In

of the brain

Galen

as

in

to be

of his

one

occasions

of

one

the most

he
aphorisms,

loss of

speech;

states

that is

explainshis meaning, superinduces

apoplectic

symptoms.
Galen
the

mentions

three sorts of instruments

for

operatingupon

the lenticulars,
and
cranium, namely the cyclisci,

raspatories.Fractures
extend

only to

the

are

diploe,and

inner surface of the bone.

He

classed

by

those

which

likewise

him

the

row
nar-

into those which

penetrate

dirides them

to

the

ple
into sim-

inflicted by the body,

depressions
the fissure extends down
injury. When

contusions,and
fissures,
which

occasioned

the

he directs us to
only to the diploe,
and then to apply the
raspatories,
the farina
of Illyrian
iris,
consisting
and
a

panacea.

by

these

of tares,manna,

the fractui'es which

simplefissure,it may

round
or

Of

the bone with

scrape down
medicines
called cephalics,

be treated

extend

in the

same

to the
manner

birthwort,
meninx, if

by

patories
ras-

if attended
with contusion,by perforating
it all
; but
with
an
?), and then using the scalpel,
(trepan
auger
of the cychsciat once.
means
Some, he says, instead of

instruments, use

projectinga

the

little

which had a circular

abaptista,
above the sharpextremityof the

der
borper-

M.

"""^

"

'

stated by our
as
lenticular,
engeisoma and camerosis,which

the

by
the

arched

and the
depressed
and
with depression,

the

prefers

then

fines
de-

translated

the former being attended

fractures,

the

latter with

are

to be

These

the fracture.

have

we

he

He

author.

vi.

instrament

modes, however,

all

(modiolus). Of

called choenix
that

onlythe

use
Some, he says, from timidity,

forator.

CoMM.

[book

FRACTURES.

436

of

elevation in the middle

taken

out

entire

by

of

means

practice
of the celebrated Hehodorus, of whose
opinionson this subject
CoUectio.) Such
will givea short abstract below.
(Nicetse
we
In a
of fractm-es of the skull.
is Galenas generaltreatment
word, he lays it down as a rule, that parts which are greatly
removed ; but that fragments,
be entirely
comminuted, must

lenticular

extend

which
He

forbids

forceps. This,by

bone

or

far, must

to

he

panned
having treleft
generally

use

by him ^a/cwroc aud KVKX'iaKoc. The latter,

properlyspeaking,a hollow chisel (un ciseau

called

instruments
he

the

that

extremities.

Sprengelremarks, that Galen

surgeons.
of the trepan, and
preferredthe two

this task to the Roman

averse

mentions

of

use

the

was

to their

be followed

bandages. He
but states
occasionally,

the

the head

was

not

the way,

remarks, was,

The former
was
a
creux),which he drove in with a hammer.
true lenticular-knife,
resemblingthat described by Petit and
Bell (Hist,de la Med., 18.)
We

will

now

attempt

abstract of Celsus's

lengthyaccount
mends
struck,he recom-

the skull has been

When

accidents.

of these

an

place to inquirewhether the person has

of \ision,with loss of
"vomited
bile,has experienceddimness
speech,or a dischargeof blood from the nose and ears ; whether
in the first

us

he fell down

at the

less state.

These

torpor has

come

ti'action of the
brain

has

on,

be

comatose

mental

been
In

upon

as

and

sense-

fractiu'e of the

serious.

But

or
aberration,paralysis,

probable that the

and little hopes of
injured,
is

order to ascertain whether

membrane

if

con-

of

recovery need
not the bone
or

better,he says, than making an

specillum(sound),that is neither too sharp

fractured,nothing answers

examination
nor

with

tendons,it

be entertained.

symptoms, he says, indicate

the accident is to be looked

bone, and

the

time, and if he lav in

too

we

are

we

know

Avith

blunt.

If the

bone

certain that it is sound

that

it is occasioned

everywheresmooth,
roughness is detected,

is felt to be
;

but

by

if
a

fracture.

He

warns

us.

HEAD.

xc]

SECT,

however,

to mistake

not

this frank
of

confession of his

does
inspection

ink

on

blow has been

which

sustained
This

is the

eulogiumfor

When

Comm.
'

this method

advises

received

part which

if softness and
it is

likelythat

of it when

existence
our

He

symptoms
one

also recommends

in any

fissure of the bone

Celsus

being able to detect

the blow.

swellingbe detected

repercussion,

afterwards.

mention

without

occurred

of fractvu'e by

case

further

ought to suspect the

of fracture have

as

done

once

part of the skull,and the fissure

one

on

will make

we

we

in the

blunder.

own

succeed, he

not

in another.

occurs

says,

was

merited

to pour writing
us
which
will
the part and to scrape the bone,
appear black
there is a fissure.
Sometimes, however, he adds, the

when

of

as
fissure,

he bestows

whom

by Hippocrates,,
upon

for

suture

437

us,

part,to examine
be found

may
he

it,

there.

swelling,of which
speaks,he probably
the ptfffytumour, described by Mr. Pott, in his
meant
work
of the Head.') Sometimes, he adds, but
on
Injuries
of
rarely,
althoughthe skull be safe,a vessel in the membrane
the brain bursts and pours forth much
blood,which^ becoming
of sight. In such
occasions great pain and dimness
coagulated,
the

(By

softness

and

'

of the extravasation,
says, the pain will pointout the seat
in the skin,the bone will be
and if an incision be made

case, he

eo loco cute
incisa,
pallidumon reperitur."
pale
extravasation has
in like manner,
states that when
(Heliodorus,
to be
taken placewithin the cranium, the bone will be found
of extravasation
The fact that in cases
pale Nicetse Collectio.)
below the skull the bone is pale,that is to say, does not bleed,
is pointed out by Mr. Abernethy as an unerring guide to practice

found

to be

"

"

"

in such

of the dura mater

out

will

probablybe

circumstanced
to the

says,

inconsiderable

place to enlarge

the

of the

wound

blood

Celsus

operation. If
he
exposed,
sufficiently

the

largevessels

I believe that

to bleed.''

be found

of
description
is not

of the

one

quantityof

the

wounded,

will not

of the bone
first

be

unless

"

He

cases.

the

poured
bone

then

so

ceeds
pro-

injuredportion

directs

us

in the

integuments.

The

scrapedaway with a raspatory. The

form of the incision,if made
solelyby the operator, is to
like the
consist of two
another
lines intersecting
cross
one
periosteumis

letter

then

X, from

dissected away.

to be

the

of

extremities

If there be

which

the

dischargeof

skin

blood

is to

be

it is to

'
'

be

CoMM.
'

'
*

[book ti.

FRACTURES.

438

stopped by
the

wLDe

dipped in vinegar,or by

sponge

is elevated.

head

In

cranium, the ancient

of the

cases

compresses,
fracture and fissure

he

says, had immediate

cutting out the part ; but he

surgeons,

for

instruments

to

recom-se

of

the surgeon, in the first place,to tiy the effect of

the in-itation,
for allaying
such as suitable plasters,
applications

recommends

wool

This

treatment

part is

the

vinegar,proper

is to be continued
be

to

return, with
appetite
in the

use

davs, and

better

much

after
the other

he
sleep,

warm

abate,and

recommends

verance
persehe

this manner,

thus,also,bones
united with caUus,which

become

may

the brain than

to

cover

bone

has been

the

cut

fever set in at the first with

hand,

in

sixth

filled with callus ;

pieceof

the

on

applications.In

often be

fractured
extensively

forms

sound

of these

adds, fissiu-eswill
more

for five

with

fomented

the like.

bandages,and

soaked
sponge
If the skin begin to heal,and the fever to

water.

if the

in

soaked

with

tegument
in-

common

out.

But

disturbed

if,on

sleep,a

copiousdischargefrom the wound which shows no appearance

of healing; if the glandsof the neck
swell, or if violent pain
comes
loathingof food,the surgeon must proceed
on, with
he adds,
forthwith to the operation. Dangerous consequences,
arise either from a fissui-eor a depression.A fissm-e may
may
allow

descend

fluids to

rise to

to

the

pain and

of the

membrane

brain, and

depressionin
and spiculae
of bones by
like manner
occasion irritation,
may
As
troublesome.
ATOUudingthe brain may prove particularly
littleof the bone as possible
as
a generalrule,he recommends
If the one
to be removed.
edge overtop the other,it wiU be

therebygi\e

sufficient to
when

it is taken

cure.

If the

be bored
of

with

that its vertex

If the fracture

all
not

away

raspatorythe prominent part ;

there will be

sufficient

openingfor

for
the

firmlycompressedtogether,a hole is to
its side,at the distance
wimble
on
(terebra)

edges are
a

breath,and from
finger's

fissure with

In

with

remove

inflammation.

it two

lines

in the
raspatory(scalpel),
be at the hole,and
may

be

are

form

to be

cut

to

of the letter

the

V,

so

its base at the fissure.

be cut out.
of these holes must
long,more
of depression
the whole depressed
moved.
cases
portionmust be reIn Avhatever way the piecesof bone are cut they are
of a suitable forceps. But we will
to be removed
by means
his method
of operatirg.
space in explaining
occupy more

FRACTURES.

440

Albucasis

CoMM.
"""^^

'

the

enumerates

[book
varieties of fracture

same

as

vi.

our

of 'the operationis little difierent.

author,and his clescripton
used
The drawings wliich he givesof the surgicalinstruments
as
by the ancients in operationson the head are interesting,
of Paulus
and the other
descriptions
authorities. We
remark, by the way, that his abaptista,
may
sort of spearwhich
he calls terebru non
a
are
i^rofundantia,
shaped instruments, having a globularball a short way above
their extremity. They, therefore,had
resemblance
to a
no
modern
trephinewith a conical crown.
of the head,
Avicenna
gives a very full account of injuries
to illustrate the

they tend

but it is taken

be
may
states that

Nearly the

same

Avenzoar
when

there

his time

know

additional

Haly Abbas.
trepanning the skull

who

surgeon

that

amputation

and

author.

our

will

be

proper
but
laments
that
in
depression;
difficult to find a surgeon
capableof performing

be

what

proofto

Galeu

said of

operation. Averrhoes

the
did not

from

with

is fracture

it would

for word

word

almost

could
have

we

intimates

that

he

trepan the skull. This is an

mentioned

in

Arabians

the

likewise

in

the

general were

section

on

timid

very

operators.
Rhases

of having recourse
stronglyinculcates the propriety
when
to the operation,
the bone is fractured and depressed,
promj)tly

before
there
of

be

dangerous symptoms have come

pressure on the brain,however, he does

haAdng immediate
It will be

denies,the
same

that

operation.

Celsus

affirms,and

of fracture

occurrence

not

approve

author

our

by repercussion.It

is the

fractuTe par contre-coup of the French medical

the counter -fissure,
namely, the fracturaper resoniearlier authorities.
lieves
Soranus,who, like Celsus,be-

la

as

authors,or
tum

recourse

remarked

to the

Unless

on.

of the

in its occurrence,
defines it to be a fissure which takes
placein the part of the cranium oppositeto that which received
the

blow.

mention

(Nicetse CoUectio.) Hippocrates himself makes

of the counter-fissure,
and pronounces
it to be incurable,
the

as

existence.
have

has

no

certain

data

(Vul. Cap. viii.) Tulpius,Pare, and

related

Boerhaav.

sm-geon

cases

of

the

counter-fissure.

to

discover its

Van

Sweiten

(See Comment,

Aph. 254.) Heister also believed in

i,1, 14.) For cases of it he refers to
(Chirurg.

its
D.

in

occiirrence.

Wagnerus,

HEAD.

xc.J

SECT.

Le Maire

and
de contra-fissura,)
(Dissert,

mistaken^ however, wlien

Sabatier

for it,
the

relates

occasioned

sternum

He is Comm.
(De resonitu.)
quotes ^Egineta as an authority
'

he

'

of

case

441

by

fall

fracture
the

in
contre-coivp

par

back.

(Memoires
Sprengel (Hist, de

on

de

la
Natural^ ii,120.) See also
of the
Med.
17.) Garengoit further relates various cases
defines it in much
the same
terms
contre fissure. Bertaphalia
ject
Soranus.
as
(v,5.) Mr. Guthrie treats learnedlyof this sub-

VInstitut

althoughhe quotes

; but

authorities of fracture

other,he

the
such

the
from

blow

the vertex

He

Head, 65.)

also

author, and that of

'

back

or

states

in

skull is knocked

term

used

by

earlier

blow

on

proof of
disputable
inskull

of the

of
(Injuries

the

of our
airr\yr]i.ia
Latin authors, was

the inner

when

plateof the
outer
one
being

the

without
fractured,

or

base

at the

the

as
resonitus,^

is little

of the head.

that

the

admits, however, as

fracture

speciesof fracture

that

appliedto

of

occurrence

on

there

that in later years

takingplace. He

states

occurrence

an

one

on

instances from
many
side of the head from

injured.(Ibid.) It does not appear, however, that the ancients

Thus
Soranus, as stated above,
appliedthe term in this sense.
defined it to be a fissure producedin the parts of the skull opposite
(Ap. Chirurg.Vet. 47.)
effect. (Ibid.107.)

to the

same

The

day scarcely
any
authorities,have
such cases,

Celsus

the

and

to

the

applylentil

grease

be made

that

when

the

dm-a

swelled,to pour tepidrose-oil upon

bone

even
on

they

are

Hippocrates.(De Cap. Vuln.

directs us,

or

of geese.

of the

at the

it.

present

Our

late

in
of cholagogue piu^gatives
utility

and it will be remarked

author

our

that
judicious,

improvement could
shown

definition is

Galen's

for inflammation

recommended

of the brain is so

membranes

by

here

treatment

the learned

See

blow.

of Cocchi.

note

or

the

received

have

which

those

to

it ; and

27.)
and

gets inflamed

the

if it rise above

pounded with
enjoinsus to avoid

vine leaves
He

mater.

recommended

fresh

butter

all kinds

of

and sternutatories. When

also smoke
mastication,
requiring
bri
the brain projects
beyond the bone (a case called hernia cereit with
to sprinkle
he
advises us
surgeons),
by modern
A
person
applications.
seris,and to use cicatrizing
squama

food

who

has

sustained

fracture

of the skull is advised to

avoid

FRACTURES.

442

'
'

abstinence

recommends

Heliodorus

diet,water
and

laxative

bleedingand

recommends

Aetius

violent

of wine

use

vi.

until

is healed.

the wound

spare

free

the

wind, frequent baths,and

the sun,

CoMM.
"

[book

for drink,

at

(vi,47.)
clysters,

first,and

afterAvards

the inflammation

bleeding,when

is

patient full,light dressings,cataplasms

the

with

fomentations

oil,and

melilot,hnseed, and

decoctions

of
of

Archigenes directs us when there is a

fenugreekor mallows.
it with
above
the bone, to remove
projecting
fungous tumour
and then to applypledgets.
the scalpel,
Collect.)
(Nicetse
septicsor
author^s directions. Haly
Avicenna
and Albucasis repeat our

strain,recommending us to remove
oils on the place,
and
of irritation,
to pour refrigerant
any cause
to venesection.
to have recourse
(Pract.ix,85.)
of the
alluded
to the pulsatorymotion
Our
author
having
ancient
the opinionsof the principal
brain,we will state briefly
this matter.
modern
authorities on
Besides our
and
author,
the ancients,
Hippocrates,Galen, Oribasius,and Aetius, among
mention
of the brain, namely, a swelling
certain movement
a
and
a
fallingdown
during insjjiration.
up during expiration,
and
Boerhaave
tained
mainFallopius,Vesalius,Voltherus, Goiter,
Abbas

in the

follows

that this

same

opinionis unfounded.

Columbo,

But

Piccolo-

Schliting,
mini, Dulaurens, Riolan, Littre,and more
recently,
Vic
and
have
Dumas,
Lamure, Haller,Lorri,
reproduced
d^Azyr,
this ancient
the

We

truth.

of the brain

pulsatorymotion

had

lost
This

considerable

shall have

we

pieceof

be
to
appear
to introduce

would

nearlyall the

had

once

information

the

on

all

about

the

occurs

the

head,

side

they are

be

cut

out

raspatory. The
if

the
wound

the

it

osseous

is derived
as

pain, or change
the body, but more

He

if

one

hard

otherwise

the

from

resistent
He

on
especially

is formed

bone

tumour,

of colour.

directs that the tumour

very base, and

is to be healed

(Ch. Vet. 124.)

which

which

occasion

of the

describes

when
temj)les,

possible,but

suitable

most

regarding

parts of

called horns.

from

in

opportunityof observing
of a poor boy who
the case
skull by exfoliation.

account

an

He
fragment of Heliodorus.
tumour, immoveable, without
says it

an

on

each
should

scraped with

tention?)
by glueing(the first inby suppm-ativetions.
applica-

xci.]

SECT,

SECT.

XCI.

The

of

NOSE.

ON

under

FRACTURE

part of the

fracture^but

but the upper

fractured.
In

when

from

blow

For

in these

medicines,in
the
therefore,

order

inner

cases

NOSE.

give the

not

admit
torted
dis-

times
bony substance is somedaging,
Hippocratesprohibitsban-

the

unless
distortion,

middle

appliesa

of the

nose

protrude.
bandage Avith

suitable

its proper shape. When,

is fractured in its under
troduced
parts, having in-

be

to

the

nose

littlefingerinto the

or

during the
because

he

cases

to their proper

parts this is

THE

the flatness and

parts about

to

nose

the index
outwards

such

the

OF

crushed^ flattened,and

part being of

only increases

CONTUSION

does
beingcartilaginous

nose

it is liable to be

which

AND

443

position.When
done

with

of the

course

bones

of the

nostril,
push the parts
the fracture is of the

the head

of

first day, or

diately,
probe immenot long afterwards,
a

get consolidated

nose

about

the tenth

day. But they are to be put into the proper position

and thumb
with the index-finger
externally.In order to prevent
the bones from
two wedge-like
changing their position,
to
one
tents, formed of a twisted linen rag, are to be applied,
each nostril,
if but one
be deranged,and
even
part of the nose
these

to

are

be

allowed

gets consolidated.

And

to
some

remain
sew

until the bone

the

of
quills

cartilage

or

the feathers

of

into the nose,

into the rags, and thus introduce them
without
in order that they may
preserve the partsin position
a

goose

the respiration
obstructing
; but this
is carried on
by the mouth.

is unnecessary,
as
ration
respibecome
If the nose
flamed
in-

use
some
anti-inflammatoryappHcation to it,
may
from vinegarand
the one
that from juices(diachylon),

we

such

as

oil,and such
with

manna

or

inflammation
the

nose

it has

been

to

cataplasmof fine wheaten flour boiled

both for the sake of the
be applied,
may
in position.When
order to keep the nose
to either side,
Hippocratesdirects us, after

or

restored to its proper

position,to

take

breadth, and havingspreadone

finger^s
to fasten one
taurocolla or gum,
extremityof

side of the
the

gum
and in

is distorted

leather of
with

like ;

nose

to which

it

and
inclines,

piece of

of its ends
it

on

after it dries to

that

bring

thong by the oppositeear to the occiputand forehead, and

fixthe other end of the thong firmlythere,so that the nose

FRACTURES.

