Book Third (part 1 of 2)

Book Third (part 1 of 2)

SECT. I.—ON AFFECTIONS OF THE HAIR, ALOPECIA, OPHIASIS, AND BALDNESS.

As some plants die from dryness for want of sap, and some from the sap being unsuitable to them, so it happens, in like manner, with the hairs; for baldness is occasioned by want of the natural juices, and alopecia and ophiasis by the badness of them. These complaints differ only in figure; for, in the latter, the affected part has the appearance of a serpent; and alopecia derives its appellation from the circumstance of foxes being frequently subject to the affection. Judging of the prevailing humour, then, from the colour of the skin, we are first to evacuate it by purging, and then to have recourse to local applications. If, therefore, the colour incline to black or white, we purge with the medicine called hiera, which evacuates both phlegm and the melancholic humour; but if it is palish, we give pills of aloes. An account of these medicines will be found in that part of our work which treats of Compound Medicines. After general depletion, we are to use masticatories composed of vinegar, mustard, and honey, and not once only, but frequently. It will be better, too, if marjoram, pennyroyal, thyme, or hyssop be infused in the vinegar. In all the other complaints of the head, the same method is to be observed, first evacuating the prevailing humour, either by purging, or by phlebotomy if there be also a fulness of blood, and then proceeding to the topical treatment.

On alopecia. Having first cleansed the part with nitre (soda), and scrubbed it with a rough cloth, more particularly a woollen cloth, and continued the friction until it become red, anoint it with vervain pounded with vinegar in the sun. Or, rub in the roughest alcyonium burnt and pounded with lamp-oil. Or, burn the root of the club-rush, or the rind of the bitter almond, and rub them in with oil or bears’ grease. These are moderate remedies. But stronger applications may be prepared from euphorbium, thapsia, and adarce, pounded with oil of bays, or liquid pitch.—Another: Having burnt the shells of sea-urchins, mix them with bears’ grease, and anoint with them, having first cleansed the part with nitre.—Another: Of pepper, of dried sheep’s dung, of hedge mustard, of rocket seeds, of each dr. iv; of white hellebore, dr. iij; of mouse-dung, dr. j: add to the gall of a bull, of a goat, or of a hog.—Another tried remedy for alopecia: Of the root of mandragora, of birthwort, of the root of wake-robin, of wax, of liquid pitch, oz. viij; of swine’s seam not salted, of the heart or inner part of the herb nerium a little: boil the seam and the nerium until the herb be softened; then strain and throw away the herb, and add to the axunge the other ingredients, and boil. Add the wax and the liquid pitch, and use boldly in the sun. When the ulcers are cicatrized, burn the head of a fox, take alcyonium, the leaves of the black alkanet, and, having pounded all together, sprinkle upon the ointment, in order to promote the growth of the hair.—Another: Of a mouse’s head burnt, one part; of the shells of the sea-urchin, one part; boil in a pot with swine’s seam, and use. They may also be sprinkled in powder.

A medicament from Thapsia, for all chronic affections. Of euphorbium, of thapsia, of bay-berries, of each, oz. j; of native sulphur, oz. ss.; of hellebore, oz. ss; of wax, oz. viij; of oil of bays, or old castor oil, q. s. When stronger applications are required, add of cardamom, oz. j; of burnt alcyonium, oz. j; and it will be applicable not only for alopecia, but for all cases of chronic coldness. But in every case of alopecia have recourse in the first place to the process of cleansing with nitre, then friction, and frequent shaving. I have seen many have their hair reproduced by friction alone, and frequent shaving.

For baldness, and to promote the growth of the hair, from Crito. Take the dried stomachs of five hares, roast carefully in an earthen vessel, add to them the third part of myrtle tops, of the fruit of acacia, of the juice of acacia, of sweetbriar, an equal part, of maiden hair, oz. iij; pound all these things together, and sift through a small sieve. Then adding of bears’ grease, lb. iv, of that of a seal the same quantity, pound and preserve in a leaden vessel. At the time of using add to any fragrant ointment.

Preservatives of the hair. Of maiden-hair, one part; of ladanum, two parts; add to wine and myrtle oil, and use.—Another: Pound the flower of anemone, and rub it in with oil. The same will blacken the hair.—Another: Pound the straight vervain dried with its roots, sift through a narrow sieve, and, having mixed with oil, so as to have the thickness of the bath-sordes, lay it up in a copper vessel, and, when softened, use instead of oil in like manner.

A watery infusion for increasing the growth of the hairs, and for blackening them. Of rain water, six sextarii; of Alexandrian sumach, three sextarii; of maiden-hair, oz. iv; of savin, oz. iv; of ladanum, oz. j; of dried gourd, oz. j; of myrtle, oz. j; allow to macerate in a glass vessel for twenty days, stirring it twice a day with a pine spatula. On the following day plunge the comb into the infusion, and use once a day. And the seed of marshmallows, when rubbed in while in a bath, preserves the hair and promotes its growth. And, in like manner, oil may be rubbed in that has had the seed of marsh-mallows boiled in it, or added to it.

For thinning the hair. Of the leaves of the fig-tree, of the rind of the white wild vine, of pumice-stone, of the shells of buccinæ, of Cimolian earth, of each one mina. Put them into a new crude pot, and having covered it with clay, burn in a furnace, and pound, adding of aphronitrum half a mina, of the galls called omphacitæ thirty in number, pulverize and use.—Another: Of aphronitrum, half a mina; of roasted pumice-stone, four minæ; of fissile alum (alumen scissile), of dried iris, of the black wild myrtle, of gum, of the root of bryony, of each dr. iv; of unripe lupines pounded, the fourth part of a gallon; use without tallow.

For falling out of the hair. Rub in aloes, with black austere wine; or, the cover of the purpura boiled with oil; or, myrrh and ladanum, with wine and myrtle oil; or, pound burnt sheep’s dung on a shell, and rub it in with oil, having first shaved the head.

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COMMENTARY. See Galen (de Med. sec. Loc. i, Parat. Facil., and Meth. Med. xiv, 18); Celsus (vi, 4); Aëtius (vi, 65); Alexander (1); Pliny (H. N. xxviii, 46); Octavius Horatianus (i, 7); Marcellus (de Med.); Isidorus (Orig. iv, 8); Oribasius (Synops. viii, 22, and Meth. Med. iv, 5); Nonnus (8); Heliodorus (ap. Nicetam); Incertus auctor. (Frag. ap. Moschionem in Gynæc. 21); Pollux (Onomast.); Myrepsus (38); Actuarius (Meth. Med. ii, 5); Psellus (op. Med.); Serapion (i, 1); Mesue (ii, 1); Avicenna (iv, 7, 1); Avenzoar (i, 1, 3); Haly Abbas (Theor. viii, 8, Pract. iv, 12); Alsaharavius (Pract. i, 2); Rhases (ad Mansor. vi, 1, Contin. xxxvi.) See also Callimachus (Hymn. ad Dianam, l. 79); with the learned Notes of Tytler and Spanheim.

Our author copies closely from Galen, who explains at considerable length his principles of treatment; which consists of purging with warm cathartics, shaving the part frequently, rubbing it, and using calefacient applications. He says that the disease is occasioned either by the deficiency or depravity of the nutritive juices. Drs. Willan and Bateman describe this complaint by the name of porrigo decalvans. Bateman justly remarks, that, “all that can be prescribed respecting the treatment of this affection has been expressed by Celsus with his usual terseness: “Quidam hæc genera arearum scalpello exasperant; quidam illinunt adurentia ex oleo, maximèque chartam combustam; quidam resinam terebinthinam cum thapsia inducunt. Sed nihil melius est quam novaculâ quotidie radere, quia, cum paulatim summa pellicula excisa est, adaperiuntur pilorum radiculæ. Neque ante oportet desistere, quam frequentem pilum nasci apparuerit. Id autem quod subinde raditur, illini atramento sutorio satis est.”

The modes of treatment recommended by the other authorities are in principle the same as our author’s and that of Celsus. Octavius Horatianus, after directing pills containing colocynth, aloes, scammony, and wormwood, recommends nearly the same external treatment as Celsus: “Omnes confectiones quæ mediocriter calefacere possunt, mediocribus et delicatioribus corporibus adhibendæ sunt. Prius ergo loca linteolo usque ad ruborem ante curam confricentur mediocriter, ne vulnerentur. Quæ si vulnerabuntur, oleo roseo, vel adipibus anserinis recuranda sunt.”

Dioscorides recommends tar-water and other preparations of pitch for alopecia.

In a Fragment of an anonymous author, published along with ‘Moschion’ in the ‘Gynæcia,’ very sensible rules of treatment are given; namely, to shave the part frequently, to rub it with compositions containing mustard, adarce, wormwood, alcyonium, &c., and to purge with aloes, scammony, colocynth, and the like. Similar directions are given by Heliodorus. Even Alexander, who in general controverts freely the opinions of Galen, does not differ from him at all in this case. He lays down the treatment of baldness very systematically, according as the falling off of the hairs arises from preternatural dryness of the part, or from contraction or expansion of the pores, or whether it proceed from the purging of the system from depraved humours. In the first of these cases he recommends baths, and a moistening diet, but forbids the use of astringent applications. For preternatural openness or relaxation of the pores he recommends applications of an astringent and bracing nature, and strongly nourishing food. For preternatural contraction of the pores he advises the opposite class of remedies. When the hairs fall out owing to the cleansing of the system from depraved humours, as happens after diseases, he cautions against a too meddlesome interference with the process of nature. Aëtius and Oribasius are the servile copyists of Galen. Marcellus gives a long list of compound medicines for the cure of alopecia. Pliny recommends bull’s gall with Egyptian nitre. The ancients were in the practice of using nitre for cleaning linen, as is remarked by Bernard (ad Nonnum, u. s.) On the ancient practice of scrubbing the head with nitre or soda, see Salmasius (ad Tertull. de Pallio, 432.)

The Pseudo-Dioscorides recommends shaving, rubbing with nitre, and stimulant applications containing arsenic. (Euporist.)

The Arabians treat the disease exactly as the Greeks. Avenzoar recommends purging, a regulated diet, and friction with oil of nuts and cherva. Haly Abbas approves of general evacuants, friction, and stimulant applications containing cantharides, nitre, &c. Alsaharavius recommends emetics after food, purging with hiera picra, friction with compositions containing mustard, euphorbium, pellitory, nettle-seed, with oil of sesame, or with liquid pitch. Ophiasis, he says, is to be treated upon the same principles. Among the ingredients of Mesue’s compositions, we remark cantharides, musk, and amber. Serapion, like Galen and some of the others, makes mention of red arsenic as an ingredient in these applications. Rhases, in his ‘Continens,’ collects the opinions of all preceding authorities on the nature and treatment of these diseases. Most of the local applications recommended by them are stimulants and rubefacients, such as mastich, euphorbium, cantharides, ladanum, St. John’s-wort, &c. which are to be rubbed in with oil or pitch. He mentions that the celebrated Antyllus recommended scarifications, cupping, and leeching. Servitor directs a depilatory, prepared by mixing two parts of quicklime with one of arsenic in a crucible or mortar, and adding a little water to them. Pliny, Samonicus, Marcellus Empericus, and other ancient authorities speak highly of bear’s grease for the cure of baldness.

For the cure of ophiasis the earlier modern surgeons recommended depilatories containing arsenic, quicklime, vitriol, hellebore, and the like. One described by Rolandus consists of quicklime and arsenic boiled in water. (i, 14.) A similar one is described by Plempius.

SECT. II.—FOR MAKING THE HAIR CURLED, AND FOR DYEING IT. FROM CLEOPATRA.

Having first scrubbed the head, anoint the hair with the root of cow-parsnip in undiluted wine.—Another: Having shaved the head, and scrubbed it, take a young pine kernel, and burn it until it be reduced to ashes, put it into a mortar and pulverize it, adding myrtle ointment, until it be of the thickness of honey, and thus anoint the head with it.—Another: Rub in equal parts of myrtles and beet, with oil.—Another: Twenty galls; of maiden-hair, oz. ij; pound with sea-water until they attain the thickness of honey. Having rubbed the hair with urine, or lixivial ashes, and cleaned it with warm water, anoint it with this medicine for two days, then stopping, on the third day clean it, and, having shaved, anoint with myrtle oil. This will render the hair smooth, and curled, and black; but it will be more curled if you shave before using it.

Preservatives of hoary hairs, and other compositions for dyeing them black. Of the oil of unripe olives, three sextarii; of spikenard, dr. j; of unguis aromaticus (sweet-hoof?), dr. iv; of schænanth, dr. iv. Boil with oil, and separately pound and dissolve carefully one ounce of the juice of acacia in wine. When only a third part of the oil remains, strain it, and mixing with the acacia, lay it up in a vessel, and anoint with it every day.—Another: Of the bark of green walnuts, oz. iij; of the root of the ilex, oz. iij; of dark-coloured wine, three sextarii; boil to a third part, and, having strained, pound the remainder with one sextarius of myrtle oil. To be used every day.

An infusion for dyeing the hair black. Of galls, one sextarius, of elm-leaved sumach (rhus coriaria), two sextarii; of the leaves of privet, an equal quantity; of black myrtle leaves, the same; of cinnaris a handful; of poppy-heads the same; of lake water, twelve sextarii. Macerate for many days, boil to a third, then rub and anoint the head. When the hairs are dry anoint with an acetabulum of Cimolian earth, and an equal quantity of quicklime. Dissolving these things in the juice of boiled beet, anoint with it, and then, for the sake of protection, put over it the leaves of beet, and, when they adhere properly, wash in the bath with it.

For dyeing tawny hairs, and making them of a bright yellow colour. Take of myrrh, one part; of the flower of salt, one part; pulverize carefully, and, having made it of the thickness of the sordes of a bath, scrub the head, anoint it with the ointment, and allow it to remain a night and a day, and then order it to be wiped off.—Another: Rub in unripe lupines with water.—Another: Of litharge, dr. j; of Cretan earth, dr. iv; of quicklime, dr. j; with water make to the thickness of bath sordes, and anoint. Apply the leaves of beet for two or three days, and then clean.

For making black hairs yellow. Add the lees of wine to the sordes of a bath, and, having made it to the consistence of cerate, use it when you are going to sleep, and in the morning the hairs will be yellow.—Another: Macerate the leaves of privet in the juice of Fuller’s herb (struthium), and use the infusion.

A gold-coloured dye. Of alum, dr. vj; of red arsenic, dr. vj; of saffron, dr. ij; of the thapsus used by dyers, called herba rubia by the Romans, dr. viij; of the lixivial ashes used by the bonnet-makers, four sextarii; boil the ashes and the thapsus pounded together, and, when but one half remains, squeeze out the juice, and dissolve in it the alum, red arsenic, and saffron; put it into a glass vessel, and, at the time of using, first scrub the head, and then anoint with it. When it is all drunk up, clean with the decoction of fenugreek, barley, and cumin, having previously washed them with a sufficiency of tepid water, and add as much soap as is required.—Another: Mixing together the burnt lees of wine and the oil used in the baths, anoint the hairs.—Another: Scrub with Gallic soap and water at each bath.—Another very fine: Of red sumach, one sextarius; of galls, lb. iss; of sheep’s dung, oz. ij; of the golden-coloured herb, called rubia by the Romans, oz. ij; of maiden-hair, two bunches (fasciculi); of wormwood, one bunch; of lupines stripped of their outer coat, two cyathi; of water, six sextarii; put all into a glass vessel, and allow to macerate for nine days, stirring it twice a day. At the time of using, strain out what is required, and, soaking a sponge in it, rub the hairs, and when they are moistened allow them to drink it up. When dried, wash with a solution of soap in warm water.

For making the hairs white. Burn the flowers of the white petty-mullein, moisten with vinegar, and mix for a detergent ointment.—Another: Of the fruit of petty-mullein, dr. j; of alum, dr. j; of the rind of radishes, dr. j; pound, and mix of bull’s glue, dr. iv.

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COMMENTARY. Galen, when about to treat of compositions for the hair, remarks that the application of these does not belong properly to the physician, but that he may sometimes be obliged to furnish them to royal ladies, whom, under certain circumstances, he cannot venture to disobey. That the ladies, in ancient times, were in the practice of painting their hair, is evident from Achilles Tatius (ii, 149), and Juvenal (vi, 354.) Eustathius mentions that antimony was very much used for painting the eyebrows black. (Comment. in Iliad, viii, versus finem.)

For further information upon this subject, with which we must confess ourselves wholly unacquainted, we refer the reader to the following works: Alexander (i, 3); Oribasius (iv, 7, 8); Aëtius (vi, 58); Nonnus (2, 3); Octavius Horatianus (i, 1); Avicenna (iv, 7, 1); Alsaharavius (Pract. xvii, 7); Rhases (ad Mansor. v, and Contin. xxxvi.) Vegetius, the great authority on Veterinary Surgery, gives prescriptions for dyeing the hair of cattle. (Mulom. ii.)

The thapsus mentioned in this Section occurs in Theocritus (Idyl. ii, 88,) and is said by the scholiast to be a Scythian wood for dyeing the hair. It also occurs in Nicander (Ther. l, 529). His metaphrasist, Eutecnius, says that it grows in Sicily. Lucan, in like manner, calls it Erycina thapsus, i. e. Sicilian thapsus. (Pharsal. ix, 916.) It is impossible to determine exactly what tree it was.

The opinions of the philosophers regarding the hair may be learned from Aristotle (H. A. iii), and Pliny (H. N. xi, 94.) Both state that the hair and also the nails grow after death; and Philoponus mentions this circumstance as a well-known fact. See Comment. in Aristot. de Anima, Præfat. It may be proper to mention that Bichat and other modern physiologists have been of the same opinion.

SECT. III.—ON PITYRIASIS.

Pityriasis is an eruption of small furfuraceous substances on the skin of the head, or the rest of the body, without ulceration. It is occasioned, either by depraved humours which have been determined to the head, or by a saltish phlegm, or by bilious or melancholic blood. After the general system has been evacuated, as formerly described, we must use some of the under-mentioned remedies. Having first macerated Cimolian earth in water, mix with the juice of beet, and anoint it, allowing it to remain until dry, then wash it away, and, having pounded frankincense with wine and oil, anoint with them. Next day, rub in stavesacre with oil.—Another: Of nitre, of the burnt lees of wine, of ben-nut, of each, lb. j; of stavesacre, lb. iss. Dissolve in wine, and rub the head; or, if the rest of the body be affected with tingling, it may be used dry. When the pityriasis is more humid, wash with brine or the decoction of lupines. Of this remedy I have had ample experience.

On psydracia and exanthemata of the head. The psydracia are small protuberances, like blisters, elevated above the skin. The exanthemata are superficial ulcerations, somewhat red and rough. Both are to be cured by the under-mentioned remedies: Of litharge, dr. ij; of ceruse, dr. iv; of alum dr. ij: of the green leaves of rue, dr. ij; pound with vinegar and myrtle-oil, and anoint.—Another: Pounding rue and alum with honey, anoint with this the head, after having first shaved it. If the head is excoriated, apply olive leaves boiled with honey.—Another: Of litharge and ceruse, of each, dr. xij; of native sulphur, dr. viij; mix with myrtle cerate.

For the thick and red ulcers of the head, resembling papulæ, or small nipples, from which ichor is discharged. Having first shaved the head and scrubbed it with water and nitre, use native sulphur livigated with human urine; or anoint with melanteria and vinegar.

For achores and favi. The complaint called achor is one of those which affect the skin of the head, corroding the skin by very small perforations, from which a discharge of viscid humour takes place. The complaint called favus is nearly allied to it in appearance, since it consists of larger perforations resembling the combs of bees, containing a honey-like fluid. They are occasioned by a nitrous and saltish phlegm. In such cases, the diet should consist of wholesome food; and everything that is acrid and saltish should be avoided, more particularly if the attack be inflammatory. After the proper evacuation of the prevailing humour, having shaved the hairs, foment twice, thrice, or oftener, with warm water, in which has been boiled myrtle, bramble, or lentil, or bitter lupines, or the root of asparagus. When the ichorous discharge is greater, apply a cataplasm of the leaves of willow, with water, or of lentil. The ointments used should consist of Cimolian, Cretan, or Samian earth, or pompholyx, or spodium, or litharge, or cadmia, or burnt paper, or the powder from pepper. All these are to be applied with vinegar. We may use the following smegma: Of sulphur, of the herb perdicias, and soap, of each equal parts. The following are compound applications: Of litharge, dr. xvj; of the leaves of rue, dr. viij; of the stavesacre, dr. iv; of copperas, dr. ij; with vinegar and myrtle oil; make to the consistence of bath-sordes, and anoint with it.—Another: Of sandyx (calcined ceruse?), dr. iv; of myrrh, dr. iv; of native sulphur, dr. ij; of manna, dr. iv; rub into the part with old oil.

For achores. When they discharge ichor, triturate the dross of silver, or yellow ore of lead (molybdœna), and sprinkle upon them.—Another, for achores and humid psora: Of the roses of the rhododaphne, oz. iv; of native sulphur, oz. iv; of liquid pitch, oz. iij; of dry pitch, oz. iij; of wax, oz. vj; of myrtle oil, q. s. For children, dissolve in milk, and anoint.

For fici. We give the name of fici to ulcerous excrescences which are round, somewhat hard, red, and accompanied with pain. They arise for the most part on the head, but also sometimes on the other parts of the body. The best application for this complaint consists of fissile alum, of the calcined flowers of copper, of taurocolla, of each equal parts, with double the quantity of the flakes of copper; triturate with vinegar, and anoint. A proper application is also prepared from the burnt heads of the cackrel fish, the bulbi boiled, and their ashes mixed with vinegar.

A dry application for ficose eruptions of the head and chin. Of misy, dr. iss; of chalcitis, dr. iiss; of squama æris, dr. j; of fissile alum, dr. j. Having washed, apply this powder in a dry state unsparingly, and allow it to remain. Next day, having again washed, wipe the part with a sponge, and apply it again. A thick scab will then fall from the ulcer. Repeat the same application the following days. The cure will be effected in a few days without leaving a cicatrix; but this medicine operates strongly.

For lice in the head. Direct the head to be scrubbed with the decoction of lupines; or pound together stavesacre and sandarach, and rub them in along with oil or vinegar; or a small quantity of pepper may be added to old oil, so as not to occasion ulceration; or the juice of ivy with honey may be used; or mustard and vinegar; or the gum vernix, or liquid pitch with alum; or the expressed juice of the bay berries; or oil of radishes. I have always succeeded by pounding stavesacre with vinegar and oil, and anointing with this.

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COMMENTARY. Drs. Willan and Bateman agree with all the best medical writers of antiquity in describing, by the name of pityriasis, a disease consisting of slight, scaly, and branny exfoliations without ulceration. See Galen (Sec. Loc. i); Alexander (i, 3); Oribasius (Synops. vi, 25); Aëtius (vi, 66); Actuarius (de Sig. Morb. ii, 5); Nonnus (4.) Actuarius, who gives a very distinct account of the disease, states in strong terms the danger of repressing the cutaneous eruption. (l. c.)

It is the porrigo sicca of Celsus (vi, 2), who recommends for it shaving the head, and using slightly repressing applications, “quale est nitrum cum aceto, vel ladanum cum myrteo et vino, vel myrobalanum cum vino.” Marcellus distinguishes the pityriasis from porrigo. (De Med. 4.)

The Arabians, especially Serapion, direct very active general treatment, such as venesection, masticatories, cathartics, and the like. (i, 4.) It is described under the name of furfures capitis by the translator of Haly Abbas. (Theor. viii, 18.) Like the Greeks, he represents it as consisting of small furfuraceous scales without ulceration. Alsaharavius uses the same name, and recommends bleeding, cupping, purging, and external applications of a detergent nature, such as flour of vetches, with vinegar and the like. Avenzoar recommends pills of drastic purgatives, and the ordinary lotions. (i, 1, 10.) See also Avicenna (iv, 7, 1, 24); and Rhases (ad Mansor. v, 1; Contin. xxxvi.) In the ‘Continens,’ the disease is described by the names of furfures and impetigo, for which Rhases recommends liniments containing nitre, sulphur, hellebore, vinegar, &c.

Willan and Bateman describe the psydracia as being small pustules irregularly circumscribed and terminating in a laminated scab. Most of the above-mentioned writers treat of them in the same terms as our author. They seem to be the balchie of Avicenna (iv, 7, 6, 1) who calls them a malignant species of achor. See Galen (l. c.)

Galen, Alexander, Aëtius, and our author describe the exanthemata as being small superficial ulcerations. Drs. Willan and Bateman use it as a generic term for rashes. The exanthemata seem to be the alraba or pustulæ dulces of Alsaharavius (i, 10.) See Book First, Sect. VI, and Book Fourth, Sect. VIII, of this Work.

Willan and Bateman apply the terms achor and favus in the same sense as Paulus and the other ancient authors. Octavius Horatianus uses the terms acora and cerio. He says, “Acoræ et ceriones distant, quod ceriones plures cavernas egestionis habent et humorem multo pinguiorem emittunt; acora autem unam cavernam habet, et humorem egerit aquatiorem.” (i, 5.) Galen has treated of these complaints very fully, and his applications are similar to those of our author. See also most of the authorities on pityriasis. The favus is the first species of tinea described by Haly Abbas. It consists, he says, of cells, and discharges a fluid-like honey. The achor is his amada, or third species of tinea, consisting of smaller cells than the former. Alsaharavius describes the favus by the name of alsahara. It contains, he says, a viscid fluid like honey. He recommends for it purgatives, and detergent applications containing nitre, lees of wine, &c. (Pract. i, 9.) The achor is called alsahafa by him. The description which Actuarius gives of papulæ, favus, and ficus is sufficiently distinct, but not different from our author’s. (De Diagnos. ii, 5.)

The other authorities gives the same account of ficus as Paulus. It is Haly Abbas’ second species of tinea, and is described by him as consisting of hard round protuberances. Haly’s fourth species of tinea consists of small ulcers of a mammiform appearance. They are mentioned by our author. Fabricius ab Aquapendente defines the ficus thus: “Tumeur qui est rouge, ronde, quelque peu dure, et de laquelle (etant ulcérée et pressée) sort une matière sanieuse, semblable aux grains de figues.” (Œuv. Chir. i, 1, 13.) He says that Hippocrates and Galen give a different account of it from our author’s; but we can see very little difference between them. Most of the ancient authors recommend the same remedies for ficus as Paulus. The most active of these are stavesacre, and sandarach or red sulphuret of arsenic. They do not appear to have apprehended danger from the free use of arsenic in this way. Galen recommends equal parts of white hellebore, stavesacre, and nitre with oil. (De Med. Sec. Loc. i.) Octavius Horatianus mentions equal parts of pellitory and galls. The same medicines are recommended by Serapion, (i, 5.) See also Oribasius (de Loc. Affect. iv, 11); Celsus (xi, 3); Cælius Aurelianus (de Morb. Tard. iv, 2.) Haly’s remedies consist of galls, litharge, mercury killed (sublimed?), sulphur, and so forth. Among those of Rhases we remark squills, assafœtida, quicklime, mercury, &c. However, he prefers excision. (Continens. xxxvi).

For pediculi in the head, the Arabians recommend nearly the same compositions as our author. They contain arsenic, stavesacre, hellebore, nitre, and the like. See Alsaharavius (Pract. i, 16), and Phases (Cont. xxxvi, 6.) Among the ingredients mentioned by the latter, we remark quicksilver, sulphur, red arsenic, mustard, stavesacre, the oil of oleander, vinegar, &c. These medicines form the ingredients in the compositions recommended by modern writers on this complaint. See Plempius (de Morbis Pilorum), and Amatus Lusitanus (Curat. 58.)

SECT. IV.—ON HEADACH.

Headach, which is one of the most serious complaints, is sometimes occasioned by an intemperament solely; sometimes by a redundance of humours, and sometimes by both; and sometimes it is occasioned by a procatarctic cause, such as external heat, or cold, or drunkenness, or a blow. The most vehement pains of the head are excited by the active qualities, particularly heat. Those occasioned by dryness are not equally vehement; but a humid quality excites no pain of itself, unless it happens to be joined to heat, cold, or a fulness of humours. Headachs occurring in a fever having been treated of in the preceding Book on Fevers, we will now treat of the others.

On headach from heat. When headach proceeds from exposure to heat, the skin feels hotter and drier than natural at the first application of the hand, and the eyes of such persons are red. They delight in cold affusions and ointments, and are benefited by them. The method of cure will correspond with that described as applicable for cases of headach in fevers. When the pain becomes chronic, we must have recourse to some of the under-mentioned applications. The following applications to the forehead and temples will also be proper, namely, bread soaked in oxycrate and rose-oil, to which may sometimes be joined almonds; or roses either dried or fresh, or mixed with mint and pennyroyal; or bread with the leaves of the peach tree. Benefit may also be derived from basil, pounded with vinegar and rose-oil; or from ivy berries boiled in vinegar, and pounded with rose-oil; or from wheaten flour mixed with the watery decoction of wild thyme; or from cardamom toasted and triturated in vinegar and rose-oil; or from leaven with rose-oil; or from dried iris with vinegar. These applications must be changed frequently; for if allowed to remain long, they have no effect.

Trochisks for headach connected with a warm intemperament. Of saffron, dr. v; of copperas, dr. x; of alum, dr. xvj; of myrrh, dr. vij; of the oil of unripe olives, dr. iij; of chalcitis, dr. iij; of gum, dr. iij; of austere wine, q. s. Use with oxycrate, and, if watchfulness accompany it, add some of the soporifics.

On headachs from a cold intemperament. In cases of headachs from coldness, the symptoms are just the reverse of those proceeding from heat; for the face is pale and not contracted, and the patients do not delight in cold things, nor are benefited by them. The diagnosis will also be confirmed by adverting to their diet, and the like. The ointments applied should contain rue, or the oil of bay, or of iris, or of nard, or the juice of balsam, more particularly if the excrementitious humours be thick and viscid. This must be rubbed into the forehead, and likewise preparations containing pepper and euphorbium. Also give thin wines and recommend exercise, hot baths, and occasionally an emetic from radishes. When the exciting cause is a chronic quality without plethora, use the following application: Of white pepper, dr. ij; of crocomagma, dr. ij; of fresh euphorbium, dr. viiiss; of pigeon’s dung, dr. iss; of the strongest vinegar, q. s. Having first rubbed the affected part, anoint with this.

On headachs from a bilious humour. The symptoms resemble those occasioned by heat, only there are more gnawing pains at the stomach, paleness of the countenance, and sometimes a bitter taste in the mouth. This affection occurs most frequently in adults who are of a hot temperament, lead an anxious life, and are subject to collections of yellow bile. They must use tepid baths, and mild ointments, with a watery drink; and their whole diet should be moistening, and consist of good juices. The bilious humours must be evacuated with the decoction of wormwood, or with aloes, or the antidote called hiera picra, either alone, or in combination with a little scammony, or the aloetic pills. The forehead is to be rubbed with the saffron trochisk, or with that called trigonos, or the like.

On headach from sympathy. If the head be affected sympathetically with the general system, this must be our first care, by attending to the intemperament and the prevailing matter. If it proceed from plethora, more especially a venous one, we will bleed; but, if it be only an offending quality, we will use a purgative medicine. If the head sympathise with some particular part, such as the liver, belly, or stomach, we must apply remedies to these organs. If a hot intemperament accompany, we give bread which has been steeped in a watery wine, or spoon-meats from chondrus. Moderately cooling and tonic applications are likewise to be used externally, as formerly described. But if the headach be occasioned by viscid and thick humours contained in the stomach, these must be dislodged by drinking oxymel, either alone or that preparation called the Julian. We must also use decoctions of hyssop and marjoram, and other things still hotter and more incisive, and likewise the emetic from radishes, hot embrocations, and cataplasms.

On headach from wine. If the wine remain undigested, we must procure vomiting, by drinking tepid water; but if the headach remain after digestion, we must use cooling and repellent applications, such as rose-oil alone and with vinegar, or the juice of ivy, or of cabbage. And the leaves of cabbage infused in warm water, and applied to and bound to the head, naturally counteract intoxication. They must also eat boiled cabbage. Dried lentil is also beneficial, particularly to those who have a loose belly. They ought likewise to eat alica, pomegranates, apples and pears, and drink water.

On headach from a blow. We must immediately bleed those who have headach from a blow (unless the injury be superficial), and use suitable embrocations to the head; bathe it with sweet oil; cover it with wool; and make the patients abstain from wine and a rich diet, more especially if they have fever; and, upon the whole, we are to accommodate our treatment as for the inflammation of nervous parts, and especially of the membranes of the brain. If there be a wound it must be treated accordingly.

An emollient application for headach. Of wax, dr. vij; of almond-oil, oz. iij; of turpentine, dr. viij; of scraped verdigris, of Cimolian earth, and of chalcitis, of each, dr. iv; of pumice-stone, dr. iij; of burnt copper and scales of steel (squamæ stomomatis), of each dr. ij; and, if appear to be too hard, soften it with almond-oil.

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COMMENTARY. By cephalalgia, as Aretæus remarks, is to be understood an acute pain of the head, and by cephalæa a chronic one. Our author does little more than abridge the contents of the second book of Galen’s work ‘De Med. sec. Loc.’, where this subject is treated of with unrivalled precision. See also Aretæus (de Morb. Chron. i, 2); Oribasius (de Loc. Affect. iv, 1); Celsus (iv, 2); Cælius Aurelianus (de Morb. Chron. i, 1); Octavius Horatianus, (ii, 1); Alexander (i, 10); Pseudo-Dioscorides (Euporist. i, 6); Actuarius (Meth. Med. vi, 2); Aëtius (vi, 40); Leo (Synops. ii, 1); Nonnus (10); Serapion (i, 6); Avicenna (iii, 1, 2); Avenzoar (i, 3); Mesue (de Ægr. Capitis, ii, 1); Haly Abbas (Theor. ix, 3, Pract. v); Alsaharavius (Pract. i, 2, 1); Rhases (ad Mansor. ix, 1, Contin. i, 21.)

In headach from heat, Galen and Alexander concur in condemning the use of poppies, hemlock, and mandragora, unless when compelled to have recourse to them by the continued watchfulness of the patient. Galen directs the application of snow to the head. Avenzoar recommends the affusion of cold liquids from a height upon the head. Serapion mentions oil cooled with ice. When the pain is obstinate, Rhases approves of opening the temporal artery. When the pain is violent, the author of the ‘Euporista’ recommends us to shave the head and bathe it with a decoction of narcotic vegetables. Galen expresses himself very clearly with regard to the sympathy between the head and the stomach, from nervous communication. (Loc. affect. iii, 9.)

For headachs arising from a hot or cold intemperament, Galen recommends the remedies called metasyncritica by the Methodists, for an account of which see Le Clerc. (Hist. de la Méd. ii, iv, 1, 3.) He says, “Ce que Thessalus appelloit metasyncrise etoit un changement qu’ il prétendoit faire dans tout le corps, ou dans quelque partie seulement.” Such rubefacients as mustard, thapsia, &c. belonged to this class. See also Prosper Alpinus (de Med. Method. iii, 15.) The term signifies “altering the system;” and, therefore, we have generally rendered it “alteratives” in the course of this translation. The treatment followed by Philagrius in the hot and fiery intemperament of the head deserves to be noticed. In a case of this description having used many other cooling remedies in vain, he says he shaved the head and applied snow to it, by which means he extinguished the intemperament. (Theophilus, Sch. in Hipp. t. ii, 457, ed. Dietz.) This practice is borrowed from Galen, as above.

Our author borrows his treatment of bilious headach from Galen and Alexander. To his judicious account of headach from wine or a blow, nothing need be added from any other author. Alexander justly remarks that, when it arises from the latter cause, it is very dangerous. He is fuller than our author in treating of headach from sympathy with the liver, for which he recommends local applications of a cooling nature and a generous diet. Similar treatment, he adds, is to be pursued when it arises from a hot intemperament of the stomach, bowels, or spleen.

According to Avicenna and Actuarius, frothy urine, that is to say, urine having bubbles on the surface, is characteristic of cephalalgia.

The Arabians generally treat of the disease by the name of soda.

Headach, says Haly Abbas, is either seated in the head, or arises from sympathy. When seated in the head, it either arises from an intemperament, or organic disease, or flatus, or a blow. One of the most common causes of sympathetic headach is the presence of bilious matters in the stomach, which case is generally relieved by vomiting. Protracted watchfulness induces headach, by occasioning a corruption of the food in the stomach; and protracted sleep in like manner fills the brain with vapours. Excessive evacuation, by producing a dry intemperament, proves a cause of headach. It is in this manner that epistaxis and menorrhagia occasion headach. Haly Abbas, like Galen, mentions as a cause of headach an excessive sensibility of the nerves which connect the brain and stomach. Haly further states that headach will arise from sympathy with the uterus, as after abortions, obstructions of the lochial or menstrual discharge, and the like causes. He remarks that violent headach will sometimes occasion loss of speech, owing to an affection of the nerve which is distributed upon the muscles of speech. His treatment, like our author’s, is varied according to the nature of the exciting causes; and his account of it is so full and judicious, that we regret our limits do not permit us to give a more ample detail of it. His remedies are, general bleeding, cupping the extremities or back part of the neck, anodyne or cold applications to the head, drastic or gentle purgatives, and so forth.

Alsaharavius treats the complaint upon similar principles. When it arises from heat, he recommends the affusion of tepid water over the head, and afterwards applies oils cooled in snow. When connected with bile, he directs the belly to be opened. When it is occasioned by a sanguineous plethora, he recommends general bleeding and the application of cupping-instruments to the nape of the neck.

Rhases, as usual, treats fully of soda and all its varieties. When of an inflammatory nature, he recommends bleeding, purging, and the application of vinegar and rose-oil to the head. When connected with bile, he directs first vomiting by drinking tepid water, and then to take purgatives, and afterwards wormwood. When the disease is protracted, he approves of opening the temporal vessels, and of using sternutatories. When it arises from a blow, he recommends bleeding, and purging with colocynth, &c. He states that Ruffus recommended the affusion of cold water, or of oils congealed in snow, over the head. In obstinate cases, he directs the use of the actual cautery.

SECT. V.—ON CEPHALÆA AND HEMICRANIA.

Each of these affections is a permanent pain of the head, liable to be increased by noises, cries, a brilliant light, drinking of wine, and strong-smelling things which fill the head. Some feel as if the whole head were struck, and some as if one half, in which case the complaint is called hemicrania. When the affection is seated within the skull, the pain extends to the roots of the eyes, and when externally it spreads around the skull. Pain then, accompanied with heaviness, indicates plethora; if with pungency, acrimony of the humours or spirits; if with throbbing, inflammation; if with tightness and without heaviness and throbbing, a fulness of a thin and flatulent spirit (gas?); but if it be attended with throbbing, it is indicative of inflammation of a membrane; if with heaviness, of a fulness contained within the membrane. If the putrid humour acquire heat, the headach will be attended with fever; and, in general, those in whom headach proceeds from inflammation have fever. When, therefore, the whole body is in a plethoric state, we must bleed (attention being paid to the strength), and use the more acrid clysters. Should there still appear to be a fulness of blood, we must open the veins of the nose, and endeavour to evacuate thereby to a sufficient amount. We must then give hiera sharpened with vinegar, and use masticatories, or medicines for evacuating the phlegm by the mouth; also procure evacuations from the nose by means of errhines, such as the juice of elaterium, which may be poured in with milk; or the elaterium may be snuffed up dry, or else the juice of sow-bread or of leeks. The following are compound medicines:

An errhine for chronic headachs, ophthalmy, and epilepsy. Of gith (nigella sativa), dr. viij; of sal ammoniac, dr. iv; of elaterium, dr. iv; pound and mix with Sicyonian oil, or that of iris, or of privet, so as to have the thickness of cerate, and apply to the nostrils.

An errhine to be snuffed up. Of dried sow bread, dr. viij.; of red nitre, dr. iv; or if, instead of the nitre, you will use elaterium, it will be still better. Snuff it through a reed. In more chronic cases use epithemes to the head and unguents, as the following:

An epitheme for cephalæa. Of the ointment of iris, of hog’s fennel and castor, of each, dr. j; of bay-berries, dr. ij; of the tops of rue, dr. iv; mix with rose-cerate, and having shaved the head, apply to the whole of it. A certain woman, by using the following application in cases of hemicrania, acquired wonderful celebrity: Having cut down the green root of the wild cucumber into small pieces, she boiled it and wormwood in oil and water until they were softened; and with the warm oil and water she fomented moderately the affected part; and, pounding the root and the wormwood, she made a cataplasm of them. And with this application she cured cases of hemicrania, both with fever and without. When a strong paroxysm takes place, so that the pain is insupportable, use paregoric and alterative applications like the following:

An unguent for cephalæa. Of the juice of hog’s fennel, dr. xvj; of the juice of poppy, of anise, of henbane, of saffron, of myrrh, of scammony, of each, dr. ij. Add to vinegar and make trochisks. When using it, anoint those who have pain of the head from thick humours or a flatulent spirit with it, along with vinegar or oxycrate. We must, likewise, use a dropax and sinapism, and the trochisk from thapsia. That, too, from writing ink is much approved of for the same cause, and is to be used, as will be described in the Book on Compound Medicines.

The following one is possessed of wonderful efficacy for hemicrania proceeding from a thick and viscid humour: Of euphorbium, one part; of castor, an equal quantity; mixing with water, insert into the ear of the affected side, and order the patient to go into a bath, and, when he has remained a short time, take it out, and bathe as usual. Thus it is of tried efficacy. It will not be improper also to add them to oil, and inject into the ear. The application described for ischiatics is likewise a successful remedy for chronic headach and hemicrania.

For chronic hemicrania. Of garlic, dr. iv; of wax, dr. ij; of old axunge, dr. ij; of cantharides, dr. ij. Apply this in the evening, and having allowed it to remain all night, break the blister in the morning, and cure with the plaster called panygrus.—Another: Of bay-berries, stripped of their skins, dr. ij; of the leaves of rue, dr. ij; of mustard, dr. j; moisten with water, and apply. It is most beneficial to those whose complaints arise from cold causes, so that frequently, when applied before going into the bath, it immediately cures the affection, and after the bath they become perfectly well.—Another: Of Sabine oil, lb. j; of wax, oz. iij; of euphorbium, oz. j; with this anoint the half of the forehead, namely, along the temporal muscle. If the cold is not great, pound an equal quantity of galls and crocomagma with wine, and anoint. In cases from hot fumes or humours, do not use the applications with euphorbium.

An apophlegmatism, or masticatory, for cephalæa and hemicrania. Of mustard pulverized and dissolved in vinegar and honey, oz. xiv; of stavesacre, dr. iv; of pellitory, dr. iv; having pounded, strained, and mixed in the sun, gargle with it. When the cephalæa becomes permanent, owing to a bilious humour or some intemperament, use the remedies formerly described for headach. If after all this the pain continue, even after cupping and leeching, and there is reason to suspect that the distribution by the arteries is affected, it will not be improper to open the arteries behind the ears. In those of a humid intemperament the natural baths may be tried with good effect.—Another, for hemicrania: Mix euphorbium and earthworms with vinegar, and anoint the affected part, or the whole forehead.

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COMMENTARY. Our author’s account of cephalæa is mostly abridged from Galen (See. Loc. iii), where the treatment is detailed at considerable length. Alexander, Aëtius, Oribasius, and the Arabians follow the views of Galen; and, as they are similar to our author’s, we need not dwell upon the exposition of them. General and topical bleeding, cooling or stimulant applications to the head, purgatives, masticatories, and errhines, applied according to circumstances, constitute the sum of their treatment. One rule laid down by Oribasius deserves attention; when the pain is acute, he recommends general bleeding; and, when it is protracted, local. When cephalæa is connected with constipation of the bowels, Alexander advises that they should be opened with laxative food and gentle purgatives, such as sal ammoniac (a fossil salt procured from Africa), scammony, and euphorbium. When it is connected with a loose state of the bowels, he recommends such means as will stop it; and when it is produced by insomnolency he recommends things of a paregoric and soporific nature. (i, 11.)

Aretæus, who probably was prior to Galen, delivers an admirable account both of the symptoms and treatment of this complaint. He recommends bleeding at the arm, and by opening the temporal arteries, or those behind the ears, or the vessels of the lining membrane of the nostrils, or cupping the back part of the head; purging with drastic cathartics, such as hellebore; errhines, masticatories, a restricted diet; and, in obstinate cases, he approves of applying the actual cautery to the cranium. (De Curat. Morb. Chron. ii.) Most of the ancient authorities recommend the cautery in this case. (See the notes on Sect. I of the Sixth Book.) Aretæus allows a small quantity of a light wine on account of the stomach, which is apt to be affected. (Ibid.)

Cælius Aurelianus has given a most minute account of the doctrines of the Methodists respecting cephalæa. (De Morb. Tar. i, 1.) He enumerates many causes of the disease, among which we may mention too much attention paid to the hair by females. The following is an outline of his practice: Friction of the extremities, emollient fomentations and soft applications to the head, such as wool, or bladders half filled with warm oil, are to be used at the commencement. When the pain is violent, he recommends venesection from the arm opposite the side affected. The head is to be shaven with a razor, and a cataplasm, or a cupping-instrument without scarificators, or leeches, are to be applied; and these are to be followed by sponging with hot water. If the belly be constipated, we are to give clysters of the oil of rue with honey, or the like. In the decline of the complaint, emollient plasters (malagmata) are to be applied. Gentle gestation before food is particularly recommended, and walking afterwards. Exposure to heat, indigestion, strong drink, hot baths, violent passions, constipation of the belly, and so forth, are to be avoided. His directions respecting diet are extremely minute, but judicious. With regard to topical applications, he recommends after the head is shaven mild ones at first, and afterwards rubefacients and stimulants, and cupping with much heat. Masticatories and gargles are mentioned. He recommends affusion of water, at first hot and afterwards cold. When the disease does not yield to these remedies, he directs a course of hellebore. The methodist oppugns freely the practice of the other sects. Refrigerant applications, containing vinegar, rose-oil, and the like, he says, are very prejudicial; purgatives injure the stomach; cauteries excite a dangerous disturbance; the cold bath produces rigidity of the nerves; and hot masticatories do not answer well.

Scribonius Largus mentions a black torpedo applied alive to the head as a remedy for headach. (De Comp. Med. c. 1.) The same prescription occurs in the collection of Marcellus Empiricus. See further Galen (de Simpl. Med. facult. in voce ναρκὴ) and Aëtius (ii, 185.) Is not this an application of the principle of galvanism in medicine?

Rhases insists, with becoming earnestness, on the propriety of administering purgatives, especially cholagogues, in cephalæa. His commentator Leonardus Jacchinus blames modern physicians for having substituted weak and ineffectual cathartics for the powerful medicines of this class used by the ancients.