444

take
sideAvays
may
Tliis practice^
however,

middle.

incision

divided
wounds

within

the

an

be

it is to

nose

lemnisci,spreadwith suitable
lest
tubes until it cicatrize,

'

"

into small

or

cured

with

ointments.

the
Some

pledgetscalled
also

should

fleshyexcrescence

leaden

use

arise

the ulcer.

is given
Hippocrates's
practice
As here mentioned, he strongly
of
disapproves
by our author.
the expectations
bandageswhich,he says, never fail to disappoint
of both surgeon and patient.He directs us to replacethe broken
also describes
or a specillum.He
parts,eitherwith the fore-finger
of which
the application
of the pieceof thong ; a distinct account
is givenby our
author.
(De Articulis,
30.)
in
his
Galen,
Commentary,^ explainsthe obscurities in the
additional facts or views of practice. He
no
text,but supplies
apphcationsand bandages.
greatlydisapprovedof agglutinative
(Fragmentum ap. Nicetse Collect.)
Celsus
givesa full account of fractures of the nose, but as
he follows the plan of treatment
recommended
by Hippocrates,
Commentary.

CoMM.
'

broken

are

enlargethe wound, and

the small bones with a hair forceps,
unite the
for recent
parts with sutures, and use the applications
If there be a
those of an
and
nature.
agglutinative
make

pieceswe must
having removed

from

nose

vi.

positionin the
approved of by

proper
is not much

of the

If the bones

moderns.

sore

the

drawn

being
the

[book

Some

of

account

'

it will be unnecessary

with

into

thong,
than

directs

us

bone

more
case

but

those

uses

for which

are

to extract

for recent

author

He

gum,

or

speaks of

ficers'
artithe

different circumstances

recommends

it.

He

of it to the nose, and the extremities

either side.
When
any fragment of

coalesce

it with

dangerouswhen
he

our

tilages
car-

cillum,
spesides ; then oblong
to be introduced

with

somewhat

the

middle

temples on

does not

it under

When

replaced^viih

both

soft skin

thin

to fasten the

to the

us

be

to

the nostrils ; or a largequillsmeared

glue may be appliedin like manner.

leathern

with

it.

upon

fingers
pressingon

two

round

sewed

tents

long

fractured,the piecesare

are
or

to dwell

recommends

with the rest,he recommends

properly
forceps.The case, he properlystates,is

there
us

to

is

an

external

apply one

of

wound; but in this

the plastersadapted

of bandages.
wounds; like.the others he disapproves

LOWER

xcii.]

SECT,

JAW.

445

Rhases, Avicenna, Haly Abbas, and Albucasis lay down

actlythe
The

rules of

same

practice

authorities

recent

Hippocratesand

as

consider

into the nostrils unnecessary,

and

SECT.

THE

the introduction

ex-

author.

our

Comm.
'"

of the tents

prejudicial.
(See Bell's
OperativeSurgery; Cooper's Surgical Dictionary.) But the
earlier modern
writers adopt exactly
the practiceof the ancients.
Theodoricus
recommends
to turn the nose
to its proper shape
us
when
of a strip
of linen fastened to its exdistorted,
tremity
by means
with ichthyocolla,
the gluten of hides,as directed by
or
the ancients,
29.)
(ii,

XCII.

ON

FRACTURE

OF
OF

We
as

have treated

of contusion

this affection is not

lower

jaw

fractured

THE

even

LOWER

and
externally,

many

is not

AND

CONTUSION

EAR.

of the

of the nature

is fractured from

JAW,

of

causes.

divided

ear
a

in the

Third

fracture.

But

If,then, it
into two,

as

Book,
be

the

only

it occasions

the symptoms of it are ob^dous.

fore,
Whereinwardly,
having introduced the index and middle fingersof one
hand
of the right,if the rightjaw be fractured,and of the
if it is the left
we
left,
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
of the teeth. When
the jaw is fractured
straight
by the equality
it is to be set by
completelyacross, {thatis to say, caulatiin,)
making extension and counter-extension,with the aid of an
assistant ; and the teeth, separatedat the broken
part,are to
be fastened together,
as
Hippocratessays, and bound with gold,
namely, with a ligatureor thread of gold. But since this is
not readily
procuredby everybody,a strong flaxen thread, a
piece of fine linen,horse-hairs,or the like,may be substituted.
with an external wound, we
If the fracture be attended
must
with a probe and ascertain whether
a
examine
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
suitable instrument, and
the lipsof tlie
removed
with some
united with sutures
wound
dressingssuitable to recent
; then
wounds
with bandages are to be applied. If there be no wound,
a

curvature

"

"

"

"

FRACTURES.

446

[book vr.

simplecerate is to be appliedto tlie jaw along with suitable

bandages. In applyingthe bandage,the middle of it is to be
placedon the occiput,and tlie fold of it brought alongby the
a

chin, and then from the chin to the

occiputagain,and then again to the chin, and thence by the
then again to below the occiput,
cheeks
to the bregma, and
terminate.
the bandage must
where
Upon these again a cover,
ears

sides to the

both

on

bandage,is

that is to say, another

and
fastened behind

pieceof

to be

appliedto

the forehead

the aforementioned
head, in order to secure
bandages. Some, also,applya lightsplint,or a
leather of proper size,
to the jaw,and bandage it as we
the

If
bandage called a muzzle.
both sides of the jaws are separatedat the symphysis,
having
with both the hands, adaptthem
them
removed
a little asunder
againto one another, and having fastened the teeth together
and applied the proper bandages,
aforesaid with a ligature,
as
with thin soups, because masorder the patient
to be nourished
tication

have

Others

described.

is hurtful

in this

derangedfrom
and applythem
daj^,

been

callus be

formed

The

three

of

caUus

the

practiceis

in all

marrow.

'jaw is

and

to be observed

Our

Commentary.

almost

taken

bandageson

generally
and

must

not

on,

we

to it ; which

cases.

for word

divides them

is

it is spongy

cataplasmssuitable

author's account
word

come

the third
until the

manner

jaw-bone

at most, because

weeks

suspect that it has

in like

do

inflammation

CoMM.
"~"^^

again,and

If any
neglectthe embrocations
full of

if you

And,

case.

its position,
loose the

formed.

within

the

use

of fractures of the lower

from

Hippocrates. (De

into external

and fractures
fractures,
to the explanation
caulatim (orcauledon),
which, agreeably
of this term, given in the 89th section,
Galen interprets
to be
fractured portions. He dii-ects
a complete separationof the

Articulis.)He

gold thread ; and in other respects

is exactly
also his practice
His acthe same
author's.
as
count
oiu*
of fracture at the symphysisis very correct.
Soranus
gives a veiy sensible account of this subject. A
he says, often takes place,
but a longitudinal
transverse
fracture,
us

one

to fasten the teeth with

seldom,

distortion.
when
fingers,

and
It

in
is to

any

certain
be

cases

it is not

recognized by

of
displacement

the

attended

examination

parts and

with
with

any
the

will
crepitus

FRACTURES.

443

outwai'ds

and

shoulder^or

and

upwards;

at

The

let

[book

vt.

pull the opposite

another

neck, and let them make

is to
sui'geon then, with his fingers,
least the

tension.
counter-ex-

ture,
set the frac-

drawing outwards
what is situated too deep. If more
counter-extension
be required,
a ball of rags, wool, or
something such, may be appliedbelow
the elbow brought to the rib adjoining
the armpit,and
to it ;
and the other things may
be done
described ah'eady. But
as
if it is found impossible
to raise up the end of the clavicle connected
pushing down

with
laid the
his

on

back, let

the

bone

it
a

his

that

back,

assistant

an

prominent,and

lodged down
placeda moderate

and

push

then

set the

with

with

broken

chisels,taking

care

cushion

under
so

that

be bent

may

fingers.

But

unconnected, and

if

make

must

the

the

below, ha\dng

downwards,

lodged below

off and

the parts,we
irritating
remove

is

fracture

claricle be broken

scalpeland

is

the shoulders

of the clavicle which

and
of the

is

shoulder

the

man

what

if

wards,
up-

part
find

we

straightincision with
mainder
portion,and smooth the rea

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 havingpreparedvarious
must
we
splenia(compresses),
applythe largerand 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,bringingthe
folds in

nected
proper du'ection ; and if the part of the clavicle conwith the shoulder fall downwards, the middle of a broad
a

thong is
whole

to be

put under

the elbow

of

the

same

side,and

the

suspendedby the neck, and the hand is to be slung

in another bandage as in cases
But
of bleedingat the elbow.
if,which rarelyhappens,the outer part be uppermost, we must
arm

have

not

must

recom'se

lie in

to this

arrangement of the

and
supineposition,

live upon
other suitable

if necessary, embrocations
and
be made
until the callus is formed.
is formed

CoMM.

in about

CoMMEMTARY.

arm.

twenty days at

The

The
spare

patient
diet,and

are
applications

to

callus of the clavicle

most.

Hippocratcsgives such

an

account

of this

CLAVICLE.

xciii.]

SECT,

accident

clearly
bespeakshis

as

449

intimate

acquaintancewitli the
healed,whereas
easily

Comm.
'

he says, are
fractures,
difficidt to manage.
such 'as are oblique
He justly
prove more
remarks,that the deformityoccasioned by this injuryappears

subject. Transverse

both
annoys
but that it gradually
becomes

at first very

great,and

little inconvenience

fi'om

the

patientand his physician,

and the patient,
ing
feelless,
and the phyit,grows careless,sician,

evil consequences
result from this neglect,
it is found that proper callus is
in it,and presently
acquiesces
further exposes the mistake of those who
formed.
Hippocrates

seeingno

bone, which, he justly

projecting
be effected.
The
he
as
part which projects,
the extremity
attached to the sternum,
universally
being draggeddown by the weightof the
portion

push down

endeavour

to

remarks,

cannot

states,is almost
the other
; and

arm

to

push

hence

down

to lie in bed

between

the

the

mistake

Galen

is obvious

of those who

attempt

the patient
the upper extremity.He recommends
which generally
until adhesion takes place,
occurs

directs

us

to

twentieth

and

the fourteenth

applyfour

16.)
day. (De Articulis,
or
oblong compresses
splenia

another like the letter X.

one
(Comment, et
intersecting
the fracture is near
Fragment,apud Nicetee Collect.) When
the spica
Galen recommends
the shoulder,
bandage(DeFasciis),
of which,see Heister's
for a drawingand description
Surgery,^
c. 3.)
c. 4, ""1,
(p.iii,
of the matter
with the account
Cflsus agrees entirely
given
he
is broken transverselj',
the bone
by Hippocrates. When
of
without
the application
says, it will sometimes unite readily
the upper end of the
In general,
as he explains,
a bandage.
is the partattached to the sternum, the other
fractured portions
being attached to the shoulder and dragged down along with
the state of
that this is so generally
mentions
He
the arm.
'

that
parts,

the

they had

never

some

great masters

seen

case

of the art had

in which

the end

who
but that Hippocrates,
projected,
had affirmed upon
these subjects,
upon

shoulder

that

such

an

occurrence

is to be

met

declared

attached

that

to the

tion
is rich in informahis

with.

own

In

authority
settingthe

properlydirects us to raise the shoulder ; and his

to have been littledifferent
of bandagingv,'oukl seem
mode
He
directs us to fillthe
followed.
from that now
generally
of
armpitwith wool, and to applyover the fractured portions

fracture he

II.

'
'

29

FRACTURES.

450

the bone

OMM.

three

compress

times

[book

folded,and moistened

vi.

in wine

'

'

into many
oil ; or^ if the bone is broken
a splint
fragments,
incline
the
bones
formed
of cane
If
the
to
common
(ferula).
and

the
position,
lias
The

is to be fixed to the

arm

tendency upwards,the

is to be Liid

man

on

Albucasis

follows

the surgeon
incision and

when

our

there

to

of
spiculse

the

end

neck.

bones

are

they are wounding the flesh.

He particularly
author closely.
enjoins
to make
an
are
spiculse,
any projecting
that

out ; after

them

cut

tied

be

All

his back.

out, if it is found

to be cut

is to

arm

if the outer

but
side,

which, a

suture

may

be used

press,
large.A comsoaked in rose-oil,
vinegar,and wine, is to be appliedto
He directs the patientto sleepon his back
allayinflammation.
with a pillowunder his armpit.
Avicenna, and Haly Abbas
give exactlythe same
Rliases,

to heal the

account

providedthe
integuments,

of the accident

SECT.

The

scapulais

as

Albucasis

XCXIV.

not

ON

fractured

THE

in

is

wound

and

author.

our

SCAPULA.

its broad

and

tabular

part,

spine. The
what
is called by expression,
fracture
times
someofi".
and
sometimes
a piece is broken
a simple fracture,
The
then, is ascertained by the touch, exhibiting
expression^
and a
of the adjacentarm
a hollow,and
occasioning
torpidity
by its roughness
throbbing pain. Simple fracture is known
and
local pain. Both
to be managed accordingto the
are
When
a
plan of treatment.
piece is
anti-inflammatory
be ascertained by the touch, if it
also may
broken
off,which
givesno disturbance it may be fixed by a convenient bandage,
it is to be
about
and
but when
it moves
produces irritation,
and
removed
sutures
used, as described above.
by an incision,
and the
Bandages like those for the clavicle are to be applied,
patientis to be laid on the oppositeside.
but

CoMM.

sometimes

fracture

may
being sometimes

take

Hippocrateshas

Commentary.

place

not

at

treated

its

of
particularly

"
'

this fracture.
Celsus

treats

the broad

in

bone

general terms
of the

of the

bone,
cheek-bone,breast-

the spine,
os
scapula,

sacrum,

"c.

BREAST-BONE.

xcv.]

SECT,

be

If there

after

If the skin

suitable cerate, and

and

Albucasis
former

The

twenty

or

directs

us

the fissure

which

callus.

with

up

external wound, it is to be healed with

an

dressings
;

451

be

hole

or

suitable

Comm.
'

'

in the bone

will fill

'

entire,he merely enjoinsrest,

gentlebandages.

Avicenna,

usual, copy

as

from

author.

our

of the

that fractures

scapulaare healed in
days. Haly Abbas, like the others,
twenty-five
which
occasion
to
to remove
irritation,
any spicules
states

and suitable bandages. Rhases remarks

applysoothingcataplasms,
is little subjectto fractures-,
that the body of the bone

hollow

portionof it is ascertained
aj:erecognizedonly by the

xcv.

SECT.

middle

The

of

the

off.

be broken

but that its extremities may

ON

sternum

by

local

fracture

risingin
pain.

the

of the

sures
part ; fis-

BREAST-BONE.

THE

by simple diA^sion

is fractured

extremityof it is broken off". When,

of the
therefore,the fracture is deranged,pain and inequality
place follow, and there is crepitusupon pressure with the
there is violent pain,dyspnoea,
fingers. When
by expression,
and
cough, owing to the pleurabeing irritated ; and rarely
and
by expression,

and

there

vomiting of blood, a

is

yieldingthereof.
we

may

recommended

having

The

same

hollow

in the fractured

appliedas that
fracture is by expression,
which
of setting

the
scapula. When
mode
Hippocrates's
practise

recourse

cushion

for

the

place,and

is to be

treatment

for the

recommended

he

the

clavicle when

it inclines

inwards,

of a
supine posture,the application
ing
back,pressingdown the shoulders,and drawto

the

the
upon
the sides togetherwith

the hands.

The

sides

being

covered

wool, we apply a circular bandage, having first put on

from the shoulders,so that afterwards the
two thongs straight
and prevent the
be united in a proper manner,
ends may
two
off".
circular bandage from falling
with

Hippocratesholds injuriesof

Commentary.
to be

in this
so

dangerous than

more
case

forth.

(De

those

of the ribs.

He

lightdiet,rest,silence,bleedingat
Artie.

50.)

the

sternum

recommends
the arm,

and

Comm,
'

'

FRACTURES.

452

Celsus directs this fracture to be treated

CoMM.
*

ciples,
as

explainedin the

yi.

general prin-

upon
section.
nreceding

'

"

[book

Albucasis
follow our
author.
evidently
speaks
of applyingthin splints.
reference
the
ninetieth
The
reader
will find, upon
to
is a comminuted
fracture
section,that a fracture by expression
with depression.
The

Arabians

SECT.

Of
of

the

ribs,called

fracture

there

in

also

ON

THE

RIBS,

those
spathae,

which

thev

of

are

bonv

nature

long admit
the spine,because

are

part, but the false only at

any

only

XCVl.

for at

their

an-

part they are

and are liable to be crushed,

cartilaginous,
but not fractured.
The
for an inequality
diagnosisis not difficult,
of the examiner,and there
presents itself to the fingers
is crepituswith derangement at the fractured part. When

tenor

the

fractured

pain,more
wounded

parts incline inwards

than

severe

with

that in

there

is

from
pleurisy,

violent pungent
the pleiu'a
being

of
sharp instrument ; there is difficulty
other
The
breathing,
cough, and often vomiting of blood.
modes
of displacement,
then, may be rectified by the fingers,
but in that inwards this cannot be done, owing to the difficulty
of appMng
distension.
direct us
to give
Wherefore, some
much

as

flatulent

food, in order

occasioned
But

in
the
as

the

of

organs

sion
disten-

propelledoutwards.
communication

tween
be-

and besides,
the
nutrition,

be

should

fracture be
"

be

occasioned

therebypushed
Let

the

bv

the

suction, and

inwardly. Wherefore,
with wool dippedin

more

parts be covered

says,
let the intercostal
space be filled with compresses,
that the circular bandage
applied,as in the case of

oil,and
order

sternum, may
in

He

smooth.

pleurisy,
accordingto the

compel
great necessity
we

the inflation and

augmented by repletion.Others apply

tion
cuppinginstrument,which is not amiss,unless a collec-

Soranus
hot

and

will

of humours
the

by

it the fracture may

be
necessaiy, for there is no

the chest

that

by

this is not

inflammation

must

divide the

us,

And

everythingbe

degreeof accident.

owing

skin and

let

to

the

lay bare

But

done,
if any

pleurabeing irritated,
the broken

part of the

SECT,

xcvi.]

rib ;

and

RIBS.

then

putting tlie

453

instrument

for

protectingmembeing \younded,cut
After
irritating
piecesof bone.

brane^ under, to prevent the pleura from

off

and
properly,

this

the

cured

parts which

inflamed

not

are

wounds

recent

as

covered

the

remove

; but

such

with

pledgetsdippedin
and
must
be anti-inflammatory^
easiest posture."
Commentary.
of

count

ends

oil.
the

this

accident.

He

and

or

and
to

are

be

treatment

be laid in the

full and

accurate

that when

any unpleasant symptoms

present he thinks that abstinence

is not

diet

patientis to

remarks

united

inflamed

pushed inwards,it

not

are

are

The

Hippocratesgivesa

of the bone

that fever

as

to be

are

the broken

seldom

Comm.
"

happens

When

supervene.

ac-

fever

an
by occasioning
ness
emptiof the belly,
rather prejudicial
by removing what
proves
otherwise tends to support the part aff'ected,
which
is thereby
made
to hang unsupported. In this case
a
slightbandage

will be

sufficient.

twenty days. When

blow

or

any

vomited

ribs,he

The

other

the
such

united
in about
says, become
about the ribs is bruised by a

skin

cause,

much

blood, he

Galen, in his commentary

up.

ou

says, is often

this passage,

states

and blood
pleura are wounded
eff'used into its cavity,a spittingof blood
take
place
may
the
have
themselves
been
not
although
lungs
injured. The
treatment
recommended
by Hippocratesconsists of bleedingat
the elbow, enjoiningsilence,
applying folded compresses Avith
He directs
broad bandages,neither too tight nor
too loose.
at the seat
to use
double-headed
us
a
bandage,and to commence
and restricted
of the fracture. He approves
of gentleaperients
diet for ten days,after which* period nouiishingfood is to be
that when

given.
if

even

the vessels

He
no

collection is
this
the

sure

a
swelling,

actual

the

is neglected,
the proper treatment
should
result from
inconvenience
it,a viscid

adds, that
other

of

to

Avhen

form

chronic

in the

part.

pain gets seated

When,
in the

in addition to

part,he advises

cauteiy to be applied.(De Articulis.)

pounds
eleganceand terseness, exHe
the rules of practicedelivered by Hippocrates.
directs us to apply a bandage,to bleed from the arm, to open
the belly; to avoid noise,speaking,
tumultuous
smoke,
passions,
dust, and whatever is calculated to excite coughing and sneez-

Celsus, with his characteristic

'
'

FRACTURES.

454

Gruels

ing.

CoMM.
'

after -wliiclibread
directs

us

Avitlifat
be

may

Should

figs.

opened

with

red-hot

the

When

recommends

The

above is but

an

the

seventh

darnel,or barley
place it is to

take

forms

mucus

of
application

imperfectoutline

day,

pain is violent be

from

made

iron.

he
fracture,

fractures

the

collection of matter

the

on

^'ben

be used,

apply a cataplasm

to

before

taken

to be

only are

'

"

[book vi.

the

about

cauter}\

of his admirable

chapter

of the ribs.

copiesfrom our author. Haly Abbas,

professedly
Rhases, and Albucasis
account, Avithout
givenearlythe same
addition of any importance. They all approve
the slightest
of
the pieces of bones which
making an incision and extracting
the pleura. Albucasis givesa
happen to be irritating
may
for protecting
drawing of the meningophylax,or instrument
the sawing of bones.
membranes
diu'ing
Avicenna

SECT.

bones

The
but

XCVIl.

admit

ON

BONES

THE

of the ischium

of the

same

then,
extremities,

are

OF

THE

HIPS

AND

PUBES.

fractured indeed,
hips are rarely
varieties as those of the scapula. Their
sometimes
broken
off; there may be
or

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'porof 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
of the external
piecesby an operationon account
parts. If
it
be
is
the
a
nd
to
set by
afterwards we must
fingers,
necessary,
the
other
convenient
treatftient,
apply
using embrocations,and
the
hollows
of the loins with
in order
fillingup
compresses,
that
The

the
same

pubes,for
CoMM.

circular

bandages which

things may
we

CoMMENTARV.

have

be

said with

nothingmore
The

othcr

minutelyas our
accurate.
sufficiently
Celsus
merely directs
cases

are

put

us

to
particular

authorities

to treat

He

may

even.

respect to the bones of the

author,whose

so

on

them

say of them.

do not
account

upon

treat

of these

of them

is

ciples.
generalprin-

FRACTURES.

456

fracture

CoMM.
'
'

of tlie dorsal

paralysisand
the
in
a

alvine and

like manner,
pieceof bone

recommends

[book

it
vertebrae,

is remarked

that

there

vi.

is

and that
of the lower extremities,
insensibility
are
he,
urinary discharges
passedunconsciously,
the case
to be desperate. AVhen
pronounces
is broken

us, like

our

off and

occasions

author,to

make

an

he
great in-itation,

incision and

take

it out.

Haly Abbas and Aricenna borrow everythingfrom Paulus.

of the
cui'ious remarks
Rhases
gives many
injuries
upon
spine,but several of them are borrowed from Galen. (De Locis
Affectis.) Galen relates many cases to show that retention of
effect of an
the urine
and
faeces is a common
injmy of the
the
spine. He also mentions that loss of speechis sometimes
of the upper
part of the spine being injui'ed,
consequence
who
lost the sensibihty
of
Rhases
relates the case
of a man
from
his arms
an
injuiyof the last vertebra of the neck, produced
fall
horse.
He
that
when
the
from
a
a
by
states,
injury
is below the neck the respiration
is never
He inculcates
affected.
that whenever
there is paralysis
of the limbs,or of any
injury of the spine.
part after a fall,it arises from some
(Cont.i.)
AYhen
the sacrum
he directs us
or
os
coccygisis fractured,
the partsby introducing
the finger
to replace
(Cont.
per anum.
xxix.)

SECT.

When

the

XCIX.

is broken

ON

THE

ARM.

Hippocratesmakes the extension

thus : he says,
We
must
take an oblong piece of wood, such
that which
is put into the holes at the end of spades,
as
and
fastening
suspend it transverseh^ from
ropes to its extremities,
some
elevated object
beam, and placingthe man
some
upon
erect
than what is called the erect sleepingposture, we
more
the above-mentioned
over
pass his hand
piece of Avood,so that
the middle
of the wood
be fitted to the ai-mpit,
and his
may
arm
beiug bent at a right angle, an assistant stooping do-wn
takes hold of the hand, and then some
such as a
heavy object,
leaden
the
is
ball,or
stone, a
like, to be fastened to the elbow,
and being allowed to hang suspended, in tliis
way you must
arm

"

set

ARM.

xcix,]

SECT,

instead of
or
fracture,

tlie

down

and instead

the arm,

step of

457

assistant may

weight an

of the above-mentioned

pull

pieceof wood

ladder."

Soranus, however, proceeds

in a chair,or, which
is better,
thus : Having placed the man
in a supine posture,then having
it occasions less disturbance,
as
round
the wrist and suspended it from the neck
put a ligatui'e
direct two
its angular figure,
to preserve
we
so
as
assistants,
and the other
the one
to applyhis fingersbelow the fracture
the extension.
Or if we
above, and thus to make
require
the

use

some

stronger pullingwe
the

applytwo

the fractiire and

above

one

piecesof tliongto the

head, and the other
patient's

equalpiecesof thong to the arm,

the other below, and gi^'ing
one

them

to make

armpit and
while

the

the

to

direct
other

counter-extension

we

the

as

middle

applythe
assistant

pulls in

of the fracture

relaxed,and

it is to

Hippocrates, ^'hen
recent,
three

we

four

or

water

must

use

above.

And

piecesof

wool

the fractui'e is free from

linen

steepedin

and
fracture,

at the

or

the

it,and,

make

the

is at the

at the wrist.

The

being properlyset,the extension is to

be bound
up accordingto the method
bandages of

fingersin breadth,which

be at the middle

hold

the fracture

when

the

near

thong to

we
oppositedirection,

the

oxycrate, but when

or

to

the
order

feet,we

of the
head

at the

elbow, the ligatureis to be apphed there

bones

his

at

one

above

If the fi^actm'e be

counter-extension.

top of the shoulder

stands

assistant who

of the

oil

of the

is

there

proper
have been

of

and

length, and
soaked

in

inflammation, thin soft

if the fracture

And

bandagingmust commence
three tm'ns the bandaging is

the

arm

after two

to be used.

are

inflammation

be

or

upwards,in order,as he says, that the overflow of

be intercepted
to the part may
; and it is to terminate
A second bandage is then to be appliedwith its head

earned

to be

blood
there.

fracture,and, having done as in the former

above downwards, and again revertingfrom

at the

it from

let it terminate
of

there.

accordingto
tightness

There
our

own

should be

and
feeling

case,

thence

moderate

cany
wards
up-

gree
de-

that of the

patient. If the fractui'e be near the top of the shoulder,the

and sternum,
firstbandage should take in the acromion,scapula,
is called the crane
to form what
so
as
bandage. The second
fi*om thence to the
is to extend to the elbow, and reverting
one
and
upper parts it is to take in,A^dth the acromion, the scapula

458

FRACTURES.

[book vi.

sternum^ like the first bandage. If the fracture be

the

fore-arm

of the
with

is to be

taken

the

the

members,

other

leg;

not

in the middle

and

it.

in
splints,

the

order

the

as

in like

so

manner

fore-arm,the thigh,and

the fracture is in any part near

and
a joint,
of the limb, the jointis to be bound
along

when

After

such

elbow,
figure

bandage,the

elbow-joint
being preserved. And

the

with

in with

at the

moderns

bandaging the

to

the bones

preserve

immediatelyapply

which

have

been

set

in

their proper shape,tightening

them
feelingand the swellingoccasioned
the

ancients

day,within
limb

had

did not
which

apply

the

the inflammation

period,as

become

agreeablyto the patient's

But
by the inflammation.
splintsuntil after the seventh

ages
Hippocratesorders the banddays,lest,o^vingto the part being

every three
covered ujd, distension
constantly
that

the

onh'

does

ulceration

has

and

pruritusshould come
on,
be
not
obstructed
might
persj)iration

insensible

after the bone

the
declined,

less swelled.

to be loosed

and

had

become

firm ; for that by these

painfulpruritustake place in certain

of the

skin

is occasioned

means

cases,

not

but

the

acrimony of the
sanious humours.
He directs us, therefore,
to bathe with tepid
water, so as to dispelthe humours, but after the seventh day to
loose the bandages at greater intervals,
because
the parts no
longerrequirethe expulsionof the humours ; the formation of
callus thus goes on properly. The splints
in
to be applied
are
this manner.
Compresses,thrice folded and dippedin oil,are
to be put upon
the bandages,and
if the limb
he of equal
thickness this is to be done even
ness,
; but if it is of unequal thickthe hollow
so

as

to make

parts

the

the

splints
; then
quantity of wool

beingnot more
binding them

arm

the
or

than

are

be

to

by

filled up

with

the

compresses
of equal thickness for the application
of

splintsbeing wrapped with a moderate

flax,we applythem around the fracture,
breadth
finger's

distant from

one

another,

moderatelytight,and taking care, as much as

that the splints
do not come
in contact
with a joint,
possilile,
and being more
careful of the inner part of the
particularly
for there they sometimes
occasion ulcers and inflammations
joint,
of tendons.
But
there the bandaging must
be made
slacker;and stronger,on
swells up.
bound with

It is better
the

arm,

lest

the
that

by

other
the

hand,

chest

its motions

where

should

the
be

it should

fracture

moderately
derange the

xcix.]

SECT,

ARM.

459

ou
position. If iuflammation sliould come
(which we know bv
and redness around_,
and from the limb being more
the swelling
ranged,
tightlybound than formerly),or if the fracture become dethe bandages become
or
if,without these occurring,

slacker^or,
to

are

soft

part is

proper,
everythingrectified. The

with his
supineposition,
pillowis to be placedunder
the

embrocations

with

be bathed

to

and

hand, tighterthan

it to receive

upon

other

be loosed

to be laid in

and

the

on

warm

be present, and

if inflammation
he is to be

fed

hand

which

patientis
his stomach,

upon

the

the bandages

having a

arm

from

run

it.

skin
The

oil every day, more

especially
inflammaduring the time of tion

and
sparingly,

afterwards

moderately,to
He
lie quietuntil the
must
promote the growth of callus.
callus is formed, which, in the arm
and leg,takes placeabout
the fortieth day. Aftei* this the bandages are
to be loosed,
and after using the bath he is to be treated Avith plasters
able
suitof procedureis applicable
This mode
to fractures.
in
all

almost

of fractui'e of limbs.

cases

Commentary.

humeri,
work

'

as

De

Fractuiis,^but

in
of

wood

of fracture of the
account
Hippocrates's
quoted by Paulus, is from the eighthchapter of

making

the

our

author

has

The

used

mode

considerable

os

comm.

his

'

"

berties
li-

using the piece

easilyunderstood,from his

extract.

of

suspendingthe arm is
without the commentary of Galen.
own
description
(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
until the seventh day,in order to give time for
not to be applied
He says, the bone
the inflammation
and swelling
to subside.
gets consolidated in about fortydays. He justlyremarks, that
when

fur

distortion

of the

arm

place it

takes

is to say, backwards.
His method
of the arm
and fore-arm
the
was
first placeto

put

cerate

to the

of

is to the

that
outside,

bandaging for

same.

He

part,and then

directs
to

fractures
us

in the

applythe

first

and carryingit two or three

bandage,beginningat the fracture,
into
down
turns upwards,so as to prevent the blood from falling
ture,
above the fracthe part. The second bandage is to commence
and

is to be

oblong compresses,
and

these

are

to

carried dowuAvards.

spreadwith cerate,are
be secured by stripsof

Afterwards
to be laid

linen

spleniaor
over

cloth.

them,
These

460

'
"

to be removed

bandages are

CoMM.
'

FRACTURES.

about the thii'd day. On

be

applied,the limb

they are

allowed

be

to

accident.

by

theybecome

when

that time
to remain

until

swellingsarise

"When

the

they are to
bandages are

He

the 24th

with

cerate

if the
time.

part of

any

off,he directs

taken

the limb.

j)Ouredupon

for

be removed

on

to
are
splints
and
swelling,
day after the

or

lost its

having

vi.

slack,generally

the seventh the ferulse

to be anointed
pressure, they are
and wrapped in soft wool ; and

limb

[book

limb

wine

or

from

and

oil,

be hurting the
splints

(De

Fract.

that hot water

recommends

be

should

diet unless

spare
Fracc.

and Galen.
integuments. (De
of
account
more
Comment.) It may be proper to givesome
used by Hippocrates
in fracthe splenia
and ferulae {i'do9r]Kig),
tures
In his work
entitled
The Surgeon^s
of the extremities.
there

be

wound

of the

"When

21.)

'

he directs the length of the spleniato be made

Shop' {i7]Tpeioi'),
proportionateto the part which theyare applied
to,their breadth
and their numtheir thickness three or four folds,
three fingers,
ber
such
less.
The
He

to encircle the limb

as

It appears
intention of them

directs the

hurt

the

used

by

order

what
some-

not

or

4th,
splints,

splints.AVith

to the

regard

of

an

folded

to

used

bandaging,it is importantto

of

bandage

outer

cerate

presses,
com-

in the

state

in his treatise, Officiua Medici,^it would

passage
that the cerate was
not onlyapplied
to the skin, but
a

that,
pear
ap-

that,

greater security,
every fold of the bandageswas
with it.
See Galen's Commentary on the work, (T. v.

rubbed

of

Littre's

692, ed. Basil,)and

It remains

by

bandages,in

part.

'

for the sake

p.

and

or
under-baudages,2d, of splenia

Hippocraticsystem
from

linen.

It appears, then, that the whole apparatus

in
the
of
treatment
consisted,
fractures,
Hippocrates

of the ferulae

the

secure

the

concave,

or

skin.

1st,of two

3d,

lengthof

the

more

to the

support

splintsto be smooth, even,

than

sound

give some

to

was

doing either

theyconsisted of folded

quiteclear that

shorter

to

without

to be

of

means
can

mentioned,

thread

surpass
laysdown

the

with

or

Hippocrates, (T. iii,p. 316.)

that
a

judgment

the

needle.
and

his rules for the

bandages were

(Off.Med.

secured

8.)

thing
No-

with which Hipprecision

pocrates
of the bandages.
application

(Ibid.)
Galen

three

or

describes the
four

spleniaas being piecesof linen folded

times,which

are

to be laid

along the

arm

longitu-

ARM.

xcix.]

SECT,

401

He says
dinallv,.He directs us to spreadthem with cerate.
He
that all the
that they support the limb.
says distinctly

bandages should

folds of the

limb

broken

are

judicious. When

most

pain and inflammation, he recommends

the callus beginsto form,
but when
and
Spiculse
use
a nourishingdiet.
allowed to exfoliate of

to be

'
'

in order to

cerate

for the treatment

his directions

All

give greater support.

with

rubbed

be

Comm.
'

of

at firstthere is much

bleedingand purging ;
directs the patientto

he

scales of

bone

in neral
genot- removed

themselves,and

are

by the surgeon. (Comment, and Fragment,ap. Nicetse

forcibly
Collect.)
in fractures of
the principles
of treatment
Celsus laysdown
that we
the arm, fore-arm, thigh,and leg so circumstantially,
He recommends
afford room
can
only for an outline of them.
duced.
time to be lost in gettingthe displaced
parts properlyreno
For
be

may
means

attached
and

and
linen
oil.

the broken

of

counter-extension

with

and

linen

if other

bandages,

limb to make
When

them.

the

tension
ex-

ends

of

by the pain
deformitybeing removed,) the limb is to be wrapped in
cloths folded two or three times,and dippedin wine and
rollers (fasciae)
then to be applied.
Six bandages or
are
adjusted,(which

been

have

bone

the

end

to each

assistants

strong,two

requiredto pull in contrary directions

do not
succeed,thongs of leather,or

be

may

be

if the limb

this purpose,

is known

shortest,which is to be three times rolled round

and three times generally
the limb upwards in a spiral
direction,

The

first is the

will be
to

second

The

sufficient.

the bone

wherever

commence

downwards

and

the former.

upwards,so

then

These

spreadwith cerate.
to be appliedupon

to

are

The
the

as

is to

by

fourth

that
principle,

the

longer,and

is

if there be

to terminate

be secured
third and

or

and

half

one

projects
;

part of the fracture

at any

be

must

no
jection,
probe carried first
a

broader

little above
linen

cloth
then

bandages are
latter is to

be

put

in the contrary direction to the former; and further,it is

on
below, whereas
to be observed that the third bandage terminates
all the others
he

terminate

adds, it is better

to

these

above
secure

the fractui^e.
the

being apt
When
properlyappliedthey ought
dnj, yet such as not to givepain ;

tight bandages,

not

the

whole,

than witli
many
mortification.
occasion

limb
to

Upon

with

to be

slacker

on

loose
the

on

the first

second, and

462

loose

CoMM.
"""^

'

the

on

and

six

fifth may
the
ever

ninth

or

takingcare
to which

These

put

all be

must

the

on

fifth

day,

above.

others

T\lien-

to be bathed

the
appliedto allay
to have

and

subsided

with

mation,
inflamthe

about

the

bandagesare again to be put

also to be added,
ferulaeor splints
are

bone

fractured

superadded to

that the third

manner

broader

stronger and

on

off

vi,

and

removed

to be

off,tlie limb is

Then

day.

above,and

to

the

proper fomentations
be found
will generally

directed

as

taken

bandages are

taken

all the

below, and

terminate

which
seventh

are

to be

on, in such

bandages put

hot water, and

to be

day. They are then

a fifth bandage is now

third

and
again a^Dplied,
them j and again, these

on

[book

FRACTURES.

rounded

splintat

the side

tendencyto be protruded.
in contact
where
with a
they come
they are only to be secured with
has

to avoid injuringit ;
joint,
such tightnessas to keep the bones in their place,and when
they get loose their thongs are to be tightened. The bandages
to be removed
are
gradually. These are his generaldirections

for all fractures of the

and
extremities,

his mode

is

of treatment
He
of

method

the
essentially

describes

afterwards

same

of the

that

that of

as

considerable

at

ends

broken

settingthe

it is to be remarked

Hippocrates.
length the

humeri.

os

After

accomplished he directs us to bind the arm

gentlyto
he properly
side.
With
recommends
regard to the splints,
the brawn
on
longestto be appliedexternally
; shorter ones
the arm
(overthe bicepsmuscle ?), and the shortest under
them
when
armpit. He advises us to remove
frequently

this is
the
the
of
the

the fractm-e is situated

the

arm

the fore-arm ; and

near

is to be bathed

with hot water, and

at

rubbed

times

these
with

soft

cerate.
It will be

seen

althoughthe same
Hippocratesuses

small compresses,
cerate, Celsus wine

as

The

Arabians

the

Greeks.

us

to make

of broader

Below

and

them

Hniment.

of

Hippocratesand Celsus^
differ in the following
in principle,
respects,
three bandages,Celsus six : Hippoci-ates
uses
Celsus largepiecesof hnen : Hippocrates
uses
that

the methods

and

oil.

conducted
In

cases

the
firmer

is to be

the treatment

in much

of fracture of the

bandages

of

linen if the

applieda

After the under

soft,thin

the

arm,

smooth

cloth

Albucasis

linen

thighor legis

same

cloth

; but

to be treated.

spreadwith

bandageshave

way
rects
di-

been

put

able
suiton

in

FRACTURES.