Galen states correctly that cephalæa often arises from disease of the pericranium. (De Loc. Affect. l. c.)

SECT. VI.—ON PHRENITIS.

Phrenitis is an inflammation of the membranes, the brain also being sometimes inflamed along with them, and sometimes a preternatural heat fixes originally in the brain itself. The cause of this disorder is either a fulness of blood, or of a yellow bilious humour; and sometimes the yellow bile, being excessively heated and converted into the black, becomes the cause of the worst species of phrenitis. And sometimes the affection arises from the brain’s sympathizing with the diaphragm by means of the nerves distributed upon it. But the aberration of intellect which occurs at the acme of very hot fevers, and that which is occasioned by sympathy with the stomach, is not called frenzy but delirium. Cases of true phrenitis are, for the most part, attended with watchfulness, but sometimes with disturbed sleep, so that the patients start, leap up, and cry out furiously; when the complaint is occasioned by a sanguineous humour, with laughter; but when by yellow bile, with ferocity; and when by a black, with unrestrainable madness. They forget what is said and done by them, their eyes are bloodshot, and they rub them; they are sometimes squalid, sometimes filled with tears, or loaded with rheums. The tongue is rough, there is a trickling of blood from the nose, they pick at flocks of wool and gather bits of straw, and have acute fever during the whole continuance of the disorder. When a fever of a bad character is seated deeply, they have the pulse small and indistinct, with a certain degree of hardness. The respiration is large and rare when the brain is primarily affected. And, if the phrenitis be occasioned by sympathy with the diaphragm, the respiration is irregular, the hypochondria are retracted and have considerable heat; but, when it arises from sympathy with the brain itself, the parts about the face are hot and suffused with blood, and the veins are full. When a pituitous humour is mixed with the bilious, as the cause of the disease is compound, so also is its appellation; for it is called coma vigil. When a bilious humour prevails, persons so affected are troubled with watchfulness; and, when a pituitous is the cause, they lie in a state of coma. The elder writers before Galen called this disease catochus, but since then it has been called catoche and catalepsy.

The cure of phrenitis. If the strength admit of bloodletting, we are to abstract blood from the arm immediately and freely; but, if the patient be delirious and will not present his arm, or if there be apprehension of hemorrhage after the bleeding from the patient tearing his arm during the agitation of his delirium, we must open the straight vein in the forehead, and take away at once a sufficient quantity of blood. We are to use clysters and injections of oil, or rose-oil with the juice of ptisan. When watchfulness prevails, we anoint the head with rose-oil, or with vinegar and rose-oil; in some cases fomenting it with hot water; and we must give the medicine from the heads of poppy, unless prevented by the weakness of the patient’s powers; and must have recourse to the other remedies for insomnolency formerly mentioned. Let the patient be laid in a place which is in a moderate state as to light and temperature, and let there be no paintings in it, for these are apt to excite emotions in such cases. Let some of his most beloved friends come in and converse with him in a suitable manner, sometimes gently soothing him, and at other times chiding him more harshly. His food at first should consist of honied water, and afterwards of the juice of ptisan, or spoon-meats formed from chondrus, with some sweet potion, such as apomel, or hydrorosatum, or rhodomel, or the sweet hydromel. But the vinous hydromel which is brought from Cebyra in small vessels must be rejected, as it produces more mischief than wine itself, especially in affections of the head and before concoction. We are also to administer bread that has been soaked in water, and succory, and boiled lettuces. Or, if there be much effervescence, they may be given raw, and also the medullary part of the cucumber, of the pompion, of apricots, and the like. They must be kept from cold water, more especially if the affection be found to proceed from sympathy with the diaphragm. If their urine (as is likely) be retained, owing to their delirium, we must foment the lower part of the belly and bladder with warm oil and water, and then, by applying the fingers of the hand to the part, we must try to incite them to make water. We must also anoint the rest of the body with warm oil; and the patients are to be kept in a recumbent posture, for a state of quietude is to be maintained as much as possible; and, if they be rich, they are to be restrained by their servants; but, if not, they are to be bound with ligatures. For irregular motion is apt to produce prostration of the strength. And for another reason, too, the feet ought to be bound with ligatures after having been bathed, and friction applied to them, namely, for the sake of revulsion. But, if the attack be more protracted and difficult to remove, we must abstain from all narcotics; and to the fomentations of the head are to be added things of a discutient nature, such as the juice of mint, or of wild thyme, or of calamint, or of rue; and then we must use errhines. After the seventh day, if the viscera be inflamed, we are to soothe them by cataplasms of linseed and raw barley-flour in oil and water. We are then to apply dry cupping or cupping with scarifications to the parts, and to the back part of the head and the spine. But, if the body be observed to be very squalid and hot, even if the fever remain, we must use baths of fresh water, and plentiful anointing, and give some thin and weak wine, in order to rouse the strength; we need not apprehend any mental alienation that will thereby be produced; for, either it will not take place at all, as the disease is on the decline, or, if it do, it may be easily removed. When the disease further abates, we must have recourse to gestation and suitable restoratives. Recovery may be promoted by avoiding intoxication, anger, indigestion of the food, and more especially exposure to the heat of the sun.

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COMMENTARY. Hippocrates treats cursorily of phrenitis in several of his works, particularly ‘de Morb.’ (iii, 9,) and ‘Epid.’ See Galen (Meth. Med. xiii, de Loc. Affec. v, 4); Aretæus (de Morb. Acut. i, 1); Alexander (i, 13); Aëtius (vi, 2); Actuarius (Meth. Med. iv, 2); Nonnus (c. 25); Pseudo-Dioscorides (Euporist. i, 13); Cælius Aurelianus (Morb. Acut. i, 1, &c.); Celsus (iii, 18); Serenus Samonicus; Octavius Horatianus (ii, 2); Serapion (i, 20); Mesue (de Ægr. Capit. c. 19); Avenzoar (i, 4, c. 6); Haly Abbas (Theor. ix, 4, and Pract. v, 13); Alsaharavius (Pract. i, 2, c. 8); Rhases (ad Mansor. ix, 3, and Contin. i, 28.)

Hippocrates, in his ‘Epidemics,’ details several cases of phrenitis, which would appear to be remittent fevers, complicated with determination to the brain, rather than inflammation of the brain.

Galen gives a very circumstantial detail of the symptoms, which is well worth consulting. (Loc. Affec. l. c.) Our author’s description is very complete, considering its brevity. He closely follows Alexander, who agrees with him in recommending the most questionable part of our author’s treatment; we mean the administration of wine. Of course, however, it must have been a weak light wine. He insists that when the strength is much reduced, it does more good than harm, by improving the powers of the constitution. Cælius, however, says that wine is nothing less than a poison. Alexander, Aretæus, and Aëtius agree that cold drink should be given with caution. Most of the authorities have correctly described the pulse as being small and dense. Our author’s practice, in regard to bleeding from the temporal vein, is derived from Alexander, who gives a very interesting case, in which he applied it with great success. He recommends great caution in the administration of narcotics. Upon the whole he is favorable to the tepid bath, as serving to procure sleep, but he condemns the hot. Among the minutiæ of practice, we may mention that Aretæus and Celsus, like our author, recommend all pictures and such like gaudy objects to be removed from the apartment of the sick. Celsus directs us, in pointed terms, after bleeding and purging, to get the head shaved, and fomented with a decoction of emollient herbs. To procure sleep, he recommends us to give draughts containing poppies and hyoscyamus; or to apply the apples of the mandragora below the pillow of the patient; or, to rub his forehead with amomum, or with the tears of mulberry. He informs us, however, that Asclepiades condemns soporifics, as inducing lethargy. For the sake of procuring sleep he recommends gestation performed at night, and of swinging the patient in a suspended couch. For the same purpose, the Pseudo-Dioscorides recommends us to introduce the juice of poppies or mandragora upon wool into the rectum.

Cælius Aurelianus gives an admirable account of the symptoms and treatment of this disease; and his views are, in this case, not very different from those of Hippocrates and Galen. He informs us that Asclepiades condemned venesection, which, he said was nothing less than murder; that he disapproved of keeping the patients in a dark place; and that he allowed them plenty of strong wine. Both Cælius and Celsus properly animadvert upon his treatment. Cælius also blames Diocles for admitting of venesection after the seventh day, and for approving of too acrid clysters. He finds fault with Themison for allowing too much food and wine at the commencement, and for using the bath indiscriminately. He condemns the practice of Heraclides, because he applied the treatment of the Empirics injudiciously, and admitted of bleeding from the frontal vein, which, Cælius says, is most prejudicial.

The treatment recommended by Octavius Horatianus is little different from that of the others.

The Arabians call the disease karabitus. The symptoms, according to Haly, are heat not much increased, but the head warmer than the rest of the body; alienation of the mind; watchfulness, but sometimes somnolency, from which state the patient wakes with starting; blackness of the tongue; picking at the bed-clothes; pulse in all cases weak, small, and hard. He is very minute on the treatment, recommending bleeding from the cephalic vein ad deliquium; cupping; gentle laxatives, such as prunes and tamarinds; vessels filled with cold water or snow applied to the head; in certain cases sinapisms to the feet; and, when watchfulness is protracted, applications to the head, containing poppies, mandragora, lettuce, &c. Alsaharavius particularly mentions general bleeding, bleeding from the temporal vein or the angular vein of the nose, pouring decoctions of refrigerant herbs over the head, and, when the insomnolency is obstinate, washing the temples with infusions of hyoscyamus, poppies, lettuce, &c. Avenzoar speaks of opening the artery in the head, an operation mentioned by Galen. Rhases directs us to pour vinegar and rose-oil from a height upon the head. His general remedies are similar to those of the others, namely, general and local bleeding, with gentle laxatives, such as myrobalans, prunes, and tamarinds. Serapion and Avicenna direct much the same treatment as our author.

SECT. VII.—ON PHLEGMON OF THE BRAIN.

When the brain is inflamed, it is often so swelled that the sutures of the skull are separated. The pain is very strong and permanent; there is much anxiety, and much redness of the countenance, with swelling; the eyes protrude, and the head swells. We must let blood from the arm, and also detract by the nose, and from the vessels below the tongue. We are also to use the fomentations suitable for inflammations of the head, and cataplasms of a moistening and concocting nature.

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COMMENTARY. This Section is taken from Aëtius (vi, 25), or Oribasius (Synops. viii, 11.) See also Avicenna (iii, i, 3, c. 4); Haly Abbas (Theor. ix, 4, and Pract. v, 14); Alsaharavius (Pract. i, 2, 9.)

The Arabians call it massera. Phlegmon of the brain, according to Haly Abbas, is attended with swelling of the brain, so as to occasion a separation at the sutures, redness of the face, acuteness of vision, and sympathetic affection of the stomach. He recommends bleeding at the arm, cooling laxatives, applications of cold things to the head, and so forth. The translator of Alsaharavius calls it ‘flegmon’ and ‘apostema in cerebro;’ says it is occasioned by a collection of corrupted blood in the vessels of the brain; and directs general bleeding, opening of the nasal vein, or of the sublingual. Avicenna’s account is nowise different from our author’s.

Hippocrates makes mention of sphacelus of the brain, which, he says, generally proves fatal in three days. (Aphor. vii, 48.) From the Commentary of Galen it would appear that by sphacelus he meant that state which is the result of an extreme degree of inflammation. Another of his commentators, Theophilus, states that by sphacelus was meant incipient mortification. (Ed. Dietz, ii, 537.) It was therefore a species of ramollissement. See an elaborate disquisition into the nature of the sphacelus of Hippocrates by Dr. Coray. (Ad Hippocrat. de Aer. &c. 64.)

SECT. VIII.—ON ERYSIPELAS OF THE BRAIN.

Erysipelas occurs also in the brain, and the patient suffers in the following manner: he has pain of the whole head, and feels as if there were fire in it; his face is cold and somewhat pale, and his mouth dry. Wherefore, bleed such a patient, and more particularly abstract blood from the veins under the tongue, and apply cooling things, such as we use in other kinds of erysipelas.

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COMMENTARY. Aëtius, Oribasius, Avicenna, Haly Abbas, and Alsaharavius treat of this disease in much the same terms as our author. Haly says there is less heat of the face than in phlegmon, nay, that the face even feels cold. Alsaharavius describes it as being accompanied with violent pain, much inflammation, and blackness of the face. He approves of the depletory treatment in general.

SECT. IX.—ON LETHARGY.

Lethargy, which is a lesion of the rational part, has the same seat as frenzy, I mean the brain, but the matter which causes it is of an opposite nature; for it is occasioned by a humid and cold phlegm irrigating the brain. It is attended with an obscure fever, which is not very pungent, and with somnolency. The pulse is large, rare, and undulatory; the respiration is very rare and weak. Lethargies are altogether disposed to sleep; are roused with difficulty; can scarcely be made to answer questions; are forgetful and delirious; they yawn frequently, and remain sometimes with their jaws distended, as forgetting to shut their mouths; their evacuations by the belly are generally watery, but sometimes, on the contrary, the belly is dry; their urine is like that of cattle. Some have tremblings and sweatings. Carus being occasioned by the same matter as lethargy differs from it in this, that fever precedes carus and is more violent, whereas it is subsequent in lethargy; and in this respect also, that carus often supervenes upon other complaints, for it often follows paroxysms of fevers, epilepsy, and compression of the brain, as from the bone in fractures, or from the meningophylax pressing upon the anterior ventricle of the brain; whereas lethargy has a certain peculiar formation.

The cure of lethargy. When the strength permits, we must open a vein; but, when it does not, we must use acrid clysters. We must also lay the patient in an apartment of large size, and having a moderate degree of light, and apply to the head an embrocation of oil to which castor has been added. Some, instead of the oil, use vinegar and rose-oil with the castor, by which they strengthen and warm the head at the same time. And, having anointed the rest of the body, particularly the extremities, with old oil, they stimulate them with calcined nitre, pellitory, pepper, or the granum cnidium. It is also possible, by making them into cerate with castor, to use them in this way. We must likewise apply strong-scented things, triturating thyme, marjoram, and pennyroyal, with vinegar. We may smear the mouth and palate with mustard pounded in a small quantity of honey, and we may even remove with the fingers the phlegm which adheres to it. And, if they will admit it, it is proper to use a masticatory consisting of oxymel with hyssop, pennyroyal, marjoram, or mustard itself. We may give also in their drink things of a diffusible nature, more particularly the diospolites, to the amount of a spoonful, with oxycrate. When there is chronic trembling, we must give two or three scruples of castor; or, if there be a redundance of humours, and there be nothing to contra-indicate the use of it, we may add a scruple of scammony to the castor. When the disease is protracted, the head must be shaved and fomented with salt, millet, and the like, in small bags; and sinapisms are to be applied to the whole head, and medicines used to excite sneezing. Afterwards we may apply dry cupping, with much heat, or cupping with scarifications, to the back part of the head. It will be necessary to attend to the natural evacuations by means of clysters and diuretics. Apply to the lower part of the belly an embrocation with oil of rue, or Sicyonian oil with some castor. We must also attend particularly to the deglutition, injecting, by means of a vessel with a narrow mouth, warm water, to which has been added some sweet potion, more especially apomel. And, if there be inflammation in the intermediate parts, we must cure it with embrocations and cataplasms. To the nose is to be applied mustard triturated with vinegar, or burnt castor. Their food should consist of ptisan, or the decoction of oats, or that of alica, with oxymel, salt, or pennyroyal, sometimes giving of it every day, and sometimes only every alternate day. After food, ligatures are to be applied to the extremities, which may also be bent back; and the limbs are to be pinched; and sometimes we may even tear the hair violently in order to rouse them. Rubefacients to the thighs and legs are also proper. When the affection is in the decline, we may enjoin suitable gestation, direct the bath to be taken, and a restorative regimen to be used properly.

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COMMENTARY. See Hippocrates (de Morbis, iii, 5); Celsus (iii, 20); Galen (Meth. Med. xiii); Aretæus (Cur. Morb. Acut. i, 2); Oribasius (Synops. viii, 1); Aëtius (vi, 3); Alexander (i, 14); Actuarius (Meth. Med. iv, 2); Nonnus (c. 22); Octavius Horatianus (ii, 2); Cælius Aurelianus (de Morb. Acut. i, 2); Avicenna (iii, i, 3, 7); Serapion (i, 17); Mesne (de Ægrit. Cap. 22); Haly Abbas (Theor. ix. 5, and Pract. v, 15); Rhases (Divis. c. 6, Contin. 1.)

The ancients, it will be remarked, ascribe the disease to serious congestion, which is a very plausible theory. All the other authorities recommend nearly the same treatment as our author.

There can be no doubt that by lethargus Hippocrates meant a remittent fever, resembling the causus. The other authorities on this subject also describe the disease as a febrile affection.

Aëtius, as usual, is minute and judicious. He remarks that purging is not only useful, by producing evacuation of the bowels, but also by occasioning revulsion. When the disease comes on after frenzy, he forbids venesection, but otherwise approves of it. He and Alexander strongly commend castor. Alexander directs venesection, if the patient’s strength permit; the application of vinegar and rose-oil to the head; and, when the disease is on the decline, applications containing castor and other such stimulants. It is to be remarked, by the way, that Haly Abbas states this as the mode of treatment directed by Alexander Aphrodisiensis, from which it may be inferred that A. Trallian and A. Aphrodisiensis were the same person.

Celsus speaks favorably of the affusion of cold water.

Aretæus gives the plan of treatment very circumstantially, but his chapter on the symptoms of lethargy is lost. He lays it down that the disease is the counterpart to phrenitis, being occasioned by a cold humour oppressing the brain. The principle of his treatment seems to be to produce revulsion; for which purpose he recommends drastic purgatives and stimulant applications of all kinds to the skin. He is guarded in speaking of bleeding.

The methodical treatment recommended by Cælius Aurelianus is not much different from that of the other sects. He approves of bleeding, of shaving the head, and applying cupping-instruments to it, or else leeches; of making the patient lie in a bright light; of using gentle means to rouse him; but he justly condemns Diocles for recommending measures of great severity, which, he says, will but increase the disorder of the brain. He also disapproves of the practice of Praxagoras, who gave wine and hot stimulants; and further ridicules him for neglecting the head, and merely applying fomentations to the feet. He does not approve of Asclepiades’ practice of treating the disease with strong sternutatories, sinapisms to the head, and analeptics. He finds fault with Themison for making his patient lie in a dark place. He also condemns Themison’s practice of giving aloes by the mouth before food, as it will make the food in the stomach spoil, that is to say, will interrupt the digestive process, or, in case of its not operating downwards, will be absorbed, and increase the constitutional disorder. He further disapproves of Themison’s practice of carrying gestation to an inconsiderate length. He likewise condemns the use of the cold bath, which had been recommended by Themison. He then gives an account of the practice enjoined by Heraclides Tarentinus, the empiric, which, of course, he does not approve of; although, judging of it from modern views, we do not think it particularly objectionable. We dare not enter upon the detail of it, owing to its length.

The Arabians generally treat of it by the name of sirsen frigidum. Like the other authorities, Haly Abbas states the causes of the disease to be a cold and humid intemperament of the brain, or a collection of pituitous humours. As stated above, he quotes the practice of Alexander with approbation. He particularly recommends acrid clysters, drastic purgatives, shaving the head, applying stimulants to it, rubbing the feet, and in certain cases sternutatories. Rhases does not mention venesection; but Avicenna and most of his countrymen do. Avicenna and Mesue recommend emetics. Their treatment otherwise, like our author’s, consists of acrid clysters, friction of the extremities, masticatories, calefacient and repellent applications to the head. With regard to the last, Mesue may be consulted with advantage. Rhases, in his ‘Continens,’ recommends bleeding, fetid pills, leeches, cupping, and afterwards sternutatories, friction of the extremities, and so forth.

SECT. X.—ON CATOCHUS, OR COMA VIGIL.

We have already, in treating of phrenitis, mentioned the formation of this disease, the symptoms whereof in general are the same as those of phrenitis and lethargy, being modified according to the prevailing matter. The peculiar symptoms are these: The patients remain fixedly stretched in a supine posture, having sometimes their countenance somewhat swelled and livid like those in lethargy, and sometimes with a florid redness in it; the upper eyelid seems drawn upwards and projecting, so that they cannot wink. They seem also not to breathe, but to be as dead. The pulse is small, indistinct, and very dense. The discharges from the bowels and bladder are suppressed, or in small quantities. When the attack is moderate, they drink whatever fluid is poured into the mouth; but those who are overpowered by it reject the same by the nose. Those, therefore, in whom the phlegm prevails over the bile, we distinguish from those affected with lethargy by this, that there is no swelling present, nor is the colour livid like lethargics, except to a very small degree; and that they perspire moderately. The cases are dangerous in which there is much watchfulness, the urine is suppressed, the difficulty of breathing is intense, when they have sweats, and the drink regurgitates by the nose. If it be a woman that is affected, the complaint may be distinguished from uterine suffocation by the circumstance that she lies in a natural state, is sensible when spoken to, can be roused, but sinks again into a state of sopor. Some say that catochus is a different complaint from the coma vigil, for that it has not a compound, but a simple cause; namely, a cold and dry matter which obstructs the posterior ventricles of the brain, and occasions the disease; in which case, the patient being suddenly seized with it, remains in the same posture as when taken with it, that is to say, standing or lying, with his eyes open or shut. The ancients, therefore, called such patients catochi, which signifies detained, but the moderns call the complaint catoche and catalepsy. The cure resembles that which is already described, but is to be varied according to the difference of the symptoms.

The cure of catochus. Wherefore we must have recourse to venesection, more especially when the face is ruddy, or if the strength does not contra-indicate, we must use clysters, sometimes stimulant, when phlegm prevails; and sometimes emollient when bile prevails. In like manner we are to apply other remedies, and give food sometimes every day, and sometimes only every alternate one. The affection is very dangerous when produced by an error of the food or drink, in which case the patient is to be made to vomit without delay, and kept upon a restricted diet; and the bowels are to be stimulated, and an embrocation with cumin or rue applied to the belly. They who have been seized with the complaint from intoxication, after their surfeit has passed off, must be cured by using a more liquid diet, such as the juice of ptisan. And the head is to be smeared with suitable ointments, which, if in summer, may be cold, but tepid, if in winter. If the surfeit do not pass off, nor the patient recover his senses, it will be time to give up the case as hopeless, and pack off.

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COMMENTARY. Most of the authors referred to in the preceding Section may be consulted on catochus, or catalepsy. It is called by the Arabians subet alsari. On the characters of the pulse in catochus, see Galen (de Causis Puls. iv, 16.) Nonnus and other authorities remark that it is accompanied with fever. Their general treatment consists of venesection; clysters of the decoctions of rue and cumin, with nitre and honey; epithemes applied to the belly; and fomentations of water and oil to the head. Haly says that the disease arises from a collection of phlegm on the brain; from pressure in cases of fracture of the skull; or from the projection of the internal plate of the cranium. His treatment is judiciously modified according to the nature of the exciting cause. He approves of sinapisms to the head, friction of the feet, and so forth. Alsaharavius recommends venesection when the exciting cause is a bilious humour, but forbids it when the disease arises from a collection of phlegm. His treatment is judicious, but not much different from our author’s. (Pract. i, 2, 13.) Rhases’ general remedies are clysters, purgatives, restricted diet, and, if indicated, bleeding at the arm or ancles.

Cælius Aurelianus describes the disease with his usual accuracy. He says it occurs in cases of continual, intermittent, and ephemeral fevers. The symptoms, as detailed by him, are acute fever, loss of speech, dulness of the senses, pulse large, strong, and full, and the eyes fixed. With regard to his treatment, he says nothing of venesection, but approves of fomentations to the head of sweet tepid oil; and mentions common clysters, cataplasms to the loins, in order to relieve the retention of urine; shaving the head, and applying cupping-instruments to it, scarifications along the occiput, baths, fomentations of oil, &c. He disapproves of the practice of Chrysippus and Themison, who recommended stimulant ointments to the head, shaving the head, and applying sinapisms to it with sternutatories and acrid clysters.

SECT. XI.—ON THE LOSS OF MEMORY AND OF REASON; ON CARUS AND FATUITY.

The loss of memory sometimes occurs by itself, and sometimes along with impairment of the reason, as an impairment of the reason sometimes happens first by itself, and is then followed by that of the memory. When both suffer, the affection called fatuity is formed. These complaints have for a cause the exciting intemperament; but, if it is humid only, it will occasion impairment of the memory and reason, torpidity, drowsiness, long and deep sleep; but if complicated with coldness, it will produce carus and lethargy. In like manner, dryness alone brings on watchfulness, but when joined with heat, delirium and frenzy. These intemperaments are seated sometimes in the fluids, sometimes in the cavities of the brain, or in its vessels; or in the chyle diffused over the system, or in the substance of the brain; or else the temporal muscles may be affected. If the humours are mixed together, they will produce this affection. Whether the exciting intemperament be simple or compound may be learned from the appearance of the excretions. That the loss of memory and of reason springs from cold we readily ascertain; but whether it be accompanied with humidity or dryness, we judge of from the discharges, the habit and temperament of the patient, his mode of life, the season, and the country.

The cure. If the intemperament be cold, we must warm, but if accompanied with humidity, we must also dry; but if with dryness, we must, at the same time, moisten and warm. In like manner, when the intemperament is warm, we must cool; but if dryness also prevail, we must likewise moisten; or if humidity, we must both cool and dry. Where we find a sanguineous humour prevailing, we must bleed or use acrid clysters, then give hiera, and use masticatories; anoint the head, by mixing with oil things of a cooling and desiccative nature, we mean roses, myrtles, lentisk, and the like; and we must attend to the general system. But, if it proceed from an over-heat and fatigue, we must apply to the head the embrocation of vinegar and rose-oil; and otherwise use a cooling and moistening regimen in all respects, and with regard to food and drink. If carus supervene upon fatuity or oblivion, it also is to be attended to as formerly mentioned under the head of lethargy, where we also stated the discrimination between these complaints.

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COMMENTARY. See most of the authors on lethargy and catalepsy.

Nonnus says that carus resembles apoplexy, only that in the latter disease the posterior ventricle of the brain is more especially loaded with serum, whereas in carus the anterior is affected. It differs also, he says, from lethargy, in this respect, that fever precedes carus, but is subsequent to an attack of lethargy. Carus, he adds, is occasioned by a blow, pain of the head, and fracture of the bone compressing the brain. Alexander also says that, in carus, the anterior part of the brain is most affected; and hence the sensorial powers are much impaired. It is occasioned, he says, by violent pains which dissipate the vital spirits. On the cure of loss of memory, see Galen (de Loc. Affect. iii, 5.)

Avicenna has treated at great length of the subjects of this Section. Among other things he recommends the celebrated theriac, which contained a very diffusible stimulant oil. His treatment otherwise resembles our author’s. The same may be said of Haly Abbas. For loss of memory, Alsaharavius recommends the application of fragrant and stimulant oils to the head, along with general treatment.

Cælius Aurelianus and Octavius have not treated of carus by name; but, according to Prosper Alpinus, the Methodists entertained similar opinions of the disease to the other sects. (De Med. Meth. x, 5.)

Procopius states that carus was a common symptom of the fatal plague which prevailed in the reign of Justinian. (Persic. ii.)

The philosophers, as well as the physicians, taught that loss of memory is often connected with disease of the posterior portion of the brain. See, in particular, the Commentary of Philoponus on Aristotle (de Anima, i.)

SECT. XII.—ON VERTIGO.

Vertigo is occasioned by a cold and viscid humour seizing upon the brain, whence the patients are ready to fall down from a very slight cause, such as sometimes from looking at any external object which turns round, as a wheel or top, or when they themselves are whirled round, or when their head has been heated, by which means the humours or spirit in it are set in motion. And sometimes it is occasioned by the anterior cavities of the brain being compressed in perforations of the skull for fractures, in which cases there are violent pains. When it is a primary affection of the head, it is preceded by strong pain in the part, by drowsiness, and noises in the ears; and some have either the sense of smell or of taste impaired. But in those cases which arise from sympathy with the orifice of the stomach, heartburn accompanies and nausea follows.

The cure. Those affected with vertigo are to be roused at the onset, by using strong-scented things of a suitable nature, by frictions, and such like; and, during the remission, for the recovery of the complaint, they ought first to be bled, and then purged with hiera. And after an interval we must use an acrid clyster of centaury, or the decoction of colocynth. After such evacuations, we are to apply to the back part of the head cupping-instruments with scarifications, and afterwards use masticatories and sternutatories. When there is heat in the head and noises in the ears, inasmuch as they are occasioned by hot vapours diffused in the arteries, we must have recourse to anteriotomy behind the ears, as will be described when treating of surgical matters.

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COMMENTARY. See Galen (de Loc. Affect. iii, 12); Aretæus (Morb. Chron. Curat, i, 3); Aëtius (vi, 7); Oribasius (Synops. vi, 5); Actuarius (Meth. Med. vi, 2); Nonnus (35); Cælius Aurelianus (Morb. Chron. i, 2); Octavius Horatianus (ii, 2, 3); Serapion (i, 3); Avicenna (iii, 1, 5); Mesue (ii, 13); Haly Abbas (Theor. ix, 5; Pract. v, 20); Alsaharavius (Pract. i, 2, 6, 7); Rhases (Divis. 5; Contin. 1.)

Galen agrees with Archigenes that vertigo may either be a primary affection of the brain, or may proceed from sympathy with the mouth of the stomach. Archigenes pretended to distinguish between the two cases in the manner described by our author, that is to say, when the disease is preceded by noises in the head, stupor, loss of the sense of smell, or of any other sense, he concluded that the disease was a primary affection of the brain; whereas, if preceded by nausea and heartburn, he believed that it had its origin in the stomach.

Aretæus details the treatment with great minuteness. He recommends restoring any suppressed secretion, bleeding at the arm, cupping, opening the frontal or nasal veins, sternutatories, emetics of hellebore and the like; cold applications to the head, friction of the extremities, gestation, walking, restricted diet, the cold bath, but not the hot. Aëtius, in an extract from Posidonius, treats of the disease in much the same terms.

Cælius Aurelianus recommends the same treatment as for cephalæa. Octavius approves particularly of hellebore.

Serapion directs us to open the arteries behind the ears, which practice, however, Galen had pronounced to be less useful than some had represented. Mesue makes mention of leeches to the nose, and medicines for renewing the menstrual and hemorrhoidal discharges when suppressed. Avicenna speaks of the actual cautery. (See Book Sixth, Sect. I, of this Work.) Vertigo, according to Haly Abbas, may arise from a pituitous or sanguineous plethora of the cerebral vessels, or from compression occasioned by fracture. He approves of general and local bleeding only when there is a plethora of blood. In other cases he recommends drastic purgatives, aromatic stimulants, masticatories, and sternutatories. His treatment is judiciously modified according to the nature of the exciting cause. Alsaharavius recommends opening the arteries behind the ears, strong purgatives, clysters, gargles, and hot plasters, containing mustard, and the like. Aaron, one of Rhases’ authorities, decidedly inculcates that vertigo may either be connected with disease of the brain or of the stomach. He principally recommends bleeding and purging, and also speaks favorably of cupping the nape of the neck.

SECT. XIII.—ON EPILEPSY.

Epilepsy, being a convulsion of the whole body with impairment of the leading energies, has its cause seated sometimes in the brain itself, and sometimes in its cavities. This is sometimes a pituitous and sometimes a melancholic humour. The disease also sometimes arises from sympathy with the orifice of the stomach (as happens in colic affections, as will be stated when treating of them); and sometimes it is propagated from other parts, when a cold aura ascends to the brain, either from the leg or the fingers of the hand. It has also been seen to proceed from the uterus in females, at the time they were pregnant, for after delivery it ceased. This disorder attacks mostly the young, more especially infants, and after them boys and adults; but least of all elderly persons and the old. Its precursors are, an involuntary commotion, both of mind and body, despondency, oblivion of accustomed things, terrifying visions in dreams, headach, continued fulness of the head (especially from acute anger), paleness of countenance, and a distorted motion of the tongue, so that some even bite it. When it proceeds from the stomach, palpitation thereof goes before, with rumbling and aching pain; and when fasting, or during a delayed meal, they fall into a paroxysm. When the attack comes on they suddenly fall down, are convulsed, and sometimes utter inarticulate cries. The characteristic mark of these cases is foaming at the mouth, all the other symptoms being common to other diseases. In certain instances the urine and fæces are evacuated involuntarily, and in some the semen also. In some cases, when the disease is very acute, it proves fatal speedily, by the continuance of the paroxysms, or the violence of the attack; but it is most frequently protracted, so that, if it be not removed by the attainment of manhood, by purging, or pregnancy, or if it invade after this period of life, it for the most part does not leave a man until death, unless removed by a suitable cure. The following substances are used to prove epilepsy, namely, the fumes of bitumen, or gagate-stone, or goats’ horn, or the liver of a buck-goat when eaten, or the smell of the roasted liver.

The cure. When the patient is an infant, we need not be particularly solicitous about it; for when its age changes to a more bilious and drier constitution, and the diet is more prudently regulated, the affection most commonly goes off spontaneously. But we must attend to the diet not only of the infants, but likewise of their wet-nurses. After boyhood, those that fall into the disease ought to have the convulsed and distorted parts freely anointed, and ligatures applied to them, when they are to be stretched out; and then the mouth is to be opened, and one must introduce a finger or a feather, smeared with oil of iris, in order to bring away the phlegm. We must also rouse the senses by strong-smelling things, such as hog’s fennel, Cyrenaic juice, bitumen, and the pitch of cedar. But after the paroxysms, if nothing prevent, we must bleed from the arm; and when the paroxysm does not abate, we must apply a sinapism to the extremities, and a cupping-instrument to the hypochondria. When after these things no remission takes place, there can be but little hope, and yet the physician ought boldly to force castor into the mouth, and Cyrenaic juice, with honey and vinegar; and the decoction of centaury, or of colocynth, must be injected by the anus. Those that are recovering from an epileptic attack are to be evacuated after recovery by purging with hiera. This is the cure of a recent and acute attack of epilepsy. We will next deliver the treatment of the disease when it is in a chronic state. Wherefore the patients are to be made to persevere for a long time in drinking cold water; and when setting about the cure, it will be proper to bleed if nothing prevent; and after an interval of four or five days to recruit the body, and thus evacuate with a purgative, more especially black hellebore, colocynth, or scammony. The hellebore, without its medullary part, is to be pounded and strained, and sprinkled on five or six cyathi of honied water, or it may be taken in boiled honey with some pepper. Rejecting the seeds of the colocynth, fill it, still retaining the medullary part, with must, and allow to remain for a whole night; in the morning dilute the must, and give to drink. Or we may use the cathartic from white hellebore. It is this: Of cleansed bay berries, dr. viij; of white pepper, dr. viij; of alypias, dr. viij; of euphorbium, dr. viij; of white hellebore, dr. viij. Give these things at one dose, with the must in the colocynth, and it will evacuate well by vomiting. After proper purgation let them be put into the bath, and on the third day cup the hypochondria and back with scarifications; and then, stopping for a sufficient number of days and recruiting the body, give the hiera from colocynth; and afterwards apply the cupping instrument to the head and nape of the neck, and the day following a cataplasm consisting of bread boiled in honied water, and pounded with bitter almonds, wild thyme, mint, calamint, or rue. This must be done for three days. Afterwards the head is to be shaven and rubbed with the juice of hog’s fennel dissolved in vinegar, wherein cow-parsnip has been boiled; then, after stopping and recruiting the body, nine oboli of the antidote from colocynth are to be given in honied water; and, again, after an interval of some days, the antidote is to be repeated, and sternutatories used. After five or six days give castor in honied water; then stopping again administer a clyster of centaury and colocynth; and afterwards give the hiera again, and use masticatories and errhines in order, and apply a sinapism to the head. Acrid food must be seasonably given. Benefit may be obtained from oxymel of squills drunk every day, and honey in which the squill has been softened, to the amount of a spoonful. The diet should be of an incisive and attenuant nature; and therefore capers may be frequently taken with pickle. But they ought to abstain from flesh, pulse, and much wine, likewise from frequent venery, baths, mustard, and from drinking immediately after the bath, more especially of undiluted wine. Let them have recourse to gymnastic exercises and friction, and the last part that is rubbed should be the head.

On the cure of epilepsy from the stomach. If the disorder is occasioned by the stomach’s being primarily affected, the patient must attend to his digestion, taking about the third hour some carefully-baked bread that has been soaked in some diluted wine, slightly astringent, and of a white colour. Give to such persons the medicine from aloes twice or thrice every year. “I once knew a boy,” says Galen, “who was never seized with epilepsy after he carried a large piece of fresh peony appended from his neck.” Agaric is beneficial to epileptics, also hartwort, the fruit and root of cow-parsnip, and the round birthwort drunk with water. Scarification of the legs frequently repeated is also of great use.

On epilepsy proceeding from some of the members. When the attack is threatened, and they feel a sensation in the part, whether the hand or foot, a tight ligature ought to be applied above it, and the cure attempted during the remissions, by applying some caustic substance to the part, such as the garden cresses (lepidium), preparations from cantharides, and the like. The Julian oxymel is also of great use to epileptics, by expelling the offending matter from the part. After those things which have been mentioned, the theriac and natural baths have place. During their whole life, they must particularly guard against indigestion, and be careful not to take food before digestion has been performed; avoid all incrassating food, too long abstinence from food, all vehement venereal impulse, much wine, and drinking, after the bath, more especially of undiluted wine, as formerly mentioned, and likewise of old and thick wines. They must avoid, also, all aromatics of an acrid smell, and such as fill the head; must abstain from looking down steadfastly from a high situation, from remaining long in the bath, and exposing the head to the heat of the sun.

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COMMENTARY. Consult Hippocrates (de Morbo Sacro); Galen (de Sympt. Diff. 3; De Loc. Affect. iii, 11; De Puero Epileptico); Oribasius (Synops. viii, 3); Aëtius (vi, 13); Aretæus (Morb. Acut. i, 5; Morb. Chron. i, 4); Pseudo-Dioscorides (Euporist. i, 21); Alexander (i, 15); Leo (6); Actuarius (Meth. Med. i, 16); Nonnus (36); Serenus Samonicus; Scribonius Largus (12); Apuleius (Apologia); Celsus (iii, 23); Octavius Horatianus (ii, 2); Isidorus (Orig. iv, 8); Pliny (H. N. xxv, 5); Avicenna (iii, i, 5, 9); Serapion (i, 23); Haly Abbas (Theor. ix, 6; Pract. v, 21); Alsaharavius (Pract. i, 2, 36); Avenzoar (i, 9); Mesue (de Ægr. Cap. 26); Rhases (Div. 7, alibique.)

Our author derives his principles of treatment, more especially with respect to regimen and diet, from Galen’s directions for the management of an epileptic boy. Part seems also to be borrowed from Oribasius.

Hippocrates with great good sense rebuts the popular belief of his own times, that the epileptic paroxysm is produced by demoniacal influence. He justly remarks, that the inferior animals, such as goats, are subject to this complaint; and that in them it is found to be occasioned by water in the brain. It is almost certain that the morbus sacer of the ancients, and the disease under which the demoniacs laboured was epilepsy. See Athenæus (Deipnos. vii, 33), with the notes of Casaubon and Schweigh.; also Coray (ad Hippocrat. de Aq. &c. 12.) Leo, in fact, says expressly, when treating of epilepsy, that the vulgar call the disease the demon and lunacy; and in like manner Aretæus mentions that some refer the disease to the moon. See further Galen (Introductio); Dietz (ad Hippocrat. de Morbo Sacro); and Greenhill (Adnot. ad Theophil. v. 30, p. 340.)

Celsus lays down his rules of treatment with his usual judgment and elegance. His practice is very similar to our author’s. He recommends bleeding; purging with black or white hellebore; shaving the head and applying cupping-instruments to it, and, in desperate cases, even the actual cautery; also friction of the extremities, and bleeding in the foot, along with attention to exercise and diet. The use of hellebore in epilepsy is mentioned by Pliny, and by Aulus Gellius (Noct. Attic. xvii, 15.)

The poet Lucretius gives a very glowing and accurate description of the symptoms and causes of epilepsy. (De Rerum Natura, iii, 485.)

Aretæus delivers separately the treatment of an acute attack and of the disease when in a chronic state. For the former he recommends the general remedies (we mean bleeding, clysters, and emetics.) Among the medicines enumerated by him for the cure of epilepsy, he mentions copper, which, he says, when given with cardamon, will act either upwards or downwards. We need scarcely say that copper has been strongly eulogised in modern practice. In the treatment of chronic cases he pays particular attention to the head, opening the veins and arteries of it, boring the bone down to the diploe, and applying the actual cautery to it. A more rational and less dangerous procedure was the application of embrocations containing cantharides and other such rubefacients to the scalp; in that case he recommends milk to be drunk beforehand, to prevent the bladder from being affected.

Aretæus and most of the authorities mention the gagate stone or jet as a test of epilepsy. The smell of it was said to bring on an attack. He exclaims in affecting terms against the abominable means often had recourse to for the cure of this disease. And so also Pliny (H. N. xxviii, 2.)

Aëtius, Oribasius, Actuarius, and Alexander treat the disease upon the same principles as our author. Alexander, although otherwise a most judicious and original writer, expresses great confidence in the use of amulets, for the preparation of which he gives very minute directions. Jasper is particularly commended as an efficacious amulet. One of his amulets is the nail taken from the arm of a malefactor who had been crucified! In his general treatment he particularly approves of giving drastic purgatives and emetics.

Isidorus thus defines epilepsy: “Epilepsia vocabulum sumpsit quod mentem apprehendens pariter etiam corpus possideat. Fit autem ex melancholico humore quoties exuberaverit, et ad cerebrum adversus fuerit.”

No ancient author has treated of epilepsy more accurately than the great Methodist Cælius; but his account is so long and minute, that it is impossible for us to do justice to it in an abridgment. The causes of the complaint which he enumerates are drinking too much wine, indigestion, compression of the brain, and frights. He says that the whole nervous system is affected, but especially the part seated in the head. When the patient is an infant, he properly directs us either to change the nurse, or to pay particular attention to her diet. Bloodletting he approves of on a first attack, unless the stomach be loaded with crudities; and if there be pain in any part of the head, he directs leeches to be applied to it. He recommends gargles, and rubbing the skin with substances which occasion an eruption of pustules. He enjoins great caution in the use of hellebore. He approves of gentle exercise, a light diet, abstinence from wine, change of scene, or a sea-voyage. With respect to the modes of treatment pursued by the other sects, he greatly disapproves of the application of fire and other hot things to the head, and of strong sinapisms to the other parts of the body. Escharotics applied to the head, he says, only increase the disorder; and the use of bull’s blood, or that of a man recently killed, and other such ridiculous remedies, he properly treats with contempt. He disapproves of diuretics, and of hellebore, scammony, and the like, when administered indiscriminately. He speaks unfavorably of chalybeates.

The Arabians follow closely the views of their Grecian masters, without suggesting any material improvement. Haly Abbas says that epilepsy is a convulsion which either comes on periodically, or at no stated times; and that it either arises from the brain itself, or from sympathy with the stomach, or with some other parts of the body. It is occasioned, he says, either by a gross humour collected in the ventricles of the brain, or from compression produced by fracture. He makes mention of the epileptic aura, and, like our author, states that the disease is distinguished by foam at the patient’s mouth. He joins Hippocrates in pronouncing such cases as occur before puberty to be not difficult to cure, but those which supervene after that age to be most intractable. When the complaint occurs in an infant, he properly directs us to attend both to the nurse’s and the infant’s diet. In cases attended with plethora he approves of general bleeding, cupping the limbs, and opening the saphena. When the disease is protracted he advises to apply cupping-instruments to the neck, and to give drastic purgatives, such as black hellebore, colocynth, &c. When it appears to proceed from the stomach he approves of emetics. He commends peony applied as an amulet. It is worthy of remark that Andreas Laurentius, in the 17th century, speaks confidently of this remedy. So inveterate is the dominion of superstition and ignorance! Alsaharavius gives a curious account of epilepsy, but mixed with some superstitious notions. He says he had had ocular proof that epileptics are possessed with demons; for that he had known many of them who had a knowledge of things which he was sure they had never learned. Like the others, he speaks of amulets; but his general treatment is sufficiently rational and scientific.

Rhases gives the theories and practice of preceding authors along with his own remarks, which, however, contain no very original opinions. One of his Arabian authorities recommends bleeding at the arm, and also by cupping and opening the occipital arteries, rubbing the head with mustard, purging with hiera, sternutatories, &c. The application of mustard to the head is approved of by most of his authorities.

Like our author, most of the ancient writers approve of Cyrenaic juice, or assafœtida, in cases of epilepsy.

SECT. XIV.—ON MELANCHOLY, MANIA, AND DEMONIACS.

Melancholy is a disorder of the intellect without fever, occasioned mostly by a melancholic humour seizing the understanding; sometimes the brain being primarily affected, and sometimes it being altered by sympathy with the rest of the body. And there is a third species called the flatulent and hypochondriac, occasioned by inflammation of the parts in the hypochondria adjoining to the stomach, by which sometimes noxious vapours or auræ are transmitted to the brain, and sometimes part of the substance of the humour. The common symptoms of them all are fear, despondency, and misanthropy; and that they fancy themselves to be, some, brute animals, and imitate their cries; and others, earthen-vessels, and are frightened lest they be broken. Some desire death, and others are afraid of dying; some laugh constantly, and others weep; and some believe themselves impelled by higher powers, and foretell what is to come, as if under divine influence; and these are, therefore, properly called demoniacs, or possessed persons. The peculiar symptoms of melancholy, from sympathy with the general system, are leanness, darkness, and shagginess; the whole appearance melancholic, either by nature, or acquired by anxiety, want of sleep, the administration of noxious food, or stoppage of the hemorrhoidal, or menstrual discharge. Melancholy, from affection of the hypochondria, is indicated by indigestion, acid eructations, heat and heaviness of them, retraction of the hypochondria, and sometimes inflammation, especially in the beginning; and then, when they increase, melancholic symptoms supervene. These are relieved by digestion, or copious discharges, or flatus, or vomiting, or eructations. When none of these symptoms, or very few of them, are present, melancholic symptoms appearing indicate that the brain is primarily affected, and for the most part from a melancholic humour. When the complaint is occasioned by yellow bile, which, by too much heat, has been turned into black, it will bring on the disease called mania, which occasions ungovernable madness, so that those affected with it will destroy persons who come near them unguardedly.

The cure of melancholy. Those who are subject to melancholy from a primary affection of the brain are to be treated with frequent baths, and a wholesome and humid diet, together with suitable exhilaration of mind, without any other remedy, unless when, from its long continuance, the offending humour is difficult to evacuate, in which case we must have recourse to more powerful and complicated plans of treatment. These cases are to be purged from the first with dodder of thyme (epithymus), or aloes; for if a small quantity of these be taken every day, it will be of the greatest service, and open the bowels gently. After purging, as we have mentioned, give wormwood, sometimes macerating and boiling the herb in water to the amount of two cyathi, and sometimes diluting the juice with water, to the amount of half a drachm, and giving it frequently. Let them drink of the most acrid vinegar before going to sleep, and dip, for the most part, their condiments in it before eating them. But it will be better if to the vinegar be added squills, poley, or the slender birthwort. When you meet with an incipient case of the complaint, from sympathy with the general system (as described above), and the body is firm, you must, by all means, begin with phlebotomy, and after phlebotomy, when the strength is recruited, purge downwards, with the wild cucumber, and the composition from the black hellebore, and promote the hemorrhoidal and menstrual discharges, if the affection be occasioned by retention of them. Diuretic remedies are likewise proper, as also evacuations by perspiration. But if the complaint arise from disorder of the hypochondria, we must attend to them, and foment them with a decoction of rue, dill, wormwood, pennyroyal, the seed of the chaste-tree, and of the fruit of the bay-tree; for these soothe the pains and diminish flatulence. They may be boiled in oil and applied; and the cataplasms of them ought to contain the remedies for flatulence, namely, parsley, or anise, or cumin; and it will not be improper to add cyperus, iris, and frankincense, to the cataplasms. These things are to be allowed to remain in general, even during the day, and whether the patient eat or fast; and, when taken away, apply some other protection, such as a broad piece of wool. Use dry-cupping for flatulence, and cupping with scarifications for pains and inflammations. While directing your attention to the cure, you must not forget mustard, and apply acrid smegmata and calefacient plasters to the back and belly. In chronic cases, the most powerful remedy is evacuation, by vomiting with hellebore. The diet for all melancholics should be wholesome, and moderately moistening; abstaining from beef, roe’s flesh, dried lentil, cabbages, snails, thick and dark-coloured wines, and, in a word, from whatever things engender black bile.

The cure of mania. Persons affected with mania are to be treated like melancholics; and, in particular, we must apply to the head rose-oil, or rose-oil with vinegar, and purge with the bitter antidote called hiera, having previously bled them; and we must use leeches to the head. But nothing is of such service as horse-fennel, either the root or seed drunk in water. A drachm of the root of bryony with water may be taken every day. If the maniacs will not be persuaded to take the purgative medicines, they must be mixed with their food, in a concealed manner, such as with mouthfuls of meat, or dried figs, or dates, or else with their drink. But, above all things, they must be secured in bed, so that they may not be able to injure themselves, or those who approach them; or swung within a wicker-basket in a small couch suspended from on high.

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COMMENTARY. Consult Hippocrates (Aphor.); Galen (Comment. in Aphor., de Morb. Vulg.); Celsus (iii, 18); Aretæus (de Morb. Chron. i, 6, and de Curat. Morb. i, 5); Aëtius (vi, 8); Nonnus (32); Oribasius (Synops. viii, 17); Alexander (i, 16); Actuarius (de Dig. Morb. ii, 34); Octavius Horatianus (ii, 2, 5); Mesue (de Ægr. Cap. 34); Serapion (i, 22); Avicenna (iii, 1, 4); Avenzoar (i, 9, 16); Haly Abbas (Theor. ix, 7; Pract. v, 23); Alsaharavius (Pract. i, 2, 27); Rhases (ad Mansor. ix, 13; Contin. 1).

Hippocrates, in his Aphorisms, points out the lower intestines as the seat of melancholy, and directs us to cure the complaint by purging. Galen, in his Commentary, agrees with his principles and practice. Galen states correctly that melancholy sometimes changes to epilepsy, and vice versa, that epilepsy is often succeeded by melancholy. (De Loc. Aff. iii, 10.) He gives a curious extract from the works of Diocles, with remarks upon the same.

Aretæus considers melancholy as an incipient mania. He gives a masterly sketch of the different modes in which mania makes its attack, and relates an interesting case of a joiner, who was perfectly sound while engaged at his work, but no sooner left the place where he was occupied than he became mad. For the cure of melancholy he advises blood to be abstracted at the commencement, according to the patient’s strength and condition. He approves then of giving black hellebore, and of applying cupping-instruments over the liver, stomach, or to the head, according as these may happen to be affected. He recommends then wormwood and aloes. When the menstrual or hemorrhoidal discharges are stopped, they are, if possible, to be restored; and for this purpose blood may be abstracted from the ancle, or even from the arm. He also approves very much of the natural hot baths.

Celsus, in cases of melancholy and mania, recommends in particular vomiting and pinging by hellebore; with the black species, if the patient is affected with grief; but with the white, if with gladness. He also approves of bleeding.

Aëtius gives an interesting account of the treatment of melancholy, principally extracted from the works of Galen, Ruffus, Posidonius, Archigenes, and Justus. The remedies which all of them seem to have reposed most confidence in are drastic purgatives combined with bitters and carminatives. They approve, however, of general bleeding and cupping, when indicated by the symptoms of the complaint, and the state of the patient. Nonnus in like manner prescribes bleeding in the forehead, purging with hiera picra, acrid clysters, and bitters, such as gentian and stæchas (lavendula stæchas.)

Alexander’s plan of treatment is very circumstantially detailed; but it differs very little from our author’s, except that he recommends Armenian bole instead of white hellebore. Like Aretæus, he strongly commends the use of the hot bath for the cure of melancholy. He speaks highly of a well-regulated diet, consisting principally of rock fishes, domestic fowls, and emollient pot-herbs, such as lettuces, mallows, and the like. He forbids cabbages, beef, the flesh of stags and of all other wild animals. Instead of hellebore, Serapion and Avicenna particularly praise the lapis lazuli. Haly Abbas gives a graphic delineation of the bizarre fancies, absurd fears, hopes, and vain imaginations of melancholics and maniacs. Like the other authorities, he attributes the disease to the prevalence of black bile. Without doubt, as has been often remarked, the alvine discharges in such cases are dark-coloured; and this, no doubt, gave rise to the ancient opinion that the disease originates in black bile. When the patient is young, and of a hot temperament, Haly abstracts blood from the arm or temples. He approves particularly of hot drastic purgatives, such as black hellebore, scammony, agaric, and the like. He also gives poppies, lettuces, &c. to compose the patient. He recommends cholagogues, such as the decoction of wormwood, and the like. But his treatment is too minutely and circumstantially detailed to admit of its being done justice to within our narrow limits. The same may be said of the account given by Alsaharavius. Rhases in certain cases approves of venesection for the cure of melancholy. When connected with dyspepsia, he recommends emetics and purgatives, especially black hellebore. He also approves of the tepid bath.

We must now mention the opinions of the Methodists. In cases of melancholy Cælius Aurelianus disapproves of aloes and wormwood, as acting too violently; and also forbids venesection and purging with hellebore. On the contrary, he recommends astringent articles of food, and astringent applications containing galls, alum, hypocistis, &c. to be laid over the stomach. Of mania he gives a fuller account, replete with much valuable matter, that does not readily admit of abridgment. He enumerates many existing causes of the complaint, such as intoxication, inordinate passions, indigestion, exposure to the sun, suppression of the hemorrhoidal and menstrual discharges, and the like. Maniacal persons, he says, are differently affected, one believing himself a cock, another a tile, another a god, another an orator, and such like ridiculous fancies. He then inculcates the important fact that the affection of the mind is always secondary, and not primary, as some had supposed. His moral and medical treatment is of the most emollient kind; and he enjoins retirement and quietude. When the patient’s strength will permit, he approves of venesection, the application of cupping-instruments to the head, and leeches to any other parts of the body which may be particularly affected. He commends strongly the bath of oil and the natural hot baths. He also approves of hellebore. He condemns the practice of the other sects in many respects. He does not approve of abstracting blood from both arms, so as to produce deliquium, nor of keeping the patient constantly in a dark place, nor of opening the temporal artery. He disapproves of applying narcotic fomentations to the head. He properly forbids all corporal punishment, although he approves of contradicting the whims of the maniac, and of reasoning him into a better train of thought.

Isidorus thus distinguishes epilepsy, melancholy, and mania: “Epilepsia autem in phantasia fit, melancholia in ratione, mania in memoria.” (Orig.)

The use of hellebore in mania and melancholy is often alluded to in the works of the Latin Classics. See, in particular, Horace (Sat. ii, 3); Perseus (Sat. iv, 16.) We are inclined to think that it was the black hellebore which was given in Anticyra. See Dioscorides (iv, 146.)

Cicero makes some pertinent remarks on the distinction between mania and melancholy. (Tusc. Disp. iii, 5.)

SECT. XV.—ON INCUBUS, OR NIGHTMARE.

Some say that this disorder is called ephialtes in Greek, from the name of a man, or from those in it fancying as if one leaped upon them. But Themison, in the tenth book of his Epistles, calls it pnigaleon, from a Greek word signifying suffocation. It attacks persons after a surfeit, and who are labouring under protracted indigestion. Persons suffering an attack experience incapability of motion, a torpid sensation in their sleep, a sense of suffocation, and oppression, as if from one pressing them down, with inability to cry out, or they utter inarticulate sounds. Some imagine often that they even hear the person who is going to press them down, that he offers lustful violence to them, but flies when they attempt to grasp him with their fingers. The evil must be guarded against at the commencement; for when it continues long, and attacks every night, it is the forerunner of some serious disease, such as apoplexy, mania, or epilepsy, when the exciting cause is determined to the head; for such as persons affected with epilepsy are, during the day, those labouring under nightmare are in their sleep. We must evacuate the patient’s general system by opening a vein and administering purgatives. Black hellebore is especially serviceable to such persons when given to the amount of a drachm, if three oboli of scammony, and some of the aromatics, such as anise, wild carrot, and Macedonian parsley, be mixed with it. The composition called hiera, from wild gourd, is also of great service; it is the hiera of Ruffus. The diet should be light, and they ought to avoid everything that is flatulent. They are benefited also by the fruit of peony: fifteen of the black grains of which may be pounded with water and drunk frequently.

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COMMENTARY. See Aëtius (vi, 12); Oribasius (Synops. viii, 2); Actuarius (i, 16); Cælius Aurelianus (Tard. Pass. i, 3); Psellus (Opus Medicum); Avicenna (iii, 1, 5, 7); Alsaharavius (Pract. i, 33); Rhases (ad Mansor. ix, 12, Contin. i.)

The other ancient authors treat the complaint, like our author, by evacuants. Bleeding (Rhases recommends this to be done at the ancle), drastic purgatives, and friction of the extremities are the common remedies. Alsaharavius says that, if not cured by bleeding, it is to be treated, as epilepsy, with hiera and the like. Even Cælius in this case nearly agrees with the others, recommending restricted diet, and, if the disorder is great, venesection. He also approves of applying cupping-instruments with scarifications on the side of the throat, and, when the disease is protracted, of emetics, and shaving the head. For the cure of incubus, Mesue and Rhases recommend bleeding and an attenuant diet. Ruffus, as quoted by the latter, recommends vomiting, purging, an attenuant diet, sternutatories, masticatories, and ointments to the head, containing castor and the like.

Psellus gives a very graphic description of incubus. (Op. Med.)

SECT. XVI.—ON LYCAON, OR LYCANTHROPIA.

Those labouring under lycanthropia go out during the night imitating wolves in all things, and lingering about sepulchres until morning. You may recognize such persons by these marks: they are pale, their vision feeble, their eyes dry, tongue very dry, and the flow of the saliva stopped; but they are thirsty, and their legs have incurable ulcerations from frequent falls. Such are the marks of the disease. You must know that lycanthropia is a species of melancholy which you may cure at the time of the attack, by opening a vein and abstracting blood to fainting, and giving the patient a diet of wholesome food. Let him use baths of sweet water, and then milk-whey for three days, and purging with the hiera from colocynth twice or thrice. After the purgings, use the theriac of vipers, and administer those things mentioned for the cure of melancholy. When the disease is already formed, use soporific embrocations, and rub the nostrils with opium when going to rest.

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COMMENTARY. See Aëtius (vi, 11); Oribasius (Synops. viii, 10); Actuarius (Meth. Med. i, 16); Anonymus (de Lycanth. ap. Phys. et Med. Min.); Psellus (Carm. de Re Med. ibid.); Avicenna (iii, i, 5, 22); Haly Abbas (Theor. ix, 7, Pract. v, 24); Alsaharavius (Pract. i, 2, 28); Rhases (Divis. 10, Cont. i.)

All the other authorities give much the same account of this species of melancholy as Paulus. If we adopt Dr. Mead’s theory respecting the dæmoniacs mentioned in Scripture, we may conclude that the man, whose state is described in Luke (viii, 27), was affected with this disease. Dr. Mead is farther of opinion that Nebuchadnezzar was seized with lycanthropia. The reader will find much curious information on this head in Burton’s ‘Anatomy of Melancholy,’ from which all Mead’s opinions are borrowed.

The Arabian term is cutubut.

Avicenna recommends the application of the actual cautery to the sinciput, when the other remedies fail. Haly Abbas describes the disease by the name of melancholia canina. He says the patient delights to wander among tombs, imitating the cries of dogs; that his colour is pale; his eyes misty (tenebricosi), dry, and hollow; his mouth parched; and that he has marks on his limbs of injuries which he has sustained from falls. He recommends the same treatment as our author: indeed he evidently merely translates this section of Paulus. Alsaharavius seems also to allude to this disease by the name of melancholia canina. Rhases’ account of it is quite similar to our author’s.

Schneider has given some interesting critical remarks upon this section of Paulus at the end of his edition of Nicander’s ‘Theriacs.’

SECT. XVII.—ON LOVE-SICK PERSONS.

It will not be out of place here to join love to the affections of the brain, since it consists of certain cares. For care is a passion of the soul occasioned by the reason’s being in a state of laborious emotion. The following symptoms attend lovers: Their eyes are hollow, and do not shed tears, but appear as if overflowing with gladness, their eyelids move rapidly; and even, when none of the other parts of the body are affected, these parts are always so affected in lovers. There is no pulse peculiar to lovers, as some have supposed, but it is the same as that of persons labouring under care. When they call to recollection the beloved object, either from seeing or hearing, and more especially if this occur suddenly, then the pulse undergoes a change from the disorder of the soul, and, therefore, it does not preserve its natural equability or order. Such persons, therefore, being desponding and sleepless, some physicians, mistaking their affection, have wasted them by prohibiting baths, and enjoining quietude, and a spare diet; but wiser ones, recognizing the lover, direct his attention to baths, the drinking of wine, gestation, spectacles, and amusing stories. Some must also be attacked with fear; for, while they think of nothing but love, the affection is difficult to remove. Wherefore, they ought also to be roused to emulation with regard to the objects of their peculiar interest in life; and, upon the whole, their understanding should be diverted to other concerns.

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COMMENTARY. See Oribasius (Synops. viii, 9); Haly Abbas (Theor. ix, 7, Pract. v, 25); Avicenna (iii, i, 5, 23); Alsaharavius (Pract. i, 2, 17); Rhases (Divis. 11.)

Although Theocritus had declared that neither ointment nor powder is of any efficacy for the cure of love, several of the ancient writers on medicine have given directions for the treatment of desponding lovers.

Rhases, with unusual brevity, merely recommends, in general terms, repeated enjoyment, fasting, walking, and frequent intoxication. Avicenna, Haly Abbas, and Alsaharavius direct nearly the same treatment; and also mention hunting and sports.

SECT. XVIII.—ON APOPLEXY, AND HEMIPLEGIA OR PARALYSIS.

When the common origin of the nerves is affected, and from it all the other parts of the body have lost their motion and sensibility, the affection is called apoplexy, by which the leading energies are impaired; but if the obstruction is in either side, it is called hemiplegia and paralysis; and if the injury is seated in any one part, it is called an affection of that part, and hence Hippocrates says, “His leg was seized with apoplexy.”

Wherefore, in apoplectics, the respiration remains small. When, then, it is greatly perverted from its natural energy, it will induce a strong affection, and when but little, a weak one. Respiration is of the worst kind when it intermits, or is performed with great exertion. The affection arises suddenly from a cold phlegm obstructing the most important cavities of the brain. Whenever the whole origin of the spinal marrow is affected, all the parts below the face become paralysed, whilst it remains unaffected, because the parts there derive sensibility and motion from the brain; but, if one half only be affected, then is there a paraplegia of these parts, that is to say, a partial paralysis. If the sense of smell is affected, this arises from the anterior cavities of the brain having contracted the intemperament, or from the pores of the ethmoid bones being obstructed. Wherefore, apoplectics lie speechless, motionless, and insensible, without fever. The precursors of this affection are sudden and acute pain of the head, distension of the jugular veins, vertigo, flashes, as it were, of light in the eyes, an inordinate coldness of the extremities, palpitation and difficult motion of the whole body, and grinding of the teeth in sleep. Their urine is in small quantity, of a verdigris-green or a black colour, and containing a branny sediment. The affection occurs in old age to those of a phlegmatic temperament, and who use a diet of this nature. If it occur in youth and in the season of summer, it indicates a strong exciting cause.

The cure of apoplexy, and hemiplegia or paralysis. Apoplexy is an affection which is never or but rarely cured, for it threatens instant death; and if it be relieved, it commonly leaves a paralysis of some part of the body. Wherefore, those persons who admit of being cured should be immediately bled, and if there be any remission of the disorder, the operation should be repeated on the same or the following day. The belly should be opened by a stimulating clyster, made by mixing salt water and honey. Then let the whole body be rubbed with plenty of sulphurated oil, but the head with the oil of chamomile, or of dill in which cow-parsnip or calamint has been boiled. Inject honied water, and apply strong-scented things, such as opopanax, sagapene, galbanum, or castor, to the nose. It may be necessary to open the mouth forcibly, and introduce a finger or feather dipped in oil to remove the matters sticking there. Anoint the anus with applications for promoting the discharge of flatus. Give honied water and oxymel to drink, and use masticatories prepared by boiling thyme, or marjoram, in vinegar. When there is a remission of the complaint, we are to have recourse to tender, diffusible, and succulent food. When loss of speech continues, if the strength permit, we are to apply to the back part of the head a cupping-instrument with scarificators, and, if admissible, it should be applied to the hypochondria also. Let them afterwards be carried about in a chair, or couch, or suspended bed, and have recourse frequently to sternutatories and masticatories. After the fourteenth day, we may bring them back to the other kinds of gestation, attend to their speech, give old apomel with pieces of bread or alica, and afterwards a small quantity of hiera. After the twenty-first day, we may lead them to the bath, give them old wine to drink; and otherwise we must promote recovery by sprinkling them with warm water, by baths, and rubbing with unguents. If possible, let them reside in places by the sea-coast.

The cure of paresis, or resolution. If there be paralysis of all or of certain members, without injury of the primary energies, we must first evacuate the offending humour, whatever it be, and then give hiera, and a certain portion of castor, beginning with half a drachm, along with some honey and warm water in which it has been dissolved, either alone, or with the addition of half a scruple of pepper; then, after an interval of four days, we may give a whole drachm, and afterwards one and a half, then two and three. After an interval of the same number of days, we may give four drachms, if the patient be able to take so much, adding one spoonful of honey. To the part we may apply some of the discutient remedies, along with rubefacients, adding to them some castor, or pepper, or pellitory, or rosemary, or euphorbium; and, in addition to these, we may have recourse to embrocations with oil of rue, or Sicyonian or old oil. The food ought to be farinaceous, taken in a slop, of easy digestion, and not excrementitious. Let cupping-instruments be applied to the affected parts separately, if there be many of them, but to one if there be few. After cupping, apply cataplasms containing pitch, rosin, or manna. A most suitable application consists of calamint, fleabane, and nitre boiled along with mugwort, and some water is to be added, which is to be evaporated during the boiling. The belly is to be again opened by means of aloes, polypody, scammony, or the colocynth pottage. Fatty inunctions are to be made with old oil in which squill has been kept for forty days in the sun; or, if it be not at hand, you may boil in oil two ounces of squill, and anoint with it; or the seed of rosemary may be prepared in like manner, but an ounce of wax must be added, that it may not be too liquid. But, if you add of galbanum, of castor, of euphorbium, of adarce, and of nitre, of each, oz. ss, it will be a more potent remedy. The herb crowfoot, boiled in the oil, and preserved in the sun, is also an excellent application. Castor to the amount of a drachm, and opopanax swallowed to the size of a bean, will make suitable potions. But sagapene taken to the size of a tare in honied water, and castor with opopanax, and the Cyrenaic juice to the size of a millet, are admirable remedies. The antidote from the three peppers is also beneficial. We may likewise use beating restoratives (acapa), and masticatories. After the fourteenth day, we may give more copious food; and, when much benefit is derived, we may lead to the bath. After the thirtieth, it will be necessary to apply a dropax, use the bath, and afterwards put on a cataplasm of mustard, taking care in those cases in which both motion and sensibility are lost, lest from want of feeling they be allowed to burn too much. Where sensibility remains, rubefacients only are to be used. After it swells, we ought to lead to the bath, and cure with simple cerates. They ought to take the emetic after a meal, and that from radishes. They should be carried about in a chair, or in a car drawn by the hand, or in one drawn with a yoke. Otherwise, let them be put into one of the natural baths. A desiccative diet, spare drink, and friction will be proper. Let them, therefore, eat dry food, and struggle against thirst as much as possible.

On paralysis with relaxation or distension. Since paralysed parts are either contracted or relaxed, and this proceeds either from plethora or emptiness, it will be necessary to attend to this, and sometimes abstract blood, and sometimes not. Again, to relaxed parts we must mix astringents with the relaxing remedies, and use intense friction; but for the contrary state we must use relaxing remedies only, along with gentle friction. For the relaxed limbs, let the oil used for friction have a little nitre and dried lees of wine pounded on it. Let hot water also be strongly poured upon them, especially sea-water, in which have been boiled bay-berries, or the shoots of the chaste-tree, or marjoram, or the like. If it is in the summer season, let them also swim in the sea. But rubefacients are particularly applicable to them, and therefore the parts may be whipped with rods, or nettle branches; but if the paralysis remain, the relaxed skin between the joints is to be drawn up, and transfixed with small and slender burning-irons. To contracted limbs it is proper to apply constantly a calefacient plaster.

On paralysis in particular parts. Paralysis occasioned by the division of a nerve is incurable; but when occasioned by an intemperament, or a certain humour, it is relieved by the common remedies already mentioned; but there are certain particular remedies applicable to each of them, which we shall describe below. Wherefore, in cynic spasms, the jaw is to be reduced to the opposite side by means of a muzzle. Detraction of blood from the vessels below the tongue will likewise be proper, as also cupping-instruments applied along the first vertebra, with masticatories, and purgatives administered by an instrument inserted into the nose. It is necessary to know that the jaw which appears to be distorted is not the one which is paralysed, but the opposite one. When the organ of deglutition is paralysed, cupping-instruments must be applied to the chin, and we must use the liniments made of castor, sagapene, and the Parthic juice. Acrid gargles are also beneficial. When the tongue is paralysed, we must open its veins, apply a cupping-instrument to the chin, and use masticatories of mustard, and exercise the tongue. When the organs of speech are paralysed, apply the remedies to the chest, enjoin retention of the breath, and have recourse to vociferation. When the eyebrows are affected, anointing of the eyelids in like manner is of great use, and, at last, the operation by suture called anarrhaphé. When the bladder is paralysed, there is either retention of urine or an involuntary discharge of it. The remedies are to be applied to the bottom of the belly and perinæum, and clysters injected by the anus, consisting of oil of rue, or Sicyonian oil, with butter and castor, galbanum, opopanax, or the juice of laserwort. And these things, if injected into the bladder by the penis, will be of great service, or prove sufficient of themselves. Clysters of centaury and colocynth, along with Sicyonian oil, are also beneficial; and diuretics may be drunk with advantage, and castor taken in like manner. But, above all things, we must have recourse to the catheter when the patients cannot make water, and get them to sit in hot baths of a relaxing nature, and use emollient cataplasms. When the urine flows involuntarily, we must treat them upon the astringent plan with tonic remedies, and make them use dry food and cold drink. During convalescence they ought to use rubefacients, and natural baths in a cold state. Cases occurring from a wound of the spine, from a fall and dislocation of a vertebra, if there be a concurrence of fatal symptoms, it is impossible to remedy. If the penis is paralysed, we must apply the remedies recommended for the bladder to the same parts, and also to the groin; and medicines which excite to erections ought also to be used. Milk, cheese, and the other cakes are improper, likewise lettuces and the other pot-herbs. When the rectum is paralysed, in which case the fæces are either discharged involuntarily, or retained, the same remedies must be used, and clysters are to be administered, sometimes of an astringent nature, such as the decoction of cypress, of rush, or of bramble; and sometimes emollient; such as the fat of swine and geese, and the oil of mallows; and sometimes stimulating, such as salt water, the decoction of colocynth, or the like. Nothing contributes so much to motion as variety of exercise with the lever. If they complain of a sense of cold, the restorative plaster of euphorbium, dissolved in oil, may be used for a clyster. But, along with the ordinary treatment, the paralysed limbs should be bent, rubbed, and stretched in the manner described; for our greatest dependence is upon friction.

On paralysis supervening upon colic disease. In our times a colic complaint has prevailed, in which convalescents are seized with complete loss of motion in their limbs, but the sense of touch remains uninjured, there being a critical translation of the disease from the internal parts. Hence, in many cases, the motion has returned spontaneously in process of time. Those of more difficult cure were remedied by using the more simple liniments formerly described. The acopa made of poplar and of the fir were found to be excellent applications; and many were greatly benefited by tonic and moderately cooling applications.

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COMMENTARY. Consult Hippocrates (Aphoris. ii, 42, de Glandulis, et alibi); Galen (Comment. de Loc. Aff. iii, 11); Aretæus (Morb. Chron. i, 7; Cur. Morb. Acut. i, 4); Aëtius (vi, 26); Oribasius (Synops. viii, 14); Theophrastus (ap. Photii Bibliothecam); Alexander (x, 2); Actuarius (Meth. Med. iv, 2); Cælius Aurelianus (Morb. Acut. iii, 5); Octavius Horatianus (ii, 7); Leo (ii, 5); Nonnus (37); Avicenna (iii, i, 5, 12); Avenzoar (i, 9, 12); Serapion (i, 24); Mesue (de Ægr. Cap. 27; de Ægr. Nerv. 2); Haly Abbas (Theor. ix, 6, Pract. v, 22); Alsaharavius (Pract. i, 2, 18); Rhases (ad Mansor. ix, 3.)

To so many excellent works on apoplexy, wherein the subject is treated of fully and correctly, it is difficult to do justice within our narrow limits. We shall give, however, a brief, though imperfect outline of their opinions.

Hippocrates pronounces a slight attack of apoplexy to be difficult to cure, and a severe one to be utterly incurable. He says that an apoplectic attack is brought on by turgidity of the veins. When a person has suddenly lost his powers Hippocrates directs that he should be bled. (Aphor.) Apoplexy, he says, occurs most frequently between the age of forty and sixty. (Ibid.) He says, in allusion to apoplexy (as his commentator Theophilus remarks), that when persons in good health are suddenly seized with pains in the head, with loss of speech, and stertorous breathing, they die in seven days, unless fever supervene. (Ibid.)

Galen states that apoplexy arises from a cold, thick, and viscid humour obstructing the ventricles of the brain. He remarks that, in severe cases, all voluntary motion is lost while respiration is performed as in persons asleep. The reason which he assigns for this is, that the nerves which are distributed upon the respiratory muscles are all derived from the brain itself, and these often escape being injured, unless the attack be of a particularly serious nature. His account of cases of partial paralysis is highly interesting. (Loc. Affect. iii, 14.)

Celsus’ brief account deserves to be given in his own words: “Attonitos quoque raro videmus, quorum et corpus et mens stupet. Fit interdum ictu fulminis, interdum morbo ἀποπληξιαν hunc Græci appellant. His sanguis mittendus est: veratro quoque albo, vel alvi ductione utendum. Tum adhibendæ frictiones, et ex mediâ materiâ minimè pingues cibi, quidam etiam acres; et a vino abstinendum.” Respecting the treatment of paralysis he delivers the following aphorism: “Si omnia membra vehementer resoluta sunt, sanguinis detractio vel occidit vel liberat: aliud curationis genus vix unquam sanitatem restituit, sæpe mortem tantum differt, vitam interdum infestat.” His other remedial measures are such as our author’s, namely gestation, the application of cupping-instruments or rubefacients to the affected part, the warm salt-water bath, and a restricted diet.

According to Theophrastus, paralysis is occasioned by a deficiency or loss of the pneuma, i. e. vital heat.

It is impossible to admire too much the brief but comprehensive account of apoplexy and paralysis given by Aretæus. He states decidedly, that there is sometimes a loss of motion alone, and sometimes of sensibility; the reason of which he supposes to be, that the sensatory and motory nerves are distinct from one another. This is the germ of the theory fully expanded afterwards by Galen. It appears, indeed, from the anatomical works of Ruffus, that the famous Erasistratus had attempted a similar classification of the nerves. Galen, however, has the merit of fully establishing the truth of the theory; and all subsequent writers on physiology stated it in nearly the same terms that he does, until ancient authority in medicine and its cognate sciences came to be despised. Aretæus states it as a general rule, that when one side of the brain is affected the opposite side of the body is paralysed; but, when the disorder is in the spinal marrow, that the affection of the spine and the paralysis are on the same side. This arises, he supposes, from the decussation of the cerebral nerves; and this explanation must be admitted even now to be tolerably correct. The causes of paralysis, as stated by him, are falls, blows, cold, indigestion, debauchery, intoxication, and violent emotions of the mind. His treatment is as follows: He inculcates, in the strongest terms, that the great remedy for apoplexy is venesection; and that the only difficulty, in general, is to determine the extent to which it is to be carried. He forbids the operation, however, when the senses are oppressed with much cold and torpor. When venesection is contra-indicated the belly is to be evacuated, in order to relieve congestion there, and to produce revulsion from the head. For this purpose acrid clysters are to be given, containing nitre, euphorbium, colocynth, turpentine-rosin, and the like. He also recommends hiera as a purgative; and if nausea be present, he advises us to encourage vomiting. He praises castor strongly as a remedy for the nervous affections. The food is to be light and of easy digestion. When the disease is protracted, cupping-instruments are to be applied to the back part of the head. When the parts concerned in deglutition, namely, the fauces and œsophagus, are paralysed, food is to be conveyed into the stomach by a suitable instrument. (By the way, Dr. Friend is mistaken in stating that Avenzoar is the only ancient author who recommends this practice. It will be remarked that our author makes mention of introducing food into the stomach by means of an instrument passed by the nostrils.) When the bladder is affected, he recommends injections, but forbids the use of the catheter, for fear of occasioning convulsions or gangrene. He approves greatly of the bath of oil in this case.

Aëtius, Oribasius, Alexander, Actuarius, and Nonnus treat of the disease in much the same terms as our author. Alexander, in particular, properly recommends moderate purging with the hiera and such like medicines. He restricts venesection to those cases in which the disease is occasioned by fulness of blood.

Cælius Aurelianus enumerates nearly the same causes of apoplexy and paralysis as Aretæus, namely, excessive heat, cold, indigestion, debauchery, and injuries of the brain. The season of winter is justly said to predispose to the disease. It is seated, he says, principally in the head. His treatment is nearly the same as that of the followers of Hippocrates and Galen, namely, emollient applications to the head and limbs, venesection, abstinence, clysters, cupping the back part of the head, and the bath of oil. Of paralysis he treats at greater length, and with much precision and judgment. He mentions nearly the same causes of it as of apoplexy; and remarks that it produces loss of sensibility, or of motion, or of both. He observes, in particular, of the tongue, that it may retain the power of deglutition although that of speech be lost. He details all the phenomena of partial paralysis with surprising accuracy; and, at the present day, we do not know a work on the subject that contains so much information. He distinctly and accurately describes paralysis of the œsophagus and fauces. His treatment is, upon the whole, not very different from our author’s; but his directions for the application of his remedies are exceedingly minute and judicious. In the first place, he approves generally of venesection, calefacient applications to the extremities, a spare diet, and afterwards of cupping with scarifications. When the tongue is affected, hot gargles of mustard and vinegar are to be given; and, when there is paralysis of the bladder, the catheter is to be used. When the disease is obstinate, he approves of hellebore as an emetic, and of calefacient plasters, depilatories, cupping with much heat, embrocations of mustard, and such things as will produce a papular eruption, namely, flour of salt, nitre, and the like. He blames Praxagoras for recommending emetics indiscriminately, and Erasistratus for omitting venesection. He finds fault with Themison for being in too great haste to apply stimulants to the affected parts, and for having recourse to cupping before the disease had begun to subside. Though he permits the occasional use of hellebore, he disapproves of purgative medicines in general. For paralysis of the œsophagus he recommends us to apply a cupping-instrument, leeches, or cataplasms to the neck.

Little additional information is to be got from the Arabians; and yet Avicenna, in particular, has treated the subject in a very masterly manner. The causes of apoplexy, he says, are either obstruction or repletion; and these are produced either by blood or a pituitous humour. We need scarcely remark that this accords with the modern division into sanguineous and serous apoplexy. Even in pituitous apoplexy he admits of venesection. He approves of vomiting when it can be produced easily. Neither Serapion nor Avenzoar makes mention of venesection. Serapion commences his treatment with an emetic. When connected with plethora, Alsaharavius recommends general bleeding, opening the temporal veins, cupping the legs, restricted diet, applications to the head, such as oil of roses and vinegar, and acrid clysters. Haly’s account is minute and judicious. He attributes the affection to obstruction within the brain occasioning a loss or diminution of the powers of sensation or of voluntary motion. It is produced, he says, by phlegm mixed with bile or blood; and sometimes arises from repletion with wine, which case generally proves fatal. He justly remarks, that one of the most common symptoms is stertorous breathing. If the face be ruddy or livid, he directs us to open the cephalic vein, or vena saphena, and abstract blood according to the patient’s strength; to apply ligatures to the extremities, vinegar and rose-oil to the head; and to give clysters. He also approves of emetics. When the disease has partly subsided, he approves of the bath. He treats separately of paralysis, describing many varieties of it. In paralysis of the face he recommends stimulant liniments, ligatures, gargles, and sternutatories. According to Rhases, apoplexy arises from congestion of blood or of viscid phlegm in the brain. He remarks correctly, that when attended with stertor it is difficult to cure. When the memory is affected, he directs us to apply a sinapism to the occiput.

The paralysis of the extremities after colic, mentioned by our author, and after him noticed by Avicenna and Haly Abbas, was, no doubt, the same disease as the palsy after colica pictonum described by modern authors. De Haen has given a masterly description of this disease. (Rat. Med.)

Rhases states decidedly that the skin of paralytics may retain its sensibility, although the muscular motion be lost. In a word, he maintains that the nerves of sensibility and motion may be affected separately. He remarks, however, that a part can scarcely retain its powers of motion when the sensibility is entirely gone. He says that he had known several cases of paralysis cured by a natural diarrhœa. His general remedies are bleeding, purging, and rubefacient applications. He, and several of the authorities referred to by him, recommend the warm salt-water bath for the cure of paralysis.

SECT. XIX.—ON CONVULSIONS, OR SPASMS.

The consideration of spasms naturally follows that of paralysis, because both are affections of the nerves; and, for the same reason, we shall next treat of tremors. When, therefore, spasms come on at the commencement of the complaint, or nearly so, and are protracted, they have their origin in plethora; but when they supervene after copious sweatings, vomitings, discharges from the bowels, hemorrhages, watchfulness, hunger, or much and violent exercise, they proceed from depletion. If they suddenly attack a person in health, they must necessarily proceed from plethora. But when from ardent fevers the nerves and whole body are dried, and then spasms come on owing to the dryness, this is one of the worst possible cases, and is almost incurable. Wherefore, we must, in the first place, bind gently the limbs which are contracted, and resist their inordinate motions, and rub them with oil of rue, Sicyonian or old oil, or the like; and the patients must take propomata of honied water. In convulsions from depletion, warm oil, or oil and water, are to be poured upon the patients, and if nothing contra-indicate, they may be put into a bath. We may use a tepid hip-bath with oil, and the gentlest friction. For food, they must take spoon-meats of chondrus and alica; and we may allow them a thin watery wine of easy diffusion if they have no fever. Then we must use the juice of ptisan and promote sleep. Spasms occasioned by plethora or inflammation, we may cure by diminishing the fulness, and removing the inflammation by suitable remedies. Spasms come on also during the agitations of violent vomitings, which cases are benefited by drinking infusions of the root of cotton-thistle, or of the white thorn, or of the Egyptian thorn; but some give the juice of the slender centaury to drink when the convulsions arise from plethora; and one should not only drink it, but rub the skin externally with castor and Sicyonian oil. If they do not cease, cupping-instruments, with scarifications, should be applied; when the legs are affected, along the ischium and the last vertebra; and when the arms are convulsed, to the back, to its first vertebra, and the one above the shoulder. When the rest of the body is not affected, but one of the lips, eyebrows, or tongue, is contracted, the symptom is to be reckoned dangerous and alarming, although the parts affected be but small in size. Wherefore you must abstract blood from the hind-head, and from over the first vertebræ.

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COMMENTARY. See Hippocrates (Aphor. v, 70); Galen (Comment.; de Loc. Aff. iii; Meth. Med. xii); Celsus (ii, 1); Cælius Aurelianus (Morb. Acut. iii, 6); Aretæus (de Morb. Acut. i, 6); Leo (ii, 17); Nonnus (38); Octavius Horatianus (ii, 10); Aëtius (vi, 38); Oribasius (Synops. viii, 16); Avicenna (iii, 2, 5, 6, 7); Serapion (i, 27); Avenzoar (ii, 3, 10, and i, 10, 3); Alsaharavius (Pract. i, 2, 21); Rhases (Divis. i, 16, and Contin. i.)

Aëtius and Oribasius treat of spasms in nearly the same terms as our author. We shall give an account of the doctrines of Aretæus and Cælius Aurelianus in the next section. The principles of our author’s treatment are mostly derived from Galen. The Arabians adopt his views without the slightest modification.

SECT. XX.—ON TETANUS AND ITS VARIETIES.

Tetanus also, being a spasm, takes place from the muscles of the body, and more particularly those about the spine, being as it were congealed by a cold humour, fixing both within and without; and hence they are incapable of bending themselves. But when the parts of the body are bent forwards, the affection is called emprosthotonos; when backwards, opisthotonos; and, when the parts are stretched equally both ways, the affection is called tetanus. Pelops says that these affections consist of a tension and contraction of the muscles and nerves about the neck, by which stooping, nodding, and turning of the head are performed; that if the affection be seated in the posterior muscles of the neck, the disease is, from this circumstance, called opisthotonos; when in the anterior, emprosthotonos; and if both are affected, tetanus. The cause, he says, is a flatus, and thick and nebulous air filling the muscles. He says that it is very cold and congealed, and that this is the cause of the difficulty of motion; and that, therefore, dry fomentations, and not moist, are most suitable to them. And these are the varieties of tetanus. “But,” he adds, “the cure of all is the same, and does not change with the varieties. Wherefore, the most potent remedy for them all is a fever supervening, when there was none at the commencement.” The symptoms are a moaning respiration, pulse rare and small, and sometimes a sardonic laugh comes on; the face is red, and their eyes appear larger than natural; their urine is either wholly suppressed, or it resembles common water, or is somewhat bloody, and contains certain bubbles; the belly is dried up; they cannot sleep; and often, from the violence of the spasms, they are in danger of falling out of their beds; they sometimes have singultus, and pains in the head, or between the shoulders and loins; and some have tremors. The disease is occasioned sometimes, though rarely, by fatigue, by lying upon the ground, lifting of weights, a fall, a wound, a burn, and a blow, or any other thing which can bring on such an injury of the nerves. The disease is to be cured like convulsions from depletion.

The cure of the varieties of tetanus. In treating tetanic spasms, we must begin with phlebotomy, and wrapping the parts in wool which has been dipped in oil, namely, the Sicyonian and castor with old oil; or a broad bladder containing hot oil may be applied to the tendons. Cupping, with scarifications, is to be applied; for dry cupping is hurtful. The neck, both sides of the spine, the muscular parts of the breast, the hypochondria, and the region of the bladder or kidneys, should be cupped. We must not be sparing of the detraction of blood, nor yet take away too much at a time, but at intervals. The sweats should be absorbed by the wool dipped in oil, lest the patient happen to catch cold. If the attack of tetanus continue long, the patient must be put into a hip-bath of oil twice a day, but not allowed to remain long in it; for, of all applications, the bath of oil is the most debilitating. Let him drink tepid hydromel boiled to the one half; and the robust may take a drachm of opopanax; or, if not so much, three oboli, or at least one obolus, if we are afraid of its proving injurious to the stomach. We must also give gum ammoniac; or the Cyrenaic juice, to the size of a tare, made up with well-boiled honey, may be swallowed. Two spoonfuls of the root of laserwort may be given in three cyathi of honied water, or in its decoction; or one drachm of myrrh, in honied water, or the decoction of hyssop. But the least dangerous and most effectual remedy is castor, to the extent of two or three spoonfuls, in divided doses. And it will do no harm, if you give it after a meal; but the drink and the other things should be taken slowly and by degrees; for if swallowed with difficulty, the drink regurgitates at the nose, the violent agitations of which bring on convulsions. The anus should be smeared with oil of rue, along with opopanax, and the same things are to be given in a clyster. The affusion of cold water being, as Hippocrates says, exceedingly hazardous, and, for that reason, I suppose, rejected by succeeding authorities, we too are disposed to condemn.

A liniment. Of nard (valerian), one sextarius; of wax, oz. ij; of malabathrum, of amomum, of storax, and of mastich, of each, oz. j; of castor, of adarce, of euphorbium, of pepper, of each, oz. j; of spikenard, of opobalsam, of each oz. j.

A potion for opisthotonos. Of the root of panacea, of white pepper, of costus, of myrrh, of poppy juice, equal parts. Give to the size of the vetch called aracus at bedtime. It is also a remedy for orthopnœa. Let the diet be attenuant, of easy diffusion, and by all means not excrementitious.

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COMMENTARY. Consult all the works referred to in the preceding Section; also, Celsus (iv, iii); Haly Abbas (Theor. ix, 10, 11, Pract. v, 31); Alexander Aphrodisiensis (Prob. i, 53.)

Hippocrates, Plato, Galen, Horatianus, and Avicenna agree in stating that a fever coming on tends to remove the tetanic affection. Cælius Aurelianus seems to question the truth of this ancient aphorism. According to Hippocrates, tetanus generally proves fatal within four days, or, if not, recovery takes place. He disapproves of the cold affusion in cases of traumatic tetanus (Aph. v, 21); Alexander Aphrodisiensis, however, speaks rather favorably of it.

Aëtius, Oribasius, and Nonnus, like our author, recommend bleeding, emollient fomentations, and the bath of oil. Archigenes (ap. Aëtium) directs the bath to be prepared by adding a fifth part of oil to the water.

The treatment recommended by Celsus is judicious and not unlike our author’s. He expresses himself hesitatingly about venesection, and forbids the early use of wine. He approves of opening the bowels.

Aretæus says that tetanus is a painful spasm, sometimes proving speedily fatal, and always difficult to cure. Like the moderns, he mentions the three varieties of it, namely, emprosthotonos, opisthotonos, and tetanus. The disease, according to his account, may arise from a variety of causes, such as a wound of a muscular or nervous part, abortion, and excessive cold. When it arises from the two causes first mentioned, it is said to be generally fatal. His description of it is given in his usual graphic manner. He advises the physician not to compromise himself by meddling with the case when the disease is fairly established. His treatment is altogether soothing and relaxant. He recommends us to lay the patient upon a soft warm bed, and, from whatever cause the complaint arise, to begin with abstracting blood from the arm. Then soft liquid food is to be given, and the whole body wrapped in wool moistened with some calefacient oil; or bladders half filled with tepid oil are to be applied to the parts most affected. He directs us to cup the back part of the neck, but cautions against exciting irritation by the application of heat. To the wound he recommends suppurative applications containing frankincense, turpentine-rosin, and the like; for he remarks (and the fact is confirmed by the experience of the late M. Larrey, who recommends a similar mode of practice) that, when tetanus supervenes, the sore becomes dry. He praises castor and assafœtida as antispasmodics; and, if these cannot be swallowed, they are to be given in an injection. He advises also hiera to be given in an injection.

Cæelius Aurelianus enumerates nearly the same causes as Aretæus, and describes all the symptoms of the disease with the greatest precision. His treatment also is nearly the same as that of Aretæus, namely, emollient applications to the neck, venesection, and oily clysters. He even enjoins the bath of oil, which has fallen into disuse in modern practice, most probably solely on account of the expense with which it would be attended. He also permits sometimes the use of the common bath, but not of cold water. He allows wine in certain cases. He condemns Hippocrates for giving both wine and emetics, and having recourse to venesection, without due discrimination. He blames him also for recommending the affusion of cold water, inasmuch as he himself had pronounced cold to be injurious to the nerves, bones, &c. Galen, however, remarks, in his Commentary upon this Aphorism of Hippocrates (sect, v, 21), that cold, in this case, is not the direct cause of the benefit derived from this remedy, but (if we understand him right) that the shock which it imparts to the system proves beneficial, by rousing the vital heat and energies of the patient. Hippocrates, however, as stated above, forbade the cold affusion in traumatic tetanus. Our author’s opinion of this practice is just such as the profession in general now entertain, after it has received another trial upon the recommendation of the late Dr. Currie. (See ‘Medical Reports,’ and Larrey’s ‘Mémoires de Chirurgie’, t. 1.)

Octavius Horatianus recommends bleeding, emollient applications, purgative clysters, the tepid bath, antispasmodics, and soporifics. The use of the last-mentioned class of remedies does not appear to have been sufficiently understood by the ancients; at all events they were less partial to them in this case than the moderns.

The Arabians enjoin nearly the same treatment as the Greeks. Avicenna and Mesue join the preceding authorities in recommending strongly the use of castor and assafœtida as antispasmodics. Avicenna, like all the others, praises the bath of oil. Serapion speaks of a bath prepared with emollient herbs. Haly Abbas describes minutely the two varieties as occasioned by repletion and inanition. For the former, he approves of purging with hot drastic purgatives, of rubbing the part affected with hot oils, and of using the warm bath with friction after it. He also approves of castor. For the other variety, he praises the affusion of plain water in which lettuces, barley, &c. have been boiled. He recommends the internal use of milk and other demulcents, and the bath of oil, and rubbing the body with oil of violets. The treatment recommended by Alsaliaravius is very similar. Rhases mentions Hippocrates’ proposal of the cold affusion; but, like our author, he rather disapproves of it. He himself recommends bleeding, when there are symptoms of repletion, emollient applications to the neck, the bath of oil, the application of leeches to the part affected, purging with aloes, &c. and the administration of antispasmodics, such as castor, assafœtida, and the like.