464

CoMM.

[book

vi.

certain it
Chir. ii,3, and i,4). We
are
Aquapendentc (CEiiv,
will be generallyadmitted
that the waxed
apparatus of the
ancients in the case of fractures was probablyquiteas efficacious
have been
the starched bandages which
introduced of late
as
advantage.
years with so much

C.

SECT.

The
and

ulna

and

sometimes

endj

one

as

THE

ON

radius

only,either in the

of them

one

elbow

at the

both fractured

sometimes

are

or

RADIUS.

AND

ULNA

The

wrist.

together^

middle

or

at

of all is when

worst

together,after that the ulna alone,but a

fractured radius is,of all cases, the easiest cured. For, although
it be largerthan the ulna,yet it has this bone as a base and
the extension
must
support to it. If only one be fractured,
be appliedprincipally
but if both,theyare to be stretched
to it,
both

fractured

are

that the
so
being put into an angularposition,
thumb
the little finger
be higherthan the fingers,
and
may
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
applyit not only with the
described when
hands but also with ligatures,
as
treatingof
the arm
everythingrelative to the bandaging and the
; and
is to
of the splints,
subsequenttreatment, with the application
the
evenly,

arm

be done

in

as

the .fore-arm
And

most.
same

have
the

their callus formed

fore-arm
the

as

are

put under

Commentary.

The

until callus is formed.

case

manner

which

CoMM.

that

arm,

is to be
with

the

in about

bones

of

thirtydays at

arranged in the
exception of those things

otherwise

it.

wish to

full

exposition
of the principles
these cases
of fracture ought to
which
upon
be conducted may consult the first part of Hippocrates's
work.
advantage
the dis(De Fracturis.)He shows, with a singular
precision,
Whoever

would

see

of the prone and supinepositions

of the hand, both
of which, it appears, had their advocates in ancient times. The

bandages,compresses,

described in the

manner
on

and

the

splintsare

to

precedingsection.
of having the arm
and
necessity

appliedin the
He insists strongly
wrist carefully
susbe

HAND

CI.]

SECT.

pended-in
neither

high

too

soft

FINGERS.

sling,and

Oribasius

directs

tied behind

to

us

slingthe

suspended with
bone

and

of this

occasion

convenient

the

thumb

uppermost.

When

the

to

us

advises

the

remove

givesproper directions about

the
tightor too slack. When

them

to be

accounts
our

When

cases

little

ends

narrow

the fractured
to

us

troublesome

make

cision
in-

an

pruritusseizes

bandagesand

bathe

applyingthe

ages
band-

not

hand

swells he

mends
recom-

slackened.
Avicenna

given by
author's.

Avicenna

and

Haly

cautions

us

Abbas
not

are

to make

quite
the

splintstoo long lest theyhurt the hand. None of the Arabians,

have noticed the fracture of the olecranon.
Like
we
believe,
most
imitators,
they often fall short of their originals.

SECT.

Cr.

ON

HAND

THE

AND

ITS

carpus, metacarpus, and

of the fingers,
being of a spongy and porous
The

bones

crushed
on

rarelyfractured.

high seat, we

are

to

The

direct

FINGERS.

of the

phalanges

nature,

are

often

patientthen being placed

him to lay his hand
prone

table,and the fractured piecesbeing stretched

with two fingers,
that is to
we
assistant,
arrange them

an

upon

by

but

of the

an

even

and
say, the thumb
be used at the time

the
that

index-finger.A tightbandage is to
inflammation
for,owing to
prevails,

of callus is
bones, a redundance
If the phalanxor fingerbe simplyl^roken,and it be
formed.
the largeone, called also the thumb, after suitable bandaging,
the

porous

II.

nature

'

napkin (mitella),

and

arm,

he
irritation,

them.

extract

similar to

the

with

arm,

in

case

the thumb

the arm, he recommends

with hot water.

The

the fore-arm

secure

of fracture very accurately.

He
the largerof the bones.
He directs the arm
to

treats

calls the ulna

too

phicedComm.

the neck.

Albucasis

Rhases

be

"

towards
the breast,in
inclined,
the broad part being applied
to

piecesof

hand

the

low.

too

nor

and
splints,
(De Laqueis,2.)

of fracture.

be

that

retain the

to

4C.5

takes notice of"

Hippocrates
the olecranon,as will be explained
afterwards.
and draAving
of a laquens calculated
givesa description

fracture of

Celsus

broad

AND

of the

30

[book vi.

FRACTURES.

466
to the

it is to be bound

if any of the others,as

palm that it may be kept at rest ; but

it
the index or little finger,
for example,

is to be bound

along with

middle, it

be

all may
at

may

next

one

along with

bound

to

that

if the

fractured

side, or

thus

kept best
supported with

been

had

of the

one

either

on

altogether.For they are

bones

if

it,or

bound

be

rest, as

the

splints.

'
"

ment

the

the

Hippocratesrecommends

Commentary.

CoMM.
'

in
applicable
which, as
splint,

all

of

cases

fracture,with the exceptionof

is
explains,

Galen

generaltreat-

admissible

not

in these

cases.

when
to
a finger is broken
says, it will be sufficient
after the inflammation
it to one
pieceof splint(surculum)

Celsus
bind

has subsided.

recommends

Albucasis
thumb

the

bound

to be

SECT.

but

in

up

with

one

the

appliedupon

of the

fingersbe

others,or

small

one

Avicenna, Rhases,and Haly Abbas

formatio
but supplyno
additional inaccidents,

of these
distinctly

The

If

be

be used.

piece of splint
may
treat

splintto

it is fractured.

when

broken, it is

small

one

ON

CII.

THE

THIGH.

thigh is analogousto that of the arm,

a fractured
thigh is mostlyderanged forwards
particular,
of

case

broken

outwards,for the bone is naturalh^ flattened on those sides.

and even
cords
It is to be set by the hands, with ligatm'es,

and

above

applied,the

one

the fracture

takes

the

middle

it may

not

nseum,

and

an

part

givethe

ends

the

above

end,if at

one

parts there,is
of it

near

ligatureround

the

the fracture.

the head

of the

with

wool,

round

to be

brought up
below
apphdng a ligature
another

the

knee, we

extension

knee

to

and
the

assistant to make

When

thigh,
so

the

appliedto

to the head

fractm'e,and

make

below

thong wrapped

of it to

to

with

hold, and

If it is fractured

which

of

the ends

assistant to

we

place at
the

cut

and the other

that

peri-

given to
fracture,

extension.

diately
applythe ligatureimme-

give the

ends

to

an

assistant,

upwards ; and while we put a

secure
it,and while the patient

THIGH.

cii.]

SECT,

lies

tliuSjwith

Pieces

his

of bone
be

are

to

we

have

leg extended,

which

taken

irritate the
from

out

above

alreadydescribed

thigh gets

consolidated

of the whole

Commentary.

in

will

we

the

has

the

section

described

been

fracture.
often

rest of the

the

on

The

fiftydays.

be

the

arrange

parts, as

; and

within

it afterwards
treatment

46/

treatment

The

arm.

of

manner

after

said,

dehvering

ranging
ar-

the

leg.

Hippocrates has

correctlystated the diffi- Comm.

of a fractured
culty attending the management
thigh-bone,
the
and
which
entails
the
an
ill-managedcase
disgrace
upon
'

'

He

surgeon.

directs

and

him

to

make

aj)plythe bandages

to

extension
and

and

splintsin

tension,
counter-ex-

the

manner

He
recommends
few tiu'ns of the bandage
a
formerlydescribed.
the loins,in order to prevent the skin
to be brought about
at the top of the thigh from
being injuredby the splints. He
points out the extreme
importance of attendingto the position
of the heel, as if improperlylaid,it is capableof deranging the
fractui'e entirely. It gets consolidated,he says, in about fifty
days. (De Fracturis.)
Celsus pronounces
it impossibleto heal a fractured thighbone
without
ever
deformity. The patient,he says, must

afterwards
be

if

worse

to

stuff up

the

his

limb

whole

We

nates.

barbaroiis

translator
the

splintsextended
and

Rhases,
directs

whole

put

will

thigh to
he

bandage

fi-om

the

fore
pads be-

him

to

sui'-

heel

to

the

think, although the

language of
is not
precise,that his
sufficiently
length of the limb.
to

be

alone
laid in

recommends

of all the
a

ancient

ties,
authori-

somewhat

bent

something

suitable to be

position,

it.

below

Haly

believe,he

we

for this purpose

and

our

the

with

inclined

are

soft

placesin the limb with

splints. He also recommends

hollow

all the

applying the
round

case

He
describes
greater encouragement.
very minutely,du'ecting the surgeon

forth

holds

of treatment

process

yet, he adds, the

neglected.

Albucasis
the

his toes ; and

tread upon

Abbas

author.

and

A\acenna,

as

usual, borrow

everythingfrom

'

FRACTURES.

468

CITI.

SECT.

patellais

The

It

into

symptoms

are

obvious,

for thus

fracture

divided

the

the

fingers,until
united

to

solution

"

of

muscles

it, yet the

into

much

occasions

their

plain

their
the

as

the

bone

that

upwards

lameness

is not

is to

irritates

and

are

if callus

so

and
the

full

None

an

Albucasis

bone,

likewise

omitted

have

symptoms,

to

namely,

apply

is distinct

splint.

and

directions

leg,Avhich

by
serted
in-

are

But

patients; for, when

they

taken

sustain

them
but

tempt
at-

in

moving along

ever,
ascending, how-

and

setting
in

And

it

where

it

long, and

in

In

raising
out

of

but

Neither

round

this

down

case

any

protrudes, and

similar

authorities

our

after

in

to

the

it if

well-stuff'ed
our

Avicenna

merely gives

part and
the

crepitus.

broken

pieces
Rhases

necessary.

splint. Haly's

author's, from
makes

given

Hippocrates

Soranus

arranging

splint over

have

author.

altogether.

applying

nor

as

hollowness
us,

he

ancient

accident
it

recommends

speaks

abridged.

difi'erent

take

not

diminished.

in

of the

of this

account

Celsus

in

separated,

does

applied.

Commentary.

CoMM.

of

pieces, when

apparent.

be

leg,

mutually touch,

perceptible.

becomes

lameness

the

the

impeded

bend

cannot

treatment

proper

is

and

brought together

much

cannot

ascent

knee

leg, the

the

to

knee

labour, the

to

walking

lameness

The

with

thigh

separationis

wound.

by extending

fractured

the

thickness, and

continuity,a hollow,

fracture

from

tendons

and

tured.
frac-

of

arranged together. For even

place,owing to the parts being di'awn
the

seldom

Avithout

thus

are

its

the

place by

or

be

and

another,

one

the

its
but

through

put in order

is

portions may

lips

crushed

also

pieces,with

small

crepitation.The

is often

fracture

vi.

PATELLA.

kept firmly in

bone

porous

undergoes

is broken

THE

ON

below, and

and

parts above

[book

any

which

mention

count
ac-

it is

of

LEG.

CIV,]

SECT.

CIV.

SECT.

The
of the

hears

the

broken

are

hands,

or

sometimes
the

likewise

the

leg corresponds with

of

the

be

Its

small

to three

when

backwards
set

in

also

when

of
its

admit

both

the

only one, namely,

the

and

the

from

one,

fractures

all sides

on

that

thicker

the

bones^

two

fibula.

tibia

it is to

Wherefore

the

called

and

LEG.

and
(tibia),

name

together,and

within, without,

bear

of the

consists

been

THE

varieties,
being deranged

same

bones

it

same

has

resemblance,
the

for

fore-arm^

which

ON

of fractures

treatment

469

same

fibula

wards.
for-

by

manner

the

ligatures,sometimes
applied to the leg itself,and
to the
thigh, (forthe knee being a strong joint can
extension
uninjured,) and ligaturesare to be applied

below

the

fore-arm.

by

fracture,as

The
in the

us

is to

case

section

on

mentioned

we

be

head

otherwise,

managed

the

the

under

of
scribed
de-

as

arm.

Hippocrates has treated of this case at con- Comm.

siderable length. The
bandages are to be applied as formerly
described, and the leg laid on a level board with a soft cushion
of the bent
under
it.
It is clear that he did not approve
tion
posiCommentary.

or

eleventh

tibia,he

remarks,
He

of the

splintsare

to

be

fractures

of

the

is the

worse,

single bone,

of the

that

being easily

to attend

givesparticulardirections

treats

fore-arm.
wood

of

of these

fractures
directs

Albucasis

pines

or

palms, of

in
us

to the

state

general terms, like those

to apply two
splintsmade
thickness, and

moderate

the knee
from
length as to extend
the
the leg and
these is be placed below
to be tied in three
are
places,namely, at

such

the

fibula

fractured

seventh

the

appliedon

heel.

Celsus
of the

Of

day.

managed.
of the

The

limb.

of the

to

other
the

the

feet.

above

One
and

extremities

of
of

they

and

in

middle.
The

terms.

other

Arabians

treat

of these

fractures

in

more

general

FRACTURES.

470

SECT.

CV,

astragaluscannot
guarded by bodies on all

THE

ON

hands

vi.

rOOT.

fractured

be

The

[book

by

the

being
and
fibula,

means,

any

tibia,the

by
the bones of the tarsus,
the OS cuboides.
scaphoides,
fractured like
and those of the toes, and the cuboides itself,
are
those of the carpus, metacarpus, and the fingersof the hand,
here and need not
said of them is applicable
that what was
so
be repeated.
But

'
''

Hippocratesremarks that these bones can

sharp and hea\T body. They are to
only be fi'actured by some
be treated Uke fractures in general,
quire
only that they do not rethe recumbent
splints. He recommends
positionwith
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, givesan accurate
anatomical description
of the bones of the foot.
Commentary.

CoMM.
*

the

is very

Celsus

patientput

his foot

of his feet

splintto

on

of the

rangement
We

this

on

He

case.

generalprinciples.Albucasis

on

one

brief

on

the

conducts

directs

us

the treatment

to make

is then
surgeon
it. Bv this means

ground,the

it and

stand

bones

will be rectified.

on

He

to

the

place

the de-

approves

of

the sole.

find

nothingMorthy of

notice

in the works

of the other

authorities.

SECT.

When

the

the limb
other

CVI.

ON

THE

ARRANGEMENT

OF

THE

the manner
thigh or leg is fractm-ed,
will be as importanta consideration

treatment.

For

the

evenness

LIMB.

of arranging
to you

as

the

of the fractru-ed parts is

when
especially
preservedby this means
properlyperformed.
the
fractm-ed
Some, therefore,
lay
part upon a canal,either of
of earthcuMare,or else they lay the whole
wood
or
limb upon
it ; others applyit only in cases
of fracture with a Avound,because,
these
be bound
cannot
with splints.But the
say they,
moderns
the use of these canals for many
altogether
reareject

FRACTURES,

472

'
"

these machines

describes

within,so

as

he

of which

all around
these

From

KVK\(p.

iv

the canal

vi.

Commentary on Hippocrates(1.c.)
and hollow
being romid externally

to inclose the limb

as

cr/cfAocoXov
that

his

Galen, in

detineant/^

CoMM.
'

[book

TripiXainfiavsi

to

"

words

speaks was

think

might
complete cylinderor

one

lay the limb upon

he speaksof was
the canal,it would
aj)pear that the machine
above, and as such it is representedand described by
open
11
words are :
Scultet (Arsenal de Chirurg,xxii,6.) His
from

But

cone.

direction to

author's

our

"

faut que le canal embrasse

plusde la moitie du membre
is a sort of trovgh. Sprengel calls it a box
therefore,
Fr.

translates it

edit.)Littre
and

of these

lower

the

Heister

machines

other

Van

Swieten

Brunus

and

extremities,see

is,9.)
(Surgery,
canals,but

of these

informs

Galen

do not

that

us

For

I. c.
by gouttiere,
ancientlyused

much

the

account

in fractures

of

(Comment. 354), and

Theodoricus

make

made

were

tion
men-

of them.

approve

canals

an

;" this,
{hoite,

of

different

He

speaksof a surgeon in his time who made

from the wood of the phillyrea.
He makes mention
them
of a
method
of a bolster laid below
of supplying
their placeby means
the limb and tied round it with fillets. (NicetseCollect, and
of wood.

kinds

1.

Comment.

Avicenna

c.)
Albucasis

and

neither

of them

the limb

in the way
canals would

The

mentions

SECT.

by

the

evil.

When

ON

must

appear

name

of

to be

be contusion

the

machines

of

which

Rhases

barangi.(Cont.xxix.)

COMPLICATED

FRACTURES

Avith

WITH

it is to be firststopped; and
use

machines, but

approbation.
They also speak of securing
described by our author.

fracture is attended

hemorrhage
we

with

take notice of these

wound,

WOUND.

if there

suitable to it ; and
applications
tlie flesh,
the flesh to
must
we
scarify

apprehensionof gangrene
spreadingmortification has

or

if there be inflammation,

the

all

be

if gangrene

or

if there
remove

any

other

it with
must
meet
on, we
The treatment
suitable remedies.
of each of these cases
you
have had delivered in the Fourth Book.
When
of
these
none

symptoms

is

present,nor

much

come

of the

bone

exposed,we

may

and

hooks

use

which

sutures,and
and

about

move

effect the
out

produce

fractures

by the

cure

treatment

for

piecesof bone
any broken
irritation.
But
if a large

muscles

and

succeed.

thigh and arm, dissuades from

protruding bones, predictingdanger

inflammation

which
has

time

Of

the

the

nerves

But

of the

the

replacingat once
from it,owing to

473

which, for its size,cannot be brought into contact

project,
will
the
it
consideration.
extension,
by
require
crates,
Hippothen, in

in

A WOUND.

wounds, having first cut

recent

bone

WITH

cvii.]

SECT,

apt

are

shown

or

to be

that this

whatever

of

has

inflammation, but

come

off.

has

gone
called the lever.

breadth
fingers'

about

or

on,

It is

endeavour

day,when
them
by an

set
may
iron instrument

in length,and

to

with them

the ninth

We
an

the

tension.
ex-

place
re-

when

first day,before inflammation

the

on

the

attempt will sometimes

we
bones,therefore,
protrudedends,we must not meddle

state

of

perhaps spasm
brought on by

about

of moderate

the inflammation

instrument

seven

or

thickness

eight

that it

during the operation

sharp,
; with its extremity
Its
and
bent.
broad,
then, is to
moderately
sharp extremity,
be put under the protrudingprominence 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;
do so, we
cut off the projections
must
cannot
by
or, if we
them
off in the manner
or
saw
(chisels),
counter-perforators
described when
treatingof fistulye. Having removed the
the wound
of bones
and set the limb aright,
we
ciu'e
spiculse
which
are
by dressingwith pledgets. But in those members
may

not

double

or

of them

bend

in
are

we
pairs,

must

take

off,that

sawn

no

care

when

contraction

the bones
of

of either

limb

the

take

place,but that it be kept of its proper lengthby extension.