SECT. XXI.—ON TREMBLINGS.

Trembling is generally occasioned by a weakness of the nerves (old age is a proof of this); but there are many particular causes which occasion it; for it arises from a cold intemperament, from draughts of cold water, more especially if taken unseasonably during a fever, also from a redundance of cold and viscid humours, and from the too liberal use of wine. Those, therefore, who have tremblings from any obvious error in regimen, must abstain from the things which prove injurious to them. And, again, when the tremor remains during fevers, we must first rub the body with Sabine oil; but in the remissions of the attacks with old or Sicyonian oil. Let the extremities after being anointed, be wrapped in soft wool, and then let cupping instruments be applied along the spine, from the first vertebra to the loins; these parts, together with the hypochondria, being previously covered over with raw barley-meal. Let them also be wrapped with wool out of old or Sicyonian oil. But if the fever continue, every alternate day let them be put into a hip-bath of oil, or oil and water, and use soft frictions. But if the affection be prolonged, and cold is suspected, they should take a propoma, or sweet potion, of honied water and castor, and be carried about in warm places; and we ought to give them food of easy distribution, at first spoon-meats, and afterwards such fowls and fishes as have tender flesh. When the fever is gone, they must be washed, avoiding the cold bath and wine. But, if there be a fulness of thick and viscid humours, we must use remedies of an incisive and attenuant nature. They are these: Of the shoots of rue, of cow-parsnip, as much as can be contained in three fingers; of castor, of nitre, of each two oboli. Give every day one spoonful with oxymel, for three days while fasting; or of panacea and pepper, five grains; take in a draught of a cyathus of honied water. The following simple things in proportion relieve tremors: Castor, the brain of a hare eaten, the decoction of the root of marshmallows, of the leaves of water plantain, dr. iv, in honied water, hemp agrimony with water. When the cold prevails, we may use the liniment of Zosimus, and the restoratives, liniments, and rubefacients described above for paralysis, also exercises and frictions. Those who have tremblings from drinking wine must abstain from wine altogether, until a complete cure take place.

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COMMENTARY. See Galen (de Tremore, et alibi); Nonnus (40); Cælius Aurelianus (de Morb. Acut. iii, 7); Mesue (de Ægr. Cap. 5); Serapion (i, 3); Haly Abbas (Theor. ix, 11, Pract. v, 32); Alsaharavius (Pract. i, 2, 24); Rhases (ad Mansor. ix, 8.)

Galen, in the work referred to above, explains the rationale of this affection with his usual penetration, but at too great length to allow of our entering upon an exposition of it. The others treat of it similarly to our author. Thus Haly Abbas mentions various causes of tremors, such as old age, drinking cold water unseasonably, excessive indulgence in wine or venery, inanition, and the like. He recommends aloes and castor, the hot bath, friction with calefacient oils, and other such remedies. Serapion gives a sensible account of the nature of the affection, and recommends fetid or antispasmodic remedies internally, and friction with calefacient oils externally. When it is occasioned by exposure to cold, Rhases recommends the hot bath and insolation. We may mention here that Hippocrates has given a very accurate history of a case of delirium tremens. (Epid. iii, 5.)

SECT. XXII.—ON DISEASES OF THE EYE; AND FIRST OF PAIN, FROM GALEN.

When violent pains in the eyes take place, consider from what diathesis the eye happens to be pained in the inflammations; for they are either occasioned by the pungency of an acrid defluxion, or from the coats being over filled and stretched, or from the distension of thick humours or of flatulent spirits. When the pains proceed from pungency, they are to be cured by evacuating with purgatives, and by injecting into the eye the white of an egg. When the inflammation is concocted, if the body be free of impurities, the most befitting remedies are baths. Inflammations from plethora are to be cured by the detraction of blood, purging the belly, and applying friction to the inferior extremities. Those from distension are to be cured by first evacuating the whole body, then by occasioning a revulsion downwards of the humours, and afterwards by using topical applications of a discutient nature. The eyes must be fomented, and the decoction of fenugreek poured into them. When the vessels of the eye are distended with thick blood, while there is no plethoric diathesis in the general system, the patient must drink wine which has the power of heating, evacuating, and removing obstructions.

On disorder of the eye, and particularly of ophthalmy. Disorder of the eye is a wateriness and heat of it, with preternatural redness, not occasioned by any cause within the body, but by some external one, such as the sun, smoke, dust, or the wind; wherefore it is soon dispelled when the cause is removed. And ophthalmy is a marked disorder, which may be occasioned not only by an external cause, but also without any obvious one, and remains until the third, fourth, or fifth day. It is best cured by avoiding every external exciting cause, by spare diet, drinking water, walking, and by opening the belly.

On inflammation. When inflammation remains in the eyes after evacuation of the general system, we may use ointments for dispelling the rheum, and soothing the irritation, such as the collyrium of Nilus made from roses, the chiac, or the collyrium from nard. When the tunica adnata is inflamed, we may use the collyria called monhemera, injecting them into the eye with the white of an egg. Next day, if the inflammation be not aggravated, we may anoint them with the collyrium of nard, and use a fomentation of the decoction of melilot and fenugreek. When the humour which occasions the ophthalmy is thick, we may use medicines which are neither obstruents nor incrassants, but which, on the contrary, will dissipate, dilute, and evacuate the humours, such as the chiac collyrium. But, if the humours are impacted in the head, we may fix a cupping instrument to the hind head, or scarify, or apply leeches to the forehead, near the eye affected. We must use cataplasms of pure bread soaked in water, with a little rose-oil, or polenta boiled in the decoction of poppy-heads also with rose-oil. We may also use a more efficacious cataplasm from saffron, melilot, the fleshy parts of dates, the tender leaves of coriander, eggs, and roasted wheat and crumbs of bread dipped in a decoction with a small quantity of rose oil, in a decoction of pounded poppy heads. We mix also the seed of the poppy as an anodyne. If compelled by the severity of the pain, we must add a little opium; but, unless the pain be very violent, we must abstain from all narcotics. If the inflammation be moderate, apply aloes by itself, or rub it in with water or the white of an egg. In order that the remedy may be ready for use, take of saffron, dr. vj; of aloes, dr. xvj; of gum, dr. ix; mix with rain water, and make a collyrium. And the saffron collyria, as they are called, are proper for the commencement of ophthalmies. In those cases in which there is an œdematous and white swelling about the eyebrows and tunica adnata, without injury of the coats, the best applications are those called liquid collyria, prepared from saffron, copperas, and honey. And this one is excellent:

A liquid anodyne collyrium. Of the melanteria used by tanners, of Attic honey, of the juice of fenugreek, equal parts. Boil to the thickness of honey, and touch the two angles of the eye with it, by means of the rounded extremity of a specillum or probe.

For a copious defluxion. For a flow of humours, in the commencement abstinence from food is proper, and the drinking of water, and most especially abstinence from venery; the belly should be opened, and the face washed with a watery oxycrate, if the rheum be of a hot nature; but if otherwise, the forehead and eyebrows may be anointed with copperas and honey. Some dissolve the copperas in water, and bathe with it. In defluxions without inflammation, or with inflammation, but so that the affection is seated above the skull, we must use agglutinative applications to the forehead, either simple ones, such as green vine leaves, or the juice of the bramble, or of purslain, or of quinces with some fine polenta, or with gall levigated in wine, or with fine polenta or hemlock, or flea-wort with water, or nightshade, or snails with their shells pulverized, and applied from temple to temple, and, in a word, with things of an astringent and cooling nature, or with the following compound applications: Wheat flour, and myrrh or frankincense, with the white of an egg, may be rubbed in; or Samian earth, with myrrh and manna, in like manner, with the white of an egg; but in colder defluxions, of native sulphur, of bitumen, of pitch, of colophonian rosin, of each, dr. ij; also the trochisk of Musa, that called aster, and the like, are suitable repellents. And the theriac, dissolved in an astringent wine, and rubbed on the forehead, stops cold defluxions, and may be drunk with great advantage. Over the eye apply wool, or a small rag wet in the white of an egg; and new-made cheese, in like manner, when applied to the eye, restrains acrid defluxions in particular; also the astringent collyria, as they are called, when rubbed in or injected into the eye in a watery state, do the same thing. But if the humour be deep-seated, and below the skull, and if fixed there for a length of time, after the general evacuations use errhines and masticatories, shaving the head, and applying rubefacients to it. But to these must be joined the surgical operations for the head, namely, Angiology, Arteriotomy, Hypospathismus, and Periscyphismus, with burning at the vertex down to the bone. But cupping instruments, with scarifications applied to the hind-head, will produce a revulsion of the defluxion. The symptoms of defluxions external to the skull are distension of the vessels of the forehead and temples, forming, as it were, a band to the head, and the complaint being remedied by agglutinative applications of a desiccant nature. When these symptoms are not present, and the defluxion proves of long duration, and sometimes is exasperated by sternutatories, the humour is to be supposed seated below the skull.

On chemosis. The disease is called chemosis when both the eyelids are everted in consequence of a violent inflammation, so that the eyes are scarcely covered by them, and the white of the eye is elevated above the black, is red, and occupies a large portion of the black. We must cure it by phlebotomy, purging, the white collyrium of roses, and the spodiac, with milk, or the white of an egg, and we may anoint the eyelids, temples, and forehead with the same, and have recourse to paregoric fomentations and cataplasms. When the inflammation begins to remit, we may rub in the more acrid applications, such as the green one from roses.

On hyposphagma and emphysema. Hyposphagma is a rupture of the veins of the tunica adnata, occasioned most frequently by a blow. Bathe the eyes with the blood of the wood-pigeon, or of the common pigeon, or the warm milk of a woman in which a little frankincense has been triturated, and inject brine, more particularly that from Cappadocian salts, and use a fomentation from the decoction of hyssop. Swellings about the eyes from blows are remedied by repeated fomentations with oxycrate, or a sponge out of oxycrate may be applied to them, or a liniment may be used, consisting of equal parts of burnt lapis specularis, and pigeon’s dung, triturated with wine or vinegar. Or a cataplasm may be applied of new cheese, or of the rind of radishes, or of dried grapes without the stones. Each of these is to be mixed with oxycrate or honied water. The same remedies apply also to emphysema.

On prurient emphysema and psorophthalmia. Emphysema is an œdematous swelling of the eyelids; but psorophthalmia is a scabious eruption of the eyelids attended with pruritus, arising from a saltish and nitrous humour. They are remedied by oxycrate, the decoction of lentils, and a fomentation of roses. The following is a liquid collyrium: Of copper, dr. vj; of calcined misy, and myrrh, of each, dr. iij; of saffron, dr. iss; of pepper, dr. j; of Chian wine, and Cretan sweet wine, of each 1½ cyathus; boil to the thickness of honey. This is the collyrium of Erasistratus called panchrestos, which applies to cynanche, ulcers in the mouth, and on the privy parts, and to the earache. They are to be rubbed with oil into the patient’s eyebrows when he is going to sleep. Acid, saltish, and acrid things are to be abstained from.

On sclerophthalmia and xerophthalmia. Sclerophthalmia is a hardness of the eye with difficulty of motion, pain, and redness, without wateriness. For this the eyes are to be fomented frequently with sponges out of hot water; and at bedtime the white of an egg with rose-oil, or the fat of geese, may be applied to the eyelids. Let them avoid everything of a cooling and hardening nature; let the head be covered and anointed, and the belly kept open. Xerophthalmia is a pruriginous affection of the eyes without rheum. It is to be cured by baths, unguents, and a wholesome diet. Applications of an acrid nature are suitable to both, as they promote a flow of tears, by which the hardness will be softened, and the dryness rendered more humid. Such are the panchrestos of Erasistratus, and those called dicenteton and stratioticum.

On ectropion, or eversion of the eyelids. This complaint is an eversion of the eyelid, occasioned either by a scar or fungous flesh. When it is occasioned by fungous flesh, and is of long duration, roast scraped verdigris, pulverise it and apply, or use burned lead washed with sulphur vivum, or apply both in equal parts, namely, the verdigris and the lead. Ectropion from a cicatrix, if at all remediable, must be cured by a surgical operation.

On ægilops and anchilops. Ægilops is an aposteme between the great canthus of the eye and the nose, which breaking and being neglected, ends in a fistula that extends to the bone. Before the aposteme breaks out into an ulcer, it is called anchilops. A very good application is horned poppy and saffron, applied with the juice of perdicias (pellitory of the wall?) They must be frequently changed, and till then it will not turn to pus.—Another: Alica, boiled in vinegar and properly triturated, not only cures the disease at the commencement, but, after suppuration, it bursts the abscess and penetrates to the bone. By using it, you may cure not only ægilops but anchilops.—Another: Garden rue, levigated and boiled with protostactos and applied, answers excellently for ægilops, penetrates to the bone, proving stimulating at first, but afterwards not so; and, what is wonderful, it does not leave an ugly scar.—Another: Pulverize snails with their shells and apply them; and sometimes aloes or myrrh may be added before the ægilops is converted to pus; and after the abscess bursts it dries up the pus.

On trachoma. Trachoma is a roughness of the inner surface of the eyelid, an intense degree of which has the appearance of clefts, and is called sycosis. When it becomes chronic and callous, it is called tylosis. We must use collyria for it, namely, the one from wine, and that prepared from the two stones; or the eyelid may be rubbed with the bloodstone itself (hæmatites,) much washed in water. But the collyrium called harmation, with a little of the cycnarius, or the saffron collyrium, answer well with these, and with cases of psorophthalmia without ulceration, when rubbed upon the everted eyelid. But if the callus be hard and do not yield to these things, we must turn the eyelid out and rub it down with pumice-stone, or the shell of the cuttle-fish, or fig-leaves, or by the surgical instrument called blepharoxyston.

On chalazion. Chalazion is a concretion of an indolent humour in the eyelid, for which pound ammoniac with vinegar, and anoint along with galbanum. It likewise has a good effect when joined with cerate and turpentine.

On hordeolum, or stye. Hordeolum is a small oblong aposteme on the tarsus of the eyelid. We may foment it with white wax; or throwing away the head of a fly, we may rub the part with the rest of its body; or wash with the decoction of barley.

For lice in the eyebrows. Having first cleared away the pediculi, wash the part with tepid sea-water, and use the under-mentioned application to the tarsus: Of fissile alum, two parts; of stavesacre, one part; triturate, and use.

On madarosis, or milphosis. This affection is a falling off of the hairs of the eyelids. Wherefore, after attending to the general health, use the detergent ointments called calliblephara. Of Cannel-coal, of Celtic saffron, of ladanum, equal parts; pulverize, and use.—Another: Of antimony, calcined and cleaned, dr. j; of lead, burned and cleaned, dr. iv; of saffron, dr. iv; of Indian nard, dr. iij; pulverize, and use.—Another: Of the burnt bones of dates, dr. iij; of Celtic nard, dr. ij; pulverize, and use. This also cures scabious eyes.

That of Neopolites for milphosis and chronic affections of the eyelids. Of antimony, of cadmia, of chalcitis, of foreign misy, of each, equal parts; beat together coarsely, mix with honey; when roasted, triturate, and use.

On ptillosis. Ptillosis is a callous thickening of the eyelids, of a red colour, and often accompanied with a falling out of the hair. In addition to those already mentioned, the following is an excellent application: Rub with mice dung burnt, and triturated in honey.

For a falling off of the hairs of the eyebrows. Anointing the fingers with oil, or geese fat, rub them upon lead, and anoint with this.—Another, which also darkens the hairs: Triturate blunt Pontic walnuts with the fat of goats or of bears.—Another, which also applies to alopecia of the chin: Of henbane, dr. ij; of mice dung, dr. j; of maiden-hair, dr. j; of the ointment of iris, four spoonfuls. Pound well together, mix the ointment, and, having first fomented, anoint. If you previously shave the part, it will be the more efficacious.

For trichiasis of the eyelids. Having first torn out the hairs which irritate the eye, anoint the part immediately with the blood of a frog by itself, or with the ashes of white chameleon, or the blood of bugs; or the juice of the fumitory, which grows among barley, mixing it with gum, or the ashes of pickled limpets with cedar rosin (gum vernix?), or the ashes of the lotos; or liquid alum, called phorimum; or the blood of a tick taken from a dog. It is very efficacious.

Agglutinative medicines. The following substances agglutinate the hairs when bent inwards: Bitumen, mastich, colophonian rosin, glue, the glutinous part of snails.

On encanthis and rhyas. Encanthis is an excrescence of the natural flesh at the great canthus, but rhyas is a wasting of it. You may treat encanthis with the remedies mentioned for ectropion, and similar caustic, or septic applications; but the whole substance must not be consumed, lest rhyas be produced, for it must only be reduced to its natural size. Rhyas, when the whole flesh is consumed, either by an awkward surgical operation or medicines, is incurable. But if part of it only be lost, you may restore it by moderately astringent and incarnating applications, such as that from saffron, horned poppy, and aloes; and the saffron collyria, and henbane boiled in wine and applied, and a small quantity of alum with wine.

On ulcers. Of the ulcers in the eyes there is but one genus, but many particular species. For that in the cornea, when hollow, narrow, and clean, is called bothrion. That which is broader than the bothrion, but less deep, is called cœloma. Argemon is the name given to that which arises on the circle of the iris, but affects the surrounding parts, so that the part which is on the external side of the iris is red, but that on the internal white. Epicauma is a foul and impure ulcer with eschars, which, when cleaned away, often give vent to the humours of the eye. There are many other varieties of ulcers, all of which we shall treat of in general terms. If, therefore, the ulcer happen to be attended with inflammation, the cure must be accomplished by such things as are calculated to soothe and digest the inflammation, regard being had to the peculiar nature of the ulcer. Such are the collyria, called libanium, cycnos, and palaria, aster, and the like; and those from starch, Samian earth, and ceruse. But the most sedative collyrium which we are acquainted with is that of Nilamon; and yet we must not persevere long with it, because it is very narcotic. The best of all applications is the collyrium from decoctions not possessed of a narcotic quality. But if the ulcer be attended with a rheum, we must mix some of the collyria for it, such as that from the hydra, the chiac, the yellow cycnos, and such as possess repellent properties without being stimulant. When the ulcers are foul, we must use honied water moderately diluted, and the decoction of fenugreek, by themselves, and along with the collyria for that purpose; when they are acrid, we may use that of Severianus with the diachylon from fenugreek; when not acrid, those from myrrh and nard. When the ulcers are cleaned, they may be cicatrized by means of the collyrium called cleon, in addition to which it will render the scar of the same colour.

On procidentia. Procidentia is a projection of the coat called uva (iris?), formed by an ulceration or rupture of the cornea. When, therefore, it is small, so as to resemble the head of a fly, it is called myocephalon. When it increases more, so as to resemble a grape-stone, it is called staphyloma; when it advances far forward, so as to protrude between the eyelids, it is called melon; and if it has become callous, it is called clavus. If, therefore, the projection is small, like the head of a fly, we must use repellent and astringent applications, such as the chian, that called fuscum, the nard, and the theodotian, and those from olive leaves, and from horn. And we must bind upon them without pressure a piece of sponge which has been soaked in oxycrate, or astringent wine, or the decoction of roses, or the compress called splenium may be used. The best application for procidentia, and all ulcers of the eye, is the collyrium called olympiac or olympus, with the juice of olive, or of knot-grass, or of poley. The same things are applicable to clavus and staphyloma, before they whiten; for after they become white and callous, they are incurable.

On hypopyon. Hypopyon occurs occasionally in the cornea, being sometimes deeply seated, and sometimes more superficially, the matter assuming the shape of a nail, and hence the affection has got the name of onyx. The indication of cure is either to dispel the pus by remedies possessing this property in a moderate degree, such as honied-water, and the juice of fenugreek, and the collyria formed from it, the libyanum, and those from frankincense; or to make it burst, and cleanse the ulcer by means of the more potent remedies, such as those called diasmyrna and the hygidian. For cases of hypopyon without ulceration one may use the following liquid collyrium: Of copperas, and of saffron, of each, dr. viij; of myrrh, dr. iv; of honey, lb. j. The phlyctæna, which is an elevation of the cornea, by a certain humour corroding its fibres, yields to the same treatment as hypopyon.

The liquid collyria of Bassus for hypopyon. Of saffron, of aloes, and of myrrh, of each, oz. j; of wine, oz. iij; of the finest honey, oz. vj. The saffron is to be levigated with a small quantity of the wine, then with the aloes and myrrh; and when it thickens, add the honey, and having mixed together, lay up in a glass vessel, and use twice a day, or, if the case be urgent, three times. It at the same time cleanses the eye and proves incarnating and cicatrizing.

On cicatrices and leucomata. Superficial scars on the eye are called by some cicatrices, and by others nebulæ; but the more deeply seated are called leucomata. The proper remedies for them are those of a detergent and cleansing nature. Wherefore, nebulæ may be cleansed by the juice of anemone, and that of the small centaury, with honey; but the more chronic are reduced by cedar gum, or by copper alone levigated with water for a collyrium, and by the cleansing collyria, such as that from hartshorn, and those called rhinarian, hecatombe, and the like. Leucomata may be cleared away by nitre carefully levigated with some old oil, and properly smeared upon them, and by the shell of the cuttle-fish (sepia) burnt and pounded finely with honey. Among the collyria, the following one proves an excellent and mild detergent: Of mamira, of ammoniac perfume, of Troglodytic myrrh, of crocodile’s dung, equal parts; make a collyrium, and use. Levigate the dung of the land crocodile with water, and anoint, having formed it into a collyrium. You may also succeed well by dissolving Cappadocian salts in water, and then dissolving the collyria for leucoma in it, and injecting it.

Dyes for cicatrices. Of galls and acacia, of each dr. iv; of copperas, dr. ij; use. The following is a collyrium: Of the flowers of the pomegranate, of copperas, of acacia, of gum, of each dr. iv; of antimony and galls, of each dr. ij; triturate with water. When the flowers of the pomegranate are not at hand, you may use the internal membrane between the seeds.

On pterygium. Pterygium is a nervous (membranous?) excrescence of the tunica adnata, arising at the angle of the eye, and advancing to the corona. When it increases greatly, it covers the pupil itself. Wherefore, large and chronic pterygia can only be extirpated by a surgical operation. But the smaller and more recent ones may be worn down by the abstergent applications, such as those used for trachoma and leucoma. Among the simple remedies are burnt copper, and copperas with the gall of swine, which answer well. The following is a more potent remedy: Of copperas, p. i, of gum, p. ss.; triturate with wine, and anoint, or form into collyria. Some mix the gall of a goat with honey, and anoint with it.

For pterygium, hypopyon, and dimness of vision. (From Oribasius.) Of the magnet-stone, of scraped verdigris (xyston), of reddle, of ammoniac perfume, of each dr. iv; of saffron, dr. ij; of Attic honey half a spoonful. It also answers for leucoma.

For carbuncle and carcinoma. Carcinoma is an affection of the cornea, attended with pain, distension, redness of the tunics, and pungent agony, extending to the temples, more particularly if shaken. They loathe their food, and have the pain increased by acrid things. The affection is incurable, but may be alleviated by a milk-diet, farinaceous and otherwise wholesome food, devoid of all acrimony; and the injection of soothing collyria, such as the Spodiac, Severianum, and the like. We must previously attend that the general system be in a proper temperament. Carbuncle also is a malignant ulcer of the sloughy kind, forming sometimes in the ball of the eye, sometimes in the eyelid, as in the other parts of the body. In cases of carbuncle of the ball of the eye, we must first evacuate with a clyster, and then purge moderately with boiled milk, afterwards foment with a sponge, and apply a cataplasm of the flour of tares, or of wheat boiled in honied water, or sometimes we may add pounded iris, and wash the eye with milk. If the ulcer spread, we may apply a cataplasm of lentils with honey or boiled quinces: if it continue spreading, we may use the boiled leaves of the olive, the rind of the pomegranate boiled in wine and pounded with honey. When the ulceration stops, and the eschar falls off by the application of the medicine about to be described, and the ulcers have become clean, we may apply a cataplasm of the roasted yelks of eggs, triturated with saffron and honey, until the ulcer is healed. The medicine is this: Of spodium, dr. iv; of myrrh not much toasted, dr. iij, and oboli iij; triturate in Aminæan wine until it become dry, mix old Cretan sweet wine, and having triturated, lay up the liquid in an earthen vessel, and anoint with it. For carbuncles of the eyelids, having cut an acid pomegranate, boil it whole in vinegar, and, when softened, pound and put it into a linen cloth, and use. Change twice or thrice during the day, and once during the night.

On mydriasis. When the pupil does not appear changed in colour, but much wider than natural, and when it sometimes wholly impairs the vision, and sometimes nearly so, and when every object appears smaller, the affection is called mydriasis. The cause of it is some redundant humour. We must cure it by bleeding from the arm, or purging; but, if not, by dividing the veins in the angles of the eye, and then applying a cupping instrument to the back part of the head, and bathing the face and eyes with sea-water, or, if it be not at hand, with brine or oxycrate. We must also use the remedies which are applicable to phyletænæ or blisters.

On phthisis and atrophy. Phthisis is an affection of the pupil, which is contracted, and appears duller and more rugose than usual, but objects seem larger than natural. The cause of it is condensation, mostly occasioned by dryness. Phthisis differs from atrophy in this, that phthisis renders the pupil contracted, whereas in atrophy the whole eye is smaller and more depressed. We may cure them by exercise, and rubbing carefully the head, the face, and the eyes; by bathing the face with water, and anointing the head with some healing ointment; and smearing the eyes with an attenuant and acrid composition, such as the following: Of ammoniac, dr. j; of crocomagma, dr. iv; of saffron, dr. ij; of verdigris, dr. j. Triturate in water, form and use.

For nyctalopia. In the disease called nyctalopia, the patient sees during the day, but at sunset his vision becomes dimmer, and when night comes on he does not see at all. We must effect the cure by bleeding from the arm and the angle of the eye, then purging or evacuating by a clyster, and afterwards ordering masticatories or sternutatories. Before food, we give hyssop to drink, or rue; but, if the disease do not yield, we must again administer the purgative medicine formed from scammony, and castor, anoint with clarified honey, and make the patient shut his eyelids, so as to retain the liquid application. Or of burnt alum, p. ij; of fossile salt, p. j; triturate with honey and anoint.—Another: Having roasted the liver of a goat, collect the ichor during the roasting and anoint, but give the liver itself to eat; or boil, and direct the vapours to be received with open eyes.

For glaucoma and suffusion. (From Ruffus.) The ancients considered glaucoma and suffusion as the same disease; but by their successors glaucoma has been accounted an affection of the crystalline humour, which is changed by a watery substance to a cerulean colour; but suffusion is reckoned a defluxion of humours concreted between the cornea and the crystalline lens. Glaucoma is in every case incurable. Suffusion may indeed be cured, but not always. We may try to cure suffusion before the disease is completely formed, by taking blood from the arm, by purging and acrid clysters, such as those made from the decoction of centaury, or of the bitter cucumber, and by keeping the bowels for some time in a loose state. Cupping instruments with scarifications may be applied to the hind-head; the patient must drink water during the whole regimen, take attenuant food, and, in process of time, masticatories may be used for a few days with advantage. When the vision is depraved, as, for example, gnats appearing before the eyes, which case proceeds from a cacochymy or from bilious vapours ascending to the head, we may give for a time the bitter medicine from aloes, or purge with it. To the eyes we must make applications at first simple, such as honey and oil, with the juice of fennel, and afterwards compound, such as this: Of sagapene, dr. ij; of Cyrenaic juice, of white hellebore, of each, dr. vj; triturate with eight heminæ of honey. We, says Oribasius, use the following medicine: Of the juice of wild carrots, of germander, of cresses, of each, equal parts; triturate. The following collyria are beneficial, namely, that from the juice of the fennel, that called proteus, the thalasseros and that from opobalsam. The collyria prepared from them are useful, and the decoction of fennel in the commencement answers well as a fomentation, and that from juices, opobalsam, honey, old oil, and the like.

On amaurosis and dimness of sight. Amaurosis is, for the most part, a complete impediment of the sight without any apparent affection about the eye; and dimness of sight is an imperfection of vision arising without any sensible cause. The same mode of cure as that described for suffusion applies generally in this case; but, in particular, blood may be abstracted from the corners of the eye, leeches applied to the temples, and friction of the extremities. In process of time we must have recourse to sternutatories, emetics with an empty stomach, and the application of ointments, at first with equal parts of honey and oil, and afterwards with the under-mentioned composition: Of saffron, two oboli; of the gall of the hyæna, dr. j; of common pepper, eighty-five grains; of fennel juice, dr. xvj; of ammoniac perfume, dr. j. Triturate the dry substances with the juice, add four spoonfuls of honey, prepare and lay up in a copper vessel for use. Before using, let him foment the eyes by immersing them in hot sea-water.

On strabismus, or squinting. Congenital squinting is cured by the application of a mask, so that the children are compelled to look straight forwards; for strabismus is a spasmodic affection of the muscles which move the ball of the eye. And the lamp should be placed fairly opposite, and not so as to shine obliquely. When the eye is turned to the nose, purple flocks of wool should be fastened to the outer angle of the eye, so that by looking steadily at them, the persons affected may correct the state of the eyes.

On ecpiesmus. The eyes are sometimes forced out, so as to remain prominent. When this happens from strangulation, we must let blood from the arm; but if otherwise, we must purge with black hellebore or scammony. When the eyes become prominent from the pain of labour, the complaint is often removed by the cleansing after parturition; hence we ought to promote it; and, in men, after phlebotomy, if it do not abate, we may affix a cupping instrument to the back part of the head, and apply wool smeared with honey, or flocks of it with water, and bind a compress gently above it. Cold salt water poured upon the face is likewise suitable to them, and also the juice of endive and knot-grass, rubbed in with the juice of poppy, and whatever else can repress and contract.

On synchysis, or confusion. Confusion of the sight occasioned by a blow may be cured by bleeding from the arm, and by filling the whole eye with the blood of a newly-slaughtered animal, of a turtle in particular, but, if not, of a pigeon, and then applying soft wool which has been immersed in an egg beaten up with wine and rose-oil, and binding it on the place. The same thing is to be done next day; and on the third, it is to be fomented, washed with milk, and suitable cataplasms applied; after which it is to be anointed with the remedies for old affections, such as Chiac.

For myopia. Those persons are called myopes, or near-sighted, who, from their births, see near objects, but not those at a distance. Such a state is wholly incurable, being occasioned by a weakness of the optic spirit. Old men are affected in the opposite manner to these, for they do not perceive near objects, but see those at a distance.

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COMMENTARY. See Hippocrates (Aphoris., de Visu, et alibi); Galen (de Loc. Aff. iv, de Med. Sec. Loc. iv); Aëtius (vii); Alexander (ii); Oribasius (Synops. viii); Actuarius (Meth. Med. iv, 11); Leo (iii); Psellus (Opus Medicum); Palladius (Comment. in Hippocrat. Epidem.); Scribonius Largus; Octavius Horatianus (i, 10); Nonnus (Epit. 45); Serapion (ii); Avicenna (iii, 3, 1, 2); Mesue (de Ægrit. Ocul.); Avenzoar (i, 7); Haly Abbas (Theor. ix, 13, Pract. v, 34); Alsaharavius (Pract. iv); Rhases (Divis., ad Mansor. ix, and Contin. ii); Canamusali (de Oculis, vi); Jesu Haly (Tract. de Oculis.)

On pain, disorder of the eye, ophthalmy, inflammation, and defluxion. The ancients treat of these complaints separately; but, as they are so nearly connected, we shall class them together. By disorder of the eye (taraxis), they meant an inferior degree of ophthalmy, as is remarked by Turnebus. (Bernard’s Nonnus, 45.) It is, therefore, the mild acute ophthalmy of Scarpa. The remedies enumerated by Hippocrates for pains of the eyes are thus given in the language of Celsus: “Sanguinis detractio, medicamentum, balneum, vinum.” Drinking wine might appear to us at first sight not a very likely mode of curing ophthalmies; and yet Galen, in his Commentary on this Aphorism (vi, 31), has related a case in which it effected a cure after every other remedy had failed. Even Scarpa allows the correctness of the aphorism as a rule of practice, and states that wine and the cold bath are proper when the disease is kept up by excessive irritability. Alexander recommends wine and the tepid bath when the inflammation arises from thick and pituitous blood. Philagrius, as quoted by Theophilus in his ‘Scholia on Hippocrates,’ indicates that the wine should be white, sweet, new, and if the patient’s head be delicate, diluted with water. (See further, t. ii, 501, ed. Dietz.) Mesue makes many interesting remarks upon the above-mentioned remedies of Hippocrates. For further explanation of the rationale of this practice, see Schelhammer (de Tumoribus), and Littré (Hippocrat. t. iv, 418.) Another of Hippocrates’ aphorisms is, that a spontaneous diarrhœa is a favorable occurrence in ophthalmy; upon which Galen remarks, that, in imitation of nature’s method of removing the complaint, physicians are in the practice of producing an artificial looseness by means of cathartics and clysters. Lead is an ingredient in several of Alexander’s collyria. For periodical ophthalmy, Hippocrates recommends purging the head and bowels; and in certain cases bleeding, cupping, and restricted diet. Celsus, Galen, and, in short, most of the ancient authorities make mention of narcotics, such as opium and mandragora, but do not approve of them as common remedies. Galen, however, instances ophthalmy as one of the species of inflammation in which opium is admissible. (De Optima Secta, 9.) Alexander, in like manner, cautions against the indiscriminate use of opium to lull the pain. Some of his prescriptions for collyria, however, contain opium. Galen recommends scarifications in chronic defluxions of the eye. Aëtius lays down very proper rules respecting purging, fomentations, venesection, and baths. He properly remarks regarding the use of wine, that it is only applicable when the patient is of a dry and cold intemperament. Celsus is a decided advocate for fomentations with hot water in all cases of ophthalmy.

The Arabians treat ophthalmy upon the same principles as the Greeks, without supplying much additional information. Mesue, like our author, recommends bleeding by opening the temporal artery, which operation he describes minutely. When the bleeding cannot be stopped otherwise, he directs us to secure the vessel with a silk thread. He also makes mention of leeching and the actual cautery. He is very minute in his directions about his collyria. One of his anodyne collyria consists of the juice of hyoscyamus, mandragora, and opium; and another contains camphor, saffron, hyoscyamus, and the like. The use of narcotics, however, is forbid by Jesu Haly. Rhases also rather disapproves of them. Avicenna makes mention of bleeding by the temporal arteries, the angular vein of the nose, and the frontal. When the usual remedies do not succeed, he approves of the cautery; and, in certain cases, recommends strongly the use of stimulant applications, such as æs ustum, copperas, and arsenic. Galen, in like manner, makes mention of arsenic, and also of misy, sori, and chalcitis (substances resembling our sulphate of copper) among his remedies for diseases of the eye. Having ourselves had occasion to use arsenic in certain malignant diseases of the eyelids, and not having found that it produced any serious disorder in the ball of the eye, we would call the attention of modern oculists to this medicine as one from which, when properly managed, the best results may be expected. When the ophthalmy is of a cold nature, Avicenna approves of treating it by an attenuant diet, the bath, and white wine. In certain cases he directs us to pour cold water on the head. Haly Abbas describes three varieties of ophthalmy. The first arises from manifest causes, such as the sun, dust, and the like; and is to be cured by bleeding, purging, and cooling lotions, containing rose-oil, camphor, &c. In the second, the symptoms are more severe, being attended with greater redness and pain. It also is to be cured by bleeding, cupping, and emollient collyria. The third variety is chemosis. Alsaharavius treats of the disease at great length. When it is connected with a bilious cause, he directs us to purge, use the bath, apply vapours to the eye, and soothing collyria. Serapion, like Haly, describes three varieties of the disease by the names of tarkinisis, noutelinie, and kermufil. Jesu Haly recommends general bleeding, purging, and fomentations, with the decoctions of fenugreek and fennel, for ophthalmy. It remains to be mentioned that Galen, Alexander Aphrodisiensis, and all the Arabian authorities have placed ophthalmy in the list of contagious diseases. See, in particular, Alex. Aph. (Prob. i, 35), and our brief sketch of the history of ancient opinions on contagion in the Second Book, Sect. XXXVI. The celebrated Fracastorius confidently maintains that ophthalmy is contagious. (De Morb. Contag.) And we may further mention that all the authorities of the middle ages speak of ophthalmy as being contagious.

On chemosis. By chemosis, modern oculists (as, for example, Scarpa) understand that state of ophthalmy when blood, owing to a rupture of one or more vessels, is effused into the cellular membrane which connects the conjunctiva to the anterior hemisphere of the eye. Our author’s account is mostly taken from Oribasius, who, in his turn, borrows from Demosthenes. Galen and Octavius Horatianus, without saying anything of the general treatment, merely recommend us to apply upon a clean linen cloth flies pounded with the yelk of an egg. Chemosis is Haly’s third variety of ophthalmy, for which he recommends copious and repeated bleeding, cupping, gentle laxatives, cataplasms containing poppies when the pain is violent, and other soothing collyria. Alsaharavius, in like manner, recommends depletion and emollient fomentations. Serapion, among other things, mentions soothing fomentations. In chemosis, according to Rhases, all the symptoms of ophthalmy are particularly strong and violent; the eyelids being swelled and everted, and the white of the eye appearing black. He recommends local and general bleeding, purging, and astringent applications.

On hyposphagma and emphysema. Hyposphagma is not described by any particular name in modern surgical works. Besides the local applications mentioned by our author, Aëtius properly recommends general treatment, we mean bleeding, purging, and the like. Avicenna also makes mention of venesection and arteriotomy. Haly describes the disease by the name of tumor oculi as his first variety of inflatio. Alsaharavius uses the same term. Serapion treats of it by the name of sanguis divisus in oculo, recommending treatment similar to our author’s. See also Celsus (vi, 6.)

The emphysema appears to have been a sort of œdema seated below the eyelid. Aëtius remarks that it occurs principally in old men. We have often seen it in them. He recommends fomentations by means of a sponge, rubbing the eyelid within with honey, pouring hot water on the head, using baths, drinking wine, and even bleeding at the arm. This last measure is omitted by our author, and must be unnecessary in general. It is described by Haly Abbas as his second variety of inflatio oculi. He says it is an œdematous swelling principally affecting old men in summer. He recommends collyria of a sharp penetrating nature, and various other applications.

On psorophthalmia, sclerophthalmia, and xerophthalmia. For these affections Aëtius gives various prescriptions containing calamine, burnt copper, chalcitis, and the like. Similar ones may be found in Galen (sec. loc.) Galen, like our author, recommends fomentations, by means of a sponge, with hot water or the decoction of poppies. One of Alexander’s prescriptions for psorophthalmia contains arsenic. Celsus describes the symptoms and treatment of xerophthalmia very minutely: “Neque tument, neque fluunt oculi, sed rubent tantum, et cum dolore quodam graves sunt, et noctu præ gravi pituita inhærescunt.” He gives the sum of his treatment in this short sentence: “In hoc vitio multum ambulare, multum exerceri, lavari sæpe, ibique desudare, multâque frictione uti necessarium est.” He also prescribes gargles, food of a middle quality, and various compound collyria, such as the rhinion which contained burnt copper, myrrh, Phrygian stone, &c. This affection, the dry ophthalmy, had been described by Hippocrates (Aph. iii, 12, 14.) Most probably, as Sichel suggests, it was the same as the catarrhal ophthalmy. See Littré (Hippocrat. t. iv, 418.) Celsus recommends this collyrium also for the psorophthalmia, which he describes by the name of scabri oculi. For this last-mentioned affection he recommends various stimulant applications; and, when other remedies are not at hand, directs us to apply bread pounded in wine. The psorophthalmia is the prurigo oculi of Haly Abbas, for which, among other things, he recommends a composition containing pepper, sal ammoniac, saffron, spikenard, camphor, &c. He describes sclerophthalmia by the name of durities oculi, and recommends for it bleeding, gentle purgatives, emollient collyria, &c.

On ectropion. Aëtius, in like manner, recommends compositions containing ærugo æris, misy, and chalcitis. None of the subsequent authorities supply any additional information. Alsaharavius in particular gives a very accurate account of the disease, which, when it arises from a fungous excrescence growing from the inner side of the eyelid, he directs us to burn with caustics; but, when it arises from a cicatrix, it is to be cured only by a surgical operation. This will be found described in the Sixth Book. In place of the caustics recommended by the ancients, Scarpa directs the argentum nitratum to be applied.

On ægilops and anchilops. These are different stages of the disease now known by the name of fistula lachrymalis. Galen states that at the commencement it is to be cured by applications which are repellent without being too stimulant. He gives a full account of the treatment recommended by Archigenes. The first application mentioned by him is a cataplasm consisting of tares and honey. Scarpa, by the way, speaks favorably of the practice of Ægineta, Aëtius, and Avicenna. Avicenna treats of the disease with great judgment. His first applications appear to have been intended to produce resolution; and, if these fail, suppuratives are to be applied. When the abscess bursts, the sore is to be reduced to a healthy state by escharotic powders containing alum, limatura æris, sal ammoniac, and the like. When these fail, a surgical operation must be had recourse to. This is described in the Sixth Book. Mesue also has treated of the disease at great length. Haly Abbas describes the disease very correctly. He says, “Aliquando autem ejus sanies ad nares defluit per foramen quod inter oculum est et nasum.” This passage puts it beyond a doubt that the ancients were acquainted with the lachrymal duct. The disease, he says, sometimes occasions caries of the cartilages (os unguis?). When it is recent, he recommends bleeding and laxatives; and when it gets into a fistulous state, he directs us to use applications containing arsenic, sal ammoniac, cantharides, alum, &c. Alsaharavius mentions that the abscess of the lachrymal sack may either burst outwards or into the nose. It would appear, therefore, that he also was acquainted with the natural structure of these parts. One of the applications recommended by Rhases for fistula lachrymalis contains arsenic, quicklime, and vitriol. Another is prepared from litharge, arsenic, and oil. These applications are mentioned by the earlier of the modern authorities on medicine. See Theodoricus (iii, 2.)

The protostactos mentioned by our author was a composition consisting of potass and lime. (See Book Seventh, in voce, κονία.)

On trachoma. This affection does not appear to be noticed in our late treatises on diseases of the eye, and yet in our own practice we have met with some cases of it. Rowley mentions it as an asperity of the internal superficies of the eyelid. Celsus describes it by the name of aspritudo. In severe cases, he says, some scarify the inside of the eyelid with a fig leaf, a rough probe, or a scalpel. But in ordinary cases, he rather approves of using exercises, frequent baths, fomentations with hot water, attenuant food, and escharotics, such as copperas, misy, antimony, and the like. Galen and Aëtius give prescriptions for various collyria. They consist principally of detergent and caustic substances, such as sal ammoniac, squama æris, calamine, and the like. It seems to be the disease which Haly Abbas treats of by the name of lapidositas. (Pr. v, 51.)

On chalazion. We will treat more fully of the nature of this tumour in our notes on Section XVI of the Sixth Book. It appears to be the species of encysted tumour said by Scarpa to be well described by M. Aurelius Severinus. (On Diseases of the Eye, 3.) Rowley describes it as a moveable tumour in the margin of the eyelids. Aëtius recommends us to open the tumour with a scalpel, and apply to it escharotics, such as burnt copper, chalcitis, and red arsenic. By Haly Abbas it is called grando, and the remedy mentioned by our author is recommended by him. Alsaharavius describes it as a gross humour congealed in one of the eyelids. He describes by the name of alsaanac a fatty tumour of the eyelids which we have sometimes met with and extracted. On the chalazion, see Celsus (vii, 7), and Isidorus (Orig. iv, 8.)

On hordeolum. Most of the ancient authors treat of this trifling complaint in much the same terms as our author. Scarpa evidently is mistaken in making the hordeolum and chalazion to be the same complaint. Haly Abbas describes it as being an oblong abscess resembling a grain of barley on the extremity of the eyelid. He recommends general depletion, and nearly the same remedies as our author; also a cataplasm of galbanum. Alsaharavius treats of it in a similar manner. Rhases particularly recommends melted wax as an application to it. He also speaks favorably of the diachylon plaster.

On lice in the eyebrows. Stavesacre is a very ancient remedy for pediculi on all parts of the body. Celsus lays down very minute directions for the constitutional treatment, and recommends a local application containing sandarach, or the red sulphuret of arsenic. Avicenna makes mention of sulphurous baths. Haly Abbas recommends general purging, various stimulant applications, and abstinence from figs. Our author states, in Section LXXXI of the First Book, that figs engender lice. Alsaharavius directs the eyebrows to be rubbed with sal ammoniac, alum, salts, &c. Jesu Haly recommends purging with hiera, the frequent use of the bath, and applications containing stavesacre, sulphur, alum, nitre, sal ammoniac, vinegar of squills, and the like. Rhases recommends a powder containing quicksilver.

On madarosis, or milphosis, and ptilosis. Aëtius, Actuarius, and Nonnus treat of these diseases in similar terms. The calliblephara are fully described by Galen (sec. loc. iv.) Haly Abbas seems to allude to these complaints in the following sentence: “Palpebrarum autem casus ex humiditate fit acutâ aut alopetia, et quidam fit cum palpebrarum grossite et duritie, ruboreque, et dolore.” His remedies are like our author’s. The same may be said of Alsaharavius.

On trichiasis. Our author’s treatment is mostly imitated from Galen. We shall treat more fully of the disease in the Sixth Book. Scarpa places no confidence in the operation of plucking out the hair, and yet it is favorably spoken of by most of the Greek and Arabian authorities, as, for example, Aëtius, Avicenna, Alsaharavius, and Haly Abbas; and also by Rowley, and other modern oculists. Haly, like our author, directs us to touch the part from which the hair has been plucked with the blood of a frog, or of a dog’s tick, or with the milk of a fig, or the gall of a hedgehog. Alsaharavius makes mention of the same remedies, and also of the mode of treating it by agglutinants. According to Actuarius, the disease consists in certain of the ciliary hairs being turned inwards and hurting the eyeball. (ii, 7.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To remove the hard sordes of the ears. Dissolve nitre in vinegar, and inject with water, and having wiped it dry, inject nitre dissolved in vinegar with rose-oil.—Another for sordes: Mixing cardamom and a little nitre with dried figs freed from their stones, make collyria, which put into the ear, and remove after three days. It brings away much sordes, and gives much relief. It also applies to fungous flesh, chronic pains, and ulcers. Or of aloes, of frankincense, of myrrh, of each, dr. j; of misy, dr. iv. Make a trochisk of it with vinegar, and, when you are going to use, dissolve it in vinegar and rose-oil, and inject. In the same manner the trochisks of Andron, Heré, and that of Musa may be used.