The
bandaging is to be thus applied: the circular folds are to
be arrangedon
both sides of the wound, and obliqueones
cording
acintersect
to the lengthof the sore, so that they may
one

the
must

with

another

in the

of the Greek

letter

X,

and

prevent

lipsof it from gaping. And when the ulcer is foul,we

dressingwith cleansingointments ; but if clean,
apj)ly
incarnating,and
same

After the

the

other

articles of known

efiicacy.

which is said to have been

pitch-plaster,
called also basilicon.
the ointment, tetrapharmacon,
as
has incarnated we
sore
applysplints.Some apply

Hippocratesused
the

form

the

FRACTURES,

474

them

the

from

firsts
taking care

not

[book vi.
to

hurt

the

parts about

ulcer^and tighteningthem

the

or again
accordingto necessity,
scale
them.
When
of
is
bone
to
a
slackening
going
exfoliate,
which we
ascertain from the dischargebeing more
copiousand
the
loose
thin,we must remove
fungous flesh about it,and the
bandages must be appliedloose ; but havingremoved the scale

with

hook

or

such

some

instrument,we

must

have

recoui'se

tighterbandages. During the whole time of the healing

of the sore, the dressingcalled motophylax with
of the
some
medicines
is to be laid over
the wound, to
auti-inflammatory
be kept on with a simplebandage,which is to be removed
at
each
else
scribed
deas
dressing;everything
remaining the same

to

in the treatment

'
'

arm.

Hippocratestreats of these cases at great

the protrudedends of bones
length. His method of rectifying
of a lever,is described by our
author.
He says,
by means
it may be done on the first or second day,but not on the thiid
after the inflammation is begun,for fear of occasioning
or fourth,
conAOilsions.
Compresses dipped in wine and oil,or soft
bandages are to be used,but splintsare not to be applieduntil
He mentions
the sore puts on a healthyappearance.
that some
in the practiceof bandaging the limb above and below
were
it bare,in order to allow the discharges
the wound, and leaving
he greatly
to escape ; but this practice
ing
of, as tenddisapproves
in the place; and he recommends
to produceswelling
the
whole limb to be well secured with bandages,but then not too
tight. He states that all bones which are completelydenuded,
exfoliate and come
When
must
out.
bone projectsand
a
Commentary.

CoMM.
"

of the

be

cannot

he
replaced,

irritate the
there

is

soft
bone

directs

parts. No
Mhich

it is

the

splintsare
seen

to cut

surgeon
to

be

will exfoliate.

it ofi"if it

appliedAvhcn
If

it be

the

the compresses
appliedto the wound are to be
soaked with wine ; but if it be winter,
frequently
greasy wool
summer

season,

is to be

dippedin

wine

and

oil and

tures
applied. Compound fracof the thighor arm, attended with protrusion
of the broken
said
be
to
bone, are
peculiarly
dangerous; for if replaced,
they
occasion
convulsions ; and if let alone,they giverise
are
apt to
to

the

acute

bone

bilious fevers.
is

Some, however,he adds,recover

replaced. (De

Fract.

cum

Comment.

when

Galeni.)

WITH

cvii.]

SECT,

that
explains,

Galeu

and

475

tlie

danger in cases of fractured femur and Comm.

their vicinity
to importantblood-vessels

arises from

humerus

A WOUND.

'

"

muscles.

laysdown

Celsus

these

with

cases

the rules for

great precision. He

with a wound
complicated
when
it is the
especially
he

directs

fractured

us

to

is

greatlyincreased
to

wound,

of the

in

treatment

states,that fractures

dangerous,
generally

are

femur.

or

ends

In the latter

of the bone.

The

easilymanaged.

more

when

the

fracture is

divide

any

muscle

blood,and

let

skin

humerus

off the

saw

humerus

us

conductingthe

near

which

case

of

case

The

danger is
commends
joint. He re-

run

may

the

across

put the

patientupon a restricted
diet.
fractures the bones are to be gentlyreplaced.
The wound
is to be dressed with a pledgetdippedin wine, to
which
added.
have been
This apjalication
is borrowed
roses
from Hippocrates. The bandages are to be put on
somewhat
Neither
slacker than when there is no external wound.
splints
be
but
broad
canals
The
must
nor
used,
bandages.
parts are
hot
oil
and
and
with
the dressings
to be fomented
newed
rewine,
small fragment of a bone
a
every day. When
jects,
proif it be blunt,he recommends
to replaceit; but if
us
the bones with
sharp,he directs us to saw it off,and then replace
to

In

the

other

hands

bones

or

suitable instrument.

die,and

after

irritate the soft

spiculse

time

drop

out ; and

parts,in which

and

wound

Sometimes

fragments of

sometimes

sharp

he recommends

case

us

off the

projecting
points.
The
recommended
treatment
by Albucasis is very judicious.
it by bleeding
he directs us to subdue
If inflammation
be present,
is not to be attempteduntil
; and, in that case, reduction
it is to be done
the ninth day; but in all other cases
at first.

to

enlargethe

When
seven

or

off
that

or

of

are

as

sawed.
the

which

very slack.
irritable and

and

His

saw

late Mr.
as

be

cannot

bears

Hey,

iron

an

length,and

lever for this purpose.

sharp

wine
cerates

in

breadth
eightfingers'

is to be used
fracture

bv the hands,

reduced

be

it cannot

cut

broad,
fingers

two

the ends of the

When

considerable

of Leeds.

Splintsare

oil.
not

ill-conditioned.

to be

replaced,
they are
He

resemblance

recommends

suitable

contain

instrument

but
application,
The
bandages are
be
to
appliedwhile
When

it does

not

an

condemns
to

be

put

the wound

cut
to
tringent
as-

all
on

is

heal,he says

"

'

476

"

"

[book vi.

of bones,
ought to suspect that it is preventedby spiculse
Avhich are to be sought out and extracted.
and Rhases
A^dcenna
givevery proper directions about removing
of
spiculse bones, and applying slack bandages,but
they evidently
copy from Hippocratesand our author.
we

CoMM.
'"

FRACTURES.

'

SECT.

CVIII.

ON

THE

REDUNDANT

CALLUS

OF

FRACTURES.

The

superabundantcallus of fractures occasions always a

deformity,and sometimes also lameness if it be formed near a
joint. If, therefore,the callus be newly formed, we use very
astringentmedicines, and bring it to its form by bandages;
and sometimes
effect our
we
purpose by applyinga plateof lead
to it.

But

and

it

if it is of

Commentary.

salt,and

make

incision,
if need
off,removing the prominent part by chisels,

pare
and
be,
boringit with

CoMM.

stony hardness

we

an

trephines.

Celsus

nitre ; to pour

directs

rub the limb with

to

us

of hot salt
great quantity

water

upon

and
it;to applyan emollient ointment; to bandage it tightly,

He
givean emetic.
of
by the application
Albucasis
author.

our

also recommends
mustard

recommends
When

case

such
astringentapplications,

with

an

wine
astringent

or

a plateof lead ; and when

of scrapingand sawing it

No

additional

to another

nearlythe

the

to

us

oil,
to

produce revulsion

part.

plan of

same

is recent, he

treatment

directs

as

to make

us

aloes,olibanum,
myrrh,
He
also
vinegar.
speaks of applying
the callus becomes hard, he approves
off,as directed by our author.
and

as

information

is to

be

got from

the

other

Arabians.
the other

and
Tlieodoricus,
describe the treatment

is

hard, they direct

SECT.

When
takes

CIX.

bones

place,more

ON

authorities
surgical
the ancients.

as
exactly
us

to scrape

distortion

heal

or

FROM

saw

THE

of that age,
When
the callus

it off.

UNION

BY

CALLUS.

distortedly
by callus,no little lameness
if in the feet. The method
then
particularly

of

BONES

ex.]

SECT,

and

have

must

and

also

we

recourse

and

pigeon^sdung,

the

bones

with

and
chisels,

Commentary.
With

again.

of

callus be

newly
nature,
relaxing

from

fat olives and

for

callus ;
dissolving
hand, and bending it

stony hardness,we
and separate the
scalpel,

make

an

union

of the

then

the fracture

cure

cision
in-

formerlysaid.

as

Celsus

of breakingthe bones over

approves
this intention he directs us, in the first place,
to

the limb with much

bathe

medicines

friction with the

But if it be
way.
of the skin with a

every

admitted,as it

if the

those

as

other

dispelit by

but

to the affusions of

cataplasms,such

to

47/

at all to be

over

occasion the

formed,Ave

UNITED.

again is not
utmost
danger;

breakingthem

may

NOT

hot water, and

to be moved

the callus is then

with

rub it with

the

hands,

Coms
'

"

cerate;
liquid

and

the ends

of

properlyset ; or if that cannot be thus accomplished,

with wool
rule is to be wrapped round
and bound
the
a
upon
part,so as to restore it to its proper shape.
Avicenna
of breaking
agrees with Celsus in speakingfavorably

the bone

bone

the

recommended

other treatment

recommends

Rhases

to restore

the

ex.

ON

Sometimes

also

bv

figureof
bone

fractured bones

the

author.

and
applications,

the limb.

tempts
gentle at-

Albucasis mentions

the

again with disapprobation.

WHICH

BONES

of
speaks favorably

our

emolhent

proposalof breakingthe

SECT.

He

again.

over

HAVE

NOT

remain

UNITED

BY

CALLUS.

without

formingadhesions,
owing to their being often
beyond the natural
loosed,or from too frequentbathing of the part,or from having
of the bandages,
been moved unseasonably,
or from the number
or
from atrophyof the whole body,by which means
comes
the limb beperiod,either

emaciated.

Wherefore

other causes, but more

which
calefacient applications

the

and

we

must

endeavour

attract

nourishment

partlyby supplyinga
also is of a refreshing
nature.

whatever

then
which

which

become

follow

the

remove

all

the atrophy,partlyby
especially

of food
sufficiency

symptoms

to

formation

of

and

Among

place,
baths,and
the

other

callus,the bandages

stained Avithblood,althoughno

probablytakes placefrom

to the

the substance

wound
about

be

present,

the

callus.

when

'

after
rub

the state of

againinto
to

and

muscles

the

hurt

the

limb,

and

them

part is then

to be

the fifth day.

and
liniments,friction,

calefacient

recommends

adhere

not

order to convert

The

nerves.

appliedon
fomented, and the splints
Rhases

were

fracture,takingcare, however,

recent

to extend

us

together,in

bone

of the

ends

the

not

directs

certain time, Celsus

portionsdo

the fractured

'

"

blood which

of the bones.

When

Commentary.

drops of

the

unites,squeezingout

it

distributed to the hollows

CoMM.

[i?ookvr.

LUXATIONS.

478

tritive
nu-

food.

CXI.

SECT.

proceedto

We

the

it)is

unusual

an

of
displacement
place,by which

We
that

some

have

of

other

no

which naturally
luxations,
luxation then (to givea definition
from

member

means

the

its proper

voluntarymotion

is impeded.

mention, except

diff'erencesof it to

the accident is called by the common

name
place,
but when
a
or
little,
brought only to
only moved
the cavity,
it is called a subluxation.

its

of

luxation,

the brim

of

givesseveral importantremarks upon

general,but as most of them may more
properly
Celsus

Commentary.

CoMM.

cavityto

to a less degree. When

greater and some
member, therefore,is completelyremoved from

to

are

the bone

LUXATIONS.

of

treatment

follows that of fractures.

of

ON

dislocations in

brought under particularheads, we shall notice them here

dislocations into two classes ; the
but briefly.He distinguishes
first consisting
of a separation
of two bones naturally
united,
such as the scapula
from the humerus, the radius from the ulna,
be

the tibia from

ankle,which

the

fibula,the

last is of

of the bone

removal

dislocation occurs,

in the

part, and

sometimes

by

limb wastes.
nerves

as

rare

os

calcis from

and

occurrence,

the

bones

of the

the second

being

jointfrom its proper place. When

he remarks,the finger
discovers a cavity

of

inflammation

and

fever

come

on,

followed

and con\ailsions.
If not reduced,the
gangrene
In a person who is lean, humid, and has weak

(muscles
?) the

dislocation is most

easilyreduced,but

is

LUXATIO^'S.

480

wards

This

and

is the mode
other

any

shut

then

of

the

jaws close,and

reduction,,and

Very

processes.

Having applieda

[book vr.

it cannot

little treatment

waxed

compress,

prevent yawning.
be

performed by

will

suffice afterwards.

it is to be secured

bandage. But the surest process is to lay the

his back, and
man
supportinghis head upon well-stufFed
upon
that they may
not yield,
to get some
pillows,
person to hold the
head of the patient.
And if both ends of the jaw be dislocated,
the treatment
is the same,
be so well
cannot
only the mouth
shut,for then the jaw is more
prominent,but less distorted from
the teeth of the upper and lower jawscorresponding
together.
exactly
is to be immediately
Reduction
performed,and the
mode
of it has been alreadydescribed. If it cannot
be restored,
continued
there may be danger of the life from
fevers,torpor,
altered
and earns.
For these muscles
and
stretched in a
being
manner
produce car us.
preternatural
They frequentlyhave
evacuations
and small in
by the belly,which are purelybilious,
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
and oil,
water
by a sponge along the dislocated jaw,more
cially
espein restoring
it to its position.
when there is any difficulty
the ground,we
stand
Wherefore, havingplacedthe man
upon
behind and operate in the manner
described by Hippocrates.
with

CoMM.

loose

The

method
When

here

given of Hippocrates's
of reduction is taken from his work, 'De Articulis,^
(31.)
of his tehnical terms
a few
are
mentary
explainedin the comis sufficiently
of Galen, the description
and
distinct,

Commentary.

is upon

the whole

very

account

correct

The

of the

symptoms

and

prominence of the coronoid

bone is well described by Hippocrates. Galen
remarks
that
the end of the jaw-bone slipsinider the zygomaticarch.
It
has been a matter of disputewhat Hippocrates
ening,
means
by slackor
incompleteluxations of the jaw. It is worthy of
remark
that such an accident is described by Sir AstleyCooper.
t. iv,29.)
(See fui'ther Littre's Hippocrates,
Galenas descriptionof the method
of reduction
is given in
the Collection of Nicetas. (Chirurg.
Vet. ed.-Cocchius.)It is
that of Hippocrates.
the same
as
substantially
treatment

of this accident.

account

is

LOWER

cxii.]

SECT,

JAW.

481

of

mode

of a machine
reducingthe dislocation by means
described by Oribasius^
in his work De Machinamentis,
30.
The account
which Celsus givesof this accident is upon the

whole

correspondsvery well
very accurate, and
If dislocated only at one
end, the
descriptions.

with

modern

chin

inclines

Comm.
'

to the

side,and the teeth of the upper and lower jaws

opposite
do not correspond. If at both ends,the whole
chin projects
outwards,the lower teeth are more prominent,and the muscles
The patientbeing properly
seated,and liis
appear stretched.
head
held by an
the surgeon
assistant,
having wrapped his
thumbs

with

hnen

mouth, while

is
cloths,

to

the

fingersare
being firmlygrasped,the chin
and

one

the

the

patient's
applied externally.The jaw
is to be

instant,the head

same

into

put them

shaken, and then,

is to

be

seized,the

at

chin

moved, the jaw forced into its place,and the mouth shut. After
if pain in the eyes and neck has been broughton by
reduction,
the accident,
The
he recommends
to let blood from the arm.
us
and avoid talking.
patientis to Hve upon liquids,
dislocations
Hippocratesin distinguishing
of the lower jaw into partial
and complete. In addition to the
flow of saliva from
he mentions
a
symptoms ah-eadydetailed,
the dislocation
the mouth, and an inability
to speak. When
of itself
is partialor incomplete,
he
retui"ns
saj^s, it soon
he directs
the luxation is complete,
to its proper place. When
into the mouth, and
the thumbs
to reduce it by introducing
us
described by Hippocrates.
graspingthe jaw in the manner
Albucasis follows

He

that

states

fatal

by

manner,

the

that
afiirms,

and

of
ab

Cooper (the

proves

Avicenna, in like

coma.

sequences.
bring on fatal confrom Hippocrates.
entirely

may

giveexactlythe

Abbas

Monteggia,Fabricius
Samuel

is borrowed

account

Haly

and

often

accident

the

reduced,it

if not

symptoms and mode

Mr.

reduced

not

superinducingfevers
His

Rhases

when

same

of
description

reducing as Albucasis.

Sir Astley
Cooper,and
Aquapendente,
author

of the

Surgical

well-known

affirm that there is no foundation for the prognostic

Dictionary)
cation
of Hippocrates,
that the accident will prove fatal if the dislofrom
We
reduced.
can
be not speedily
say, hoAvever,
our
own
personalknowledge, that such fatal consequences do
who
was
knew
We
a
once
occur.
occasionally
poor woman

very liable to dislocations of the lower

II.

jaw, which

we

'

31

reduced

'

LUXATIONS.

482

three

CoMM.
'

'

'

wliicliit is unnecessary
time

she

all the

afterwards

with

We

mention

may

also

Heister

that

tlian

more

died

this

By
few

days
by Hippocrates.
a

fatal

sequences
con-

4.)
(Chirurg.
p. i,iii,
Mag. i);
(Chirurg.

accident.

the

of

that

states

vi.

circumstances

to

the reduction.

described

symptoms

result from

may

and

accident

and
indisposed,
seriously

become

was

interval

an
explain,

to

the

day elapsedbetween

last^owing

At

four different times.

or

[book

thingis affirmed also by Brunus

43) ; and by Guido de Cauliaco (v,2.)
by Theodoricus (ii,
described
That
by Hippocrates,is
speciesof sub-luxation
mentioned
by Guy of Cauliac in the followingterms : Mandibula quan deque mollificatur."
(v,2.)
The

same

"

The

force from
be

motion.

no

fall out

the

torn

treatment

same

with

as

the

beingpreventedby
joint,

thorax,

clavicle.

If

neither

of its own,
and

hence

it should

does

the

beingmade
man

is the

sometimes

sternum, where

fracture.

shoulder

of the

But

cation,
dislo-

to

it

and violent
any sudden
from its place,it is to

if from
be

liable

not

the

is articulated

peculiarmotion
of the

with

which

acromion.

the

But

without, it should

subjectedto

ACROMION.

AND

extremity,is

it is articulated

for there
of

CLAVICLE

its inner

at
clavicle,

admits

THE

ON

CXIII.

SECT.

the

does

And

its extremity

not

readily

bicepsmuscle

clavicle admit

any

solelyfor the
only animal

happen

be

to

and

strong

expansion

which

has

dislocated in

replacedwith the hand, assisted by the

venient
together with conapplicationof many-folded compresses,
the
sub-luxated
it
When
acromion
is
bandages.
may
It is
be restored to its proper placeby the same
treatment.
the clavicle to the scapula,
bone connecting
a small cartilaginous

wrestling,it

which

is not

little from

be

is to

its

to

be

This, if

in the skeletons.

seen

place,exhibits

the

to

appearance

moved

inexperienced

being dislocated ; for the top

persons of the head of the arm
of the shoulder
sharper,and there is a hollow from
appears
removed
the cases
which it was
to be distinguished
are
; but
from

'
*

another

Commentary.

CoMM.
^

one

vicle from

by

the

The

the acromion

symptoms about

to

be enumerated.

dislocation of the outer

is treated

of

end

of the cla-

by Hippocrates,who gives

AND

CLAVICLE

cxiTi.]

SECT.

very distinct account

of

the

ACROMION.

the surgeon
not
warns
dislocation of the humerus^

with
done.

directs the surgeon

of the bone ; and then to

end

He

bind the
leaves

to young

he

had
down

push

to

of treat-

this accident

comm.
'

"

"

frequentlyseen
the projecting

it with

and
compresses^
holds that the accident always

secure

He

side.

confound

to
as

mode

15.)
deformity.
(De Articulis,

some

Galen

the

to

arm

and

symptoms

He

ment.

483

mentions

that this accident

persons,

and

wasting of the

arm.

and, copyingfrom

that

when

The

account

him,

it occasions

Galen

which
have

commonly

most

reduced

not

author

our

happens

in this

givenof the

place

accident

has
they represent the acromion as being subject,
of much
been the subject
controversyamong modern authorities.
See Cocchi (Chirurg.
Vet. 133) ; and Littre (Hippoc.iv,12.)
had in view,(deArtie.
whom
Hippocrates,
they both evidently
refers to dislocation of the scapularend of the clavicle
13), clearly
probablyGalen alludes to the same, complicated
; and
to which

with

separationof

the acromion

the

from

what

would

subjects.We

scapula in
Monro

young
says of

beg leave to quote

the acromion
in children ; and in some
This is an epiphyse
:
old subjects
I have seen
it joinedby a cartilage
to the spine.
that in
(Anat. of the Bones, p. 231.) Galen states decidedly
"

^^

along with the

replacementof the parts to their
is not
is easily
effected.
He adds, as dry wood

persons this process

that
and in them
clavicle,

young

natural

"

state

adaptedfor bending,but
the

same

bent

is sometimes

in
and green bear this,
of growing animals can be bent by

such

the bones

manner

as

is sappy

as
porous and fistulous,
the clavicle is."
relates that in his own
Galen
person he met
with the accident while wrestlingin the Palestra,and that by

force,and

such
especially

more

usingoilyfomentations
effected.

He

account

in

life.

(Ibid.134.)

of the acromion

Neither

Celsus

nor

are

lightbandages, a cure was at last

-five years old,but adds,
then thirty

says he was
another
known
never

that he had
advanced

and

as

as

was
person cured who
Avicenna
gives the

the Greeks,

Oribasius

occur

sternal end

of the clavicle.
that

the

same

of this

case

location.
of dis-

agree that
at the acromial than at the
frequently

dislocations

hand, affirm

far

5,1, 10.)
(iv,

has treated

Rhases, Avicenna, Haly Abbas,

more

so

Desault

accident

occurs

Albucasis

and

and

Bover,

oftener

at

on

the other
the

sternal

'

LUXATIONS.

484

extremity
; but

CoMM.

[book

confirms
AstleyCooper^sample experience

Sir

'
"

the

ancient

of the

correctness

SECT.

The

CXIV.

DISLOCATION

ON

end

the acromial

that dislocation at
stating
frequentthan at the sternal.

more

]\Ir.Listen

statement.

in

agrees

vr.

THE

OF

also

is much

SHOULDER.

of
of the arm_, which is articulated with the ca\dty
the scapula,
is often dislocated;but neither iipwards,
owing to
the

head

coronoid

often

of the

process

also

backwards, owing

the

to

forwards

scapula,nor

bicepsmuscle and the

it is dislocated inwards
Sometimes, though rarely,
but
and
in those
frequently,
particularly

owing

the

scapula,which, prevents it,nor

to

tendon

lean,downwards.
is
so
dislocated,

brawny,

In

with

hand,

some

downwards

shoulder,when

from

cases

the
with

hand

elbow
it.

to

distance

onlybring it

can

the

be

of the

to

be raised to the

; nor

can

any

finger of

the clenched

of the
more

is

blow

suspicions
taken
place,

the sound
whence

arm,

one,

the

appears
dislocation

ear,

other

owing to

varied

effectual modes

not

be often

the

motions

in recent

of the

if he be
patient,

and used

armpit.

and

dislocated
The

elbow

of
stretching
be performed

inconsiderable

reduced,as Hippocrates

protuberantknuckle
hand

the

and

the ribs ; or, if you attempt

the ribs Avith difficulty
; neither

In

remarks, by the

are

are

from

children,
then, and
of the bone, it may
displacements

hand

readily

who

with regard
place,seeming hollow ; and (as mentioned
the sub-luxation
of the acromion,) the top of the

also is removed

can

those

are

fore,
Wheresupervenes.
thus ascertained.
The

sharperthan natural ;
appears
of the arm
is distinctly
felt in the

it,you

wards,
out-

who

it is

as

has

shoulder
head

and

which

may

part

acromion.

and
dislocated,
readily

compared with

the upper
very different,

to

in

formed, although none

are

dislocation

took

but

it is not

the violent inflammation

owing to

however,

persons,
reduced
;

In
difficulty.

of dislocation

affected

such

it also

the other

on

reduced

of the

of the

middle

surgeon, or of the sound

child.
But the following

of reduction.

HaAdng bathed

the

let him be laid on the ground

relaxing
affusions,
in a supine posture, and apply a moderately-sized
ball,either
of leather or
otiier soft thingto the armpit; and the
some
surgeon being seated with his face turned to the patientupon
man

SECT,

cxiv.]

the

affected

SHOULDER.

side,if the right shoulder

put the heel of his rightfoot upon

the

the

time

same

making

he

let him

fitted to
previously
left foot ; and seizing

pull down

counter-extension

assistant,
standing behind

an

other shoulder

in

let him
dislocated,

the ball

of the

left,that

of the affected arm,

armpit,while
the

if the

armpit,or

the hand

485

by

to the

the

the

heel

feet,at
in

the

head, pullsat

to prevent the body

direction,
opposite
is another
from being dragged along. There
mode
of reduction,
namely, by susj)endingthe patient upon a person's
taller than
the patient,
A young
ing
standshoulder.
man
or
elevated object,
on
some
by his affected side,(the patient
also being in a standingposture)is to apply his shoulder
below the patient's
armpit,while he stretches and puUs the
that the rest of the
hand
towards his own
so
patient's
belly,
patient's
body is suspended at the back of the person who

supports him.

But

an

if the

patientbe light,another lightchild

suspendedfrom him. For while the arm and the rest

the shoulder put
of the body are
oppositely,
pulleddownwards
And
under the armpit,readily
replacesthe dislocated limb.
of the instrument called
the same
thing may be done by means
a
pestle. It is a long piece of wood which is erected on the
other firm object. Its upper extremity,
some
ground upon
then, being rounded, and neither very thick nor thin, is applied
who
either stands or
below
the armpit of the patient,
and the hand beingsits,accordingto the lengthof the pestle,
stretched
along the pestleand pulled downwards, while the
the oppositeside and weighs
on
rest of the body is balanced
or
downwards, the reduction takes place either spontaneously,
down.
Aud
this
with the assistance of another person pulling

is to be

may

be

done

with the

step of

ladder,as

we

described when

Here
treatingof the extension for a fractured arm.
body is to be fitted to the step of the ladder,such
and
the armpit of the patient,
propelthe head
But

if,owing

the body,

we

to

the oldness

as

will suit

of the

arm.

accident,or the hardness

have recourse
must
we
difficult,

of the

find the reduction

round

some

of

called ambc.
of the instrument
by the means
of the
The ambe
is a pieceof wood about two cubits in length,
ness,
breadth in thickand about two fingers'
breadth
of three fingers,
having the one extremityround and adapted for the
hollow of the armpit,like the extremityof the pestle.Having
to

the

method

LUXATIONS.

486

[book

vi.

wrapped its end with Hnen rags^ in order that it may be

pit,
we
softer,
adjustit under the head of the humerus in the armthe hand
and stretching
along the wood, we bind it at the
fore-arm, and wrist ; then bringing the hand with the
arm,
transverse
wood
a
over
piece of wood, fastened between two
erect pedestals,
or
again over the step of a ladder, so that the
draw the hand
to the step,we
armpit may be fittedtransversely
downwards, and allow the rest of the body to hang suspended
side ; for then the limb will return
to its place.
the opposite
on
must
After the reduction,we
apply to the armpit a secure
mation
ball of wool,which, if there is no inflamand moderately-sized
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
take place above
the
letter X, so that the decussation
may
then

aff'ected shoulder
and

the

elbow

and

and

the

hand

is to be bound

arm

to be

are

slungby

to

the

the

sides ;

neck, so

that

again while the dislocation is recent.

After the seventh day or later,
having loosed the bandages,we
that the body
have
to moderate
must
recourse
so
friction,
less liable to
being rendered firmer,the jointmay become
either owing to
luxations.
But if the limb is often dislocated,
from its being long subject
to the
its humidity (flabbiness),
or
accident,we must
proceed to burning,as formerlydescribed.
the foetus in utero
since sometimes
the child,while
But
or
sustains a dislocation of the part which is not reduced,
gi'owing,
the flesh upon the shoulder is nothingreduced
from the natural,
obstructed
in any of its operations,
is the hand
but the
nor
in size ; and such persons
bone remains shorter,
not increasing
But
in the case
of the thigh,the
called weasel-armed.
are
bone does not grow and the limb wastes ; for,not being able
And
to sustain the weight of the body, it is not
exercised.
with regardto all the other members, if theyremain unreduced
the partsbelow are greatlyimpaired.
the limb

"

fall out

Commentary.

CoMM.
'

not

may

'

dislocations

at the

remarkable

air of

with

in the

case

Hippocratesdelivers his opinionsrespecting

with singularmodesty and a
shoulder-joint

in which

armpit,and

truth.

He

the head
expresses

savs,

that

he

of the

humerus

doubt

whether

had
was

in

never

met

lodged
there
reality
not

LUXATIONS.

488

of

CoMM.
'

'

reducing dislocations

is to be
leather

on

another

push
the

his

back^ and

attention.

merits

stripof

cloth

or

beingplacedin the armpit,its two ends are to

the patient^s
head
and given in chargeto an

behind
while

laid

inwards

[book

back

takes

the

other

hold

of the

arm

he raises the fore-arm and

and

arm,

place.After reduction the armpit is

wool, and suitable bandagesapplied.
forwards

of dislocations

treats

thong of
be brought

assistant,

is then to
surgeon
left hand, while with

into its

Oribasius

man

the

Avith his

patient'shead

The

vi.

bone

pushes the

to be stuffed Avith

downwards, outwards,and

; and

of complicated
givesa very elaborate description
machines
for reducing them.
Of these it is impossibleto
idea without
plates. We must be
proper
convey any correct
the reader to his work.
content, therefore,with referring
(De

Machinamentis.)
Albucasis

describes three kinds

namely, downwards,
upwards^ about
denies

He

the

by

the

as

those

inwards,below

which

the

former

he

being prevented by

mentioned

methods

by

had

of it very
of reduction
mentioned

cautery

Haly

Abbas

to

the

agree

shoulder

ob\aate

the

Hippocratesin

only unequivocalcase

other

shoulder
other

the
are

joint.

He

same

at

He

case.

of dislocations upwards,

occurrence

appears, therefore,
as
consideringthat downwards

of the

subjectto

He

recommends

He

of the

ligamentsthe bones

luxations

describes the symptoms

than

very

those

the

glenoid
at

The
accurately.

natural,the

of the humerus

cannot

armpit,the

arm

the

of any

top of the shoulder,he says, is sharperthan

is felt in the

any

He
by oui' author.
approves
cations.
tendency to repeated dislo-

of dislocation.

weakness

more

latter

describes all the

author.
processes of reduction described by our
Rliases remarks,that owing to the shallowness

caAdty and

and

except downwards,

any
and
accurately,

questionsthe

with

wards,
back-

doubtful whether

being

as

forwards,inwards,or backwards.
to

and

exactlythe

are

experienceof

no

givesthe symptoms
of the

doubtful.

Paulus.

himself
expresses
dislocation takes place at the

adds, he

the muscles

of reduction

Avicenna

methods

shoulder,
pectoralmuscle, and

the

expresses himself somewhat

of dislocations forwards
possibility

scapula.His

least,he

of dislocation at the

be

head

brought

ELBOW.

cxv,]

SECT,

to the sides without

remarks

deliveryor

in

size.

mentions

He

raised

pain,nor

correctlythat

when

childhood,the

489

the

to the

accident
does

arm

head

that venesection

at all.

He

Comm

happens during

'
"

"

grow to its natural

is often of great use in
not

reducing dislocations. He also recommends

He denies the possibility
of a dislocation in

the

bath.

warm

any other direction

except downwards.
The

ancient

modes

by Guy

of Cauliac

SECT.

Inasmuch
of the

as

the

of reduction

cxv.

(v,2) ;

ON

are

recommended

and

Theodoricus

THE

is
elbow-joint

scribed
de-

(ii,
47.)

ELBOW.

than
complicated

more

shoulder,so, in like manner,

difficult to manage

and

its dislocations

are

that
more

they are less readilyoccasioned,and

of its processes
more
reduced,owing to the number
difficultly
and cavities.
Sometimes
it undergoes sub-luxation
only,but
often it is completely
dislocated in every direction,
and more
It is easilyrecognised
backwards.
forwards and
especially
and the dislocated bone may
be felt in the
even
by the sight,
place to
the
arm

comes

and

; for

it has been

which

removed, while

hollow

appears in
comparisonwith the sound
a

A
placewhence it was moved.
of the accident.
discloses the nature
tion
Reducparticularly
be made
then must
immediatelybefore inflammation
supervened,it is difficult to cure,
on, for,if this has
such cases
become
more
some
utterlyirremediable,
cially
espeif the dislocation

was

backwards

for of all the

tions
disloca-

is the most
that backwards
painful
elbow-joint,
then may be restored by
and dangerous. Small displacements
moderate
a
degree of extension,the assistants keeping the
and making counter- extension
at the
hand
extended,pulling,
at

fore-arm

pushes

the

the surgeon with the palm of his hand

the dislocated bone into its natural place. Hippocrates
and

arm,

while

by bending the hand suddenly

of the same
to the shoulder
to force the palm straight
as
so
sion
side ; and that backwards
againby frequentand strong extenlent
dislocations forwards
as
are
producedby vio; inasmuch
extension,and those backwards by violent flexion. If the

rectifies the dislocation forwards

dislocation has

continued

long unreduced, we

must

have

re-

'

490

LUXATIONS.
as
stronger extension,sucli in particular

to

course

[book
that

by Hippocratesfor a fractured arm, where

to the piece of wood
adapted to a spade.

recourse

the moderns
the

the matter

manage

the
aforesaid,

thus

Two

vi.

scribed
de-

he

has

Some

of

assistants stretching

holding at the armpit,and

the other below at the wrist,
the surgeon, standingopposite
the
patient,grasps the arm with the palms of both his hands near
the joint,
and gi^angorders to bind a long folded robe or broad
his hands and the arm
swathe round
of the patient,
and
to
arm

as

pull outwards

and

the
secured

until

should

arm

and
Thus

same

downwards

the

'

'

is to

be

to

his

oil,to render

palms of

hands

thus

joint.

The

the

part slippery

the

No

theii' proper

bent

oblong compresses

Commentary.

CoMM.
'

with

with

Avith the

of the assistants -^ill return

treated

lowing
hand, whilst he,fol-

surgeon'shands.
parts beingviolently
pulledby the hands

the dislocated

arm

the

articulation of the

first anointed

moved
easily

I'cduction the

towards

dragsthe parts with

course,

they pass

be

one

to

and

place.

and
angular position,

an

suitable

author,ancient

After the

nor

bandages.
modern, has given

is
completea view of the accidents to which the elbow-joint
In
his
works
De Arsubjectas Hippocrates.
(De Fracturis,
a
nd
has
he
treated
of this subjectwith
ticulis,
Mochlicus,)
injuries
surprisingaccuracy and skill. He describes the following
of the elbow-joint:1st. Complete luxations,
laterally,
and
of the radius,
anteriorly,
posteriorly.2d. Luxations
and
anteriorly,
posteriorly,
laterally.3d. Fracture of the
olecranon.
4th. Fracture
of the apophysisof the humerus.
We must
of the last-mentioned injurj^
in
give his description
his own
words :
It sometimes
happens that the head of the
is broken at its apophysis
humerus
; and this,althoughit appear
so

"

other

serious

more

accident,is,in fact,less

so

than

many

injuriesof the

joint." It is singularthat this distinct

of a very common
account
injuryof the jointshould have been
overlooked
misunderstood
or
and the
by all his commentators
authorities down to the present day. We
surgical
have often
met

which

with

it in

it had

surgeons.

has been

It

our

been
is

own

and
practice,

seen

many

instances in

misapprehendedin the practiceof other

only within the last five or six years that it

described in any

modern

work

on

surgery.

Lateral

ELBOW.

cxv.]

SECT,

luxation

of the

diastasis.
taries of

is described

radius

althouo'h thev contain

is often

of

the

impaired;
observation.

of the olecranon

is remarkable

(Chirurg.Yet.
Celsus

the

and

The

of Comm.

name

Commen-

worth

are

Galen

matter.

new

modern

by

Galen

remarks

this,we

Galenas
for its

that in

extension

add, is

may

"

consulting

of flexion and

radius, the power

much

not

no

under

Articulis,
20.)

and

ApolloniusCitiensis

bv him

'

; De

44
(De Fracturis,

dislocations

491

firmed
con-

of fractures

account

and
precision

accuracy.

84.)

describes

four diflFerent kinds

elbow, namely, forwards,backwards,

also mentions

that

rare

of

and

dislocation

either side.

to

varietv,in which

at

there

is

the
He

dislocation

of the

in its place. (See Sir

ulna, while the radius remains
AstleyCooper^s Lectures.) The other varieties are all well
of treatment
recommended.
described,and suitable methods
When
there is a dislocation forwards the arm
is extended, but
cannot
be bent ; when
backwards, on the contrary, it cannot
be extended, and
natural.
is shorter than
"When
to either
is somewhat
bent towards that side from which
side,the arm

the bone

been

has

moved.

He

laysit

down

as

generalrule

both the members

to extend
treating all such dislocations,
until the bones are separated
concerned
in difi'erent dii-ections,
from one
another,and then to push them into their rightposition.
When
the dislocation is forwards,he directs us
to
make
with
or
thongs, and
strong extension with the hands

for

then
arm,

placing some
to push the

This

method

mentions

the four

and
elbow-joint,

describes

Oribasius
the

reduction

replacementof

for the

machines.

has

He

far

as

likewise

we

bv Celsus.
uncommon

We

need

accident

cases, the
same

way

rather

best
that

distinctly
in-

method,
it is performed

fractures.

ordinarykinds of dislocation at
of reducing them
methods
by

described

know, who

of the ulna, but

other

in the

the humerus,

of the radius from

as

by Hippocrates,but

In all the

make

says, is to

the

upon

over

described

Paulus.

anterior part of the

it suddenly to the shoulder.

body

fore-arm

is well

by
he

roimd

and
has

the
he

separate dislocation

is the

described

thority,
only Greek auation
the separatelux-

which, as stated above, had been noticed

scarcely remark
have

been

that

reported of

few

cases

late years.

of this

LUXATIONS.

492

Albucasis

CoMM.
'

""

'

tions,but

that

says

and
is

of reduction

mode

of the

forwards.

His

scription
de-

evidently
copied from

his

likewise borrows

A^dcenna

vi.

is dislocated in all direc-

fore-arm

backwards
especially

more

Paulus.

the

[book

whole

from

account

author.

our

and

Rliases

but
elbow-joint,

at the

luxation

describe the

Abbas

Haly

they nor

Arabians

take

the

ulna, nor

the

any of the
radius from the

of

ordinarycases
believe

we

that

plete
com-

neither

notice of the dislocation

abruptionof

the

of

apophysis

of the humerus.