For chronic ulcers. Mix gum juniper with honey, and anoint.—Another: Blow in misy what has been burnt and levigated. Before using those things which are injected into the ear, syringe it first with oxycrate in oxymel, or in mulse, or in a decoction of some repellent article, such as dried lentil or roses.

For bloody ears. Wash with the decoction of bog-rush, and inject the juice of knot-grass, with a little vinegar, or lycium, or lees of oil, or acacia, or the juice of leeks.

For fungous flesh. Wash nitre in hot water, and use with equal parts of flakes of copper and sandarach. Clean the eschars which are formed by it with honey.

For vermes in the ears. Wash with a decoction of wormwood, of centaury, or of leeks; inject the juice of the green leaves, or of the fruit of capers, or cedar-gum, or old human urine, or white hellebore with honey, or the juice of calamint, or scammony with vinegar, or the juice of wormwood. Oil poured into the opening of the ear, so as to make them ascend to the top, answers well. But a better application is vinegar and oil. It also applies to animalcules which fall into the ear.

For calculi and the like which have fallen into the ear. Having wrapped some wool about an ear specillum, dip it into turpentine-rosin, gum, or some glutinous substance, and thus draw it out; but if it does not yield, pour frequently warm oil into the passage; and if it do not fall out or is left behind, use the other means to be described in the Surgical part of this work.

On noises. If noises occur in fevers at their crisis, they ought not to be interfered with, for they will commonly cease of themselves; but, if they remain after the disease, having fomented with the decoction of wormwood, inject vinegar and rose-oil, or the juice of radish with rose-oil, or that of black hellebore with vinegar. For chronic noises occasioned by thick and viscid humours (which you may know from their coming on not suddenly, but gradually), syringe with vinegar, nitre, and honey.—Another: Of white hellebore, dr. ij; of castor, dr. ij; of saffron, dr. iij; of nitre, dr. xvj. Make trochisks, which triturate in vinegar, and use.

For chronic noises and hissing sounds. Triturate euphorbium with oil of privet, heat and use. When, from increased sensibility, they experience the sensation of vapours or spirits carried upwards, triturate castor and the seed of hemlock with vinegar, and inject.

On difficulty of hearing and deafness. Those cases which are congenital, or which, although not congenital, are inveterate, and attended with complete deafness, are incurable; and those which, although not complete, are inveterate, prove also incurable, or difficult to cure. Those which are formed by a bilious humour ascending upwards, you may easily cure by evacuating with cholagogue medicines; and sometimes the complaint goes off spontaneously, when bile is discharged downwards. Deafness, or difficulty of hearing, occasioned by crude and thick humours, you may cure by opening a vein, by purging freely with hiera, and by using masticatories, errhines, and natural or salt baths. It is also proper to inject into the ear those things which are recommended above for noises. But the following are particularly applicable: Inject the urine of a goat and the gall of a goat together, or the gall singly; or the juice of rue with honey; or castor with the oil of dill; or the medicine œsypum with nard ointment; or the gall of a goat with galbanum; or this: Of castor, dr. ij; of nitre and white hellebore, of each, dr. j.

For contusions of the ears. Hippocrates recommends us to apply nothing to them; but since we are often compelled by those who have sustained the injuries to do something, we may use the following: Of myrrh, of aloes, of frankincense, of acacia, equal parts; anoint with vinegar or the white of an egg. Or, pound in a mortar the inner part of warm bread with honey, and apply as a cataplasm. Or this: Of bitumen, of frankincense, of aloes, of the flesh of snails, of African bulbi, equal parts, triturate with vinegar, and apply. When there is inflammation, triturate with oily grain (sesame), or with chondrus boiled in vinegar, and apply as a cataplasm; but let the cataplasm be light, and not bandaged at all, or but slightly; and let wool dipped in oil be introduced into the passage.

On parotis. Parotis is an affection of the glands about the ears, being sometimes occasioned by humours from the head which are impacted in it, and sometimes by those collected from the rest of the body during the crisis of a fever. If it be deep-seated, and do not occasion a swelling, we may assist nature by applying attractive remedies, either by putting on a cupping-instrument or using frequent fomentations. For if the matter be determined inwardly, there is no ordinary danger; but, if it inflame and swell out to a tumour, we must, on the contrary, use soothing and digestive cataplasms, such as that from barley-flour, that from wheat, or from the flour of linseed with honied water, or boiled with the decoction of fenugreek, or of marshmallows, or of chamomile, and that from dock and axunge without salt. But if it appear that there is a fulness of blood, we must first evacuate by phlebotomy, if the strength permit: but if the swelling be not dissipated, we must use suppurative medicines, such as wheat-flour, with the decoction of dried figs and oil, and the application made from pollen and that from leaven. When the aposteme is converted into pus, we may evacuate it either by opening it, or produce its rupture by means of an acrid medicine, such as that called smilium, or that from garlic. The milder kinds of parotis are discussed by a fomentation of salt water, or the composition from Aperanus. This medicine is calculated to discuss the converted pus, and to prove very anodyne. For inveterate cases of parotis, we may apply the ashes of burnt buccinæ, or purpuræ, with honey or axunge, or figs boiled in sea water, or horehound with salts. Hard ones are softened by the composition of Mnasæus, and that of Ariobarzan; but one of the best applications is that formed from the juice of linseed. But before using these, we are to apply cataplasms of ammoniac, mixing with them liquid pitch, bull’s fat, bdellium, storax, or hart’s marrow.

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COMMENTARY. The following ancient authors treat of diseases of the ear: Hippocrates (de Affectionibus, et alibi); Galen (Sec. Loc. iii); Celsus (vi, 7); Oribasius (de Loc. Aff. iv); Aëtius (vi, 74 et seq.); Alexander (iii); Scribonius Largus; Marcellus (de Med. 9); Nonnus (74 et seq.); Cælius Aurelianus (de Tard. Pass. ii, 3); Actuarius (Meth. Med. iv, 10); Pliny (Hist. Nat. xxviii, 48); Octavius Horatianus (i, 7); Mesue (de Ægr. Aurium); Avenzoar (i, 4); Serapion (2); Avicenna (i, iii, 4); Albucasis (ii); Haly Abbas (Theor. ix, 14; Pract. v, 62); Alsaharavius (Pract. iii); Phases (ad Mansor. ix; Contin. iii.)

For relieving earach Hippocrates recommends the warm bath and fomentations; and when these do not succeed, phlegmagogues and masticatories are to be used.

Celsus gives very judicious directions for curing pain of the ears, but his treatment is little different from our author’s. When the pain is not violent he recommends abstinence alone; but if severe, venesection, purging, hot cataplasms from linseed and fenugreek, or sponges squeezed out of hot water. When the inflammation is particularly violent, poppies are to be added to the injections, which must be tepid; and when the ear is filled with them, soft wool is to be put over it to contain the injection. He mentions various compound applications, which contain poppies, castor, myrrh, alum, saffron, and the like.

Our author copies from Galen. He recommends the following simple application: Having scooped out the heart of an onion, fill it with oil, and having heated it in ashes, put it into the ear. He gives prescriptions for various injections and other compositions, which are similar to those of our author and Celsus.

Aëtius on this head is more brief and less distinct than our author.

Alexander, Actuarius, and Octavius Horatianus treat of these complaints very properly, but not differently from Celsus and our author. Alexander states correctly that inflammation within the ear sometimes spreads to the brain, and proves fatal. He enjoins caution in using opiate applications to the ear, as he has seen dangerous effects from them by their inducing stupor. He particularly approves of introducing steam into the ear, by means of a tube connected with a vessel containing some boiling decoction.

Marcellus gives a long list of empirical applications, from which, perhaps, something valuable might be extracted. He recommends, like some of the other authorities, a solution of alum in hot vinegar, with some honey. We shall see in the twenty-sixth Section that alum was much used for allaying the pains of toothach. Among the ingredients in his injections we remark tepid milk, opium, castor, spikenard, saffron, opobalsam, millepedes, &c.

The treatment directed by the Methodist Cælius Aurelianus is little different from that of the other sects. He approves of putting tepid oil into the ear; of stuffing it with wool; of using fomentations, cataplasms, leeches, and scarifications; and when the disease becomes chronic, of shaving the head, and applying acopa, dropaces, malagmata, and so forth.

Serapion and Rhases treat the complaint exactly like our author.

Avenzoar relates a case of inflammation seated in the meatus, which he cured by filling it with oil of eggs. He further recommends bleeding and the other remedies already mentioned. Avicenna treats of diseases of the ear most minutely and scientifically, but at too great length for us to do justice to his account of them. For pains from a hot cause he recommends camphor-oil, or oil of violets with camphor. Mesue also treats of these complaints very minutely. When the pain is violent, he recommends injections containing poppies, henbane, mandrake, nightshade, and the like. Haly Abbas, in such cases, also approves of rose-oil, with opium, the juice of mandrake, &c. Alsaharavius varies his treatment according to the nature of the exciting cause. When it is caused by congestion of blood in the organ, he recommends bleeding, abstinence from wine, a restricted diet, and pouring warm oil into the ear. When it arises from a cold cause he approves of oil of costus, of spikenard, &c., and of applying to the ear a cataplasm of hot flour.

On ulcers of the ears. Aëtius and Alexander give various prescriptions for these cases. The fullest account, however, is contained in Galen (sec. loc.) When there is a discharge of pus, attended with pain, Octavius recommends alum, mixed with honey and oil. When ulcers of the ears are recent, Mesue recommends injections of honied water, wine and honey, vinegar and honey, or the like, by a syringe. They are to be dried by means of olibanum, or sarcocolla dissolved in wine. He also praises myrrh, aloes, alum, and red arsenic, as ingredients in the applications to ulcers of the ears. When the ulcers are chronic, they are first to be cleansed by such applications as the decoction of wormwood in wine, or oxymel of squills, with a small quantity of the flowers of copper; then they are to be dressed with the usual incarnants; and, lastly, they are to be dried or cicatrized by compositions containing aloes, myrrh, and frankincense. When the ulcers are foul, he and Serapion recommend escharotics, such as the scoria æris. Haly’s applications are quite similar. For sanious discharge he recommends us to wipe the ear with a piece of cloth wrapped round a probe, and dipped in an astringent solution. He directs us to remove fungous flesh by an operation, or with the ointment of flos æris. In this case Celsus recommends applications, consisting of verdigris and honey, or frankincense, or squama aris triturated with red arsenic. These powerful ingredients enter into some of the compositions recommended by Rhases.

For vermes in the ear. All the ancient authorities in this case recommend acrid and bitter injections. Wormwood, hellebore, nitre, calamint, birthwort, and sulphur are the common ingredients in the compositions recommended by Galen, Alexander, Aëtius, Oribasius, Celsus, Mesue, Serapion, Haly Abbas, Alsaharavius, and Rhases.

On calculi and the like which have fallen into the ear. Alexander, Aëtius, and Haly Abbas recommend similar means, and also direct us to compress the patient’s nose and mouth, and to make him sneeze. Galen, copying from Archigenes, gives similar directions. This subject is more fully treated of in the Sixth Book.

On noises. These are fully treated of by Galen. (Sec. loc.) He remarks that they commonly arise from indigestion, excess of wine, violent vomiting, or the improper application of medicines to the ear. He says the disease sometimes arises from excessive sensibility, in which case he mixes with the injections the juice of mandragora, poppies, or the like. Our author’s applications are taken from Alexander. Celsus treats of this affection very circumstantially, and modifies his application according to the circumstances of the case. He recommends particular attention to the diet, and injections, such as castor with vinegar, oil of iris, or oil of bays, or myrrh and nitre, with roses and vinegar. When local applications do not succeed, Haly states that the disease is occasioned by an affection of the brain or auditory nerve. Alsaharavius treats of the complaint with singular precision and at great length. (Pract. iii, 4.)

On deafness. On this subject Galen gives copious extracts from Apollonius and Archigenes, from which the aurists of the present day might derive perhaps some information. In deafness occurring suddenly he recommends fomentations with the decoction of wormwood. Aëtius copies from him. Alexander is very particular about the general treatment, recommending emetics of hellebore, drastic purgatives, errhines, topical applications, exercise on horseback, change of place, shaving the head, and applying leeches to it, or a sinapism, or using friction, and even opening the arteries. Celsus directs us to examine the meatus, and if any scab of a sore or sordes appear in it, to inject warm oil, ærugo with honey, or the like; and afterwards to syringe it with tepid water. When the sordes is hard, it may be first softened by an injection of vinegar with a little nitre. Haly Abbas directs us to mix mustard with figs, and apply upon a tent for three days. As an injection he recommends castor dissolved in oil of dill, and the juice of rue. When it proceeds from bile, he recommends hot purgatives and things of an attenuant nature. According to the nature of the exciting cause, Alsaharavius applies various remedies, such as purging, gargles, fumigations with decoctions of stimulant herbs, detergent oils, such as those of dill, chamomile, &c.

Aaron, one of the authorities quoted by Rhases, states that deafness sometimes arises from congestion of blood about the ear; and, in that case, recommends local bleeding and an attenuant diet, with fomentations of hot oils, and the like. When it arises from obstruction, he directs the use of injections containing hellebore, vinegar of squills, &c.

For contusions of the ears. Galen gives various prescriptions for this case. Similar ones occur in Aëtius and Oribasius. Modern aurists forbid to bandage the ears tightly.

On parotis. Celsus properly directs that if the gland swell without any other disease, applications to produce resolution should be first tried; but if the system is labouring under disease, that the swelling is to be brought to a suppuration, and opened as soon as possible. It is from Galen, however, that all the subsequent authorities copy their account of parotis. He lays it down as an established rule of practice that no attempt is to be made to discuss the swelling by repellent applications, but that suppuration is to be encouraged by the proper means. When there is plethora of blood, he allows venesection; and, when attended with pain, he recommends paregoric cataplasms of linseed, fenugreek, chamomile, and the like. When any hardness remains, he prescribes some of the malagmata, or emollient plasters. He informs us that Archigenes applied figs boiled and pounded. Octavius Horatianus and some of the others mention this application. Of the subsequent authors, although they contain little additional information, Alexander may be referred to as one who has treated of the complaint very fully and judiciously. He recommends bleeding before having recourse to topical applications.

The Arabians adopt the views of the Greeks. Alsaharavius directs the use of diachylon plaster as a maturative application. When the inflammation runs high he approves of bleeding.

SECT. XXIV.—ON THE AFFECTIONS OF THE NOSE, AND OF THE SENSE OF SMELL.

When the faculty of smell is impaired, but the speech remains uninjured, it is to be suspected that the anterior cavities of the brain are affected, being impaired either by a simple intemperament, or a collection of noxious humours. But if the voice be at the same time impaired, and have become thick, it is to be conjectured that the affection proceeds from certain noxious humours obstructing the ethmoid bones. Having ascertained the intemperament of the brain from the symptoms often mentioned, use the opposite remedies. Evacuate the humours by masticatories, and more particularly by powerful errhines; but apply attenuant aromatics as for catarrh. But if you suspect a plethora of the whole body, in the first place evacuate it by venesection, or by purging with hiera. Do so likewise for polypus and ozæna. Then use the topical applications. Theriac also is drunk with great advantage. Polypus is a preternatural tumour formed in the nose, resembling the flesh of the polypus. The sarcoma is a substance of the same kind; but ozæna is a putrid ulcer formed by a defluxion of acrid humours.

For polypus and sarcoma. Of the flakes of copper, dr. viij; of copperas, dr. vj; of sandarach, dr. iv; of black hellebore, dr. ij. Blow in, and use confidently, as being an excellent remedy; for in thirteen days it will prove of manifest service. Copperas alone with vinegar is of use.—Another: Of the rind of pomegranate, dr. xij; of copperas, dr. x; of chalcitis, dr. viij; of bull’s gall, of amomum, of myrrh, of calamint, of horehound, of each, dr. iv; of saffron, dr. ij; of white hellebore, dr. iv. Use in a powder.—Another: Touch with levigated diphryges (husk of brass?), and distend the nostrils with the pledget from lamp-wicks.

For ozæna. Of misy, chalcitis, and myrrh, of each, dr. vij; of copperas, dr. vj; of fissile alum, of galls, and of the flakes of copper, of each, dr. iv; of round alum, dr. ij; of frankincense, dr. j; of vinegar, one sextarius. Boil the whole in a vessel of copper, and when of the consistence of honey, use upon tents.—Another: Of verdigris and flakes of copper, equal parts. Use in a dry state.

For fetid smells of the nose. Of myrrh, of acacia, and of amomum, of each, dr. j; mix with boiled honey, and direct that it be glued to the extremity of the septum narium.—Another: Of amomum, of myrrh, of dried roses, equal parts; mix with nard ointment, and anoint with it. The malagma of hedychroum with wine produces the same effects.

For ulcers in the nose. Of whitelead, lb. j; of litharge, oz. iij; or of the dross of lead, oz. iij; of burnt lead, (see that all be washed); mix with wine and myrtle oil.

For those ulcers called sweet. Of litharge, dr. iv; of fresh rue, dr. iv; of fissile alum, dr. ij; mix with myrtle oil and vinegar.

Sternutatories. White hellebore, castor, pepper, fuller’s herb, either alone or together. They must not be blown in, but applied with a feather or the end of a finger to the innermost parts of the nose. If the sneezing continue too long from the use of the medicine, it may be appeased by injecting into the nostrils some nard, or rose-oil, or sweet oil. Sweet-scented things, likewise, appease sneezing, as anise, and the pounded chaff of basil. In all these cases the head must be dried by detergent ointments (smegmata) of nitre and pumice-stone, or we may use that which is called Æsculapium, and the soap of Constantine, the Cappadocian salts, and the like.

For hemorrhage from the nose. Of bleeding from the nose in fevers we have treated in the Second Book; but we shall now treat of it when it arises from any other cause, and is difficult to restrain. Triturate chalcitis, and apply upon the tent formed from lamp-wicks, or the one called priapiscus, soaked in water, and press it into the nostrils; or burn an eggshell, and add to it of galls one half; or touch it with Indian lycium, or blow in the ashes of burnt ass-dung, or press out the juices from it, and inject into the nose; or let the person smell to the vapour of lapis molaris heated and plunged into vinegar; or use the following obstruent preparation: Of the manna of the frankincense tree, p. j; of aloes, p. ss; mix with the white of an egg, and use, by means of a tent made of lamp-wicks, having added externally to it the down of a hare; or apply to the nostril the preparation called Lysimachium; or apply for a length of time a large dry cupping-instrument to the hypochondrium of the side from which the blood flows; or stuff the ear firmly; or apply sponges out of cold water to the forehead; or apply a cupping-instrument with scarifications so as to detract blood; and sometimes it will be proper to let blood from a vein, if this be not contra-indicated; and to apply ligatures to the extremities, more especially the arms and thighs, as if for venesection. Direct motion to be made with them, exerting the hands by rubbing, and the feet by walking; for when the veins there are filled with blood, the parts about the nose will have a smaller supply of it. But a sponge soaked in cold oxycrate and bound externally to the bleeding nostril will often accomplish the purpose. It is best, however, to stuff the nose first with a long tent in the form of a wedge.

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COMMENTARY. Consult Hippocrates (de Affect. et alibi); Galen (de Med. sec. loc. iii); Celsus (vi, 8); Cælius Aurelianus (de Mor. Tard. ii, 1); Oribasius (Loc. Aff. iv, 45); Alexander (iii, 8); Aëtius (vi, 90); Actuarius (Meth. Med. iv, 12); Nonnus (92); Scribonius Largus; Marcellus (de Med. 10); Octavius Horatianus (i, 11); Serapion (ii); Mesue (de Ægr. Narium); Avicenna (iii, 4); Albucasis (ii, 24); Haly Abbas (Theor. ix, 15; Pract. v, 68); Avenzoar (i, 5); Alsaharavius (Pract. ii); Rhases (ad Mansor. iv, 45; Divis. 40; Contin. iv.)

Of polypus. Hippocrates describes five species of polypus. The first is represented to be like a piece of torn flesh hanging in the nostril, and is to be extracted. The second consists of hard flesh which fills the nostril, and is to be treated by the cautery, with the application afterwards of the flos æris to the part. The third is a round and soft piece of flesh growing from the cartilage, and is to be extracted by a ligature, which operation he describes minutely. The fourth is of a stony hardness, and is to be cut all round with a scalpel, then burnt, and the part touched with flos æris. The fifth grows from the top of the cartilage, and is to be burnt.

Galen gives various prescriptions from Archigenes, Asclepiades, Lampon, and others, for removing polypus. The most active ingredients in them are copperas, burnt copper, verdigris, alum, chalcitis, and arsenic. One of the simplest of Galen’s prescriptions consists of arsenic, quicklime, and white hellebore, which are to be triturated together and applied. Another, named from Antonius Musa, is a powder consisting of equal parts of arsenic and copperas. We can from experience speak of the good effects of a similar application; and would, therefore, wish to call the attention of the profession to this method of curing polypus. That it may prove dangerous if misapplied cannot be doubted, but in the hands of a cautious surgeon such an application will be found both safe and effectual.

Celsus forbids us to meddle with the disease when it is of a cancerous nature. But when soft it is to be cured by an operation. He adds that it may sometimes be made to drop off, if touched by means of a tent or pencil with the following composition: ‘Minii Sinopici, chalcitidis, calcis, sandarachæ, singulorum, p. j; atramenti sutorii, p. ij.’ We need scarcely say that all these ingredients are powerfully caustic.

Scribonius gives prescriptions similar to those of Galen.

Octavius Horatianus says he has seen the tumour drop off after such applications as arsenic with honey have been used.

Aëtius gives prescriptions for removing polypus without incision or burning. One of the most simple of his compositions is a powder composed of alum, ginger, red arsenic, burnt copper, and galls.

Alexander, like the others, recommends escharotics, such as misy, copperas, and chalcitis. Marcellus makes mention of the same.

The Arabians imitate the practice of the Greeks. Serapion gives a prescription containing arsenic, copperas, black hellebore, &c. Avicenna describes the treatment by ligature, extraction, burning, and septic applications. He prefers the operation. Mesue treats with great precision of the different modes of cure. When the tumour is not large it may be removed, he says, by septic applications. His prescriptions contain arsenic, alum, flos æris, &c. Haly says that when a polypus is hard and cancerous it is incurable, but when soft, it may be removed by applying septic substances, such as flos æris, arsenic, and the like. Alsaharavius describes the two species of polypus, the cancerous and the fleshy. For the latter, besides the operation, he recommends us to introduce a thread smeared with the Egyptian and green ointments. Several of the authorities quoted by Rhases approve of the septic applications prepared with arsenic, vitriol, oil of oleander, alum, and the like.

The ancient method of removing polypus with septics is mentioned by Guy of Cauliac, and other surgical writers of that age.

For ozæna Celsus recommends stimulant and escharotic applications containing copperas, lees of oil, turpentine-rosin, squills, &c. They are to be applied by means of a specillum or probe wrapped round with wool.

The prescriptions given by Galen from Archigenes and Asclepiades contain misy, chalcitis, burnt copper, orpiment, red arsenic, alum, red nitre, myrrh, saffron, &c. The other Greek authors do but copy from him on this subject.

Avicenna recommends such aromatics as amomum, cloves, and roses, with camphor, hellebore, and the like. Haly makes no mention of escharotics, but recommends aromatics, such as marjoram, cloves, amomum, myrrh, and such like substances. He directs us to purge with hiera, and to gargle with mustard. The substances which enter into the compositions of Alsaharavius are very similar to this. The ingredients in Rhases’ applications are mostly desiccants and aromatics; but a few of them contain escharotics, such as vitriol and red arsenic.

On ulcers. Galen’s prescriptions contain burnt lead, burnt antimony, ceruse, litharge, and the like. Avicenna and Rhases praise the powder of Ruffus, which contains alum, galls, cyperus, myrrh, saffron, and arsenic. For the sweet ulcers Avicenna recommends the same applications as our author. Those of Haly are nowise different.

Sternutatories. Similar lists of substances for exciting and appeasing sneezing are given by Aëtius, Nonnus, Avicenna, and others.

On bleeding at the nose. Most of the remedies mentioned in this Section are taken from Galen (sec. loc. and Meth. Med.) Aëtius repeats his directions (vi, 94.)

Avicenna has surpassed every other author in the accuracy with which he details the phenomena and treatment of epistaxis; but his account is too long for us to do justice to it. His local applications consist of styptics, incrassants, and caustics. He very properly inculcates the propriety of producing revulsion and evacuating the general system by bleeding at the arm, which, he says, should be carried the length of producing deliquium animi. He directs us to apply ligatures to the testicles and extremities, to place the patient in water cooled with ice, and to pour the same upon his head. He says a man will lose from twenty to twenty-five pounds of blood before he dies. Haly’s treatment agrees in most respects with that of Avicenna. He directs us to pour water upon the head, to apply to the forehead a plaster of galls, roses, &c., or a piece of cloth soaked in the infusion of roses cooled with snow and vinegar. He also makes mention of general bleeding, and the application of a cupping-instrument to the nape of the neck. Alsaharavius cautions us not to stop a critical epistaxis. Like Haly, he recommends us, as a general practice, to bleed from the arm if the strength be good, to apply a cupping-instrument to produce revulsion, to pour cold water upon the head, and to snuff up the nostrils water impregnated with the virtues of such astringents as galls, alum, camphor, roses, &c. One of the styptic powders recommended by Rhases contains quicklime, vitriol, galls, and red arsenic. He also directs snow to be applied to the head. In extreme cases he approves of the cautery.

Respecting the manna thuris, mentioned in this Section, see Bernard’s Nonnus (96.) Dale thus explains it: “Manna thuris, offic. sunt micæ, fragmenta, pollen, et farina thuris, quæ ex collisione, dum in saccis vehitur, colliguntur. Alii autem per mannam thuris grana ejusdem intelligunt.” (Pharmacol. 381.)

SECT. XXV.—ON AFFECTIONS OF THE FACE.

How to preserve the face free from wrinkles. Of frankincense, dr. iv; of fucus, dr. iij; of crashed litharge, dr. viij. Dissolve them all in a decoction of bruised ichthyocolla, make trochisks, and use.—Another: Of ivory shavings, dr. viij; of male frankincense, of ichthyocolla, the same quantity. Use as aforesaid.

For darkness of the face. Of iris, of ptisan, of bruised beans, of each a sextarius and a half; of sal ammoniac, of burnt hartshorn, of ammoniac perfume, of each, oz. ij. Dissolve in water, and make trochisks, and having again triturated with water, anoint before bathing.—Another: Of ptisan, of tares, of frankincense, of bruised beans, of Illyrian iris, of aphronitum, of costus, of each, the fourth part of a chœnix; bitter almonds, xx in number; form with the white of an egg and the milk of an ass, and use as aforesaid. The trochisk peponatus also answers well.

For freckles and lentigo. Of toasted Cimolian earth, half a hemina; of toasted aphronitum, dr. viij; of the flour of tares, dr. iv; of the refuse of bull’s gall, dr. viij. Triturate and use.—Another: Of the lees of wine, dr. x; of the flour of tares, dr. x; of bruised beans, dr. x; of white hellebore, dr. v; of aphronitrum, dr. x; of alcyonium, dr. x. Triturate, and rub with it.

For bruised spots, or hypopia. First foment with the decoction of fenugreek, and afterwards with that of melilot, mix the collyrium of Nilus from roses with water, and anoint; then use the myrrh collyrium. If these do not produce the effect, anoint with the collyrium of burnt sandyx; or apply hyssop with water; or bind hyssop into a piece of rag, dip it in warm water, and foment; or foment with strong salt water, and rub down the skin of radish with honey, and apply. This answers also for chronic cases. For chronic spots and lividity, take of Cretan hartwort, two parts; of Samian earth, one part; apply with honey, taking care that it do not produce an ulcer.—Another abstergent application: Of hyssop, of thapsia, and of cassia, of each, dr. ij; of wax, dr. ij; of turpentine, dr. j. Apply, taking care that it do not occasion an ulcer, and on that account removing it frequently.

For vari or warts. They are small hard tumours about the face. Anoint, by rubbing with oxymel; or triturate litharge with turpentine and some white oil, and anoint by rubbing; or rub in fissile alum with turpentine; or triturate bitter almonds in vinegar, and rub. For callous vari: Of Gallic soap, dr. iv; of frankincense and ammoniac, of each, dr. j. Dissolve in water, and anoint; after an hour, wash away.

For vari, hairs, and roughness of the face. Of wax, dr. x; of turpentine, dr. j; of mistletoe, dr. ij; melt, adding a small quantity of oil, and scrub the face with it, for it takes out the hairs by the roots.—Another: Apply powdered poppy, or pennyroyal, with salt and vinegar.

The cerate of Thais, for rendering the face ruddy. Of saffron, of madder-root, of fucus, of frankincense, of myrrh, of each, dr. ij; mix with calf’s fat and mastich oil, and then anoint, and after a little interval wash away with a sponge out of hot water. These applications for the face will also answer for other parts of the body.

* * * * *

COMMENTARY. Most of the authors referred to in the preceding Section may be consulted on these complaints.

This Section is mostly copied from Oribasius (de Loc. Affect. iv), who, however, is greatly indebted to Galen (De Med. sec. loc. v.) Aëtius gives a long list of compositions for these complaints of the face, and to it the lovers of personal appearance are particularly referred. Celsus seems to have thought it necessary to make an apology for treating of these trifling complaints: “Pæne ineptiæ sunt curare varos, et lenticulas, et ephelidas; sed eripi tamen fæminis cura cultus sui non potest.” His applications are like those of our author. For vari he recommends equal parts of rosin, fissile alum, and some honey. Ephelis, he says, is removed by rosin, with a third part of fossil salts, and a little honey.

The φάκος and ἐφηλίς are, we believe, the lentigo and maculæ of Haly Abbas. (Theor. viii, 18; Pract. iv, 15.) His remedies consist of bitter almonds, mercury killed (sublimed?), mustard, with the oil of figs. The ἴονθος is his morum. For it he recommends the flos æris and other stimulant applications. Alsaharavius speaks of the juice of the wild cucumber, the root of iris, pine-gum, and if these are not sufficient, venesection. He treats minutely of these affections of the face. (Pract. vi.) The ἴονθος is the acne of Drs. Willan and Bateman. Galen says these affections are to be removed by emollient and discutient applications in general. He treats very fully of hypopion or ecchymosis of the face. For it Alsaharavius recommends an application consisting of the infusion of radish and red arsenic. (Pract. iv, 4.) This must have been a powerful stimulant. Marcellus recommends to apply frequently a new sponge soaked in hot salt water. (De Medic. xix.)

Rhases describes this affection by the name of pannus faciei. Among the ingredients of his compositions we remark fenugreek, ammoniac, frankincense, liquid pitch, &c. Some of them contain arsenic. He also recommends scarifications.

SECT. XXVI.—ON AFFECTIONS OF THE MOUTH; AND, FIRST, OF THE TEETH.

The teeth are pained without inflammation of the gums, sometimes from pain attacking the body of the teeth, and sometimes from the nerve which enters them being affected. Wherefore they require the strongest remedies; the greater part of which are prepared from the most acrid vinegar. When the gums are pained from inflammation, the best application is oil of lentisk retained in the mouth in a tepid state. But see that it is new; for the older it is so much the worse is it for this purpose. This general rule ought to be observed, to evacuate first whatever humour prevails in the general system.

For inflammation of the teeth. Wash with vinegar in which have been boiled galls, or the root of winter-cherry, or the seed or leaves of henbane, or pennyroyal, or the juice of nightshade, or the root of capers, or the leaves of myrtle, or poley, or the root of the wild cucumber, or the leaves of rue with oxymel, or hartshorn, or the vinegar of squills, or pellitory with hyssop. To the eaten part of the tooth apply storax with opium, or galbanum, or sulphur vivum with lycium; or, let the patient inhale the steam from the seed of henbane through a small funnel. And the antidote of Philo, if applied round the tooth, removes the pain. When there is a defluxion on the teeth, rinse with a decoction of myrtle, lentisk, and galls, or of Syrian sumach, or of the flowers of the wild pomegranate, or of its rind. Sprinkle also of salts two parts; of burnt alum extinguished in vinegar and pulverized, one part; then wash with wine. For bloody gums, sprinkle fine alum, or rinse with aloes in wine, or with the root of bramble boiled in wine, or Syriac sumach. When the gums both bleed and are affected with a rheum, burn pickled tunny in a pot until it be reduced to ashes, with which touch the parts. Loose teeth are fastened by being sprinkled with aloes, or Syriac sumach, or fissile alum, or galls, or the root of bramble, either by themselves or boiled in wine.—Another: Pulverize the bark of green nuts, and to the expressed juice add Minnæan myrrh and fissile alum, and mix together, and use, by pouring it into the mouth, and put upon the gums of the pained tooth, which it will cure.—Another: Triturate together garlic, pepper, and stavesacre; put into a linen cloth; make small balls of it, and change frequently; by which means you will purge the humour in the head, and effect a cure of the teeth.

For loose teeth, running gums, and for every spreading ulcer in the mouth. Of burnt chalcitis, dr. xij; of calamine, dr. viij; use in powder with vinegar.

How to remove the teeth without pain. Apply flour with the juice of spurge, and above it an ivy leaf, and leave it for an hour. They will spontaneously break in pieces.

A dentifrice, also for parulis, or gumboil. Of that kind of alum called plinthitis, oz. iv; of sal ammoniac, oz. iv; of myrrh, of costus, of pellitory, of each, dr. iv; of pepper, eighty grains.

For parulis. Of sulphur vivum, of pepper, of fissile alum, equal parts. Parulis is an inflammation in a part of the gums, which, not being resolved, suppurates. Haring suppurated, and being divided with a scalpel, it is to be kept separate with a tent. Epulis is a fleshy excrescence from inflammation on the innermost dens molaris, being attended sometimes with fever and pain. It must be repressed; and, therefore, we must use the species of verdigris called xyston, either by itself or with an equal part of galls, or burnt sori, or burnt alum, or galls alone, or the flakes of copper triturated with vinegar for a sufficient number of days and dried.

A dentifrice. The burnt roots of birthwort, burnt hartshorn, with some mastich.—Another: White salts mixed with honey, and wrapped in the leaves of the fig-tree, and burnt until reduced to ashes.—Another: Buccinæ filled with salt and burnt; land snails burnt with honey; unwashed wool burnt with a little salts. With each of these, for the sake of fragrance, let there be mixed the schænanth, or spikenard, Indian leaf (malabathrum), or cyperus, or iris.

An application which will whiten the teeth, repress swelling of the gums, and produce fragrant breath. Of pumice-stone, of roasted salts, of iris, of each, dr. iv; of cyperus, dr. v; of spikenard, dr. j; of pepper, dr. vj; pulverize, and use.

For teeth set on edge. Painful feeling in the teeth is relieved by chewing purslain, or by rubbing oil of unripe olives, or by lees of oil boiled in a copper vessel to the consistence of honey, and rubbed in after being long kept.

For worn teeth. For worn teeth, apply, of bay-berries, of fissile alum, of the climbing birthwort, equal parts.

For corroded gums. Of the flowers of roses, dr. viij; of galls, dr. iv; of myrrh, dr. ij. Erosions and running from the gums are cured by washing with asses’ milk, the decoction of olive leaves, or vinegar of squills; or by the following dry applications: the rust of iron, and flowers of the cultivated pomegranate. For swelling and fungous flesh of the gums, the juice of purslain retained in the mouth, the brine of pickled olives, warm oil of unripe olives, or lentisk oil, or oil of apples, or lees of oil, are applicable; and the following powders: the rust of iron or copper, the roots of birthwort, the seed of plantain, diphryges, calcined copperas, pomegranate flowers.

For fissures of the lips. Rub with boiled lees of oil. Or this: Of geese fat, with honey and turpentine, equal parts; of the flowers of roses, of the sordes of unwashed wool, of rose-oil, a small quantity.

On the disease called ranula. Ranula is an inflammatory swelling which forms below the tongue, particularly in children; wherefore rub the part with equal parts of misy and scraped verdigris (xyston) in powder; and to the chin apply the plasters called antherum, sphærium, and the parygrum from eggs. But, in adults, divide the veins below the tongue in the first place.—Another, (it answers likewise with aphthæ): Of scraped verdigris, of galls, of chalcitis, equal parts. With must it will form a gargle.—Another: Having previously rubbed with the flour of tares and honey, anoint with galls triturated in honey, or with the flowers of roses in like manner, or rinse the mouth with a decoction of olive leaves.

For inflammation of the tonsils. If the tonsils and uvula be inflamed in a fever, the most proper gargles are the decoctions of bran, or of roses, or of dates, or of Sebesten plums, or of dried lentil. When the inflammation is at its acme, or is on the decline, we may mix with them some honey, which we must not do at the commencement, nor during its increase, lest, by its acrid nature, it attract a defluxion. If it suppurate and burst, the patient must gargle with honied water, or with the decoction of lentil, or of roses, persevering until it is completely resolved; or we may give him to gargle some of the mixtures for rinsing the mouth. If pestilential ulcers in the tonsils take place, we may use the afore-mentioned remedies, and particularly apply the gargle from mulberries with hot water, or hydromel, having the flowers of roses sprinkled upon it, or costus or sumach, either in powder, or in a decoction; or a decoction of the dried leaves of horned poppy. It is bitter, and it answers best if you dissolve the juice, as we use it for collyria, in honied water. It may also be used with advantage by blowing in the dry herb, or applying it upon the finger. Care must be taken not to touch it with the hand, or, at least, it should be very gently. The trochisk of Andron is also of service. After the irritation from these things is removed, they should use a gargle of liquorice, or that from Scybelitic wine, and of saffron, and of Chian mastich, and of myrrh, and afterwards of starch and tragacanth. When the ulcer has stopped spreading, they may use a gargle of milk and Samian earth.—Another, for antiades: Pound sweet pomegranate along with its peel, and mix six parts of its expressed juice with one of honey, boil to the consistence of honey, and anoint.—Another: Of immature galls, oz. ij; of fissile alum, oz. j; of burnt sal ammoniac, oz. j; touch with it in powder.—Another: Of galls, dr. viij; of misy, dr. ij; of roasted salts, dr. v; use in powder. Antias is a scirrhous swelling of the tonsils.

On the uvula. When the uvula is inflamed, we must use the gargles recommended for inflammation of the tonsils, and those of a moderately astringent nature, such as the juice of pomegranate, applied by means of a small spoon, or the surgical instrument invented for the purpose; and these things may be applied either by themselves, or with moderately boiled honey, or the liquorice root may be mixed with the pomegranate juice. The juice of the liquorice root enveloped in honey also answers well. The swelling may be repressed by the following substances: blood-stone, the Phrygian stone burnt, agerat, the composition from Phrygian stone used for complaints of the pudenda; also Samian earth, Eretrian, Sinopic reddle, the Lemnian earth, the oil of unripe olives by itself, or with some of these; and the fruit of the Egyptian thorn, and fissile alum. The seed and leaves of roses act more mildly, but still more so gum traganth, sarcocolla, and starch, which we must use, if pained when repressed by astringents. When the swelling is of equal thickness throughout, in which case we call the disease columella, we must trust to the gargles prepared from myrrh, saffron, and cyperus, and avoid all pressure, and rather anoint with a feather. The following composition answers well: Of Syrian sumach, dr. viij; of saffron, dr. iv; of costus, dr. viij; of rose-seed dr. iv. It may also be applied to the gums. But a thread of a sea-purple colour which has been bound round the neck of a viper, and strangled her, has wonderful effects as an amulet in relieving affections of the tonsils and neck, as Galen testifies.

For hemorrhages from the mouth. Apply the pounded leaves of leeks; or, dip a new piece of sponge in raw pitch, burn, pulverize, and use. It is also beneficial to rinse the mouth with a cold decoction of green or dried roses, that of vine tendrils, or of the leaves of lentisk, or of bramble, or of quinces, or of roses, or of grape-stones, or of lentils.

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COMMENTARY. All the authors referred to in the twenty-third section may be consulted.

On the teeth. Galen, in particular, deserves to be consulted on diseases of the teeth, which he has treated of very fully in the fifth book of his work ‘De Med. sec. loc.’ He very properly combats the opinion, which we still sometimes hear maintained, that the teeth themselves are devoid of sensibility. He states that, once having toothach, he felt his tooth not only painful but throbbing. One of the best of our modern writers on the teeth, Eustachius, justly remarks that the teeth have a nerve of considerable magnitude distributed upon them, and are in fact possessed of exquisite sensibility. When the teeth ach, Galen says the strongest medicines are indicated, in order to repel and discuss the exciting cause. Most of these are to be prepared with acrid vinegar. He then gives from Archigenes a long list of compositions for allaying the pain of toothach, from which most of those mentioned by our author are taken. One of the articles which most frequently occurs in them is alum, a solution of which in the spirit of nitre was lately much cried up as a cure for toothach. Of the great number of substances recommended to be put into the hole of the carious tooth it is difficult to form a judgment, as most of them are now never tried in such cases. Some of them seem plausible applications. One consists of pellitory with myrrh; another of opium and pepper; others contain ginger, poppy-juice, hyoscyamus, galbanum, castor, &c. He approves of hot fomentations, and of the heated flour of barley or linseed applied to the cheek. He speaks favorably of filling the hole in the tooth with hot wax. When part of a tooth projects, it is to be filed down with an iron file. For pains of the gums he recommends fomentations with vinegar, in which henbane has been boiled. Of dentifrices he has treated at considerable length, and it is from him that our author takes his list.

Scribonius Largus mentions alum among his remedies; and we may remark, by the way, that this medicine is recommended for toothach by many of the earlier modern authorities. (V. Guido de Cauliaco, vi, 2.)

Celsus delivers very judicious instructions for the treatment of toothach. He circumscribes the use of wine, enjoins restricted diet, and food which does not require mastication; then fomentations of hot water by means of sponges are to be applied to the tooth, and so forth. If the pain is more violent, the belly is to be opened, hot cataplasms applied, and some warm liquid retained in the mouth, and often changed. The liquid may be a decoction of some narcotic, such as poppies, mandragora, and hyoscyamus. He praises hot oil applied by means of a probe wrapped round with wool. He also mentions compositions containing pellitory, alum, bitumen, and mustard. He directs us not to be in haste to extract the tooth.

Aëtius gives a variety of applications for removing teeth without an operation. One of them contains red arsenic; another sori and the juice of spurge. Modern dentists are ignorant of such remedies. His account of the nerve which supplies the teeth with sensibility is accurate, but borrowed from Galen.

Octavius Horatianus, like our author, affirms that the juice of spurge (tithymallus) will make the teeth fall out. For the same purpose he likewise praises the power of pellitory and mugwort. After Hippocrates he approves of the application of small bags containing salts or millet.

The medicinal substances recommended by Marcellus, the Empiric, are the same as those already mentioned. He praises strongly a composition consisting of acrid vinegar, alum, and cedar rosin, boiled to the consistence of honey and applied to the carious tooth. To prevent hollow teeth from falling out he directs us to fill the hole with the gum which grows upon the ivy. The juice of poppies pounded in a woman’s milk and applied to a carious tooth is said to remove the pain instantly. As a dentifrice he recommends finely-powdered glass with spikenard.

Cælius Aurelianus recommends abstinence, rest, and rinsing the mouth with some astringent decoction containing white poplar, mandragora, poppies, henbane with vinegar, hot oil, milk and honey, and the like. He applies bags containing hot flour. If the pain does not abate, venesection is to be had recourse to, a cupping-instrument applied near the affected part, and the belly opened afterwards by a clyster. Sometimes the gums are to be scarified or separated from the teeth by means of a scarificator. Respecting anodyne medicines, he remarks that they diminish sensibility, but do not remove pain. He says, like the other authorities, that the juice of the tithymallus, or spurge, breaks the teeth—“dentes infringit.” He disapproves very much of early extraction, and mentions that Herophilus and Heraclides of Tarentum relate cases of persons who had died in consequence of this operation. He says that in the temple of Apollo at Delphos there hung a tooth-extractor of lead, which was meant as a hint not to exert great force in extracting teeth. For bleeding of the gums he recommends alum with honey, and the like.

Serapion, like the Greek authorities, mentions a variety of remedial means for diseases of the teeth. One of his prescriptions consists of burnt alum, with vinegar, salt, and sumach. When the pain is violent he directs us to fill the hole with opium or some other narcotic. Avicenna recommends general bleeding, the application of leeches to the gums, opening the ranal veins, and cupping below the chin. His compositions contain opium, burnt alum extinguished in vinegar, galls with vinegar, and the like. He mentions the juice of tithymallus, and several other substances, as possessing the property of making the extraction easy.

Avenzoar recommends in particular bleeding from the ranal veins. Mesue’s general treatment is very judicious, but similar to that of our author and the others. He also makes mention of alum and vinegar. He says that some apply the actual cautery to the tooth. Haly directs us to heat two needles red hot, and then, having dipped their extremities in oil, to burn the hole of the tooth with them. He recommends us to fill the hole with a composition consisting of pellitory, sal ammoniac, opium, and wax. Some of his applications contain arsenic. That this article would deaden sensibility, and might destroy the vitality of the diseased parts, we can readily suppose, but of course it would require to be used with extreme caution. Certainly not more than two grains should be used, and every precaution ought to be taken to prevent the patient from swallowing his saliva. Haly, like most of the others, makes mention of alum. Alsaharavius recommends general bleeding, cupping, scarifications, and leeches; then warm vinegar, or some warm anodyne infusion, is to be held in the mouth; or the part fumigated with the vapour of water in which opium, camphor, or henbane has been boiled. He speaks also of the actual cautery. Rhases recommends bleeding, cupping, alum in vinegar, opium, henbane, &c.

The dentifrices and applications to the gums recommended by the Arabians are similar to those of the Greeks. See in particular Haly Abbas (Pract. v, 78); Rhases (Cont. v); and Alsaharavius (Pract. viii, 2.) Like our author’s, theirs contain such astringents and aromatics as balaustine, sumach, galls, spikenard, wild mint, cinnamon, salt of gem, and the like. The pumice-stone in particular was much used for this purpose; but, as Dr. Hill remarks, it is apt to hurt the enamel.

On ranula. Aëtius, Actuarius, and most of the other authorities recommend similar applications. They consist of astringents and escharotics.

Avicenna calls the ranula an enlargement and induration of the sublingual gland. He approves of nearly the same treatment as our author. He recommends in particular burnt vitriol and hermodactylus with the white of an egg. Alsaharavius recommends, in the first place, applications containing nitre, sal ammoniac, and the like. If these do not succeed, caustics are to be applied, so as to occasion a blackening of the part. If this does not answer, an operation must be performed. Rhases makes mention of an application containing green copper, vitriol, &c.