SECT.

CXVI.

wound.

Those

extension

and

the

and

side.

to either

table,and

with

the

hand

is

Cooper

wound.

head
may

This

of

with

dislocations

be remedied

no

fore,
case, there-

by

with

moderate

treatment.

to
impossible

He
directs

us

push

doAvn

the

heel.

the

also makes

He

the

bend

He

and
fingers,

mention

in

of dislocations

counter-extension

to make

end
projecting

of the bone

also describes the

separate

and

ulna ; and, upon

the whole, his
the radius
little different from
that given bv Sii' Astlev

very

in his

to
or

dislocation of
account

wound

them.

the latter to extend

FINGERS.

attended

anti-inflammatory
plan of

it is found

case

upon

AND

Hippocrates says that the hand is dislocated

inwards.
In the
outwards,but most frequenth'

Commentary.

'

former

without

WRIST

fingers are

the

treated of under

will be

inwards

and

THE

accompaniedwith

imless
difficulty,

'

AT

at the wrist

Dislocations

CoMM.

DISLOCATIONS

ON

'

Lectures,^and by Mr. Liston

in his

'

Elements

of

Surgery.'
Celsus

forwards

his

describes,in
and

usual

He

denies

the dislocations

the

of
possibility
the lateral dislocations,
and, in fact,it is now
acknowledged
do
that if ever
occur
they
they are incomplete. Like Hippocrates,he directs us to replace dislocations of the fingersby

making
the

extension

upon
dislocation
separate

Oribasius mentions
and

backAvards.

elegantmanner,

likewise

the

table.

He

of the lower

does not
end

make

mention

of

of the radius.

the dislocations forwards

and

backwards,

separate dislocations of the radius and

ulna.

SPINE.

cxvii.]

SECT,

^93

while the ulna reSometimes, he says, the radius is dislocated,

mains
in its place,and sometimes
the ulna is dislocated while
the

radius

with

remains.

lie

describes

the process

of

Comm.
'

'
'

reduction

machines.

Allucasis, Avicenna, and

the

dislocations

forwards

reduction

immediate

that

Haly

Abbas

and

describe

backwards.

very
Thev

rately
accu-

state

is

required in the case of

peculiarly
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
hot water
to pour
us
it
motion, Albucasis recommends
upon
and apply friction.
Rhases

than
rather

that the ulna

states

the

more

apt

to

be

dislocated

parately
se-

radius,which

generallyundergoes fracture
he says, are
cated
lingers,
mostly dislo-

The

luxation.

than

is

inwards.

CXVII.

SECT.

The

ON

THE

vertebrse of the

VERTEBRAE

OF

spine,when

accident,occasion instant

death

; for

THE

SPINE.

completelydislocated by
the spinalmarrow
goes
under-

of its
extraordinary
compression; and even Avhen one
it bringson dangeroussympnervous
processes is compressed,
toms.
and
when
this takes
It often suffers sub-luxations,
wards,
backof repandation
place forwards it gets the name
; when
and when
that of gibbosity;
that of wry-neckedsideways,
ness.

When

there

together,the
and

in this

is

distortion occasions

case

some

of many
vertebrae
circular flexure of the spine,

small sub-luxation

are

apt

to be

deceived,and

take

it for

tion
spine,whereas a completedislocaof one
spinalvertebra does not produce a circular but an
ger.
danangular flexure of the spine,which is attended with more
be reduced
When
the dislocation is inwards,it cannot
because
no
counter-pressure can be made on the belly. But
efi'ectanything in this case
those who imagine that they can
struments,
the patients
a ladder,by applycuppinginby stretching
upon
or
or
by producing
administeringsternutatories,
crates.
are
exposed by Hipposufficiently
coughing, or by inflation,
of the small
But since,often the breaking off*of some

complete dislocation

of

one

LUXATIONS.

494

dislocation forwards

its callus is

soon

is

forwards

and

it

least,to
place,with

faeces takes

and

this state is followed afterwards

These

the excrements.

from

have

For

cure.

coldness

by

the

been

taken

that
it be

this

tion
disloca-

curable,
whollyin-

retention

of the

of the

body ; but
involuntary
dischargeof

an

arise from

the

nerves

and

die,more

soon
patients

partsand the vertebrse of the neck

if the upper

vi.

healed,(for
being speedily

symptoms

sympathy,and

muscular

(ashas

appearance

formed,)they have given out

cured, although in fact
readily

difficult at

or

urine

hollow

some
treating of fractures),

when

mentioned
for

spine leaves

of the

bones

[book

cially
espebe affected.

gibbousstate of the spinewhich mostly takes place

affection and
is a protracted
fatal ;
not
from infancy,
speedily
curable.
but, as Hippocrateshas shown, it leads to disease and is inBut

that

this

when

But

state

remedy it with

from

occurs

an

accident,the

ladder,suspendingthe patient
ridiculous.
erect, and inflation with a bladder, are altogether
of rectifying
But the method
it,recommended
by Hippocrates,
will be alone sufficient.
For, he says, a board, in lengthand
breadth such as to contain the man,
a bench
or
equal to it,is
to be placed near
a
wall,being extended along the wall,and
than a foot distant from it,and some
robes are to be
not more
contrivances

it to prevent the

spreadover
the man,
or

to

being bathed,is

bench, and

by the

thong
armpitsalong the
a

body

to be

from

laid

; and

his face

on

is to be twice
back

beinginjured.
along the

passedround

Then
board

his breast

the extremities of the

thong

pestlelike a piece of wood erected on

the floor at the extremityof the board or bench, and this to be
head to hold,
given to a person standingbehind the patient's
secured
and the
that when
the lower parts are
so
oppositely,
the head, extension may
be made
at the
upper pulled towards
Then
another thong being bound
round both the
proper time.
feet above
the ankles, and again another above the loins,so
to be

are

that

fastened to

its two

ends

of these

bound

to another

described
the

near
we

are

may

meet

thongs are

upon
to be

tremities
haunch-bone, the exagainunited together,and

pestle-like
piece of wood resembhng
and this pestle,
like the former,is to be

extremityof

the board

or

to order the assistants to make

piecesof wood.

the

Others

bench

that already
erected

at his feet ; and

by these
operation
by what

counter-extension

effect this part of the

then

496
last mentioned

CoMM.
"

'
"

LUXATIONS.

is called

by

[book
asellus.

him

(See

De

vi.

Fracturis

Galeni.)Hippocratesmakes mention of a mode

of reducingdislocations of the spine,by succussion in a ladder,
but expresses
himself
unfavorablyof it as being a procedure
which
but charlatans would
none
practice. He speakswith
to ostentatious
becoming contempt of those who have recourse
modes
of performancead captandum viilgus.
the fatal nature
of dislocations
Celsus states very decidedly
of the uppermost vertebrae.
Even
those below the diaphragm
wards
are
designatedas highlydangerous. They happen either forThose
backwards.
above the diaphragm occasion
or
of the hands, vomitings,contractions of the tendons,
paralysis
Those
of breathing,
pain,and relaxation of the ears.
difficulty
below the diaphragmproduceparalysis
of the lower extremities,
of urine,or an involuntary
dischargeof it. Even
suppression
these cases, he adds,prove fatal within three days. He
says,
of reduction by counter-extension
that Hippocrates's
mode
and
the part with
the heel,applies only to cases
of
on
pressure
incompleteluxation.
Oribasius describes the method
of reduction by means
of a
It will readily
be understood
machine, as mentioned
by our author.
that the whole
consisted
in
making counterprocess
extension upwards and downwards, and pressingupon the part
which projects
with a pieceof wood.
(De jNIachiuamentis.)
Albucasis
the nature
of the accident and the methods
explains
cum

Comment.

of reduction

in

much

the

terms

same

as

author.

our

The

patientis to be laid upon a board or bench of sufficient

soft thing to prevent him from being
length,spreadwith some
hurt.
Then
a poleor
pieceof wood is to be fastened at each
extremityof 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

Powerful

and
part affected,
counter-extension

presses upon
it into its place.
to fasten

Other

If these

of the

methods

are

the

to

be thus

may

do not

means

into

hole

pole

his feet.

at

made, while the

protnidedpart with

pieceof wood

protuberantpart
it.

the

fastened

his hand

and

succeed,he

in the wall

back
patient's

and

also described

by

pushes

directs

us

oppositethe

to press

him.

geon
sur-

down

After

with

reduc-

SECT,

cxvii.]

tion

he

SPINE,

directs

mended

by

describes

and

cases,

com
"
"

all the methods

in the Latin

to illustratehis

of such

recom-

author,

our

Avicenna

witli bandages,as
applya splint

to

us

497

of reduction here

edition of his Avorks there

descriptions.
Judgingfrom

our

tioned;
men-

plates

are

experience

own

would

however,

say that such contrivances can

these dislocations,
as there is much

we

seldom be

to reduce
required
less difficulty
in the reduction than in keeping the parts in
placeafterwards.
of
Haly Abbas copiesthe description
givenby Hippocrates

the

mode

of reduction.

place,he recommends
broad,and of
fingers

After the parts are restored to their

to applya board (tabula
three
lignea)

us

such

cated
lengthas to comprehend the dislovertebrae and some
of the adjoining
ones
; and to bind it
of the displacement.
firmlyon to prevent a recurrence
well acquainted
with the curvature
The ancients were
of the
of the lower extremities.
Alsahaspineoccasioning
paralysis
remarks
that
it
in childhood,
ravius
most
and
occurs
frequently
arises from

flatus.

inflammation

an

the vertebrae.
This

or

collection of humours

between

Sometimes, he adds,it is occasioned by

is the disease called spina ventosa.
When

gross
nected
con-

a collection of blood in the part, he recommends

and various emollient
When
applications.
bleeding,
clysters,

with

flatulence he

it arises from

the usual

means

the hermodactylus. If
prescribes

succeed

do not

he approves of the actual

tery.
cau-

xxviii,
9.)
(Pract.
But
the

no

spineas

author has treated

ancient

He

Rhases,

states that it

the

thoracic viscera.

a blow, an
fall,

fullyof

curv^ature

of

frequently
fatal by occasioning
pressure on

and often
childhood,

in

so

occurs

most

proves
The
disease,he

or
abscess,

says, may arise from a

tebrae.
gross flatus contained in the ver-

of the lower extremities connected

paralysis
he approves of applpng the actual cautery to
with this disease,
that dislocations of
the back.
(Cont.i.) He states correctly
the upper vertebrae often prove suddenlyfatal. He directs the
reduced with a splint
to keep them
extending the
surgeon
whole length of the spine.(Cont.
xxix.) On the spina ventosa
of it,
further Serapion (v,26.) For the cure
or
see
gibbositas,
if these do not
and
first discutient plasters,
he recommends
In

cases

of

succeed he advises

recourse

to the actual cautery,

(v,27.)

'

II.

32

r-

DISLOCATIONS.

498

CXVIII.

SECT.

of the human

sometimes

and

the

hip and

DIS^LOCATION

ON

other bones

The

[book

AT

THE

HIP-JOINT.

body sometimes

but
complete luxation^

shoulder

vi.

luxation^
undergo subthe articulations

subjectonly to completeluxthe hip-joint,

because it has a deep and
atioUjmore
especially
is further strengthened
round cavitywhich
by a strong brim.
The
limb, then, being subjectto displacementfrom its cavity
differences arise according
to the
by some
great violence,
many
greater or less degree of the dislocation. Dislocation at the
takes placein four ways, or rather places
hip-joint
; for it is
at the

dislocated either
and

inwards

are

inwards,outwards, forwards,or

backwards

outwards

more
inwards; but
frequently,
especially
the dislocation is
forwards and backwards
very rarely. When
inwards,the affected leg,if compared with the sound one, appears
is
the
knee
more
longer,
prominent, the patientcannot
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

dislocation is

the

to these ; for the

outwards,the symptoms are

there is a
leg appears shorter,

the

trary
con-

hollow

in

the

perineum, a protuberanceabout the nates, the knee is

turned
When
the dislocation
inwards,and the leg can be bent.
is forwards,the patientcan
stretch the leg without pain
knee, but

at the

foot inwards

when

he

the urine

attempts
is

to walk

he

cannot

turn

the

retained,the groinis swelled,the

buttocks

appear wrinkled and destitute of plumpness; and in

walking he supports himself upon his heel. Those who experience
dislocation
backwards
neither extend the ham
a
can
nor
the

knee,

also.

nor

theybend

can

the limb

before

bending the groin

The

leg appears shorter,the groinlooser,and the head

of the thigh is to be felt at the buttock.
When, then, from
infancy,or simply,when for a lengthof time the limb has been
and allowed to remain
neglectedafter being dislocated,
so, the
is impracticable,
callus having been alreadyformed.
cure
But
when

the luxation is recent, it

may
We
Hippocrates.
by
to the

allowed

be

managed

must, then,

reduction,for dislocations

to remain

then, in all the

at the

in the way

commended
re-

diately
proceedimmewhen
hip-joint,

In general,
long,are whollyirremediable.
four kinds of dislocation,
the reduction may be

HIP-JOINT.

cxviii.]

SECT,

499

accomplishedby rotatingit,by bending the limb^and

For if the accident be recent
we

sometimes

may

and

the
rotating
is inwards

succeed

in

and

the

reducing the

thighthis way and

sometimes
we
may

that.

bv

tension.
ex-

patientyoung,

hmb

by graspino-

When

the dislocation

accomplishour pm-pose by
and strongly.
bending the limb at the groininwards frequently
If the dislocation does not yieldto these means
must
have
we
extension, first with the hands, certain

to

recourse

graspingthe thigh and

while

Or,

others

if

leg and

the

pullingthe

at the

body
grasp
stronger extension be

assistants

limb

armpits and

downwards,
pullupwards.

the leg may be bound

required^
with twisted cords or thongs,above the ankle, and a little
higherthan the knee, lest it suffer injury; but it is not necessary
a

the breast in this manner,

for,as has been said,
the hands
And
may be put under the armpitsfor this purpose.
the middle
of a soft and strong thong is to be appliedto the
to

secure

perineum,and brought up to the shoulders anteriorly

by the
and posteriorly
groinsand clavicles,
along the back, and the
two
ends are to be given to an assistant to hold.
Then, all
pullingtogetherso as to raise the patient's
body, extension is
of extension is applicable
to be thus made.
This mode
rally
genein all the four varieties of dislocation.
the nature

to
replacementvaries according

the bone has been dislocated

middle

by having the

head

the

of

and

thong be broughtupwards by

This
the

let

of the dislocation.

If

the

perineum,and
adjoininggroinand

the

let the
the clavicle,

limb

the

does

man

thus

yieldwe
but
complicated

not

more

be

stretched upon

that upon which we

stretch those
spine,and alongnearlyits whole

scoopedout, in

breadth

not

more

that

the

extremityof

impel the
board, or

than

and

four

and

any of the others. When

have recourse
must
to other

is easier than

of reduction

mode

contrivances
Let

of

manner

with both his arms

man
grasp the thigh
young
outwards.
is affected in its thickest part,and pullstrongly

and
which

the

be stretched
inwards,let the patient
tween
thong appliedto the perineum be-

bone

of the

But

more

efficacious than

these.

largeboard, or bench,
who

have

like

dislocation of the

lengthlet certain gutters be

than three fingers,
depth not more

fingersdistant from

one

another, so

being inserted into them may

it is required. In the middle of the
limb wherever
bench, let another pieceof wood be fastened about a
the lever

DISLOCATIONS.

500

[book ti.

length,and in thickness like that which is inserted in

is pulledalong,
the extremityof a spade,so that when the man
the perinenm and the
between
this piece of wood
may
come
of the body
head
of the thigh, so as to prevent the yielding
the necesAvhen pulledby the feet,and therebyoften obviating
sity
foot in

making counter-extension

of

this

body is extended
thigh outwards.

the
the

pieceof

and

at the

wood

will

time

same

the

push

extension is to be made

The

when

head

in the

of

ner
man-

above,more
by the foot. But if it
particularly
is to be taken
thus reduced, the erect pieceof wood
and two other piecesof wood
fastened on the sides of it

described
is not

away,
like posts,not

be

of wood

than

more

adaptedto

foot in

like the

them

let another

length,and
step of

piece
that

ladder,so

piecesof wood may resemble the Greek

letter H ; the middle
pieceof wood being fixed a little below
Then
the man
the upper extremities.
beinglaid on the sound
the two posts below the
side,we bring the sound leg between
to the step of a ladder,while the
pieceof wood corresponding
is brought above it,so that the head of the thigh
affected one
is to be adapted to it ; but a folded garment is to be first
wrapped about it to pres^entthe thighfrom beingbruised. Then
another board of moderate
breadth, and of such a lengthas to
extend from the head of the thighto the ankle,is to be bound
along the inner side of the thigh. Then extension beingmade
either by the pestlesmentioned
of the dislocation
in treating
of the vertebra,or some
other instrument, the leg is to be
pulled downwards
alongwith the board which is fastened to it,
so

the three

figureof

the

that

by the force exerted

to its proper

return

place.

without

making

be bound

by
looselyto

round

both

stretched
man

There

extension

upon
The
Hippocrates.
the

from

one

of the

is another

thigh-bone

hands,
patient^s
a

ankles

another,so

is much
he

the

ground.

Then

an

says,

mended
comare

to

soft but strong thong put

and above the knees, four
that the aff'ectedleg when

inches lower
down
than
two
come
may
is afterwards to be suspendedwith the head

distant from

may

of reduction

mode

board, which

sides,and

his feet at the

fingersdistant
The

the head

expert young

the

other.

two

cubits

man

is to

seize the aff'ected thighin his arms, at its thickest part, where
the head of the thigh is lodged,and suddenlysuspend liimself

from

the man,

by

which

means

the

return
jointwill readily

to

cxviii.]

SECT,

IIIP-JOINT.

501

its

place. This mode of reduction is simplertlian any of tlie

others,being performed without much
apparatus, but many

reprobateit as dangerous.

now

the

extension

perineum
and

clavicle.

inwards,the

outwards,
as
above,
thong at the
the groin
passedby the opposite
parts,I mean

is to be

is to be
The
lever

made

being

a strong man
stretched,

to the

that

fastened into

dislocations
is to

affected

the

groin,and
depressingforce

the knee.
so

to raise him

as

one

limb

in dislocations outwards

to

dislocations of the vertebra

merly
for-

that the

nates

of the

righthand

with the other

down

hand,

so

downwards,

and

to

is not

to

be

man

up, but he is to lie upon

mentioned
; and, as we

as

without

of the furrows

applythe palm

press

from

forwards,the patient
being

may be exerted
dislocations backwards, the

In

stretched

propelthe

the

assistant fixingthe sound

an

yield.In

not

but

is to

surgeon

prepared,and

body may

If the dislocation is

hard

with

body

regard

is to be laid
backwards,the man
his face upon a board or bench, and the ligatui'es
on
to be apare
plied,
not to the loins,
but to the leg as mentioned
little,
above.
a
But the depression,
of
is
be
at the
a
board, to
applied
by means
where
the dislocated bone is lodged. And
thus much
buttocks,
dislocations at the hip-joint
occasioned by some
ternal
exrespecting
takes placeat
But
since dislocation sometimes
cause.
the hip-joint,
mours,
at the shoulder,owing to a collection of huas

must, in this case,

Ave

have

recourse

dical authorities
found

givenby
Although the descriptions
who precededand followed our author

in the main

exactly the

give a

brief outline

means

in

our

in the

mentioned

we

other,

biu'uing.

to

Commentary.

as

power

of
a

them,

same

as

in order

his,we
to

subjectso important

are

the

one

me-

Comm.

will be

induced

illustrate
as

the

by
now

'

to

every
on

hand.

Every subsequentauthor is indebted to Hippocratesfor his

lucid and correct exposition
of dislocations at the hip-joint.
tions,
He
says trulythat the thigh-boneis dislocated in four directhe
namely,inwards,which occurs
frequently
; outwards,
and
most
forwards,both very
frequenth'of all ; backwards
wards,
rarely. The followingare the symptoms of dislocation indescribed by him.
The
as
leg is longer than natural,
the buttocks outwardlyappear hollow ; the knee, foot,and leg

'
*

DISLOCATIONS.

502

CoMM.

are
'

"

'

turned

out

patientcannot bend his thigh at the

in
of the thigh-boneoccasions a tumour
scribed
evidentlyto be the varietydeappears

downwards, the head

The

exactlythe

same

seen

of it,we

cases

vi.

the

groin; and the head

the perineum. This
by modern
surgeons
foramen.

[book

as

the

as

and

dislocation inwards

being lodged near the thyroid

symptoms described by modern authors are
those mentioned
by Hippocrates. Ha\'ing
of the

can

bone

testimony to the

bear

correctness

of

wards
description.The symptoms of dislocation outHippocrates's
enumerated
as
by Hippocratesare, shorteningof the
limb, relaxation of the inner part of the thigh,and projection
at the buttock,inclination of the knee, leg,and foot inwards,
is described by
the limb.
This case
with
to bend
inability

modern

authors

as

dislocation

upon

the

dorsum

of the ilium.

also testify
to the accuracy
we
can
personalexperience
of it givenby Hippocrates.The next variety
of the description
is the dislocation Ijackwards,which, he remarks, is of rare
to
It is rather obscurelymarked
occurrence.
by inability
and ham, relaxation of the
extend the leg at the hip-joint
flesh in the groin,distension of the nates, a slight
degreeof
He
states that the
shorteningand inclination of the limb.
From

head

of the

bone

is situated

below

the

flesh

of

the

nates.

the tuber
assuredlyis the dislocation backwards
upon
the symptoms
of which
admitted
are
ischii,
by Sir Astley
obscure.
Cooper to be sufficiently
Hippocratesdescribes with
This

great accuracy the appearance

when

the

which

dislocation is not

the limb

The

in

wards
after-

on

(De Articulis.)
accomplishedby the hands, with
reduced.

Reduction,he says, may be

All these modes
with a lever.
a bench, or
mentioned
by our author,and therefore we
time

puts

describingthem.

(Ibid,and

De

of reduction
shall not

take

are

up

Yectiariis,
15.)

Hippocrates,
givenby Littre,would
to us
and
it renders the description
excellent,
easily
appear
understood.
also
Littre
gives an
(Hippocrat.
Op. t. iv,44.)
excellent figureof the reduction
by suspension.(lb.291.)
Citiensis
ApoUonius
givesa most elaborate and interesting
the
methods
of reduction
recommended
by
commentary on
Hippocratesin cases of dislocation at the hip-joint. These
be best learned by examining the
methods, however, may
figuresgiven in the Index Galeni,or in H. Stephens^sLatin
figureof

the bench

of

DISLOCATIONS.

504

CoMM.
"
"

round

forwards, some
and

in

In

tlie

the

same

other
its

towards

and

the

four

in

the

these

Albucasis

dislocations
describes

of reduction
of

modes

reducing them are

dii'ections.
2d. By making

with the aid of two

and

getting
himself

ducing
re-

the

and

His

Paulus.
limb

in all

counter-extension

By suspending the patient,

3d.

strong assistant

and

extension

assistants.

as

By rotatingthe

1st.

terms

same

of

givesplates,

of dislocation

four varieties
the

he

which

and

it is bent

method

the

the

at

extended

backwards,

described

has

in much

push the bone

hip-joint.

to

leg is

says, the

by machines, of

the

reason

tlie shoulder.

at

propelsthe

dislocation

He

same

varieties of dislocation

he

them,

be extended.

cannot

methods

; but

bent

assistant

an

tlu'ee of

dislocations

vi.

groin,and

the

it,for the

over

is directed

siu'geon

mentions

hip-joint. In
be

the

cases

in

as

place,while

Oribasius

cannot

manner

placed in

be

body is to
suddenly carried

is to be

tlie knee

[book

to

grasp

the

affected

and

leg

By making extension with ropes

for
recommended
fastened to two
sticks or piecesof wood
as
dislocations of the spine. When
the dislocation is forwards,
the
is to press
the
down
prominent part with his
surgeon
hands ; but if backwards,a board is to be used in the manner
described
by our author.
A\dcenna
agrees with Hippocrates,in oppositionto Celsus,
that dislocation outwards
of the ilium)is of
(on the dorsum
than the dislocation inwards
more
frequentoccurrence
(on the
foramen
of the modes
of reduction is
ovale.) His description
eAddentlytaken from Paulus.
Haly Abbas describes the four varieties mentioned
pocrates
by Hip-

swing

by

and

The

earher

varieties
the

of

contents

of

modern

the

Ehases

writers

is
on

same

exactlythe
surgery,

The

treatment.
same.

describe

four

the

dislocation at the

in the same
terms
hip-joint
evidentlyfollow the Arabians.

They
(ii,
51); Guido

this section

statement

professionwas

much

givenby

ancients.

Theodoricus

is the

4th.

recommends

of them

account

it.

de

Caidiaco

it will be

made

by the late
entirelyignorant of

until within

these last few

(v, 2, 7.)

as

See
the

From

how
erroneous
clearlyseen
Sir Astley Cooper, that
the

years.

uatui'e

of these

the

dents
acci-

KNEE.

cxix.]

SECT,

SECT.

The
and

CXIX.

toAvards tlie ham

being dislocated
have

must

by

the
to

recourse

AT

in tliree ways

THE

KNEE.

inwards, outwards,

for it is

forwards.

sometimes
we

DISLOCATION

ON

is dislocated

knee

505

preventedby the patellafrom

modes
of extension,
Using,then, the same
hands
alone,and sometimes by cords,
suitable

bandages, and

the other

able
suit-

treatment, the part being in particular

preservedfree from
motion.

like
Hippocrates,

Commentary.

the bones

directions in which
cated

of the

namely, inwards, outwards,

author,mentions

our

be

knee-jointmay
and

three

backwards.

dislo-

He

Comm.
'
'

has

forwards,which is,in fact,a very

Celsus mentions, hoAvever,that Meges had related
case.
rare
treated by
of dislocation forwards,which was
a
case
successfully
he says, have denied
of the other authorities,
him.
But most
noticed

not

the

the

of
possibility

such

an

extension

and

He

occurrence.

dislocations at the

to reduce

making

dislocation

knee

being of

as

surgeon

generalprinciples,
by

upon

counter-extension.

dislocations at the knee

directs the

Hippocrates represents
more

rence,
frequentoccur-

dangerous, than those of the elbow.

Oribasius, like our author,treats only of three kinds
but

less

at

the

dislocation forwards.
to turn

between
the
a

his knees

Albucasis

knee.
He

his back
;

then

directs the
to the

while

proper

method

the

of a
possibility
in making reduction,

surgeon,
and take
patient,

an

foot,he is to replacethe bones

very

denies

assistant makes
with

of dislocation

his hands.

the

limb

out

extension

This

at

seems

of reduction.

only three modes of dislocation.

omitted
a
case
He has described dislocation of the patella,
by
fillthe
after
directs
to
He
author.
us
reduction,
making
our
and bandages.
and
then
to
with
hollows
applysplints
compresses,
is often dislocated in walking. He must
He
says that the knee
surelyallude to a speciesof sub-luxation firstwell described by
the late Mr. Hey, of Leeds ; for a completeluxation is a very
occasioned but by great violence.
and is never
rare
occurrence,
describe only three kinds of disloand Khascs
Halv Abbas
Avicenna

likewise

mentions

DISLOCATIONS.

50G

cation

CoMM.
'

'
'

the

at

forwards.
The

Arabians^

and

forwards.

See

in modern

In

the

times.

related

case

author

from

same

to have

Arabians.

is necessary
mistakes
occur
typographical

several

ON

It

Commentary.

in

AT

DISLOCATION
THE

articulation

The

of the

'

are

CXX.

SECT.

the

Celsus^and

of

the works

partlycorrected
periodical.

which

usual^adopt the \dews

found
to be of much
knee-jointare now
than they are represented
to be by the ancient
have been
fact only a very few cases
reported
would beg,therefore,
readers
We
to refer our
in the
Medical
Gazette,'Dec. 16, 1842, by

of this

however, that

author.

our

at the

occurrence

authorities.

dislocation

of a dislocation
possibility
(ii,
52.) They would appear to have

Theodoricus

Dislocations
rarer

vi.

the

accordinglydeny

all their information

derived

from
as

surgeons,

whollyunacquaintedwith

been

to

deny
evidentlycopy

earlier modern

of
possibility

the

knee, and

Both

[book

at

the

to

remark,

in the

subsequentnumber

THE

ANKLE,

AND

ALSO

port,
Re-

of the

OF

TOES.

ankle, if but

little

is
displaced,
completelydislocated,
a

extension ; but if
by moderate
in this
it requires
therefore,
greater force. We may endeavour
strong extension by the hands ; but if reduction
case, to make
the ground in
does not take place,
on
having stretched the man
a
supineposture,we are to fasten into the floor a long and strong
his two thighs,so as to prevent the body from
peg, between
yieldingto the extension by the foot ; or rather let the peg be
is laid down
fastened before the man
have the large
; or if we

remedied

board

at hand

on

the

of

middle

which,
make

foot

we

as

the

said,a wooden

extension

it.
long is fastened,we may
upon
An
assistant then
graspingthe thigh, and making counterextension,another assistant is to pullthe foot with his hands
the dislocation with
or
by a thong, and the surgeon is to rectify
his hands, while
other person
some
keeps the other foot down
it is to be bound
After the reduction
below.
some
carefully,
folds of the bandage being carried along the front of the foot,
peg

and

some

towards

the

ankle

but

we

must

take

care

not

to in-

ANKLE

cxx.]

SECT,

AND

TOES.

507

tendon which is inserted into the heel. And

posterior
is to be kept from walking for fortydays; for those
the man
who
is completed impair the
attempt to walk before the cure
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
and secure
embrocations
reduction,anti-inflammatory
bandages,
also
in
until
the man
the
is
a quietstate
beingkept
part restored.

elude the

And

dislocation

may

be

of the toes,

remedied

without

all these luxations

rest for

which

may

of

the

the
applications,

days,any
and
joints,

in the
function

moderate

thereof,is

with

the matters

the

In

reduction, and

occasion
to be

fingers,

extension.

inflammation

pairment
protractedim-

cured

relative to

swelling

or

emollient

by

be known

materials of Avhich must

is conversant

who

of

the

regard to

after
sub-luxations,

and

remain

said with

we

by
difficulty

suitable number

as

to every

one

art.

our

that dislocation at the Comm.

states
Hij)pocrates
ankle
is generallyproduced by leapingfrom
a
great height.
accident
rise
excessive
that the
He remarks
to
swellingof
gives

Commentary.

the

When

part.

apply a bandage to
some
says, it requires
He

recommends

us

them

address
to

reduce

According

of the hand.

to

Celsus,dislocations

all directions.

He

His

os

us

to make

the

at the

recommends

hands, by making extension

advises

suitable

manner.

of the toes and

dislocations

of the

of the
of dislocations

account

calcis is

curious,but

some

need

placein

perform in

in clearlyapprehending his views.

difficulty
dation.
scarcelysay that it is a subjectstill requiringeluci-

is

there

reduced, he directs us to
which, he
properlyin position,
been

to

astragalusand

of the

the

retain

of the foot like those

bones

We

parts have

the

patientlie

us

and

ankle-joint
may
to reduce

them

counter-extension.

in bed

take
with
He

nary
in ordi-

longer than

cases.

Oribasius
at

the

ankle

makes
;

mention

of

only three

namely, inwards,outwards, and

According to Albucasis,dislocation

placeinwards
he
displaced,

modes

or

outwards.

directs

us

When

to restore

of dislocation
backwards.

at the ankle

the bones
them

can

only take

of the tarsus

by making

the

are

patient

DISLOCATIONS

508

CoMM.
*
"

foot

his

put
foot

it and

upon

After

the

upon

standing

reduction,

with

copy

author.

Luxations

the

of

be

are

will be

and

that

they

may

This

is the
of the

account

and

of

the

in

that

states

of

there

foot

limb
the
with

waxed

leaden

By

taiy

like

on

the
he

be

believed,
mode

He

and

Chian
does

Hippocrates,

chapter
but

practicalpm-pose.

that

of

above
be

supplies
(v, 642,

no

ed,

most

of

cases

for
for

securing

it

piece

of

which

Over

be

applied

if

to

declare

that

or

any

all

necessarj^
the

formity
de-

one

would

other

plex
com-

Galen's

information

the

restoring

illustrating the

additional

Basil.)

declination

bound.

burning,
in

He

imjjediment ;

readilythan

more

use

subject

attemj)ted before

(De ArticuHs, 62.)

is

nature

little hesitation

this

fingers,and
is to

or

some

Stromeyer.

directions

hesitate

cutting

without

if it be

shoes, may
not

of treatment.''
this

lead

have

of

and

compresses,

of

It

Hippocrates

dislocation,but

the

generally overcome
"

time

gives minute

shape by

rections,
all di-

give

to

of the

need

variety of

of cure,

plate

means,

may

have

or

in

practicalacquaintance

the

one

Modern

of the

treated

one

Astley

of sub-luxations.

ancients

has

position;

admit

bandages

boot,

these

natural

its

its proper

leather

stout

than

as

incomplete.

or

singular that

of him

properly speaking,

wasted.

to

the

Sir

place

expected

displaysmore

more

club-foot

is much
limb

are

from

congenital

be

who

-UTiter until

other

any

it is not,
the

he

afiirming,that

it than

that

and

interestingmanner,

an

with

author

ancient

in
works.

mention

It is

Club-foot.

only

account

take

complete

shall

we

place.
secured

evidently

same

modern
may

makes

where

Abbas

described

knowledge possessed by

treatment

is almost
in

place

be

Paulus

sole, and

the

other

dislocations

that

Haly

are

that

remarked

and

into their

astragalus.

agreed

and

the

give

bones

tarsal

them

under

vi.

by placing his

surgeon,

push

put

of the

Cooper's 'Sm-gical Lectures/

authors

is to

They

of dislocation

Hippocrates

the

Ancenna,

Rhases,

our

and

erect,

splintis to

bandages.
from

ground

[book

commen-

text

for

of
any

WITH

cxxi.]

SECT,

CXXI.

SECT.

In

the

of

case

ON

WOUND.

509

DISLOCATIONS

dislocations with

WITH

wound

WOUND.

the

utmost

cretion
dis-

is

required. For these,if reduced, occasion the most

imminent
death,the suiToundingnerves
danger,and sometimes
and
muscles being inflamed
by the extension,so that strong
paiiiSj
particularly
spasms, and acute fevers are produced,more
in the case
of the elbows, knees, and
jointsabove, for the
that they ai*e to the ^ital parts the greateris the danger
nearer
they induce. "NMierefore,
Hippocrates,by all means, forbids us
to apply reduction and
strong bandaging to them, and directs
and
to use
to
us
only anti-inflammatoiy
soothing applications
them
life
at the
for that by this treatment
commencement,
sometimes
be preserved. But what
for
he recommends
may
the fingersalone,we
would
attempt to do for all the other
mation,
and while
free fi'om inflamthe part remains
joints: at first,
would
reduce the dislocated jointby moderate
tension,
exwe
and
if we
succeed in our
object we may persistin
mation,
treatment
only. But if inflamusing the anti-inflammatory
spasm,
on,

Ave

or

any

afore-mentioned

of the

dislocate it againif it can

must

apprehensiveof

symptoms

be done

come

violence.

without

this

danger (forperhaps
if inflammation
it will not peld,)it vnH be
should come
on
of the greater jointsat the combetter to defer the reduction
mencement
when
the
and
inflammation
subsides, wliich
;
foretold
happens about the seventh or ninth day, then, liaA-ing
the danger from reduction,and explainedhow, if not reduced,
we
try to make the attempt
they will be mutilated for life,
may
without "violence,
using also the lever to facilitate the process.
"We are
treatment
to the ulcer
mended
recomto apply the
as
same
If,however, we

are

for fractures with

averse

to immediate

complicatedwith
dislocations

attempts
gangi'cne.

at

wound.

Hippocrates,as

Commentary.

decidedly

at the

an

reduction

in

us

by
cases

author, was

our

of dislocation

Hence, in compound

wound.

ankle, he forbids

reduction
Modern

external

stated

to

interfere

at

first,as

certainly
bring on coiiAailsions or
experienceagrees with that of the father
will

Comm.

1'
DISLOCATIONS

510

of medicine

CoMM.
'

'

'

as

pound

the

at

if let alone

but

dangerattendingthese

to the

hixations

[book vi.

he
wi'ist,

accidents.

says, prove

generallyget better.

they

dislocations at the knee

Compound
66.)
dangerous.(Ibid.

fatal if

(De

said to be

are

Com-

reduced,
64.)

Artie.

particularly

the line of

recommended
practice
by Hippocrates.
of compound dislocations at the shoulder and
In cases
he states that the danger is great if they are left unreduced,
hip-joint,
death
but pronounces
to be certain if they are
duced.
rehe approves of immediate
Like Hippocrates,
reduction
of
the
of
the
and
hands.
Even
bones
feet
in
dislocations
only
follows

Celsus

these,however,
in

are

inflamed

an

diet,and

to be

not

are

He

state.

When

rest.

interfered

Galen

at reduction

swellingand

the work

De

Articuhs^

of Haly Abbas
practice
our

author

Rhases

appears
He
author.

pai'tsbefore

gentle attempts

inflammation

come

and

difi'ersnothingin

Albucasis.

to have

fi'om
principle

If reduction has

it until the inflammation

copiedhis

recommends

inflammation

If

CXXII.

must

ON

comes

DISLOCATION

common

been

not

has subsided.

rules of ti'eatment

us, if

from

to replacethe
possible,

on, but

COMPLICATED

dislocation be attended

applythe

and

on,

forbids it while

convulsions and
in that state,for fear of occasioning

SECT.

and

afterwards.

he forbids
performed early,

we

on

author, recommends

o\ir

before

soothingtreatment

are

bleeding, spare
approves
lione protrudesand cannot
be

to its

Albucasis, like

our

parts

CoUectio.^

Nicetse

that of

the

of

naked

poci*ates.See his commentary

The

while

he advises it to be sawed off",(^dii,

place,
25.)
sanction
his
of
the
to
unqualified
practice Hipgives

got restored

'

with

WITH

FRACTURE.

with fracture without

and
extension,

they

death.

wound

replacementby

the

hands, as described for simple fractures. But if complicated

with a wound, we must
applythe suitable treatment from what
has been
said of fractures with a wound, and dislocations in

particular.

C.

AND

J,

ADLARD,

PRINTERS,

JWRTHULOJIEW

CLOSE.