For an account of the manner in which the veterinary surgeons treated ranula in cattle, see Columella (vi, 8), and Vegetius (Mulom. iii, 3.) They recommend the tumour to be opened and stimulants applied to it, such as garlic pounded with salt.

The disease which Hippocrates describes by the name of ὑπόγλωσσις appears to have been somewhat different from the one we have been treating of. The hypoglottis of Hippocrates was an inflammatory swelling of the tongue ending in abscess. When matter forms, he directs us to open the abscess. It is also described by Aretæus.

For inflammation of the tonsils and of the uvula. Since, as Galen remarks, the same treatment applies to inflammation of the tonsils and uvula, we shall treat of both together.

Aretæus has described inflammation of these parts with great accuracy and minuteness. He has also given a very circumstantial account of the ulcers which occur there. Some, he says, are common, mild, and not dangerous; others are uncommon, pestilential, and fatal. The latter are described as being covered with a livid or black crust. The ulcer, he says, is apt to spread to the tongue, or it passes down the trachea and proves fatal by occasioning suffocation. The disease, he says, is brought on by cold acrid substances, and sympathy with disease of the stomach or lungs. Children are most subject to it. It is endemial in Syria and Egypt. He gives a striking description of death occasioned by suffocation. With regard to the treatment, when the parts are inflamed, swelled, and threaten suffocation, he advises copious bleeding from the arm, acrid clysters, purgatives, ligatures to the extremities, astringent and emollient applications to the parts, cupping the hind-head or breast, and other such means. Respecting the pestilential ulcers, when attended with inflammation and sense of suffocation, he approves of clysters, venesection, gargles, fomentations, ligatures to the extremities, cupping, and so forth. When the disease is spreading, he directs us to burn the sore with powerful caustics, such as alum with honey, chalcitis and the like. Sometimes, as he remarks, the uvula and parts there are eaten down to the bone.

Galen gives a long and very interesting account of these complaints intermixed with curious extracts from Archigenes. The general treatment consists of venesection, acrid clysters, and purgatives. The local applications are mostly of an acrid and austere nature.

When the tonsils suppurate, Aëtius directs us to open the abscess. He gives an interesting description of pestilential ulcers, which, however, is not very different from that of Aretæus. He approves of bleeding at the arm, suppositories, clysters, ligatures to the extremities, and so forth. The subsequent Greek authors follow him and Galen in their descriptions.

Marcellus, the Empiric, recommends for swelled uvula various escharotic applications containing chalcitis, flos æris, alum, &c.

Celsus delivers a brief account of ulcers of the internal fauces. He speaks in rather equivocal terms of warm cataplasms, fomentations and fumigations; but is, upon the whole, inclined to permit the use of them if there be no danger of cold afterwards. He very properly forbids such things as will irritate the parts. He does not approve much of gargles of vinegar, although recommended by Archigenes, whom he calls, “multarum rerum auctor bonus.” He prefers emollient gargles at first, and afterwards repellent ones.

The Arabians treat inflammation of these parts like the Greeks. Avicenna follows closely our author’s plan of treatment. Mesue approves of bleeding, clysters, and so forth. Rhases mentions bleeding and gargles with vinegar, the water of roses, and other astringents. In inflammation of the uvula, Haly Abbas recommends general bleeding, gentle purgatives, and astringent gargles containing alum, pomegranate flowers, sal ammoniac, and the like; and when these do not succeed, he advises us to have recourse to the operation. (See Book Sixth.) Alsaharavius recommends a plan of treatment perfectly similar, and, like Haly, directs us to have recourse to excision when other remedies fail. Alexander Aphrodisiensis says, however, that those who have had the uvula cut off die of consumption; and attempts to account for the operation having this effect. (Probl. ii, 3.)

Avicenna and the other Arabians make mention of the amulet recommended by Galen.

SECT. XXVII.—ON ANGINA, OR QUINSEY, AND THE COMPLAINTS ALLIED TO IT; IN WHICH THE SUBJECT OF THOSE WHO HAVE BEEN STRANGLED OR OTHERWISE SUFFOCATED IS TREATED OF.

When the parts within the throat are inflamed, the disease is called synanche; when those without it, parasynanche. In like manner, when the parts within the windpipe are inflamed, the disease is called cynanche; and when those without it, paracynanche. All these complaints are attended with orthopnœa and pain, with difficulty of breathing, and in some cases with fever. There is redness of the face and neck, and swelling in some cases, and sometimes the mouth is kept constantly open, and they cannot swallow drink. Cases of cynanche are sometimes attended with a sense of suffocation. This disease attacks children but rarely, and then only from injuries of the spinal vertebræ occasioned by a fall, which case, being incurable, is not to be meddled with. In the others, we must immediately bleed from the arm, and take away not a great quantity at once, but in divided quantities; for from a rapid evacuation there is danger of suffocation, owing to the matters rushing to the affected part, if the patient should faint. Should they not be immediately relieved by it, we must open the veins below the tongue; or make incisions into the tongue itself, if it be swelled and protrude out of the mouth. The bowels are to be evacuated by acrid clysters; hot water is to be poured upon the feet, and the extremities firmly bound with ligatures. The neck is to be wrapped in unwashed wool, or in wool smeared with oil, and a cataplasm of raw barley-meal applied. At the commencement we may use the gargles described for inflammation of the tonsils, or the simple medicine from mulberry, with the decoction of sumach; but the best remedy is that from wild mulberry, and after that the compound application from mulberry, or the parts are to be anointed with the composition from walnuts. When the disease is at its height, we may add a little nitre or sulphur vivum, unless the acrimony prohibit their use. And dog’s dung, dried and powdered, and rubbed in with honey, is a most excellent application, more especially the white kind; also the dung of wild swallows, in like manner. When the complaint is of long standing, we may use the liniment from besasa, or wild rue, sometimes increasing and sometimes diminishing its strength, by the mixture of other medicines. Cupping-instruments or leeches are to be applied to the chin and neck, and the patients must use the stronger gargles from iris, hyssop, gith, southernwood, liquorice, dried figs boiled in honied water, or in the juice of rue with milk, or mustard with oxymel. If irritation arise from the use of them, we must give warm oil of the finest kind, or rose-oil by itself, or with the juice of ptisan or of fenugreek, to gargle with. The food should be honied water until the third day, after which the juice of ptisan, with some of the sweet drinks, and then the yelks of eggs in a liquid state. They may use spoon-meats made from chondrus, when deglutition is unobstructed, and take food suitable to their strength. When the disease is on the decline, we may get them to take exercise and the bath. The parts are to be enveloped in a cerate of the oil of rue; and we must have recourse to the other means of an analeptic nature.

In suspended animation, such as have the foam already at their mouth we must do nothing to, agreeably to the precept of Hippocrates (Aph. ii, 43); but the others may be resuscitated by pouring into their mouths vinegar and pepper, or the fruit of the nettle pounded in the strongest vinegar. It is with difficulty that they swallow it, but they must be compelled; and when the redness about the neck is dispelled, they immediately look up and recover. The same means are to be used towards those who have been wrecked in the sea; and, in fine, towards all those whose respiration has been suspended; for their heat is thereby resuscitated.

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COMMENTARY. See Hippocrates (de Victu Acutorum, 39; de Prognos.; de Morbis, ii, iii); Galen (de Med. sec. loc. vi; de loc. Affect. iv); Aretæus (de Morb. Acut. i, 7); Alexander (iv, 1); Aëtius (viii, 48); Oribasius (Morb. Curat. iv, 71); Leo (iv, 10); Actuarius (Meth. Med. iv, 14); Celsus (iv, 4); Nonnus (123); Scribonius Largus (16); Cælius Aurelianus (Morb. Acut. iii, 1); Octavius Horatianus (ii, 6); Marcellus (de Med. 15); Serapion (ii, 18); Avicenna (iii, 9); Mesue (de Ægr. Gutturis); Avenzoar (i, 10); Haly Abbas (Pract. i, 26, and vi, 2); Alsaharavius (xi, 2); Rhases (ad Mansor. ix, 54, and iv, 25; and Contin. vii).

The plan of treatment recommended by Hippocrates can scarcely be improved upon: general bleeding, opening the veins below the tongue, giving warm gargles and linctuses, shaving the head, wrapping the neck in soft wool, or applying fomentations to it, giving honey and water, or ptisan not cold, and administering clysters or purgative medicines. According to Le Clerc, he performed bronchotomy in extreme cases. He refers, we suppose, to lib. iii, 11, ‘de Morbis,’ but the language is not so precise as to make it quite certain that bronchotomy was there meant to be described. Sprengel supposes that he only introduced a tube by the nostrils into the trachea. He describes a species of cynanche in which there is no external swelling, and which proves fatal in the course of a day, or at least of a very short time. (Prog.) Cynanche, he says elsewhere, is apt to be determined to the lungs. (Aph.) Fever, again he says, attending ulcerated sore throat is bad. (Prog.) When the tonsils are swelled and red, he says it is dangerous to scarify them. (Ibid.) His commentator Stephanus remarks that when the disease becomes indolent the part may be burned or cut.

Aretæus states that the parts affected with synanche are the tonsils, epiglottis, fauces, uvula, the upper part of the trachea, and, if the inflammation spread, the tongue and jaws. He makes a distinction between cynanche and synanche. The former is attended with swelling of the parts and other well-known symptoms, of which he has given a striking description. In synanche (which he attributes to the pneuma being over-heated and over-dried), the parts, on the contrary, are contracted, and there is a strong sense of suffocation. This disease, he says, generally proves soon fatal, unless swelling and inflammation of the parts supervene, or erysipelas of the breast occur; in imitation of which, he states that a good physician will apply a sinapism or cupping-instrument to the chest to produce revulsion. In treating of the former variety of the disease, he begins with administering two clysters to evacuate the bowels and produce revulsion; he bleeds in the arm from a large orifice so as nearly to bring on deliquium animi, and he approves also of bleeding by opening the veins below the tongue: he recommends applications at first of an astringent nature, but, if suppuration be expected, he directs hot ones from fenugreek, hot fomentations, sponges squeezed out of the decoction of bay or hyssop, and the like, to be used. In the other variety, he recommends us to determine outwardly by all possible means, such as by applications containing nitre, mustard, &c. He says the application of fire would be most suitable in such cases, but as it cannot be applied from the situation of the disease, he recommends medicines which resemble fire (caustics), so as to stop the ulceration from spreading. The caustics and astringents mentioned by him are alum, galls, pomegranate rind, and in particular calcined chalcitis. The last was a vitriol resembling sulphate of copper. (See the preceding Section.) He mentions that in this variety some were said to have opened the windpipe, in other words to have performed laryngotomy. He does not believe, however, that the operation had ever actually been performed, and dissuades from attempting it, as it would only increase the evil; and he apprehended that the wound in the cartilages would never heal. From his account of synanche, Le Clerc concludes that Aretæus belonged to the Pneumatic sect; and although Ackerman is doubtful upon this point, we could point out many passages in his works which have quite satisfied us on this point. By pneuma was probably meant the vital heat in the body, acted upon by a spiritual substance within us, the same being a portion of that principle which the ancient philosophers called nature. It was truly a vis medicatrix. (See Morb. Chron. cur. i, 7.)

Celsus, like Aretæus, describes the two varieties of the disease, and recommends nearly the same treatment.

Galen, and after him Aëtius, give a similar account with great minuteness and precision. We cannot pretend to do justice to their treatment, and shall merely mention that, in the second variety, they praise mustard for a gargle, and elaterium as a purgative. It is worthy of notice that Galen describes a rare species of this disease, in which the tongue is so swelled that the mouth cannot contain it. (Meth. Med. i.)

Alexander’s directions are most minute and judicious, but we must be content with stating that he approves of opening the ranal and jugular veins, and that his treatment is otherwise similar to that of Galen. This is the first mention of opening the jugulars that occurs in a medical author.

Octavius Horatianus we shall merely mention, in order to state that he has described the two varieties of the disease like the others.

Cælius Aurelianus gives a singularly accurate and circumstantial account of this disease, but it is so long that we can merely afford room to point out a few of his leading opinions. He approves of a fomentation made with a bladder half filled with hot sweet oil. He directs the patient to inhale the steam of hot water, and to have sponges squeezed out of it applied to the neck and throat. He approves of cupping the neck or of leeching it, and also of scarifying the tongue and fauces if they are much swelled. With respect to the treatment of the other sects, he blames Hippocrates for making too rapid a detraction of blood, and also for opening the veins below the tongue, which, he says, will only aggravate the evil, and may be productive of inconvenience, owing to the difficulty of stopping the bleeding. But, in particular, he finds fault with Archigenes for mentioning laryngotomy, and treats the operation as entirely fabulous and the fiction of that physician. His aversion to it is so strong that he pronounces it a crime. Before having done with this author, we may remark that Prosper Alpinus, the modern advocate for ancient Methodism, does not agree with Cælius in condemning the Hippocratic practice of opening the veins below the tongue. In his own case he had experienced the good effects of this practice. (Meth. Med. vii, 10.)

The Arabians, like their Grecian masters, describe the two varieties of the disease, and treat them accordingly. For the variety called synanche by the Greeks, they approve of hot gargles consisting of mustard, pepper, and the like. This resembles the modern practice of using gargles of Cayenne pepper. In the following passage, Rhases evidently points at the contagious synanche: “It happens on certain years in spring that a bad and destructive species of synanche attacks a great many persons. Wherefore at such a time it will be proper to anticipate the disease by venesection, abstracting blood from the legs with cupping-instruments, opening the belly, and gargling with rose-water, or infusions of sumach, mulberries, and nuts.” Haly Abbas likewise states that the disease is sometimes epidemical. Rhases approves of general bleeding, of opening the sublingual veins, and of using astringent gargles at first, and afterwards maturative ones consisting of figs, sweet almonds, and the like. In his ‘Continens’ he seems to allude to bronchotomy. Alsaharavius describes the two varieties of the disease with great minuteness. He agrees with the others as to the danger of that variety in which there is no swelling nor inflammation outwardly. Avicenna and other of the Arabians follow Alexander in recommending bleeding by opening the jugulars. The two kinds of angina, mentioned by the ancients, are described in similar terms by Sydenham, Boerhaave, and Van Swieten. The first variety, or common quinsey, is well known. The second is of less frequent occurrence. The modern authorities have found it as fatal as the ancients gave them reason to expect. The reader will find a very interesting commentary on Aretæus’ description of malignant sore throat in a tract, ‘de Recondita Abscessum Natura.’ (Mangeti Bibl. Chirurg. i, 48.) It is the disease now called laryngitis acuta.

Haly approves of the treatment recommended by our author in cases of suspended animation. In treating those who have been in water, he directs, very improperly we are convinced, the patient to be hung by the heels, to favour the escape of the water by the mouth. It would appear, however, from the late experiments of Professor Meyer, that the ancients were correct in supposing that water is generally found in the lungs of drowned persons. When a person has hung by the neck for a time, and there is any prospect of recovery, Haly directs us, as soon as he can swallow, to make him gargle with oil of violets and tepid water, and to drink barley-gruel and the like.

SECT. XXVIII.—ON CORYZA, CATARRH, AFFECTIONS OF THE TRACHEA, AND COUGH.

All these complaints have this in common, that they are occasioned by the defluxion of a redundant humour from the head to the parts below. When, therefore, it seats in the nostrils, the disease is called coryza; when in the pharynx and roof of the mouth, simply catarrh; but when it attacks the larynx and arteria trachea, so as to occasion a roughness of the membrane which lines them, the voice becomes hoarse, and the disease is called branchus, or morbus arteriacus: these terms being applicable not only to the inflammatory roughness occasioned by a defluxion from the head, but also to that arising from vociferation and inhaling cold air. When the complaint is protracted, and the defluxion is carried down to the chest and lungs, it gives rise to bad coughs. And a cough often arises from an intemperament; sometimes a hot one, as in fevers, and sometimes a cold, as in northerly states of the weather, which is rather a dry one. Cough is also sometimes symptomatic of some other disease, such as pleurisy, hepatitis, phthisis, or peripneumonia. Wherefore Galen relates that, in certain chronic cases of cough, chalazia (hail-stones) have been brought up from the chest. But Alexander relates that a certain heavy stone, like that which forms in the urinary organs, was brought up in a chronic cough, upon which the cough ceased. We ourselves have seen a discharge of stones with vomiting of blood, as we will describe more accurately when we come to that part. Those who have coryza and catarrh from exposure to heat have a sensation of heat about the parts, and a running of acrid and thin humours from the nostrils and mouth, and there is redness about the face and nose. When they are occasioned by cold, there is distension about the head and forehead, and obstruction of the ethmoid pores, so that the voice does not resound through the nose; and when they are protracted, cough supervenes, and expectoration of phlegm, which is sometimes unconcocted and fluid, and sometimes green. In some cases fever comes on, which does not alleviate the complaint when it proceeds from heat, but when from cold it promotes concoction.

The cure of catarrh and of coryza. When a hot intemperament prevails, those remedies will apply which suit with headachs from the same cause. They must have recourse to baths, and have a large quantity of hot water poured upon the head. The food most befitting are spoon-meats and eggs in a state to be supped, starch, sweet cake, sesame, rice, almonds, the fruit of the cones of pine, and all confections from milk. The wines which are drunk should be sweet and not old. The lohoch from poppy-heads, called diacodium, and other compound medicines for these complaints, are to be taken. When a cold intemperament prevails, and the disease is difficult to remove, a restricted diet is to be observed, and the head anointed with some heating and attenuating ointment, such as that of nard or rue. But the ointment of iris is not only to be rubbed in, but is also to be injected into the nostrils; and, internally, they are to be rubbed with frankincense and myrrh, with oil; and this more especially when the coryza arises from cold. But these are remedied by odoriferous substances with burnt linen, or by gith and cumin burnt and bound up in a linen rag. Let them also smell to the cyphi seleniacum, and let it be rubbed into the forehead; and to it let there be added one of the antiphlogistic plasters, such as the Icesian, the Oxera, the Barbarum, and the Athena. For catarrh from cold it will be expedient to drink of cyphi, and to rub into the chest the juice of balsam by means of unwashed wool; or to apply calefacients to it, along with storax, the ointment of iris, or that of dill. Let them also use hot and concocting food. But when the matter is already concocted, a masticatory will answer well with them, and detergent ointments (smegmata) to the head, such as the soap of Constantine, and the like.

The cure of affections of the trachea, or hoarseness. For the complaint called arteriacus and branchus, those things already mentioned will apply; but, in particular, when an inflammatory affection of the trachea and larynx prevails, we must, at the commencement, use the emplastic remedies, until the inflammation become more moderate; such as those from Cretan sweet wine, tragacanth, gum, and starch, and a decoction of the fatty dates and that of liquorice, with rob, until it become of the consistency of honey. And we must use that class of electuaries called hypoglottides. But, above all things, the patient at this period must abstain from drinking wine; but when the inflammation becomes moderate, he may take some sweet wine. And let him use those spoon-meats which are made from honey and milk, with starch, and bread of fine flour, and almond emulsions; and let him take butter. When a humour remains fixed in the parts, he must have recourse to detergent remedies, such as the porridge of beans, and those things which are prepared from honey, cabbage, and well-boiled leeks. He may also take the hotter medicines, and those used for the cough, in the rob of dried figs, of frankincense, iris, turpentine, storax, galbanum, pepper, cinnamon, cassia, and the like.

On cough. Coughs are to be cured by the same method, attending only to this, whether they be occasioned by sympathy with other parts, such as a defluxion from the uvula or head, and whether they be symptomatic of other diseases; in which case, they are to be disposed of in the manner already mentioned, or as will be described afterwards. An exposition of the compound remedies follows.

Pills for catarrh and cough. Of storax, of myrrh, of opium, of galbanum, equal parts; mix with must, or pound by themselves in a mortar, and make into pills the size of a tare. Give three, four, or five at bedtime, and swallow with some must. These things are for an acrid and thin rheum.—Another: Of the seed of henbane, dr. xij; of pine-nuts, dr. vj; of saffron, dr. ij. Mix with rob or with must, and use.

An electuary. Of honey, oz. j; of butter, oz. ss. Boil together and give; and let the decoction of hyssop, of figs, of pine-nuts, and of iris, be swallowed.

Pills for more inveterate coughs. Of storax, dr. vj; of myrrh, dr. iiss; of turpentine, of galbanum, of opopanax, and of iris, of each, dr. ij; of white pepper, of nitre, of henbane-seeds, of the juice of poppy, of each, dr. j. Beat in a mortar without any liquid, form into pills, and use as formerly directed.

For roughness of the windpipe, cough, and bloody expectoration. Of bitter almonds whitened, xxv in number; of toasted linseed, dr. iv; of tragacanth, dr. ij; of pine nuts, xxx grains; the yelk of an egg roasted in dough. The tragacanth is macerated with water, and the whole mixed with must. If the sound of the voice be broken, mix honey instead of the must, more particularly when there is anything to expectorate.

An arteriac to be kept below the tongue for those who have lost the voice, for hoarseness, and bloody expectoration. Of tragacanth, dr. vj; of gum, dr. vj; of myrrh, dr. iss; of white pepper, xx grains; of saffron, dr. j; of liquorice-juice, dr. vj; the flesh of three dates; of Cretan sweet wine, q. s. The juice of the tragacanth alone placed under the tongue answers very well. Instead of the juice of liquorice, its decoction boiled down to the proper consistence may be substituted in quadruple quantity.

An arteriac for loss of voice, suiting also for strengthening the voice. Boil six leeks to a third part; throw them away, but with the decoction mix the juice of alica and honey; boil with them the yelks of three eggs previously boiled, stirring with a branch of dill.

For coughs. Of pennyroyal, oz. ij; of pine-nuts, of bastard saffron, of linseed, of each, oz. j; of white pepper, oz. iv; mix with boiled honey.—Another: Of hyssop, of pennyroyal, of pepper, of each, oz. j; of Macedonian parsley, oz. ss; of honey, a hemina.

For concocting an inveterate cough. Of honey, dr. xvj; of turpentine, dr. ij; of galbanum, dr. xiv. Having boiled them together, and having formed to the size of beans or of walnuts, let them be sucked.—Another: A dry cough is cured by the arteriacs, and also by the drinking of hot water; for, not being able to expectorate, owing to the thickness of the phlegm, they are assisted in so far by diluents. A decoction from hyssop, and iris, and pine-nuts, also answers with them.

A trochisk to be inhaled for a continued cough. Of storax, of pepper, of mastich, of Macedonian parsley, of each, oz. j; of sandarach, scr. vj; two bay-berries; mix with honey; and fumigate by throwing them upon coals, so that the person affected with the cough may inhale the vapour through a funnel. It answers also with those affected by cold in anywise.

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COMMENTARY. All the writers referred to in the preceding Section (with the exception of Aretæus) may be consulted here.

Galen, in the seventh book of his work, ‘de Med. sec. loc.’ has treated of these diseases so fully that he may be said to have exhausted the subject. We can only afford room for a few of his general remarks. He states that the arteriacs, or compositions for affections of the arteria trachea, consist of three different kinds of medicines. First, those called by him obstruents, and answering to those now called demulcents, such as Cretan sweet wine, tragacanth, liquorice, and the like, which act by smoothing the asperities of the parts. Second, the acrid, containing cinnamon, turpentine-rosin, and the like. Third, the intermediate, consisting of the juice of ptisan, almonds, and the like. He gives a great number of compositions from Andromachus, Criton, and others, which might deserve attention. Of their ingredients some are expectorants, such as squills, myrrh, &c.; some demulcents, such as liquorice, tragacanth, &c.; and some narcotic, such as opium, mandragora, hyoscyamus, and hemlock. With the medicinal properties of the last-mentioned article (we mean the conium maculatum), which Dr. Paris commends so highly in diseases of the chest, the ancients were sufficiently well acquainted. For humid coughs Galen recommends a composition of alum, opium, galbanum, and storax. He mentions lumbrici in the stomach as a cause of coughs. (Com. in Epid. iii.) Among the remedies mentioned by our author, by Galen, and by most of the ancient authorities, we may remark the inhaling the fumes of certain acrid medicines, such as yellow orpiment and sandarach, or realgar, i. e. red orpiment. Whether the practice be safe or not we shall not pretend to determine; but, unquestionably, it is recommended upon high authority; and therefore it is not true, as has been often stated, that this practice arose from the mistake of confounding the gum juniper, or vernix of the Arabians, also often called sandarach, with the sandarach of the ancients, or realgar. (See Bree on Asthma, p. 231.) We refer to Aëtius (viii, 61); Pseudo-Dioscorides (Euporist. ii, 33); Pliny (H. N. xxxiv, 55); Alexander (v, 4); Myrepsus (xli, 76); Serapion (ii, 19, and 24); and Rhases (Cont. viii.) The ancient veterinary surgeons used arsenic in fumigations for the coughs of cattle. See Vegetius (Mulom. iii, 67.) Platearius, a modern writer of the thirteenth century, recommends arsenic for chronic coughs, both in fumigations and taken into the stomach, and yet he distinguishes quite correctly the sandarach, or red arsenic, from the gum vernix. (De Simplici Medicina.) Some of the earlier writers on the venereal disease recommend fumigations with arsenic for syphilitic ulcers of the throat. (V. Aphrodisiacus, and Sect. XXIX of this Book.)

At the commencement of a common catarrh, Celsus advises to abstain “a sole, balneo, vino, venere;” but to use “unctione et assueto cibo.” When the lungs become affected he recommends much friction and exercise on foot. He gives the following account of the origin of these complaints: “Destillat autem humor de capite interdum in nares, quod leve est; interdum in fauces, quod pejus est; interdum etiam in pulmonem, quod pessimum est.” The idea of the disease originating in the head and spreading downwards prevails in all the ancient descriptions of the disease, and, we may mention, is now sanctioned by the authority of the illustrious Laennec. See, in particular, Aëtius, who copies, however, in part from Galen.

Alexander devotes a whole chapter to the consideration of these complaints. He forbids diuretics, because they carry off the thin part of the humours and leave the thick behind. Respecting the chalazia mentioned by Galen, and “the smooth, hard, and firm stone” said to have been expectorated by Alexander’s patient, we have a few remarks to make. The passage in Galen’s work where they are described is at ‘de Loc. Affect.’ iv, near the end. These sputa have been described by recent pathologists. Thus Andral calls them small clots, of a dull white, or inclining a little to yellow, from a small pin’s head to a pea in size. (Clinical Medicine, 464, Engl. ed.) The modern authorities agree that they are indicative of phthisis. Aretæus describes by the name of pneumodes, and as a species of asthma, a diseased state resembling that which we are treating of. The symptoms are dyspnœa, cough, and wasting; pulse small, frequent, and feeble; the sputa, if any, small, white, round, and like hail. The disease proves fatal in the course of a year, and often ends in dropsy and anasarca.

The treatment recommended by the great Methodist Cælius Aurelianus is not much different from the practice of the other sects, only he enjoins a more rigid abstinence from wine and food of a heating nature. He also condemns the practice of inhaling the vapours of red arsenic (sandaracha), and the like. In protracted cases he recommends a change of place.

There is nothing original in the practice of the Arabians. Avicenna prudently forbids preparations of poppies after expectoration has commenced. For coryza Haly Abbas recommends, if the patient’s age and temperament permit, bleeding, a spare diet, abstinence from wine, fumigations with the vapours of camphor, lignum aloes, vinegar, &c.; avoiding to lie on the back, and so forth. He treats at great length of coughs, distinguishing them according as they are seated in the throat, gullet, or lungs, and whether they be sympathetic or not. For hoarseness, he directs gargles from the seed of anise or fennel, or a decoction containing radishes, parsley, fennel, mastich, spikenard, iris, figs, &c. Alsaharavius treats fully of these complaints in much the same terms.

SECT. XXIX.—ORTHOPNŒA, ASTHMA, AND DYSPNŒA.

Those who breathe thick without fever, like those who have run fast, are said to be asthmatic, that is to say, to pant for breath; and from their being obliged to keep the chest erect for fear of being suffocated, they are called orthopnoic. The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs. Dyspnœa is a common symptom which accompanies these and many other complaints. The indication of cure in asthmatic complaints is to consume the viscid and thick humour by attenuant and detergent medicines. Wherefore the vinegar of squills will answer well with them, and the oxymel prepared from it; the baked squill itself when triturated with honey; the antidote called hiera, continued purging with drastic medicines, and vomiting from radishes. And, in like manner, the round birthwort may be drunk, the root of the great centaury, the fruit and root of cow-parsnip, the fruit of calamint, hyssop, iris, and gith. Put a sextarius of slaters, into an earthen vessel, roast upon the coals; when whitened, pulverize, and, mixing with boiled honey, give a mystrum thereof before and after food. If there be any urgent necessity, before doing all these things, open a vein and evacuate proportionably to the patient’s strength; and stimulate the belly by clysters. Externally to the chest we may apply cataplasms from figs, the flour of iris, and of barley, containing rosin, wax, and honey; and iris and manna may be sprinkled upon them. Some benefit may also be derived from raw barley-flour, with rosin, wax, iris, and manna. We may use the more heating ointments, such as those of iris, dill, and rue. But the following application is particularly proper: Of pumice-stone, p. j; of burnt lees of wine, p. iv; of arsenic, p. j; of the schenanth, p. ij; of alcyonium, p. j; of aphronitrum, p. ij; pound, sift, mix with the ointment, and with it rub the parts about the chest, and use emollient ointments for attracting the humours.

A draught for asthmatics. Of poley, of southernwood, of castor, of ground pine, of ammoniac perfume, equal parts; mix with honey, and give.—Otherwise: Some give a spoonful of aphronitrum in three cyathi (cupfuls) of honied water.—Another: Of aphronitrum, dr. ix; of pepper, dr. j; of laserwort, dr. ss; give a spoonful in water.—Another: Of castor, of ammoniac perfume, of each, dr. vj; of pepper, xl grains; mix with must, and give to the size of a bean in honied water.—Another: Of mustard, dr. j; of the spuma nitri, three oboli; of elaterium, a diachylon (i. e. half an obolus): form the whole into eight trochisks, and give two every two days; for they will evacuate upwards gently. To those who are choked for want of breath, give, of aphronitrum, dr. iij, with three cyathi of hydromel, and sometimes with cardamom, and it will relieve them immediately. It is also useful in ischiatic disease.

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COMMENTARY. The following ancient works may be consulted: Hippocrates (Aphoris.); Galen (de Comp. Med. sec. loc. vii); Celsus (iv, 4); Aretæus (Morb. i, 11); Cælius Aurelianus (Morb. Tard. iii, 1); Aëtius (viii, 63); Oribasius (Loc. Affect. iv, 79); Actuarius (Meth. Med. iv, 4); Marcellus (de Med. 17); Nonnus (127); Octavius Horatianus (ii, 2, 12); Serapion (ii, 24); Avicenna (iii, 10, 1, 38); Mesue (de Ægrit. Pect.); Haly Abbas (Pract. vi, 8; Theor. ix, 20); Alsaharavius (Pract. viii, 5); Rhases (ad Mansor. ix, 56; Contin. viii.)

Our author’s theory of the disease is borrowed from Galen, and seems very plausible. It being admitted by our best modern pathologists, that there is no organic alteration of structure in ordinary cases of convulsive asthma, it seems likely that the paroxysm is occasioned by thick and viscid humours infarcted in the lungs; or, most probably, in many cases from the system being loaded with such humours which nature casts off by the lungs. We need scarcely add, that it is now well ascertained that asthma is frequently produced by engorgement of the lining membrane of the bronchi, thus forming what is called the dry catarrh. Galen, like our author, maintains that the use of attenuant and detergent medicines is indicated. His internal remedies are squills, pepper, wormwood, opopanax, storax, sulphur, oxymel, millepedes, &c. He forbids all things which are either of a very hot or cold nature, as in either case they tend to thicken the humours.

Aëtius gives nearly the same account as our author, both having evidently borrowed from Galen. He strongly praises vinegar of squills, myrrh, pepper, and the like. In certain cases he advises the application of the actual cautery to the head (see Book Sixth, Sect. I) under the impression that the disease is occasioned by a defluxion from it. He also speaks of burning the chest in several places for the purpose of making issues; and further recommends strong rubefacients.

Among the articles recommended by Marcellus, the Empiric, for difficulty of breathing, we remark vinegar of squills, natron (soda), opium, horehound, &c. The first article, it will be perceived, among his remedies for asthma is vinegar of squills. Almost all the ancient authorities praise the virtues of squills in this disease.

Aretæus gives a good description of the symptoms of the disease, which he attributes to a humid, thick, and glutinous matériel in the lungs. He says, the lungs are primarily affected, and through them sympathetically the diaphragm, and parts about the chest which assist in respiration. But if the heart be affected, he adds, the issue is speedily fatal. Among the incipient symptoms he mentions flatulence of the bowels, restlessness, and latent heat by night. As the paroxysm proceeds, the cheeks become red, the nose sharp, the eyes prominent as if from strangulation, there is a râle even when awake, and still more so when asleep; the voice is humid and devoid of resonance, with an insatiable desire of cold air, panting, and orthopnœa. To these symptoms are added, paleness of the countenance, with the exception of the cheeks; profuse sweats about the face and chest; constant and difficult coughing, with little expectoration. His chapter on the treatment is lost.

As Oribasius, Actuarius, and Nonnus follow the principles laid down by Galen, we need not give any account of their opinions.

Octavius Horatianus adopts Galen’s theory, which he thus explains: “Pingui autem et frigido phlegmate pulmonibus adhærente, cavernæ, vel meatus, quibus naturaliter spiritus redditur et accipitur, concluduntur; et ex hoc impedimento suspirium, vel anhelitus molestissimus, nascitur, ut sedendo magis quam jacendo respiret.” He recommends bleeding, if not contra-indicated; but, if that is the case, frequent abstinence. Among his internal remedies we remark oxymel, gum ammoniac, castor, and vinegar of squills. He approves also of emetics. He recommends stimulant applications to the chest, also fomentations and sinapisms. A long journey, he says, is beneficial.

Cælius Aurelianus disapproves of burning the head and of strong purging. He approves of bleeding, if the patient’s strength permit, of clysters, cupping the breast, gestation, friction, vociferation, emetics from radishes, or even from hellebore, and of giving the vinegar of squills. He speaks favorably of the cold bath. His description of humid asthma is very striking, and has been commended by late authorities on the subject. The sounds within the chest are thus described: “stridor, atque sibilatio pectoris, cum vocis debilitate.”

Cassius discusses the question why there is a sibilant murmur in cases of orthopnœa, and decides that it is because the affection is a contraction and falling-in of the cells of the lungs, and the breath rushing through a narrow passage produces this murmur. (Prob. 82.)

Serapion recommends friction, exercise, squills, fumigations with arsenic, &c. Mesue also recommends arsenic in various forms. Avicenna’s account is particularly full and judicious. He properly remarks that asthma is sometimes connected with derangement of the heart, liver, and stomach. Like the others, he approves of arsenic, both in pills and in solution.

Haly Abbas, like Galen, refers asthma to a collection of gross phlegm about the cells of the lungs. His remedies are of an attenuant and incisive nature, and he particularises the vinegar of squills. He cautions asthmatics to beware of indigestion, and, therefore, forbids exercise after food, but recommends it before a meal. After exercise he enjoins hard friction, no doubt with the intention of favouring the cutaneous perspiration. Rhases commends squills and the tepid bath. Like the others, he approves of inhaling the vapours of arsenic.

Vegetius, the veterinary surgeon, recommends squills with wine, assafœtida, and oil, for these complaints in cattle.

Respecting the use of arsenic in asthma, Prosper Alpinus remarks: “Præterea audent aliqui arsenicum summè exitiale venenum illis exhibere. Narrant quidam nepotem patris fratri decrepito orthopnoico, ut cum interimeret, clam in ferculo ex cucurbitâ parato porrexisse arsenicum, coque non modo non interimisse decrepitum, verum et ab asthmate prorsus sanasse.” (De Meth. Med. x, 13.) He states further, by the way, both in that work and in the one “de Medicina Ægyptiorum,” that the Egyptians were in the practice, for the cure of asthma, of applying cones of cotton to the breast, and setting them on fire. Fracastorius, who recommends this practice of imbibing the fumes of arsenic, for contagious phthisis, speaks of it in the following terms: “Nonnulli antiquorum jubent Sandaracæ nidorem per anhelitum in pulmones trahi: quum autem Sandaracam dico non eam intelligi volo quæ vernix vulgo vocatur, sed quæ auripigmentum a nobis dicitur: porro nec per auripigmentum velim a te accipi priorem illam speciem quæ citrina est sed alteram, quæ est ruffa, et propriè Sandaraca vocatur.” (Morb. Contag. iii.)

Dr. Hill, however, properly remarks that the arsenic of the ancients, or orpiment was a much more innocent substance than the factitious arsenic of the moderns. See also Cleaveland (Mineralogy p. 680.) The arsenic of the ancients, in fact (as will be shown in the proper place), was the mineral substance called yellow orpiment, consisting of sixty-two parts of arsenic and thirty-eight of sulphur, according to the analysis of Klaproth. The sandarach was realgar, which consists of seventy-five parts of arsenic and twenty-five of sulphur.

SECT. XXX.—ON PERIPNEUMONIA.

Peripneumonia is an inflammation of the lungs, supervening, for the most part, upon violent catarrhs, cynanche, asthma, pleurisies, or other complaints, but being sometimes the original affection. It is accompanied with difficulty of breathing, an acute fever of the ardent type, weight and tightness of the chest, a râle, a seizure of the face with great fulness, the morbific matter being determined upwards like fire. Wherefore the cheeks appear red, the eyes swelled, with falling down of the eyebrows, and the cornea appears somewhat glossy. When the symptoms incline to a more ardent type, it is to be apprehended that the inflammation is of an erysipelatous nature. When the disease originates from the conversion of other diseases into this, we must not have recourse to venesection, more especially if the diseases be of a chronic nature, and if blood had been previously let. But, in the remissions, clysters are to be injected into the bowels, which are moved with difficulty; or, when nothing contra-indicates, large cupping-instruments with scarifications may be frequently applied to the breast and sides. But if the peripneumonia was the original affection, and the strength permit, we must open a vein; or if not, we may cup, proportioning the evacuation of blood to the powers of the patient. Let draughts of the juice of ptisan, or of chondrus with honey, be taken, or from bitter almonds with semilago, or chondrus having some sweet potion mixed with it, such as hydromel, apomel, or hydrorosatum. Fresh butter to the extent of three spoonfuls is also proper. The patient must also drink the propoma of the decoction of figs with hyssop, or of iris boiled in honied water, or of powdered iris, to the amount of two spoonfuls sprinkled upon honied water. This also evacuates downwards. To keep up the strength, he should be made to drink frequently of honied water alone, and with pine-nuts, and the seed of cucumbers. And cupping-instruments and the cerate of privet, having some iris sprinkled upon it; or the cerate of the oil of rue and dried iris; or that made of wax, and rosin, marrow, butter, hyssop, dried iris, and nard ointment, may be applied to the whole chest and sides.

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COMMENTARY. The reader is referred to the authorities on pleurisy, as most of them treat of both diseases together.

Hippocrates recommends bleeding, purging, and attenuant drinks as his general plan of treatment. If the appendix to his treatise on the Regimen in Acute Diseases be genuine he approved of carrying venesection the length of inducing deliquium.

Aretæus gives a minute and faithful account of the disease, but his description is too long for our limits. He remarks that as the lungs have but small nerves, there is little pain unless the investing membrane be affected. He states that when the suppuration takes place, a metastasis of the matter to the bladder or belly sometimes occurs and relieves the patient, whereas, if it be determined to the lungs, it is apt to terminate in phthisis. He gives excellent directions for the application of his remedies, which are the same as those now in use, namely, copious bleeding (but so as to avoid deliquium), purging, attenuant and diluent drinks, rubefacients, containing mustard, to the chest, alkaline substances, such as soda, given in the decoction of hyssop; and when the fever has subsided he allows wine devoid of astringency.

Aëtius makes the same remark as Aretæus respecting the metastasis of the matter. His account of the disease is excellent, but like our author’s.

Celsus properly states that the danger is greater than the pain. His account of the treatment is too long for our limits, but is well deserving of attention.

According to Actuarius, in hot affections of the lungs the urine is first a bright yellow, but if the disease gain ground, and dyspnœa and thirst supervene, the urine becomes red and of a dark wine colour. (De Urinis, vii, 5.)

As the Arabians treat the disease like the Greeks, it is unnecessary to say much of their practice. Haly Abbas describes the disease as a hot inflammation of the lungs, for which he recommends bleeding, cooling and diluent draughts, containing linseed, fenugreek, barley, oil of almonds, liquorice, &c.

Rhases describes a species of pneumonia, requiring the use of tonics, analeptics, and wine. He relates the case of a patient who, he affirms, would infallibly have sunk under this disease, if he had not resisted the advice of the other medical attendants, who prescribed the anti-inflammatory treatment and laxatives.

Although our business be with facts and opinions, and not with words, we are confident we shall be excused in giving here a short verbal disquisition on one of the terms which occur in this Section, we mean ῥωγμὸς, translated by us rále. It occurs again at Book Sixth, Sect. XXXIII, in the description of laryngotomy, and in Aretæus’s description of asthma (Morb. Chron. i, 11.) Cælius Aurelianus thus defines the term: “gutturis stridor quem Græci rhogmon vocant.” (Morb. Acut. ii, 10.) In the Latin translations of the Arabians it is made oregmon. See Rhases (Div. i, 5.) About the terms used by Hippocrates in describing ráles there is some difficulty, owing to the differences of the readings. Thus in the appendix to the work on Regimen in Acute Diseases we read ῥωγμὴ in some MSS., and ῥωχμὴ in others. See Littré (Hipp. t. ii, 464.) In other places he uses ῥέγξις. (Ibid. 262.) In Psellus we read ῥεγμός. (Op. Med. l. 230.) These, as far as we know, are the only terms used by the ancients for the noisy sounds of the respiration in the throat and chest. Ῥόγχος, in Latin rhonchus, we believe, always signifies snoring.

SECT. XXXI.—ON SPITTING OF BLOOD.

When the spitting of blood arises from rupture, a great quantity will be evacuated, and sometimes from an obvious cause, such as a fall, straining of the voice, and the like; and sometimes from an obscure cause, such as plethora, or immoderate cold; for cold, as Hippocrates says, occasions rupture of the veins. If it proceed from erosion, the discharge of blood will not be rapid, but in small quantity, and will have been preceded by acrid and unwholesome food, or abstinence, or an acrid defluxion. When it arises from exhalation, none of the afore-mentioned circumstances, unless, perhaps, the plethora precedes; but a more moistening and heating diet, the use of immoderate baths, and living in very hot places, may appear to occasion it: and it will neither supervene upon inflammations, nor fevers, nor pains, as in the case of erosion; but, on the contrary, the patients will appear in all probability to be relieved by the evacuation. If the hemorrhoidal or the menstrual discharge in women be suppressed, the renewal of these will remove the danger; and the like good effects will result from discharges of blood by rupture, when the disease is connected with plethora, unless the ulcer, or the greatness of the loss of blood prove injurious. When the discharge of blood is from erosion, it is never productive of good. If it is brought up by vomiting, it is clear that it comes from the stomach or bowels, from which parts it is sometimes evacuated by the anus; but, if by coughing, it comes from the respiratory organs; but if it is frothy and whitish, and is brought up at intervals, without pain and oppression, it is clear that it is brought up from the lungs, upon which, in process of time, a continual fever will supervene, more especially if occasioned by erosion; and part of the substance of the lungs, bronchia, or veins, will be brought up. I knew a certain person affected with spitting of blood from the lungs, who, after a time, with much coughing, and full evacuation of blood, spit up four or five stones, rough as caltrops, and of the weight of three or four siliquæ; and he was immediately relieved, but soon after fell into a consumption and died. If the discharge consist of phlegm, with a slight cough or hawking, and the expectoration be frothy and light, you may know that it comes from the trachea. But if it consist of black and grumous blood, and there is pain in the part, it indicates that the discharge is from the thorax, being transmitted by the lungs or bronchia. If it be brought up with hawking, it is by the palate from the parts about the pharynx. But if it flow from the head, it is evacuated with some tickling and cough, for it runs down into the windpipe, and is again brought up. Such discharges are commonly preceded by an acrid defluxion, headach, or heaviness. Sometimes the evacuation of blood is from the palate, owing to a leech having been swallowed, and fixing on some of the parts there. But of this case we will treat on the subject of Poisons.

The cure. Those who have a spitting of blood from catarrh are to be immediately bled (unless the defluxion be very acrid), and a quantity of blood taken away proportionate to the strength. Ligatures are to be applied around the extremities, and the whole body, excepting the head, is to be rubbed with hot old oil, or with Sicyonian. Farinaceous food, containing the juice of some austere fruit, such as that of pomegranate, of apples, or of pears, is to be taken; or let these be boiled with it. When going to sleep, give them the trochisk from amber; and on the third day give some boiled honey to lick. If these do not succeed, and the disease is protracted, shave the head, and use the application from wild-pigeon’s dung; and after three hours remove this application, and put the patient into a bath, taking care not to anoint the head. Then, having given him spoon-meats for food, administer to him the theriac antidote at bedtime, and repeat this next day; and rub in like manner the whole body, except the head, but to it apply the cerate from thapsia, or the like, and again use the spoon-meats. When the complaint is protracted, apply a cupping-instrument to the back part of the head. But if the defluxion be of a very acrid nature, we must abstain from venesection, and have recourse to the food and remedies formerly described when treating of Catarrh, and such as are now to be mentioned. When the spitting of blood proceeds from cold, the chest should be warmed, along with remedies which are of a desiccative nature; and we must give the medicine from two peppers, with the trochisk of amber. Those who bring up blood from the respiratory organs, owing to rupture or anastomosis of the vessels, are to be bled from a vein, unless the discharge of blood be great. In every case, the patient is to be laid in a well-ventilated place, upon a steady couch, in an erect position; and he ought to abstain from strong respiration and talking. To the affected parts we may apply sponges soaked in tepid oxycrate; but after the seventh day, unwashed wool, with the oil of roses, of myrtle, or of lentisk, sometimes with vinegar, and sometimes with austere wine; or, if the discharge be great, we may apply fine flour and manna, with vinegar, or alum and acacia, or pomegranate rind, or galls with vinegar, or dates with polenta and quinces boiled in austere wine. Afterwards we may put on the plaster from willows, more particularly if the discharge be moderate. But the following things are to be taken by the mouth: Purslain when eaten is of use (but its juice when drunk is more powerful), the flowers also of the wild pomegranate, the fruit of the bramble and its flowers, the fibrous part of the common oak, and the membrane under the shell of the acorn (but these are used more especially in decoction); and yet those of the fagus and ilex are more powerful remedies. The Samian aster applies to every spitting of blood, and also the Lemnian earth, and bloodstone finely triturated with the juice of pomegranate or knot-grass. The dose of the stone should be one scruple. The following compound remedies are useful; namely, the trochisk from amber, that from coral, and that from Egyptian thorn, also the powder composed of the earth called Samian aster, Lemnian earth, coral, comfrey, and starch, of each, equal parts. When the disease is occasioned by erosion, more especially if a catarrh precede, we may mix half a part of opium. And the composition admitting of equal parts of Samian aster, agerat stone, and Lemnian earth, is an excellent remedy when drunk to the amount of two spoonfuls (cochlearia) in two cupfuls (cyathi) of plantain-juice.—Another: Of Lemnian sealed earth, dr. xvj; of Samian aster, dr. xviij; of starch, dr. viij; of sarcocolla, dr. iv; of gum, dr. ij. Of this in powder let one spoonful be taken with two cyathi of the decoction of dates. Let them also take cold oxycrate, or the decoction of dates, of apples, of pears, of vine tendrils, or the like. They may take food, if the strength urgently requires it, about the second or third hour, but if otherwise, about the fourth. Let it consist of bread that has been soaked in cold water, or halica, or chondrus, with some of the refrigerant juices, such as those of pomegranate, or myrtles, or with honey and unripe grapes mixed together, or eggs softly boiled, or cakes prepared from milk with some astringent. Of pot-herbs they may take endive, succory, plantain, boiled with the oil of unripe olives and vinegar. Of autumnal fruits they may use apples, pears, medlars, pomegranates, and the fruit of the cornel-tree. When they have no fever, their drink may consist of a small quantity of diluted wine; but, when they have fever, of some of the afore-mentioned draughts, or Cibyratic hydromel. Those who vomit blood may be treated on the same plan, only they must abstain from taking food often. They are easily cured, because the remedies taken by the mouth are applied directly to the parts from which the blood flows. When blood is coagulated in the stomach, let the patient drink of rennet, more especially that of a hare, or the lixivial ashes of figs with water, or thyme, or savory with vinegar; or evacuations may be produced by means of milk divided into parts (lac scissum), or of aloes. Those who hawk blood from the palate must use astringent gargles, and apply to the forehead and the rest of the head the remedies for bleeding from the nose. Such is the treatment of spitting of blood, which must be carefully attended to, on account of the danger from an immoderate discharge of it; for if a great quantity be evacuated, it will bring instant death, as in the case of a slaughtered animal; but a continuance of the complaint threatens a conversion into phthisis. Wherefore, when everything is properly attended to, and the discharge of blood ceases, their strength must be recruited by getting fish and the feet and brains of young swine. We must also direct them to get their bodies rubbed, to abstain from the frequent use of baths, from drinking wine, and from mental emotions and venery.

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COMMENTARY. See Hippocrates (de Morbis, et alibi); Galen (Meth. Med. v, and sec. loc. iv and vii); Aretæus (de Morb. Acut. ii, 2); Aëtius (viii, 65); Celsus (iv, 5); Alexander (vii, 1); Oribasius (Synops. ix, 2); Leo (iv, 30); Actuarius (Meth. Med. i, 17); Octavius Horatianus (ii, 2, 9); Nonnus (128); Scribonius Largus (83); Marcellus (de Med. 17); Serapion (ii, 25); Averrhoes (Collig. vi, 34); Mesue (de Ægr. Pect. 6); Avicenna (iii, 10, 3, 4); Avenzoar (i, 16, 5); Haly Abbas (Theor. ix, 26; Pract. vi, 10); Alsaharavius (xii, 6); Rhases (ad Mansor. ix, 59; Contin. ix.)

The father of medicine has mentioned this disease casually, but has not given a full account of it. We may mention, however, that he refers one species to disease of the liver. (Coac. 450.) Aristotle states that vomiting of blood is not dangerous when connected with obstructed menstruation. (H. N. vii, 10.)

The description given by Aretæus is exceedingly accurate. Blood that is discharged by the mouth, he remarks, may come from the fauces, nose, and palate, in which cases it is seldom attended with danger; or from the lungs and arteria trachea, which is exceedingly dangerous, and may prove fatal either suddenly, or by terminating in consumption; or from the stomach, which is less dangerous, as the remedies can be applied direct to the part affected; or from the liver and spleen, which is a more dangerous case, as the remedies cannot be so readily applied to them. They all arise, he says, from rupture, erosion, or rarefaction. By rarefaction (ἀραιῶσις) he means the same as exhalation (ἀναστόμωσις). If the blood be black and thick, it comes from a vein; and if florid and thin, from an artery. Of these cases that in which it proceeds from rarefaction is said to be the least dangerous, as it may readily be cured by astringents. The circumstances and characters of all the other cases are stated with great accuracy and at some length. He concludes with the remark, that in hemoptysis the patient despairs from the first, whereas in consumption he flatters himself with the hopes of recovery to the last. With regard to the treatment he directs that the patient be laid on a firm couch (as all motion increases the complaint), in a cool place, and that he abstain from speaking and all mental emotions. In every case, if the patient’s strength will permit, he recommends venesection at the elbow. Ligatures, not so tight as to occasion pain, are to be applied to the extremities. Over the place from which the blood flows he directs us to apply wool or sponges soaked in austere wine and rose-oil, or in vinegar. In certain cases he directs us to put an astringent plaster upon the chest. With regard to the medicines taken by the mouth, he recommends astringents, especially coral, when the disease is occasioned by dilatation. These, however, are only to be given when no fever is present. The diet is the same as that recommended by our author.

The account given by Celsus is very similar, and highly interesting. He approves of bleeding, the internal and external use of vinegar, and cold water to drink. Part of his treatment deserves to be given in his own inimitable language: “Præter hæc necessaria sunt quies, securitas, silentium. Caput cujus quoque cubantis sublime esse debet, rectèque tondetur. Facies sæpe aquâ frigidâ fovenda est. At inimica sunt vinum, balneum, venus, in cibo oleum, acria omnia, item calida fomenta, conclave calidum et inclusum, multa vestimenta corpori injecta, etiam frictiones. In hoc casu per hiemem, locis maritimis; per æstatem, mediterraneis opus est.”

Scribonius Largus, among other remedies, mentions sponging the chest with vinegar.

Pliny the elder recommends the juice of henbane in hemoptysis. (H. N. xxvi, 15.) See also Marcel. Empir. (17); Plin. Valerian. (iv, 69.)

The account given by Aëtius is full and judicious, but mostly borrowed from Galen. He approves of the internal use of vinegar, and of applying to the chest wool soaked in the same.

Oribasius, Actuarius, and Nonnus recommend internal remedies like those of our author.

Alexander’s observations are exceedingly judicious; but we can only afford room to state his opinion of external applications. He approves of embrocations by means of wool soaked in rose-oil, or the like, with some vinegar or austere wine not very old; but recommends us to change the application frequently, as by allowing it to remain it will only irritate and provoke the flow of blood. With such precautions Octavius Horatianus, in like manner, approves of sponging the chest with sour wine and water, or vinegar. Alexander properly forbids us to give anything warm, and cautions against violent exercise, anger, venery, and saltish food.

Galen expounds the pathology and principles of treatment so fully, that we cannot even venture to give an abridgment of his account, but will venture to recommend it to the serious attention of the medical reader. We must not omit, however, what he says respecting the use of cold and astringent applications to the chest: “I do not, like most physicians, approve of applying externally astringents, or things which are of a cooling nature without astringency, in cases of hemorrhage; for it appears to me that they have sometimes a contrary effect from what they are intended to produce, as they occasion a determination inwardly, and congestion in the deep-seated veins. I have therefore known cases of persons affected with spitting of blood who were evidently hurt by the application of cold to the chest. Wherefore, in cases of hemorrhage, I do not approve of the indiscriminate use of cold applications.” (Meth. Med. v, 6.) See also de Const. Artis Med. (16.) Galen mentions that blood may run down from the fauces into the windpipe, and thereby occasion groundless apprehensions of hemoptysis.

It deserves to be remarked that Dioscorides, Pliny, Galen, Alexander, and Paulus agree in recommending the hæmatite, or bloodstone for hemoptysis. It is a native oxyde of iron.

To the long and accurate account given by Cælius Aurelianus it is impossible to do justice in a short abstract. Passing over entirely his description of the symptoms, and explanation of the sources from which the blood is discharged, we shall merely dwell upon a few points of his practice. He insists with proper earnestness on the necessity of complete rest, coolness, and abstinence from everything of a stimulant nature; and recommends the practice already often mentioned of applying to the part affected sponges or compresses soaked in cold water, or in water and vinegar, or in some astringent decoction. He also approves of the application of ointments or plasters composed of galls, alum, the rind of the pomegranate, and the like. From among his many internal medicines we would point out the composition consisting of gum acacia, alum, and the decoction of poppies. When the discharge does not stop before the third day, he recommends venesection. But if pain, difficulty of breathing, or a dry cough should come on, he approves of bleeding at an earlier period of the disease. He then directs us to give emollient epithemes, electuaries containing frankincense and opium, and the like. When the pain is protracted, he recommends us to apply cupping-instruments or leeches to the part affected. Food of a middle quality, milk, and the like are to be given. From his strictures upon the practice of the others, it appears that some of the medical sects had condemned venesection, but it is satisfactory to know that most of the authorities were agreed about the propriety of it. The Methodist forbids it when there are no symptoms of inflammation present. It seems there were disputes also about the propriety of ligatures to the extremities, but Cælius pronounces in favour of this practice. He informs us further that some questioned the propriety of giving vinegar, but he decidedly approves of it. When there is any inflammation, he disapproves entirely of astringents. He also condemns sudorifics and diuretics. He allows exercise only when the complaint has abated.

Marcellus condemns ligatures to the extremities, but approves of applying to the chest a sponge soaked in cold water or acrid vinegar.

We have not room for many extracts from the Arabians, who, however, supply little additional information, although they treat fully of the disease. We would refer to Avicenna’s account as being particularly full and excellent. He approves of the internal use of vinegar, and when there is a tickling cough, of anodynes, such as mandragora, henbane, and poppy. Rhases and Serapion approve of sponging the chest with vinegar. Averrhoes, who is fond of contradicting preceding authorities, condemns the practice of giving vinegar in hemoptysis. Mesue recommends the use of chalybeate water for drink. He approves in general of astringents. Haly Abbas gives a very full and interesting account of the causes and varieties of the disease, and modifies his treatment accordingly. He recommends bleeding from the basilic vein, to be repeated if circumstances require, purging with gentle laxatives, such as myrobalans and rhubarb, giving demulcents, such as gum arabic and starch, to which poppy is sometimes to be added, for allaying irritation. He directs the bath, strong exercise, and vociferation to be avoided. When the disease arises from a cold cause (he means in cases of passive hemorrhage), he forbids venesection, and recommends stimulants, such as frankincense and myrrh. In certain cases he allows astringents, such as alum, balaustine, galls, sumach, &c. He also directs us to apply to the breast an astringent cerate containing roses, plantain, purslain, &c. Alsaharavius recommends bleeding, cold applications to the chest, opiates, and astringents, according to circumstances. Rhases states that opium, by thickening or congealing the blood, proves useful in hemoptysis. He approves very much of a milk-diet. In general he recommends venesection. He directs the physician to be at pains to ascertain from what part the blood proceeds.

Cold applications to the chest are not now generally resorted to in this disease, although it will be seen that the ancient authorities generally approve of this practice. It will be remarked, however, that Galen condemns the indiscriminate use of this remedy; and Rhases also states that he had seen mischief produced by the unseasonable application of cold to the chest. In short, like every other mode of practice, it ought, no doubt, to be applied with proper caution and discrimination.

SECT. XXXII.—ON EMPYEMA AND PHTHISIS.

Empyema is formed either in the cavities of the chest, or in the pleura, sometimes arising from vomiting of blood, when the ulcer has not healed (in which case phthisis soon comes on, provided the discharge came from the lungs), and sometimes from a precursory inflammation, which has formed into an abscess and burst (as is sometimes the case in pleurisy), or from a defluxion from the head. The symptoms of a confirmed empyema are weight in the chest, an intense dry cough, with pain, and sometimes with a fluid, in which case they seem to experience an alleviation. At the commencement the attacks of fever are weak, irregular, and difficult to perceive; but when the abscess is about to burst, they have more violent fever, attended with rigor, and in speaking their breathing is obstructed. When the abscess bursts, matter is brought up, sometimes pure and sometimes feculent: sometimes it is discharged upwards, when it is attended with more danger; and sometimes downwards, in which case the matter is partly translated to the stomach and bowels; and partly to the bladder, the metastasis taking place by certain vessels. All along they have hectic fever until the ulcer becomes clean; and if this do not speedily take place, the empyema is converted into phthisis from the lungs undergoing ulceration. When this takes place, the cheeks are livid; there are copious sweats about the forehead and neck; the flesh is melted, the nails bent, and they appear glossy, white, or pale. When the disease gains ground, the bowels become loose, the hypochondria are retracted; for the most part thirst and a loathing of food oppress them; and the expectoration is very fetid.

The cure. Our first object, therefore, ought to be to assist the concoction of the abscess, which may be attempted by fomenting with sponges, and applying cataplasms made of barley-flour, with dried figs boiled, some rosin, pigeon’s dung, nitre, and mallows. The rupture of the abscess is promoted by lying upon the side which is not affected. Let them drink at intervals honied water, and the juice of ptisan with honey. Those who are stronger may likewise drink the decoction of hyssop and thyme with honey. Eating pickles also forwards the breaking of the abscess, and likewise the pills from the colocynth hiera, taken at bedtime. When the pus begins to be discharged, give again the decoction of hyssop, iris, and liquorice boiled in honied water, or liquorice triturated with sesame; and apply a cataplasm of fine flour, boiled in honied water and oil. When the ulceration is difficult to cleanse, we must use the compound remedies, such as that from horehound, either the simple or the compound one; that from tares; and those called dodecatheon, and the medicine named from Philoxenus. When it is converted into phthisis, we may give the headed leek, dissolved in draughts of chondrus or ptisan, and let them be twice boiled, and given by themselves. Let the water which is drunk be rain, and honied water made from it. At the beginning of the remissions apply cataplasms of linseed and fine flour, with the decoction of fenugreek, or mallows, oil, honey, and the leaves of marshmallows. In process of time we may have recourse to cerates, such as those from butter, oil of privet, oil of bays, and iris. The plaster of Mnasæus is also to be used. When there is a defluxion upon the chest, that made of willows may be applied to it. They may also take the simple propoma, mentioned already for empyema, and some of the compound ones. When a violent cough prevails, mix thyme and hyssop along with the juice of liquorice, in well boiled honey; and, having formed them properly, give to be retained under the tongue. The antidote of Mithridates, at intervals, will likewise suit with them, as also that from vipers. But the best remedy is the Armenian bole taken in a draught, and the antidote esdra is not at all inferior to those aforesaid.

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COMMENTARY. See Hippocrates (de Morbis, ii, 45; Coacæ Prænot. et alibi); Galen (Meth. Med. v); Aretæus (Morb. Chron. i, 8); Aëtius (viii, 75); Oribasius (Synops. ix); Alexander (vii, 2, 3, 4); Leo (iv, 10); Actuarius (Meth. Med. iv, 4, and i, 17); Nonnus (123); Cælius Aurelianus (Morb. Tard. ii, 14, and v, 8); Celsus (iii, 22); Octavius Horatianus (ii, 8); Marcellus (17); Avicenna (iii, 10, 5); Mesue (de Ægrit. Pect. ii, 12); Serapion (ii, 27); Alsaharavius (Pract. xiii, 3); Haly Abbas (Pract. vi, 12, Theor. ix, 20); Avenzoar (i, 16, 4); Rhases (ad Mansor. ix, 69; Contin. x.)

Hippocrates states, as tests of the nature of the sputa, that, if they possess a fetid smell, or sink to the bottom of salt water, they indicate great danger. When a collection of pus is suspected, he directs us to shake the patient, when a peculiar sound will be heard if there be fluid in the chest. And here, by the way, we may mention that Laennec gives Hippocrates great credit for his diagnostic talent in this case. It is in pneumothorax that succussion is applicable as a test of fluid being confined in the chest. In that case, he directs us to make an incision into the chest; in other words, he recommends paracentesis thoracis, an operation revived of late years, but with very equivocal results. Hippocrates, however, restricted the operation to those cases in which there is protrusion of the collected fluid. (Aff. Int. xxv.) It would appear, from one of his Aphorisms, that the pus was let out either by a cutting instrument or the cautery. (vii, 43.) In his Prognostics, he pronounces a falling out of the hairs and a diarrhœa to be fatal symptoms in phthisis. He gives a very striking description of confirmed empyema. (Prognost. 17.) His account of the formation of hydrothorax (Affect. Int. xxv.) has also been highly commended by the great master of auscultation. According to Hippocrates, phthisis is most common between the ages of eighteen and thirty-six. (Aphor. v, 9.)

Aretæus gives a good description of the phenomena attending empyema thoracis. He says that when the abscess points outwardly, it separates the ribs from one another to make room for itself. It is occasioned, he says, by inflammation with a collection of blood. But the most graphic delineation of the phenomena of disease to be found in the whole records of medicine is that which he draws of a patient in the last stage of consumption. We will not mar it by attempting a copy which would fall so short of the original. He does not approve of the common tests, as recommended by Hippocrates; and, instead of forming an opinion of the case by throwing the sputa upon fire or water, he prudently directs us to judge of the case from the general symptoms. Unfortunately only a fragment of the chapter on the treatment has come down to us. It appears from it that he approved of a milk-diet and a sea-voyage. In cases of empyema he states that the matter sometimes forms a communication with the windpipe, and is evacuated in that way, and sometimes it is carried off by the urinary passages.

Celsus recommends in particular a sea-voyage, change of air, gestation in a couch, and a milk-diet. He cautions against the bath and exposure to the sun or cold. When other means do not effect a cure, he directs us to burn the chest in different places with the actual cautery, so as to form issues. See a strong recommendation of this practice in Caillot (Elemens de Physiologie, p. 6.)

Galen has detailed the principles upon which phthisis ought to be treated in the fifth book of the ‘Meth. Med.’ He commends strongly a diet of milk, especially that of goats, which is, he says, of an intermediate consistence between the milk of cows and of asses. The ancients, he says, made consumptive patients suck a woman. Whatever kind be used, he recommends it to be drunk as soon as it is milked from the animal; and he further directs sometimes honey or a little salt to be added to it. According to Galen, portions of the lungs are sometimes brought up in the sputa. (Loc. Affec. iv.) Cælius Aurelianus also confirms this statement. (Tard. Pass. ii, 14.) Aretæus, Alexander, and Leo further say that portions of the bronchia have been brought up with the expectoration.

Alexander gives very judicious directions for the choice of milk, and treats of empyema otherwise very fully. He says, when pus is collected in the chest, the sound of it may be heard in succussions of the body.

Aëtius states, upon the authority of Archigenes, that in certain cases empyema is formed without fever. This is now well ascertained to be the case. He approves of the cautery, like Celsus. His account of phthisis is taken from Galen.

Cælius gives many important observations on the proper treatment of consumption, and strictures on the practice of the other sects. He remarks that in old coughs attended with fever, although the expectoration be at first transparent and not purulent, the complaint often terminates in phthisis. His description of the disease is singularly accurate. The pectoral râle he notices in these words: “Quosdam etiam sibilatio vel stridor thoracis sequitur.” The pulse is said to be “debilis, densus ac deinde formicalis.” He mentions that it usually terminates by a colliquative diarrhœa. His treatment is judiciously suited to the circumstances of the case. He condemns the early use of the bath, hellebore, and the formation of issues on the part affected. Of the varieties of empyema he has treated elsewhere at great length. He appears to consider the operation of paracentesis as dangerous.

Many of the remedies recommended by Marcellus contain a combination of stimulant with narcotic substances, that is to say, of myrrh, storax, and the like, with opium and hyoscyamus.

Pliny speaks of navigation, that is to say, a sea-voyage, as a popular remedy for phthisis in his time. (H. N. xxxi, 33.)

Vegetius, the veterinary surgeon, remarks that tubercles like boils form in the lungs of cattle. (Mulom. ii, 45.)

Avicenna’s treatment is in general like that of Galen and his followers. He speaks of inhaling the vapours of arsenic, pine-fruit, &c. He and his countryman Avenzoar approve of paracentesis and the cautery. Mesue recommends the tepid bath in the decline of phthisis. Serapion approves of opening the abscess in cases of empyema by means of a red-hot iron. In the treatment of empyema Haly Abbas appears to have put great confidence in absorbent earths, such as burnt crabs, gum Arabic, Cyprian earth, &c. He gives the milk of asses in the morning, and at night the syrup of poppies. He also praises goats’ milk. He approves of a milk-diet and demulcents likewise in phthisis. He makes frequent mention of poppies, doubtless with the view of alleviating the cough. In certain cases he prescribes the tepid bath; and, under proper regulations, we are convinced that it might often be of service. Haly approves of the tests of purulent expectoration, which we have stated above that Aretæus condemned. Alsaharavius says that the bath may prove useful in phthisis, but that it ought not to be tried except under the direction of a skilful physician. He seems to direct the patient first to use the tepid bath in a warm place, and afterwards to go for a short time into a cold bath. He does not explain the principles of his practice. He approves in general of a milk-diet, but directs us to change it if a diarrhœa come on. The milk of asses or of goats is what he prefers. He approves of the Hippocratic tests of pus. Rhases describes several species of consumption. One of them he represents as being seated in the trachea. His account of the various modes of treatment is most ample. He strongly commends the milk of asses.

Galen, Rhases, and most of the ancient authorities held that consumption is contagious. See, further, Aristotle (Prob. 7), and Isocrates (Æginet.) Alexander Aphrodisiensis accounts for the propagation of the disease by supposing that putrid matter is conveyed from the lungs of the affected person to others. (Prob. ii, 42.)

The historian Sallust uses the word tabes as synonymous with contagium, in the following sentence: “Tanta vis morbi, uti tabes, plerosque civium animos invaserat.” (Catalin. 36.) Livy does the same in several places. (See ii, 23.)

SECT. XXXIII.—ON PLEURISY.

Pleurisy, properly so called, is an inflammation of the membrane which lines the ribs, and is attended with difficulty of breathing, cough, continual fever, and pain shooting to the clavicle and hypochondrium. You may distinguish pleurisy from inflammation of the liver (for in it there are all these symptoms), by the pain in pleurisy being pungent, and the cough being sometimes without expectoration (when it indicates that the disease is not yet concocted), and sometimes with expectoration, the appearance of which indicates the nature of the humour that occasions the complaint; for it is red and tinged with blood when a fulness of blood is the cause; yellow and palish when caused by yellow bile; white and frothy when from phlegm; and blackish when from the melancholic humour. And the pulse is hard and serrated. But, in inflammation of the liver, the pain is not pungent, nor is the pulse so hard; and the cough throughout is dry and without expectoration, and the face appears paler. Pleurisies from inflammation of the external muscles (which are not, properly speaking, pleurisies) are not accompanied with cough and expectoration, nor is the pulse hard; and if one touch the part affected with his hand, the patients feel pain; and if not resolved, the swelling is converted into pus, which may be evacuated externally by an incision; whereas pleurisy from inflammation of the membrane which lines the chest has not this termination; for if it do not discharge the empyema either internally or externally, it terminates in peripneumonia.

The cure. If the pain shoot to the clavicle, we must straightway open a vein; or if to the hypochondrium, we must purge downwards. Physicians of late, in all cases, have recourse to venesection, apprehending, I suppose, the disturbance occasioned by purging. When the strength prevents us from having recourse to either of these remedies, we must use stimulant clysters; and if the pain is moderate, after the clyster we may give honied water, and the juice of ptisan and of chondrus. When the affection is on the decline, we may add to the juices leeks or calamint, and the patient may get the seeds of pennyroyal and nettle, with honey, as a linctus. When the pains are violent after the evacuation, they must be soothed by the application of hot wool, or of sulphurated wool; or by fomentations of millet and flour in a bag, or by means of hot water or oil in a bladder. Unwashed wool may be applied with oil; and wine, containing an admixture of sea-water, or salt, may be added to it. Or we may apply a cataplasm, formed of the medicine from seeds, with the decoction of chamomile and marshmallows, or of dried figs, iris, wormwood, and some honey, with oil of nard. About the fourth day give spoon-meats for food, with some honey; but after the seventh day we are to give a linctus of almonds and nettle-seeds, triturated in honey, or the linctus of butter and honey pounded together. And we are to use the hypoglottis (electuary) of boiled honey. And we must apply to the affected parts the fetid epitheme—that from sweet marjoram, and the rue-plaster. The bulbi, applied with axunge, are often an effectual remedy, and they may also be administered in a clyster with butter and turpentine. Among the most powerful remedies is the linctus from pine-nuts and bitter almonds, linseed, pitch-fruit, and starch, in equal parts, with honey. When they are troubled with insomnolency, it will be proper to give a linctus of poppy-heads; and we may use the antidote called athanasia, and those prepared for this purpose. When the disease remains after the fourteenth day, we must cup them, and keep them upon a spare diet; and then, when the disease is on the decline, we may make them take the bath (but avoiding the cold), and allow them to use a more nutritious diet. If the inflammation of the pleura be not resolved, but appear to be converted into pus, we must have recourse to the remedies formerly mentioned.

For pains of the sides without fever. Pains of the sides without fever are cured by bdellium and costus, mixed with the ashes of burnt cabbage-leaves and tallow: for this remedy is powerfully discutient.

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COMMENTARY. See Hippocrates (de Morbis, ii; de Rat. Vict. in Acut.); Galen (de Med. sec. loc. vii, et alibi); Celsus (iv, 6); Aretæus (Morb. Acut. i, 10; Curat. Morb. Acut. i, 10); Aëtius (viii, 76); Psellus (Op. Medicum); Alexander (vi, 1); Oribasius (Synops. ix, 7, 8); Actuarius (Meth. Med. iv, 4); Nonnus (129); Cælius Aurelianus (Morb. Acut. ii, 13); Octavius Horatianus (ii, 4); Marcellus (de Medicam. 24); Serapion (ii, 21); Mesue (de Ægrit. Pect. 7); Avicenna (iii, 10, 4); Alsaharavius (Pract. xii, 8); Avenzoar (i, 16, 4); Haly Abbas (Theor. ix, 21; Pract. vi, 13); Rhases (Divis. 54; Contin. x.)

Hippocrates gives brief descriptions of pleurisy, and recommends nearly the same treatment that is now practised, namely, bleeding ad deliquium animi, purging, diluent drinks, and fomentations to the side by means of sponges squeezed out of hot water, or of bags filled with salts and millet, or the like. He says, those who have neither been bled nor purged die on the seventh day, either with delirium, or with orthopnœa and a râle. One of his aphorisms is, that pneumonia supervening upon pleurisy is dangerous. (vii, 11.) He was acquainted with pulmonary adhesions, as is remarked by his devoted admirer Laennec.

Aretæus, with his usual accuracy, gives a most complete description of all the symptoms of pleurisy, but, as it is not much different from our author’s, we shall not enter far upon a detail of it. He states distinctly that the disease is an inflammation of the membrane which lines the chest. The sputa are pituitous, bilious, or deeply saturated with blood, or yellowish. He remarks, by the way, that pleurisy is sometimes a sporadic disease, and sometimes epidemical. His directions about the application of the common remedies are dictated by his usual excellent judgment. On the necessity of early and repeated venesection he insists strongly, but recommends it not to be carried the length of producing deliquium animi, as the fluids will thereby be determined inwardly. Archigenes (ap. Aëtium) and other ancient authorities joined him in this rule of practice, although in opposition to Hippocrates. He approves of cupping the side, but not until after the seventh day, and directs us to apply to the scarifications salts or nitre. His internal remedies consist of demulcents, diluents, and narcotics, varied according to circumstances. He forbids the use of cold drink and cold air. Celsus also cautions against cold, and directs sinapisms to the chest. His general treatment is nothing different from that of Hippocrates.

Galen treats of pleurisy cursorily in many parts of his works, but, as he follows entirely the views of Hippocrates, we need not enter into a detail of his practice. We may mention, however, that the worst character of the pulse, according to him, is when it is hard, small, and very frequent. (Diff. Puls. iv, 5.)

Aëtius gives an interesting account of a species of pleurisy arising from indigestion or crudities of the stomach. In this case he forbids venesection, and recommends clysters and calefacient applications.

Alexander gives very minute directions how to distinguish pleurisy from hepatitis. He remarks that, in the latter disease, the patient is yellowish: in the former the pulse is hard and serrated. When the pain is not violent, he recommends us to trust to cupping, which he says was a popular remedy in Armenia. He disapproves in general of opiates. When the discharges from the bowels are bilious, he directs purging with scammony, black hellebore, and the like. According to Actuarius, the urine in pleurisy is first reddish, and afterwards becomes red and of a dark wine colour. (De Urinis, vii, 9.) The sputa, he says, in pleurisy and pneumonia, is of a whitish and bloody colour. (De Diagnos. i, 16.)

Psellus cautions us not to confound pleurisy with abscess of the side. In the latter case, he remarks, there is no cough, and pain is felt upon pressure. He appears to copy from Paulus.

There is nothing particularly original in the accounts given of it by Oribasius, Nonnus, Octavius, and Marcellus. We shall, therefore, proceed to explain the views of the Methodists. The remedies recommended by Cælius Aurelianus are, upon the whole, nearly the same as those directed by the other sects, but he attaches much importance to his own method of applying them. In illustration of his principles, we shall mention a few of his strictures upon the practice of the others. He condemns Hippocrates for carrying venesection the length of producing deliquium animi, which he pronounces to be a very pernicious practice. Indiscriminate purging, he thinks, increases irritation. He disapproves of abstinence for seven days, as enjoined by the father of medicine. Diocles he blames for enjoining the same rules with regard to bleeding and purging, and for allowing cold food in summer. Praxagoras he strongly and properly condemns for giving pepper or southernwood in mulse; and also for recommending the warm bath, and fomentations to the side, which he justly remarks will only occasion cold to the patient; and for prohibiting venesection, when the disease is occasioned by cold, and the patient is old and weak. He finds fault with Asclepiades for saying that venesection is not proper in certain countries, as at Rome and Athens, whereas Cælius properly maintains that venesection is everywhere proper. It is worthy of remark, by the way, that prejudices against bleeding prevailed in Rome when Galen wrote, and to a certain extent do so still. Cælius also justly condemns his too free allowance of mulse, or wine and honey. He blames Themison for using acrid applications to the chest. Of his strictures on the treatment of Heraclides, the most just are his condemnation of the practice of giving mulse with rue, and garlic with vinegar, to remove the nausea; and of his direction to bleed only on the second day after two or three clysters had been given.

Of the practice of the Arabians little need be said, as their views of treatment are entirely conformable to those of the Greeks. Avicenna’s directions are most minute, and would furnish an excellent guide to practice. He forbids cold things, and approves of cupping and sinapisms only when the disease does not yield to the ordinary treatment. When insomnolency continues long, he permits to give the syrup of poppies. Convalescents are directed to avoid saltish and sharp things, repletion, the sun, wind, smoke, loud talking, and the like. Serapion, on the fourth day, adds liquorice to the decoction of barley. Mesue and Avicenna agree in opinion, that fomentations to the side do no good unless in slight cases, and when applied early. Mesue forbids cupping until the seventh day; and, when the stomach and bowels are loaded, he opens the bowels before bleeding. Haly Abbas directs bleeding from the arm opposite the side affected, at first; but, if the disease is protracted, from the arm of the same side. He recommends gentle laxatives, and, after bleeding and purging, warm applications to the side, such as a bladder half filled with hot water. He also speaks of cupping, and of stimulant plasters, sinapisms, and such like. He says, when the body is cleansed, and the disease matured, the patient is to be put into a tepid bath. This practice may deserve consideration.

It is worthy of remark that the Arabians in general bleed from the arm of the opposite side. The Greek and Latin authorities are divided in opinion upon this rule of practice. Hippocrates, Galen, and Celsus recommend us to bleed from the arm of the affected side; but Aretæus, Aëtius, and Cælius Aurelianus, from the opposite. Galen, in one place, mentions that he had abstracted blood in a case of pleurisy by opening one of the arteries of the hand.

SECT. XXXIV.—ON AFFECTIONS OF THE HEART.

When the heart itself is primarily affected, the case is far beyond all medical aid, occasioning sudden death; and so also in the inflammations and erysipelas of it, strong distemperatures in very acute fevers, and hemorrhages when it is wounded, especially in the left ventricle. When it is affected sympathetically with the brain, the liver, the orifice of the stomach, and from sorrow, fear, and many other causes, it brings on the affection called syncope, being a sudden collapse of the vital powers, indicated by prostration of strength, deliquium animi, a small pulse, coldness of the extremities, and copious perspiration. When this affection is of a violent nature, it also is irremediable; but if the strength stands out, it may sometimes be relieved. But strong palpitations of the heart often arise from a fulness or effervescence of its blood. When, therefore, the heart is over-heated, it renders the respiration large and dense; but when it is too cold, the respiration is small and rare. The complete cure of syncope of the heart, when it occurs among the symptoms of fever, we have treated of in the Second Book. This only may now be added, that when the collapse gains ground after friction and ointments have been applied to the extremities, and after purification of the floor, and other cooling means, we must sprinkle upon the parts of the body which are sweating powdered myrtle, Cimolian earth, or amber, or pomegranate-rind with manna, or Samian earth with gum; and cataplasms of mustard or pellitory, or adarce, are to be applied to the cold extremities, as far as to the groins and armpits. The food should be bread out of water, or out of cold diluted wine, swines’ feet and the joints and snout, and fowls; all the things being given in a cold state. On the head and forehead is to be rubbed the juice of unripe olives, or some astringent application, with gum, and the decoction of roses; and a cataplasm is to be applied to the hypochondria and stomach, formed from dates, roses, the flower of the wild vine, acacia, hypocistis, and alum.

On palpitation of the heart. “I knew a certain person,” says Galen, “who suffered an attack of palpitation of the heart every year in the season of spring. Wherefore, having for three years experienced benefit from venesection, in the fourth he anticipated the attack by getting bled, and escaped from it, and did so for many years afterwards, using at the same time a suitable diet. And yet even he died before attaining old age, as every other person in this complaint does, some being suddenly cut off in acute fevers by syncope; but some of them without syncope, being unexpectedly deprived of life, as if by apoplexy. The majority of those who are thus affected do not reach the fiftieth year of age, but pass the fortieth.”

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COMMENTARY. See Galen (de Loc. Affect.); Aëtius (viii, 58); Oribasius (Synops. ix, 6); Actuarius (Meth. Med. iv, 3); Leo (iv, 21); Nonnus (134); Avicenna (iii, 11, 12); Serapion (ii, 27); Avenzoar, (1, 12); Mesue (de Ægrit. Pect.); Haly Abbas (Theor. ix, 22, and Pract. vi, 16); Alsaharavius (Pract. xiii); Rhases (Divis. i, 58, and Contin. xvi.)

Most of the knowledge which the ancients possessed of these obscure complaints may be found in Galen (l. c.) In the body of a monkey he had remarked hydrops pericardii, and in that of a cock he had detected a scirrhous tumour, from which he inferred that these diseases occur also in the human subject. One would almost suspect, however, that the ancients were more familiar with inspectiones cadaverum than they chose to avow. As a proof of this, we may mention what is related by Hesychius of Hermogenes the rhetorician: “Hermogenes the rhetorician having died was dissected, and his heart was found covered with hair, and greatly exceeding its natural size.” (See also Suidas.) Respecting persons having hair on their hearts we quote the following note from Fabricius (Bibliotheca Græca, iv, 429): “Plura exempla hominum quorum cor pilosum est repertum collegit elegantissimus. Muretus (xii, 10, Var. Lect.); Pontanus (Bellar. Attic. 301), et Alexander Tassonus in libro Italicè edito cui titulus Pensieri Diversi, (vi, 30.) De Aristomene Messenio idem tradit præter alios Dio. Chrysost. (xxxv, 430) de Leonida Plutarchus in parallelis minoribus (306.)” It is proper to mention, however, that Senac is incredulous as to the truth of these stories (Essai, &c. 62.) On the subject we are treating of the learned Stephen Bernard has the following remark: “Apparet, ni fallor, ex hoc loco Pauli (iii, 68), veteres morborum sedes in cadaveribus rimari non neglexisse quod etiam patet ex illis quæ de hepatis inflammatione habet (181), qui enim scire poterant aliquando partem ejus cavam, nonnunquam vero gibbam inflammatione tentari nisi ex cadaverum inspectione?” (Ad Nonni Epit. 208.) See also Pliny (Hist. Nat. xi, 70), and the note of Harduin.

Since all the writers subsequent to Galen merely copy from him, we need not say more of their opinions. We may state, however, what Actuarius says regarding the characters of the urine in affections of the heart. In hot intemperaments of the organ the urine at first is more acrid and thinner, but as the disorder increases, it assumes an oily colour and consistence. The sediments become grumous, furfuraceous, scaly, and gritty. When it is affected with a cold intemperament, the colour of the urine is whiter, and the sediment at first moderate and crude, but afterwards it becomes black. (De Urin. vii, 4.)

The Arabians, especially Avicenna, treat of these complaints at great length, but without supplying much additional information. Avenzoar speaks obscurely of certain tumours resembling pellicles or cartilages on the pericardium. He mentions also hydrops pericardii, and abscess of the same. Pain of the heart, says Haly Abbas, may arise from an intemperament, organic disease, or a solution of continuity. The last two causes soon occasion death. He mentions that palpitation may be occasioned by dropsy of the pericardium. He recommends bleeding in cases of palpitation, upon the authority of Galen, and also things of a cold nature, such as seeds of cucumbers, citrons, gourds, roses, and camphor. Alsaharavius gives a similar account of these affections. Rhases also approves of venesection and cold applications. He mentions that palpitation is sometimes felt in the region of the stomach, for which he recommends bitters, such as wormwood.

The disease which Galen and his followers describe under the name of palpitation was no doubt that state of the heart now called hypertrophy with dilatation. In confirmation of the truth of Galen’s prognosis, we may quote the words of the celebrated translator of Laennec, as to the issue of the disease of the heart we have mentioned: “Such persons however are marked for destruction. After a certain time the disease obtains the mastery, and brings the strong man down, the sooner, alas! for the bold resistance made to his dominion.” (English Translation of Laennec, p. 62.)

SECT. XXXV.—ON AFFECTIONS OF THE BREASTS.

After childbirth, the milk frequently being converted into cheese in the breasts, produces inflammations. Wherefore at first we may use these applications: Having squeezed a soft sponge out of tepid oxycrate, apply it to the breasts, and bind it on in the proper form; or use dates triturated in oxycrate with bread, or a whole egg with rose-oil and some cerate; or alum, fleawort, with coriander and purslain, may be applied in the form of a cataplasm; or apply the firestone triturated with cerate, and bind it on. When there is distension or thrombus in the part, apply a cataplasm of bread with water and honey, or with wine and honey; or bread with the green herb perdicias (pellitory of the wall?), along with cerate twice a-day; or bean-flour with hydromel, or sodden must. But if they cannot bear the weight we must use an embrocation of hot sweet oil by means of soft wool. But we must foment them with the steam of hot water, or a decoction of fenugreek, or of marshmallows, or of linseed. And we are to apply to them a cataplasm made of fine flour with linseed, or fenugreek with hydromel, or sesame with honey, or pounded butter. But we must interdict sucking of the breasts, because it only attracts more milk to them. When the inflammation is on the decline we may apply the following cerates: Boil beet in oil until it is softened, throw it away, but add to the oil a moderate quantity of wax, and use.—Another: Mix the red parts of ten raw eggs in a cerate consisting of wax, oz. iiss, and of rose-oil, oz. iv; stir with a spatula, and add as much salt water as it can receive, and then again stir with a spatula, and use. For hardness of the breasts, the composition from honey is applicable, and all emollient applications. When the swelling is converted into pus, we must use those applications which have been mentioned for parotis, and those that will be mentioned afterwards for apostemes.

From Archigenes, for spreading ulcers of the breasts attended with malignity. Of good Adriatic wine, xx sextarii; of the sumach, lb. j; of cypress balls, lb. j; of black galls, called omphacitæ, oz. vj; of cassia, oz. vj; when bruised, macerate in wine for ten days, then boil down to one half, stirring with a cypress spatula; then throw away the herbs; and when the juice is boiled to the consistence of honey, lay it up in a glass vessel. Use it for spreading ulcers, undiluted, or, if it is too thick, let it be diluted with wine. It is so made as to apply to spreading ulcers in the breasts, to runnings of the ears, foul defluxions from the gums, and dysentery. When diluted with milk it acts as a paregoric in soothing pain. Other kinds of ulceration of the breasts must be treated like ulcers in general.

Preservatives of the breasts. Having pounded cumin with water, apply to the nipples, then lay upon the breasts a sponge squeezed out of oxymel, and bind it with a bandage. After three days, having taken away the cumin, put on a cataplasm of the bulbous roots of the lily upon the nipples, and having bandaged it let it remain again for three days, and do the same three times a month.—Another: Apply powdered hemlock for nine days, and the sponge externally, as mentioned above; and after an interval of a few days repeat the same. The rubbings from the Naxian whetstone act as a preservative of the breasts of virgins.

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COMMENTARY. See Oribasius (Synops. ix, 9); Aëtius (xvi, 35); Nonnus (151); Scribonius Largus (102); Avicenna (iii, 12); Haly Abbas (Theor. ix, 40; Pract. viii, 29); Alsaharavius (Pract. xiv); and Rhases (Contin. xv.)

A considerable part of this Section is copied from Oribasius. Aëtius, however, has treated of these complaints more fully than any other author. He gives from Philumenus various prescriptions for inflamed breasts, the most important ingredients in which seem to be ceruse and litharge, with wax or honey. One of them also contains the recent leaves of henbane, evidently for the purpose of allaying pain. For indurated mammæ he directs linseed, or the seed of fenugreek with hydromel to be applied. In short, his applications and our author’s are very similar. He describes a certain induration of the mamma under the name of chondriasis. This affection is alluded to by Aristotle (H. A. vi, 20.) When an abscess forms, he recommends us to open it and evacuate the pus. Nonnus, as usual, copies from our author.

Avicenna treats fully of these complaints, but his remedies are mostly borrowed from the Greeks. The most simple of his applications for apostemes of the breasts is a sponge squeezed out of tepid vinegar and water. Haly Abbas recommends the same, or a plaster of the oil of roses, bread, and the yelk of an egg. When suppuration is expected, he directs us to apply a cataplasm of figs. Alsaharavius treats minutely of this subject. When pain of the breast arises from coagulated milk, he recommends a piece of cloth soaked in warm water or vinegar. When milk cannot be extracted from the breasts, he directs them to be sucked by means of a suitable instrument shaped like a nipple. To dispel coagulated milk Rhases recommends a mixture of hot vinegar and rose-oil. He also recommends a composition of mint and common salt.

SECT. XXXVI.—FOR FETID SMELL AND SWEATING AT THE ARMPITS.

Of liquid alum, p. ij; of myrrh, p. j; dissolve in wine, and use.—Another: Plunge heated Molybdæna into fragrant wine, triturate with the wine, adding a little myrrh until it become of the thickness of the sordes in baths, then use. Another: Of litharge, dr. xvj; of myrrh, dr. ij; of amomum, dr. j; mix with wine.—Another: Of liquid alum, dr. viij; of amomum, of myrrh, and of spikenard, of each, dr. iv; triturate with wine, and use.

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COMMENTARY. See in particular Oribasius (Synops. viii, 36); Nonnus (155); Geopon. (xii, 26); Alsaharavius (Pract. xv); Rhases (ad Mansor. v, 51, and Contin. xxxvi.)

All the authorities concur in recommending for the cure of this complaint, a combination of astringents with aromatics. They therefore direct us to mix alum with storax, myrrh, and the like. Rhases recommends tutty with rose-water and camphor, and also various astringent and odoriferous liniments. The plan of treatment directed by Alsaharavius is deserving of attention. He recommends purging with the hiera picra. Alsaharavius further recommends a bath in which mint, marjoram, centaury, spikenard, and the like have been boiled. The part is afterwards to be rubbed with an ointment, consisting of litharge or tutty, mixed with alum, myrrh, &c. in fragrant wine.

The ancients believed that living freely upon figs rendered the perspiration fetid. Eustathius, the commentator on Homer, makes mention of two Sophists, called Anchimolus and Mochus, who lived solely upon figs for food, and water for drink; and he adds that their perspiration was so fetid, that when in the bath everybody shunned them. (Ad Iliad. xiii, 6.)

SECT. XXXVII.—ON AFFECTIONS OF THE STOMACH, OF THE HYPOCHONDRIA, AND OF THE BELLY.

Those complaints which occur in fevers, such as loathing of food, bulimia, the canine appetite, atony of the stomach, deliquium animi, thirst, hiccough, nausea, and syncope, have been treated of sufficiently in the Second Book, and it would be out of place to say more about them. But inflammations of the orifice of the stomach and of the liver require the admixture of astringents; for, if treated by the relaxant method alone, it will prove dangerous. It will be necessary, then, whether oil be affused on the part or a cataplasm be applied, to add some of the astringents to it, such as wormwood or the nard ointment; or that of apples, or of quinces may be boiled in it. The following is a cerate which we frequently use: Of white wax, oz. j, (but if in summer, dr. vij); of aloes and mastich, of each, dr. j; add of the oil of unripe olives, or of apples and of nard, when going to use it, as much as will be sufficient to give it consistence. Or, if the stomach require greater astringency, as not being able to retain the food, mix also of oil of unripe olives, dr. j; or of the juice of wormwood an equal quantity; and, thirdly, of the juice of hypocistis, of wild vine, and of sumach. We must make the quantity of the cerate proportionate to the number of the other medicines. When the inflammation becomes protracted and hard, we must apply more complicated remedies, containing aromatic, emollient, and discutient ingredients, such as that prepared from melilot, the philagrianum, and the fragrant. And a necklace of green jasper appended from the neck, so as to touch the stomach, is of great use. In hot intemperaments of the stomach, or ardent affections of it with prostration or deliquium animi, or anorexia from any other cause than fever, give cold water with the juice of unripe grapes, or the decoction of quinces, or of vine shoots, or the powdered seed of cucumber with cold water. Apply to the stomach a bladder filled with cold water, or the shavings of gourd. And the pills called Adipsa are to be given, as described when treating of thirst. The following medicine is proper for cooling and strengthening a watery stomach: Of green rose-leaves, dr. vj; of liquorice juice, dr. iv, mix with sweet wine, and make into an electuary, to be allowed to melt under the tongue. When, on account of a gross phlegm, medicines are required to heat and incise it, the following one will be useful: Of the rind of fennel-root, oz. ij; of vinegar, a sextarius and a half; of aloes, oz. iij; of honey, lb. iv; the roots being boiled in the vinegar, are to be squeezed out and thrown away, and honey being added, it is to be boiled to a proper consistence, and then powdered aloes sprinkled upon it. Give three spoonfuls of it with water. Some prepare it without the aloes. The composition from calamint is also proper for such cases. When the food turns acid on the stomach, give in water for drink a drachm of coriander seed sprinkled upon it like polenta, or one spoonful of mastich, or two spoonfuls of the seed of the white lettuce. The following is a compound medicine: Of pepper, dr. j; of the seeds of dill, dr. iij; of cumin, dr. iv; triturate, and give at bedtime one spoonful in diluted wine. Those who form black bile, and have the stomach inflated, may, during the exacerbations, apply to it sponges soaked in the strongest vinegar, after which, if the complaints continue, alum with pulverized copper may be added to honey, and applied. Let them drink the juice of endive, or let mint be sprinkled upon the draught. When the stomach is inflated and distended, mix a moderate quantity of honey and pepper with the decoction of calamint, and give. For subversion of the stomach, take of the juice of the kernels of the unripe pomegranate, p. iij; of the juice of mint, p. j; boil until it thicken, and give a mystrum (two spoonfuls?) of it before a meal.

For salivation of the stomach. Rinse the mouth with vinegar of squills, the sauce of pickled olives, or the decoction of the green leaves. Or a very small quantity of the same may be swallowed. A still more effectual remedy is aloes dissolved in water. For those who cannot retain their food (who were particularly called stomachics by the ancients), mix with honey the flour of fenugreek and the dried seed of mallows in powder, and apply. The cerate consisting of wax, the lees of oil of iris, and castor, is also proper.

On anorexia. Anorexia is a loathing of food, either from the prevalence of an intemperament in the stomach, or a collection of humours. You may know a hot intemperament by the thirst, by the fetid and feculent eructations if compelled to take food, and from the circumstance that cold and intractable substances are most easily digested; and a cold by the opposite, for they neither have thirst, nor can they endure cold things, and they have sometimes acid eructations. Of those who have anorexia from humours, they who suffer from thin and sharp humours, have gnawing pain at the stomach, and are more affected with nausea and thirst. When the humours become putrid, they sometimes have fever. When they suffer from thick and viscid humours, these for the most part neither occasion acute pain nor thirst, but the common symptom of all these cases is nausea. Wherefore, if the humours are contained in the cavity of the stomach, they vomit them up; but, if they are absorbed and infarcted in its coats, they have nausea only, but do not vomit, unless it be when they have taken food. Those, therefore, who have anorexia from a hot intemperament, should take cooling things for diet, more especially such as are prepared from vinegar. Wherefore give them bread that has been soaked in oxycrate, or oxycrate itself to drink, and oxygal (vinegar and milk), and that which is called melca by the Romans (it is a condiment from milk), endive, lettuces, and sometimes cold water: all these moderately, according to the degree of the prevailing intemperament; for the immoderate use of them is not only not beneficial, but often renders the complaint utterly incurable. When the affection is connected with coldness, it is to be cured by the opposite remedies; wherefore give to drink old wine and prepared wine, hydrogarum, and the decoction of anise, rue, and Macedonian parsley, and pepper, in hot common water; or the composition from the three peppers, or that from calamint. You may give also the theriac from vipers, which is also not inapplicable to those who loathe food from a collection of humours. Garlic, both as food and as medicine, is applicable to them. When the anorexia proceeds from a collection of humours, you may evacuate such as are thin and sharp, either by vomiting or purging downwards, and they may readily be made to vomit, by drinking beforehand tepid water, or hydromel diluted with a large quantity of water. But it will be better to give previously some moistening food, such as the juice of ptisan, or the yelks of eggs. How to produce easy vomiting has been explained in the First Book. But if the patient be hard to make vomit, it will be better to determine the matter downwards, having previously diluted their system by means of plenty of mild food. The cathartic medicine may either be the picra from aloes, that from quinces, which also admits of scammony, or that from rhodomel. If it be possible without the scammony to evacuate by a large dose of aloes, it will be better, because the scammony is bad for the stomach. When the anorexia proceeds from thick and viscid humours, you may cure them by attenuating and incisive remedies, such as oxymel, and the preparations from it and brine, as capers, olives, mustard, and the like. The remedies recommended for anorexia from a cold intemperament are not inapplicable to these, and more particularly after evacuation. You may evacuate them by the oxymel called Julian. Externally you must use those unguents and emollient ointments which have power to warm and strengthen the stomach, such in particular as that from the unripe grape, that called Marciatum, and all the common ointments; also such epithemes as the Baium, the fragrant, and the like. They ought particularly to have recourse to exercises and friction. When dyspepsia and anorexia arise from a cold and liquid humour, or such an intemperament, the medicines composed from quinces will be applicable to them, I mean that called meloplacuntion, that from the juice of apples, and that from the flesh of them, and that which is prepared from the citron. Also the malagmata or emollient unguents, such as the Marciatum, that from the juice of the unripe grape, the Baium, Polyarchium, and such like. When there is an ulcer in the stomach or bowels, the patient must abstain from all acrid food and drink, and use remedies of a soothing nature, such as draughts without oil, and those from starch, Samian earth, Lemnian earth, and milk, or a small quantity of honey, so as to purge without griping. A convenient epitheme is prepared from dates, the flour of quinces, and a cerate from quince-ointment, or rose-oil with ammoniac and frankincense; and also the epitheme of Nileus, the plaster from willows, and the Icesian may be used. You may know that an ulcer exists by blood, pus, or the scabs of a sore being vomited up.

For those whose stomachs are enervated and in a state of atony, and who, for that reason, do not digest their food, or vomit it up. Of aloes, of masucha, of mastich, of storax, of each, oz. ij; of wormwood, oz. iv; of the flowers of the wild vine, oz. iij; of Gleucine oil, oz. vj; of quince-ointment, oz. iij; of wine, q. s. Some also add of cyphi and roses, of each, oz. ij. These things, being powdered, are received upon purple or wool, and applied to the stomach. But some, by adding of wax, oz. vj, make an epitheme of it.

For iliac affections of the stomach, that is, strong and spasmodic pains. The trochisk of the Amazonians is the best medicine in this case. An account of it, and of the ingredients which enter into the composition of other compound remedies for the stomach, you will find in the last Book, where Compound Medicines are treated of.

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COMMENTARY. See Aretæus (Morb. Chron. ii, 8); Cælius Aurelianus (Pass. Tard. iii, 2); Celsus (iv, 5); Galen (de Med. sec. loc. vi); Oribasius (Synop. ix, 10); Aëtius (ix, 1); Alexander (vii, 5); Actuarius (Meth. Med. iv, 5); Octavius Horatianus (ii, 16); Marcellus (de Med. 20); Avicenna (iii, 13, 1, 2, 3); Serapion (i, 1); Avenzoar (i, 15); Averrhoes (Collig. v, 54); Haly Abbas (Pract. vii, 2, Theor. ix, 24); Alsaharavius (Pract. 16); Rhases (Divis. 59, Contin. xi.)

To all these authors, almost every one of whom has treated of these complaints more fully than Paulus, or upon a different plan, it is quite impossible for us to do justice within the narrow limits to which we confine ourselves in these annotations. We shall, therefore, direct our attention principally to Celsus, and merely add a few remarks from the others. The stomach, he says, is affected by great heat, inflation, inflammation, and ulceration; by phlegm or bile; and by resolution, which is a common and fatal complaint. Heat is to be cured by cold external applications, such as vinegar and roses, along with cold drink. Inflation we shall see treated of in the next Section. Inflammation which is attended with pain is to be treated by rest, abstinence, sulphurated wool, and wormwood, when fasting. If attended with ardor, he prescribes cold and repellent applications, occasionally exercise, and a fuller diet. Ulceration is to be cured by exercise, friction of the extremities, smooth and glutinous food, and avoiding every thing that is acid and acrid. Redundance of phlegm is to be treated by emetics, exercise, friction, hot drink, and hot food. When bile prevails he recommends laxatives, potions of wormwood, gestation, or a sea-voyage; emetics, if they can be conveniently borne, and suitable food, so as to avoid indigestion. Resolution, he says, is a severe affection of the stomach, when it cannot retain the food, and the body wastes. The bath, he says, is useless, but exercise of the upper parts of the body peculiarly proper. He recommends pouring cold water on the stomach, swimming in the same, and living on cold food, rather such as is difficult to digest than what will readily spoil on the stomach. Hence, he says, some digest beef. Undiluted austere wine, either cold or very hot, is proper. If there is vomiting with pain, he directs us to apply over the stomach, wool or sponge soaked in vinegar, or cold cataplasms; or, if the pain be more severe, a cupping-instrument; then bread which has been steeped in cold diluted wine is to be given. If this is not retained, some smooth article of food not disagreeable to the stomach is to be administered; and, if this be not retained, a cupful of wine is to be taken every hour until the stomach becomes settled. He also praises an acid mixture, containing pomegranate, endive, &c.

Aretæus gives a lively description of the feelings of a dyspeptic. The student who, heedless of the allurements of the senses and of the ties of nature, follows his divine pursuits with indiscreet ardour, and neglects to take proper food and exercise, is said to be particularly liable to affection of the stomach. The cure, he says, is to be effected by gestation, vociferation, a suitable diet, and indulgence of the patient’s caprices as far as possible. Wormwood, ginger, aloes, and mastich are also proper.

Alexander properly remarks that disorder of the stomach affects sympathetically the heart and brain. He treats fully of inflammation of the stomach, for which he directs us to give relaxants and tonics, such as wormwood and mastich. He further recommends the application of a plaster, composed of emollient and stimulant ingredients, such as wax, turpentine, ginger, opopanax, &c. It is singular that he and most of the ancient authorities have omitted to mention venesection for this complaint. We therefore entertain some doubts whether they meant by it the gastritis of modern Nosologists, which, by the by, is of so rare occurrence, that some late writers of high name are of opinion that it never occurs spontaneously. (See Christison on Poisons.) Some of the ancient authors, however, do recommend venesection in this complaint, as for example, Serapion, Rhases, Avicenna, and Haly Abbas. Horatianus recommends the same for sudden pains of the stomach. Cælius Aurelianus, while treating in general terms of stomach complaints, recommends bleeding, “si in vehementiam passio venerit.” He also prescribes cupping and leeching. His account of these affections is highly interesting, but so circumstantial that we dare not venture even upon an abridgment of it. Haly Abbas speaks of the inflammation ending in suppuration. To Alsaharavius we particularly invite attention. Rhases gives a copious statement of the opinions of all preceding authorities on this subject.

SECT. XXXVIII.—ON INFLATION OF THE STOMACH.

The formation of flatus in the stomach arises from the juices or food being dissolved into vapours by a gentle heat. For cold, as it is not of an attenuating and dissolving nature, does not engender flatulence; whilst a violent heat not only attenuates, but likewise dissipates, and thus prevents the formation of flatulence. But a lesser degree of heat dissolves and changes the food, but not sufficiently, and hence flatus is gendered. Wherefore we must attenuate them by calefacient medicines—boiling in oil the seed of cumin, of parsley, of cow-parsnip, and of carrot. When the affection partakes of cold, you may boil rue, bay-berries, gith, and fennel in the oil, and mix bitumen and oil of bays. But if the pain be attended with inflammation, instead of calefacients, you may use relaxants, making a decoction of dill, and mixing with it the fat of a cock and of a goose. Those who have flatulence may be relieved by the decoction of a fasciculus of poley, or a decoction of calamint, having a small quantity of honey and a drachm of pepper mixed with it. These remedies must be applied when the pain is violent; but if it is moderate, fomentations from millet will be sufficient. But a large cupping-instrument that will comprehend the navel often removes the symptom at once. Castor also is of use to them, when taken in a draught with oxycrate, and when applied externally with Sicyonian oil; and it also cures flatulence when attended with tormina. But the ankles of a swine burnt, and taken in a draught, cure tormina and flatulence; and the round birthwort does the same. Pains from obstructions of the bowels, or flatulence arising from thickness of the humours, or from cold, are relieved by drinking undiluted wine after food; and, if sleep follow, it completely removes these complaints.

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COMMENTARY. See all the authors referred to in the preceding Section.

Our author’s treatment, which consists of dry cupping, dry fomentations, and the internal use of calefacients and wine, is what Celsus also recommends. He likewise speaks favorably of exercising the upper parts of the body, of friction, and of using purgatives occasionally, and sometimes, though rarely, the bath. Serapion, Rhases, and Avicenna, recommend similar treatment, namely, purgatives and aromatics, such as aloes, anise, calamint, cumin, and the like. Haly Abbas forbids all flatulent food, such as pulse, milk, and grapes; recommends the bath after much exercise, and before dinner, and the stomach to be rubbed, and a cataplasm of salt and cumin applied to it. He also prescribes many calefacient and carminative articles, such as anise, rue, castor with old wine, also the peppers, theriac, mithridate, hiera picra, &c. Alsaharavius recommends aromatics and carminatives, and afterwards that the pit of the stomach should be rubbed with calefacient oils. Averrhoes directs us to give all solid food, as flesh, puddings, &c. quite cold; but spoon-meats may be eaten as warm as the blood or somewhat warmer. This method, he adds, will clear the head and stomach of wind, beget finer blood, brisker spirits, and cause a lively circulation of all the humours.

Rhases and Avicenna describe ulceration of the stomach very accurately, and also thickening of its coats.

Avicenna mentions rupture of the stomach, but does not say whether he alludes to spontaneous rupture or rupture from accident.

Actuarius has given a more distinct account of hæmatemesis than any other of the ancient authorities. He says the blood may be brought up either pure or of a dark colour, and it may be occasioned either by external injuries or proceed from constitutional causes. The constitutional causes are commonly either general plethora or atony of the liver. In certain cases, he says, it proceeds from rupture of the vessels, and in others from relaxation of them, in others again from corrosion. In melæna, he says, the skin is pale. (De Diagnos. i, 39.)

SECT. XXXIX.—ON CHOLERA.

Cholera is an immoderate disorder of the belly, with discharges upwards and downwards, arising from continued indigestion of the food. Persons are affected with indigestion sometimes from the badness of their food, and sometimes owing to a redundance of depraved humours. Wherefore, if the patient be seized with nausea and lancinating pains, while the food remains in the stomach undigested, we must order him to drink tepid water, and to produce vomiting by putting his fingers or feathers down the throat. We must also encourage the discharge by the bowels. After the evacuation of the superfluities, he must take rest, and apply warmth to the hypochondrium, by means of sweet oil, with some wine; or by the oil of mastich, or of spikenard, if it is winter: and he must be allowed to sleep. After digestion has been accomplished, let him have recourse to baths and wholesome food. When the discharge is immoderate, it will be sufficient at first to try those things which are mentioned in the Second Book for disorder of the belly. But when the discharge continues, and the belly loses its tone, and the pulse gets small and dense, we must apply a cataplasm of dates, with flowers of wild vine, acacia, the juice of hypocistis, and pomegranate rind. For drink, give a cupful of moderately cold water to swallow; or, what is still better, a decoction of roses, of the flowers of wild vine, of sumach, or of vine-shoots; or we may give the juice of an acid-sweet pomegranate, sprinkling upon it a little mint. When the excretions are more acrid, and heat and thirst come on, we must give the seed of cucumber, with three cupfuls of water; and succory and lettuces boiled in oxycrate are to be used for food. When the discharge cannot be stopped, we must administer some of the austere wines; if the patient be free of fever, the Palmatian, the Aminæan, or palm wine, or that from unripe grapes, with honey; but when he has fever, pomegranate wine, or myrtle wine, or Cibyratic hydromel for drink, and along with crumbs of bread, alica, or chondrus. If he loathes food from grain, he may chew some summer fruit, or medlars, pears, quinces, or pomegranates, but he must spit out the fleshy and hard parts. When he cannot retain the food, let a large dry-cupping instrument be fastened over the stomach, and while it is on let some of the afore-mentioned food be taken. For the spasmodic contractions apply to the muscles hot rags dipped in oil, and liquid cerates, containing some castor and Sicyonian oil; but before applying them let hot water be poured upon the legs. If he cannot get sleep, we must have recourse to the remedies recommended for watchfulness; and if his strength permit, he may take a potion from poppy-heads. When the disease is on the decline, he may be put into a bath, and recruited with chickens, pigeons, the feet of swine, or the like. Diarrhœa, being a corruption of the food, for the most part ceases spontaneously, if no more food be taken until after the complete digestion and evacuation of the corrupted matters; but if it continue, we must use the remedies applicable to cholera.

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COMMENTARY. Consult Hippocrates (Epidem. v, 4, et alibi); Galen (Comment., de Fac. Part., de Rat. Vict., de Med. sec. loc. viii); Aretæus (Morb. Acut. ii, 5; de Curat. M. A. ii, 4); Celsus (iv, 11); Alexander (vii, 16); Aëtius (ix, 12); Oribasius (Morb. Curat, iii, 11); Leo (v, 5); Actuarius (Meth. Med. iv, 5); Nonnus (164); Cassius Medicus (Problem.); Scribonius Largus; Cælius Aurelianus (Morb. Acut. iii, 19); Octavius Horatianus (ii, 16); Marcellus (30); Avicenna (iii, 16, 1); Serapion (iii, 14); Avenzoar (ii, 1); Alsaharavius (xvi, 20); Haly Abbas (Pract. vii, 14; Theor. ix, 25); Rhases (Divis. 60, Contin. xi; ad Mansor. ix.)

Hippocrates in his ‘Epidemics’ has given several well-detailed cases of cholera. In one, the patient drank hellebore in the juice of lentils, and vomited; he became cold, and was put into the hot hip-bath, where he regained his heat and recovered. In another place, he says that the disease is, for the most part, occasioned by unwholesome food, such as pork improperly boiled, pot-herbs, summer fruits, &c.

Aretæus defines cholera to be a retrograde movement of the matters in the body upon the stomach and intestines, consisting of a discharge upwards and downwards of bile, which, if the disease proves fatal, becomes black; and, at the same time, the extremities are cold, with profuse sweats, pulse small and dense, constant straining to vomit, and tenesmus. He also makes mention, among the symptoms, of spasms and contractions of the muscles in the legs and arms, borborygmi, tormina, and syncope. The complaint, he says, is occasioned by continued indigestion, and proves fatal by superinducing convulsions, suffocation, and retching. With regard to the treatment, he cautions us not to stop the discharge at first, but to encourage it by giving frequently some tepid water; and when attended with tormina and coldness of the feet, to apply to the belly hot oil of rue, and rub the legs to restore heat. When the fæces are all evacuated, he recommends some cold water to compose the stomach; and when the pulse sinks and becomes frequent, while at the same time there are profuse sweats and deliquium, he approves of adding a small quantity of wine to the water. It is to be of a fragrant and astringent kind, so as to strengthen the powers of the system. When all the symptoms get worse, when spasms of the legs occur, and the pulse becomes insensible, he advises us to give more wine and water. Should the vomiting continue, we must return to very hot drink and hot food, for, he remarks, the transition often proves beneficial. When all these fail, a cupping-instrument is to be put on between the shoulders or below the navel. He afterwards speaks of such applications as those recommended by our author, namely, calefacients applied to the belly, chest, and legs. He concludes with saying, that, if the symptoms, instead of improving, should get worse after this treatment, it will be proper for the physician to accelerate his retreat.

When cholera is not attended with fever, Galen approves of giving a piece of bread soaked in diluted wine, of cold drink, and of applying cupping-instruments to the belly. When the patient is strong, he even recommends the cold bath. He directs afterwards astringent food, and also speaks of clysters, old wine, and asses’ milk. He mentions with seeming approbation that Asclepiades gave tepid water at the commencement.

Celsus depends most upon tepid water, dry cupping, and sinapisms to the belly. In extreme cases, he prescribes a light fragrant wine diluted with water.

Alexander’s account is very minute, but little different from that of Aretæus. In certain cases, he permits poppies to remove insomnolency and wine to support the strength. Like Hippocrates, he describes correctly dry cholera. In this variety, which he attributes to a bilious humour, he recommends purging with scammony or the picra of aloes. But in particular he approves of friction and the application of strong ligatures to the extremities; to the arms and hands, when the evacuations are by the belly; and to the feet and legs, when by vomiting from the stomach.

Aëtius, Oribasius, Actuarius, and Nonnus treat of the disease in nearly the same terms as our author.

For cholera, Marcellus recommends various astringent remedies, both externally and internally. Myrtle-wine, he says, will stop the vomiting. He also commends opium.

Octavius Horatianus calls cholera “omnibus acutis ægritudinibus velocior.” Like the others, he recommends draughts of tepid water at the commencement, and wine and aromatics in extreme cases.

Cælius Aurelianus, with his accustomed accuracy, gives a complete history of the symptoms of this disease. The bile which is vomited, he says, is at first yellow, afterwards green, and at last black. His treatment is very similar to that of Aretæus, namely, tepid water at the commencement to facilitate vomiting, sponges out of cold water applied over the stomach, or else cupping-instruments with much heat; aromatics, bread soaked in wine, and the like. He condemns Hippocrates for sanctioning the giving of hellebore. He blames Diocles for recommending southernwood, which, he remarks, is a very harsh medicine; and also for allowing milk, which, he says, is apt to grow acid. He finds fault with Heraclides Tarentinus for trusting to opium and henbane.

Cassius Medicus accounts for the coldness of the extremities and contractions thereof upon the supposition that they are occasioned by the vital spirits having left them and been determined to the stomach.

There is nothing very original in the works of the Arabians. Haly remarks that cholera consists of a discharge of bile. He inculcates as a settled principle of treatment, that, when the strength continues good, and the discharge not immoderate, the vomiting is to be encouraged by giving tepid water with oil of sweet almonds to drink. When there is great prostration of strength and tendency to deliquium, he directs us to sprinkle water on the patient’s face, to apply ligatures to his limbs, and to rub his feet and legs with a calefacient oil. When the discharge cannot be got otherwise stopped, he advises us to apply a cupping-instrument over the stomach. Alsaharavius, like the others, directs us to promote the vomiting at first by giving tepid water. Among his other remedies, he recommends an infusion of aloes and wormwood, Rhases recommends draughts of tepid water, the application of snow over the stomach, ligatures to the extremities, wine, and astringents. He, Avicenna, and most of the authorities direct us to encourage sleep. Avicenna’s plan of treatment is exactly the same as that of Rhases.

With respect to diarrhœa, Celsus recommends us to give an emetic; to anoint next day with oil; to give moderate food and undiluted wine; and to apply over the belly a cerate with rue. Cælius Aurelianus enjoins at first rest and abstinence, then astringent applications to the belly, next day astringent food, and then wine and the hath. Haly Abbas remarks that a diarrhœa is not to be rashly stopped unless it become excessive, in which case astringents are to be given, such as galls, roses, pomegranate fruit, &c. Serapion and Rhases mention an emetic as a remedy for diarrhœa.

For the cure of diarrhœa, the veterinary surgeons recommend at first bleeding and hot water, and then astringents, such as sumach and pomegranate rind. (Geopon. xvi, 8.)

SECT. XL.—ON LIENTERY AND CÆLIAC AFFECTION.

There are two varieties of lientery: the one arising from superficial ulceration of the intestines, and (according to some) from a cicatrix occasioned most frequently by dysentery or other defluxions; and the other from an atony of the retentive faculty of the bowels: the second variety being in our opinion connected with the cæliac affection; for in it the stomach being unable to concoct and distribute the food, it is discharged downwards in a smooth, undigested, and liquid state, the stomach in all cases labouring under a defluxion. But in lientery the passage of the food is quick, and the indigestion more intense; so that the appearance of the food which has been taken is preserved, and by these circumstances it is more especially distinguished from cæliac affection. Wherefore we must apply cataplasms of linseed with dates. And lentisk and bramble boiled with oxymel is a very effectual remedy; but, when there is flatulence of the bowels, we must mix some cumin, dill, and rue. If the defluxion increase, we may add quinces, moist alum, acacia, hypocistis, galls, some or all of these. Cerates also made of myrtle-oil with some astringent wine are useful, and the caleficient epithemes from the bay-berries, or from seeds. But that from the flowers of wild vine, that from grape-stones, and that ascribed to Antyllus are more astringent. But the one called Erythrian is wonderfully efficacious. When the disease is protracted, we must have recourse to a dropax (calefacient plaster) along the abdomen, and the cerate from mustard, or mustard itself. The drinks which are taken should be simple, containing plantain-seed, or the seed of dock, or the rind of pomegranate, or dried services, or dried unripe grapes from the Aminæan vine, to the amount of three oboli; which things, when there is no fever, are to be taken in six cupfuls of an austere wine, but when there is fever in rain water. It will injure the stomach less if the dried crop of hens be sprinkled upon the drink. But diuretics, such as parsley, maiden-hair, and the like, occasion a metastasis of the fluid; and, in like manner, the compound ones, as that of Polyides (it is the sigillum), the trochisk from amber, that from Egyptian thorn, the one called clidium, and that from seeds. The following one is most excellent: Of the seed of the wild dock, oz. iss; of plantain-seed, oz. j; of the juice of the hypocistis, dr. vj; of gum or acacia, dr. iij; add to a decoction of the juice of quinces boiled to a third part.—Another: Of cumin, of pepper, of Syriac sumach, of the flowers of the wild pomegranate, of each, oz. iss; of pomegranate-rind, oz. j; of laserwort, oz. ss; either sprinkle a drachm of it dried upon the drink, or mix with oxymel, and give morning and evening.—Another: Of black myrtle, a spoonful and a half; of anise, of dried roses, of the flower of wild vine, of each, half a spoonful; of dates, xx in number; make trochisks, and give a drachm with water or diluted wine. And the theriac from vipers is also an excellent remedy for them. When the discharge is acrid and bilious, the food should be from chondrus, rice, alica, and the like; but some of the astringents should be boiled along with them, such as pears, apples, quinces, medlars, and such like. Boiled milk is also proper. The drink should be either a light watery wine, or some of the sweet potions. If the discharges consist more of phlegm, we may change the diet to the opposite kind, mixing the seeds of some of the stomachic vegetables, anise, cumin, or the seed of parsley. The dried lentil twice boiled is often of use to them, when eaten with a little vinegar or oxymel, and cabbages likewise twice boiled; but it is better to make the second boiling in oxycrate. They should drink some of the older and more heating wines.

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COMMENTARY. Hippocrates (Aphor., de Affect.); Galen (in Hipp. Aphor. Comment. vi, 1; de Med. sec. loc. vii); Aretæus (Morb. Chron. ii, 10); Celsus (iv, 16); Nonnus (166); Theophilus (de Alvi Retrim. 2); Actuarius (Meth. Med. i, 42); Aëtius (ix, 37); Oribasius (Morb. Curat. iv, 88); Leo (v, 5); Psellus (Opus Medicum); Scribonius Largus (xi); Marcellus (de Medicam. 27); Avicenna (iii, 16, 1); Serapion (iii, 18); Haly Abbas (Theor. ix, 25, Pract. vii, 16); Alsaharavius (Pract. xvii, 1); Rhases (ad Mansor. ix, 72; Contin. xiii.)

In lientery, says Hippocrates, the food passes through the bowels in a liquid state and without change. Galen remarks that the affection may be defined to be a loss of digestion, the food having undergone no change in consistence, smell, or quality, while in the bowels. The intestines, he says, are either in a state of ulceration and great tenderness, or they have lost their retentive faculty.

Aretæus calls it a disease arising from broad ulcers of the intestines when the food passes through the bowels not at all altered. With respect to the treatment, he merely says that an emetic after food will remove it.

Celsus recommends astringent food, stimulant and rubefacient applications externally; and afterwards exercise, friction, insolation, and vomiting, which, he says, Hippocrates directed to be produced with white hellebore when other things fail.

Dioscorides states that when the inner membrane of a cock’s stomach has been dried and reduced to powder, it may be given triturated in wine with great advantage in stomach complaints. Our author, it will be remarked, makes mention of this medicinal article.

Archigenes and Aëtius describe cæliac affection as an atony of the intestines, so that the food is not retained until it is digested. They treat of it at great length, their principal remedial measures being purging, vomiting, and astringent applications. According to Psellus it arises from superficial ulceration of the intestines. Psellus defines lientery to be a loss of the retentive faculty of the bowels, so that the food passes undigested in a liquid state.

Serapion for lientery directs us to give astringent decoctions, and to apply to the belly an astringent epitheme containing galls, roses, pomegranate-flowers, &c. the food to consist principally of millet and the like. He also recommends a mixture of goat’s milk and water boiled until the water evaporate. When the stomach is loaded he prescribes an emetic. In cæliac affection he directs us to strengthen the intestines by astringents internally and externally. Haly Abbas defines lientery to be a quick discharge of the food in an unchanged state. It arises, he adds, from immoderate debility of the retentive faculty of the intestines, or from excess of the expulsive. It is said to be generally caused by ulcers which, being irritated by the food, stimulate the intestines to expel it. He recommends a variety of remedies, most of which are either astringents or acids, such as balaustine, rind of acorns, mastich, sumach, galls, roses, &c.

SECT. XLI.—ON TENESMUS.

Tenesmus is sometimes the precursor of dysentery, but often it prevails alone for a short time, and then ceases. The affection is an irresistible desire of evacuation, discharging nothing but some bloody or mucous matter, which is the cause of the whole complaint, being an œdematous inflammation in the rectum, which creates the impression of fæces lodged in the intestine, and a desire of evacuation. And Galen relates that a stone has sometimes been discharged by the anus in attacks of tenesmus. But tenesmus often arises in consequence of fæces being retained in the small intestines, and is increased by astringents and obstruents, but immediately removed by acrid injections, such as honied-water with salts, or by any of the emollients taken by the mouth, such as damascenes, dried figs, the herb mercury, or the whey of milk; for when the fæces are evacuated, the complaint immediately ceases. When the tenesmus occurs without such a cause, it will be proper to allay the inflammation by barley-flour heated, the embrocations from wine, myrtle-oil, rose-oil, or the oil of unripe olives, applied to the loins and lower belly. The mucous matters shut up in the rectum must be cleared away by an injection of honied water. And salt and water when injected often effects the purpose, or six drachms of salts in a hemina of hot water. But we must mitigate the pain and intense sufferings by sitting in a hip-bath of fenugreek, mallows, or linseed. Sometimes the following hip-bath will effect the purpose: Of bramble, of myrtle, of the flowers of the pomegranate, of bays, and of green cypress shoots, mixing these in equal parts, boil in water. It is the Marcellian. When the inflammation and irritation are deep-seated, we must use injections of some of the juices of grain boiled with some of the astringents. And sweet oil injected and retained for several hours has the effect of removing the violent pain. When the desires to go to stool are frequent, we must apply a ball of warm threads to the anus, or warm bran in a bag, or a sponge, or some such thing.

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COMMENTARY. See the authors referred to in the preceding Section.

Celsus recommends the tepid bath, emollient and astringent applications to the rectum, such as butter and roses, or alum wrapped in wool and applied, the remedies for tormina, and an austere wine every alternate day.

Aëtius may be referred to as an author who has treated of this affection in a very accurate manner, although nearly to the same effect as our author. Among other things he mentions the application to the anus of a sponge soaked in a solution of galls in vinegar.

Nonnus defines tenesmus to be an inflammation of the rectum, and says that it is to be benefited by injections of the oil of rue, or of wine and honey with brine; by hip-baths of astringent decoctions, such as myrtles, bays, &c. or by fomentations with a sponge.

Avicenna describes two varieties of tenesmus, the false, which is occasioned by the lodgment of hardened fæces in the intestines, and is to be cured by emollient clysters, &c.; and the true, which, if occasioned by cold, is to be relieved by fomenting the parts with a sponge or the like soaked in hot water; if by hard pressure, a sponge is to be squeezed out of hot oil and applied; if by an aposteme, it is to be treated upon general principles by bleeding and embrocations; if by a flux, remedies suited to that complaint are to be given; and, if by ulcers, the common applications to them are to be used. Haly Abbas treats fully of tenesmus, like Avicenna. In several of his prescriptions poppies and opium occur. When produced by retention of scybalæ, he recommends powerful evacuants, such as colocynth, prunes, turbit, scammony, &c. One of Serapion’s prescriptions contains burnt lead, sumach, myrrh, &c. By a stone, said by our author and Galen to be sometimes discharged in cases of tenesmus, must have been meant an alvine concretion of a hard nature.

SECT. XLII.—ON DYSENTERY.

Dysentery is an ulceration of the intestines, sometimes arising from the translation of tenesmus, or some of the disorders of the bowels formerly mentioned, and sometimes being itself the primary affection; and it is attended with evacuations, at first bilious, and of various colours, then, accordingly, bloody, and at last ichorous, like that which runs from dead bodies. Dysentery, arising from black bile, is necessarily fatal, as indicating an ulcerated cancer. If, therefore, the appearances of ulceration be discharged, mixed with the fæces, and attended with pains and tormina, you may be sure that the ulceration is seated in the small intestines, and is to be remedied by medicines swallowed by the mouth; but if the fæces be passed unmixed with the blood, it is an affection of the large intestines, and will yield rather to clysters. When there is a great discharge of blood by itself, the disease is called the bloody dysentery. Sometimes the blood which is discharged is blacker than natural and shining, owing to the liver’s not digesting properly the food which is sent to it; and owing to an atony of the retentive or of the alterative faculty of the stomach, it is discharged from it like the washings of newly-killed flesh. This is called hepatic dysentery, and will be treated of along with the affections of the liver.

In general, therefore, we must use those things which were recommended for cæliac and other preternatural evacuations; but, in particular, the Lemnian earth cures a spreading dysentery when drunk or injected, the intestine being previously washed out with honied water, and afterwards with salt water; and the juice of purslain is proper for dysenteric affections when drunk, or the purslain itself when boiled in oxycrate and eaten. Plantain also is proper, and the fruit and leaves of the bramble, the decoction of the root of marshmallows, the herb horsetail drunk in water or wine, and the juice of it, the unripe fruit of the mulberry dried, and, still more, bramble-berries when similarly dried. Eggs boiled with vinegar and eaten, dry up fluxes of the belly; but it will answer better if, mixing with them some of the articles which are good for dysentery, you fry them, and give to eat. The wine of unripe grapes is most useful in these cases, and the red sumach, and the juice of it, the rind of pomegranate, galls, grape-stones, medlars, myrtles, cornels, the ashes of snails roasted whole. The following is a compound medicine: Of the ashes of snails, p. iv; of galls, p. ij; of pepper, p. j; reduce to a fine powder, and sprinkle upon the condiments, or give to drink in water, or a white watery wine. It greatly helps dysenteric patients, when the ulcers are not putrid. But the dried dung of dogs who have eaten bones, when drank in milk which has been curdled by having heated pebbles put into it, is of great service. The following are compound remedies: The trochisk from Egyptian thorn, that of Philip, that from hartshorn, that from seeds, and the Trigonus. The pills from macer are excellent remedies. The following is an admirable one: Of opium, of saffron, of Indian Lycium (catechu?), of acacia, of sumach, of frankincense, of galls, of hypocistis, of pomegranate-rind, of myrrh, of aloes, equal parts; give in water to the amount of three oboli.—Another: Of sumach, dr. viij; of galls, of pomegranate rind, of each, dr. iv; give in a spoonful of wine.—Another: Of sumach, dr. viij; of galls, of acacia, of gum, of each, dr. ij; of opium, dr. j; give one drachm in diluted wine. This linctus will suit with them: Of black myrtles, one sextarius; of Syriac sumach, one sextarius; of Theban dates, lb. ij; of the flesh of quinces, lb. j; ten sour pomegranates with their rind; of astringent wine, one sextarius: boil to a third, and, having strained, add of honey, lb. vj; and, having boiled to a proper consistence, give for a linctus. It is clear, that the cataplasms should be made from astringents the materials of which you are acquainted with. On account of the tenesmus, which proves a troublesome symptom in dysentery, injections made from the juice of rice, chondrus, or the like, with the tallow of goats, and likewise those recommended in the section on Tenesmus will prove serviceable. But, if there is a discharge of blood, we must inject the juice of knotgrass, or of plantain, with acacia, hypocistis, or the like. But, if this symptom be urgent, we may inject some styptic, such as the ashes of unwashed wool, or of new sponge, which has been soaked in liquid pitch, or the blood of an ox, or liquid alum; or it may be soaked in the juice of asses’ dung in like manner, and burnt. And the trochisk of Andron is an excellent remedy, and that of Musa, and the like. But suppositories of collyria are among the most effectual remedies, more particularly when the discharges are attended with pain. When there is a spreading ulcer in the intestines, which you may ascertain from the fetid smell and putridity of the discharges, and from its not having occurred at the commencement, but after some interval, we must use escharotic injections, such as the trochisks called Faustiani, that from paper, the Bithynian, the Thronian, and that from cork, injected in the decoction of dried lentils, or of some of the other astringents. And the following enema is of approved efficacy: Of burnt omphacis (it is the cavity from which grows the acorn which the tanners use), of arsenic, of comfrey, of Syriac sumach, equal parts. Mix about two spoonfuls of these when pounded together with the juice of rice, and the juice of alkanet that has the thorny, broad, and black leaf (which they call chærospelethron), and with the white of eggs, to the amount of two or three ounces; and give for an injection. Those epithemes apply which were mentioned for cæliac affection. And, in like manner, those liniments to the belly which are composed of astringent and desiccative materials, with some of the glutinous substances, gum, frankincense, taurocolla, fine flour, may have place with the corresponding cataplasms. The food at first should be eggs mixed with milk, and the spoon-meats made from frumentaceous substances, either alone or boiled with milk. And milk itself moderately boiled is an excellent thing. The use of pot-herbs is not necessary; however, we may allow the patients to taste of boiled endive, of succory, of plantain, of cabbage twice boiled, and of the autumnal fruits, such as are astringent, spitting out the fleshy parts, and whatever else will irritate the intestines. When the intemperament is very hot, we must give raw succory, and make the patients drink of cold water. The other drink should be rain-water; and, when the stomach is languid, wine may be taken. Afterwards they may take the drier and more digestible parts of fowls, and use baths of sweet water. But if the flux is brought on by the use of them, soak a large sponge or pieces of bread made from fine flour in wine of Ascalon, or some of the hot astringents, apply to the whole abdomen, bind it on, and order them to bathe in this state.

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COMMENTARY. Consult Hippocrates (Aphoris., de Affect. Epidem.); Galen (Comment. de Med. sec. loc. ix); Aretæus (Morb. Chron. ii, 9); Celsus (iv, 15); Cælius Aurelianus (Pass. Tard. iv, 6); Alexander (vii, 21 and x, 1); Aëtius (ix, 43); Oribasius (Synops. ix, 14, and Loc. Affect. iv, 88); Actuarius (Meth. Med. i, 41); Nonnus (167); Leo (v, 9); Octavius Horatianus (ii, 31); Marcellus (27); Scribonius Largus (xi); Averrhoes (Collig. iv, 59); Avicenna (iii, 16, 2, 7); Serapion (iii, 26); Avenzoar (ii, 1, 5); Haly Abbas (Theor. ix, 26; Pract. vii, 22); Alsaharavius (Pract. xvii, 1); Rhases (ad Mansor. ix, 72; Divis. 67; Cont. xiii.)

Hippocrates briefly describes dysentery as being a complaint attended with pain throughout the whole belly, tormina, and discharges of bile, phlegm, and blood. The disease, he says, is occasioned by an overflow of phlegm and bile to the veins of the belly, producing erosion and ulceration of the intestines. His treatment consists of purging the head, emetics, opening the belly, emollient clysters, and a regulated diet. In one of his aphorisms he states that a spontaneous vomiting cures dysentery. Another of his aphorisms is that a dysentery commencing from black bile is mortal. Another is, that when substances resembling flesh are discharged by a person affected with dysentery it is a mortal symptom. (iv.) His commentator Theophilus says, in explanation, that it is because the intestines are ulcerated and do not readily heal. (Ed. Dietz, 401.)

Galen treats separately of hepatic dysentery and of dysentery connected with ulceration of the mucous membrane of the intestines. Of his remedies some are astringents, such as galls, alum, dried roses, and hypocistis; some anodyne, such as opium and henbane; some are detergents, such as myrrh, pepper, spikenard, &c.; and some escharotics, such as arsenic, sandarach, the scales of copper, and the like. These last are to be given only in clysters. Modern physicians will be disposed to condemn them without a trial; and yet, as arsenic may be given by the mouth in properly-regulated doses, there appears no good reason why it may not be safely administered in injections. Rogerius, one of the earlier modern writers, speaks favorably of trochisks of arsenic. (i, 37.) Sprengel, however, decidedly condemns the practice. He says of Athenæus: “Il recommandait dans la dyssenterie un lavement dont un mélange affreux d’orpiment et de realgar formait la base.” (Hist. de la Méd.) See Sect. xxix of this Book.

Aretæus gives a very circumstantial description of the symptoms of dysentery, but unfortunately his chapter on the treatment is entirely wanting. He describes all the varieties of ulcers, the superficial, the deep-seated, the irritable, the callous, and the like; and the discharges from them, whether thin, bilious, fetid, devoid of smell, high-seated, or otherwise. Of the other authorities, Alexander may be mentioned as the one who has most correctly pointed out the importance of attending to the part of the intestines in which the ulceration is seated. The large intestines, he says, are most commonly affected. He approves of bleeding in certain cases. His treatment is judiciously regulated according to the exciting causes; and, in many cases, he prescribes gentle laxatives. One of the varieties of dysentery described by him is said to proceed from disorder of the liver, which is impaired in its attractive faculty. This variety he calls hepatic dysentery, which, instead of attempting to cure, as he says many do empirically, by a combination of aloes with astringents, he recommends to be treated according to the nature of the affection and the humour which produces it. His views of the treatment are given at great length.

Celsus gives a very distinct account of the treatment. He enjoins rest, as all motion proves injurious to the ulcers; recommends astringent cataplasms, frequent washing with warm water in which vervain has been boiled, astringent food, injections of ptisan, milk, oil, the decoction of linseed, the yelks of eggs with rose-water, &c. For drink he directs tepid water to be given, either alone or with an austere wine; or, if these things fail, a draught of cold water to stop the discharges from the bowels. When the disease is seated high up, the belly is to be opened.

Aëtius allows the abstraction of a small quantity of blood from the arm when inflammation is present. He says it allays heat, produces revulsion, and induces sleep. His internal remedies are much the same as those of Galen.

Much of our author’s treatment is borrowed from Oribasius.

Octavius Horatianus, like the others, recommends, when the ulcers are attended with putridity, a powder containing arsenic, quicklime, and burnt paper, administered in an astringent wine, or in a decoction of astringent herbs. Marcellus makes mention of a similar application, which he directs to be used only when symptoms of malignity appear.

Cælius Aurelianus gives a very comprehensive description of dysentery, the principal symptoms of which are fever, anxiety, rumbling of the belly, sometimes retention of urine; tongue rough, furred, and black; tenesmus and pungent pains of the intestines and anus. The disease, he says, consists of a defluxion from the belly with ulceration, and is preceded by diarrhœa, cholera, or inflammation. He animadverts upon the treatment of others with his usual freedom. Thus he blames Erasistratus for using nothing but astringents, whereas many cases of dysentery require laxatives. His treatment is minutely detailed, but is not very different from our author’s.

Leo, for bloody dysentery, like our author, recommends pills of macer, the troche of corals, and the decoction of rhubarb.

According to Sprengel, Nonnus is the first author who distinguishes the white dysentery from the red. It is obvious, however, that the distinction between the two varieties had been made by earlier authorities. We may add that Actuarius treats of the bloody dysentery very fully.

The Arabians follow closely the treatment of the Greeks. Injections containing arsenic are recommended by Serapion, Avicenna, and Haly Abbas. Rhases, like Aëtius, admits of venesection in certain cases. He refers the disease, in general, to debility of the retentive faculty of the liver and derangement of the bile. Haly treats separately and minutely first of intestinal dysentery and next of hepatic. The intestinal, he says, is occasioned by ulceration of the intestines. He also describes the bloody dysentery, like our author. His treatment is directed upon general principles. He recommends various clysters; and, when the ulcers are in the rectum, he directs us, among other remedies, to introduce a tent, soaked in a solution of arsenic, quicklime, hypocistis, &c. Some of his stimulant applications, however, are merely detergents, and do not contain septics. The ingredients of his ordinary injections are either emollients or astringents, according to circumstances. The account given by Alsaharavius is valuable, but too long for our limits. Rhases, in cases of protracted dysentery, directs snow to be applied to the belly. In fact most of the ancient authorities recommend cold applications in cases of chronic dysentery.

SECT. XLIII.—ON COLIC AFFECTION.

The colon, being a part of the large intestine, takes its origin in the right iliac region, and passes across to the left, in the form of a belt. The most violent pains arise in it from various causes, either from a thick and pituitous humour shut up between its coats, or from a thick flatus that cannot find a passage out, or from inflammation of the intestine, or from acrid and sharp humours. Those, therefore, who suffer from a thick and pituitous humour, have a deep-seated pain along the whole abdomen, and especially in the region of the colon; there is a sensation as if it were pierced by a wimble; they are troubled with tormina, eructations, nausea, and vomitings of all kinds, but more especially of phlegm. The belly is greatly constipated, so as not to allow the passage even of wind; and any fæces which are discharged seem like the dung of oxen, light and windy. These symptoms are usually preceded by the continued use of food of a cold and incrassating nature, repletion, indigestion, inactivity, and the like. When the attack proceeds from flatulence, there is rather a sense of distension. When it is from inflammation, there is a sense of heat in the part, and no inconsiderable fever, retention of the urine as well as of the fæces, pulsation in the belly, thirst, and troublesome heat, nausea, and vomitings, more especially of bile, which afford no relief. In short, this is the most severe of the colic affections, and threatens to pass into ileus. When acrid and sharp humours are the cause of the pain, the patients, as in the case of inflammation, have heat, thirst, and sleeplessness; if they have fever, it is less than in the former case; their urine is acrid; the alvine discharges bilious; and often along with the discharge from the bowels the pain is aggravated, and exacerbations thereof take place, more especially after heating food or drink. Pains occasioned by cold, viscid, and thick humours are to be cured by such things as are not violently heating; for by things which are thus heating the humours are dissolved and converted into air. Wherefore we must try to incide and concoct them by carminatives, and such medicines as are attenuant and desiccant, without heating much at the beginning of the complaint. The fæces being evacuated from the bowels by suitable clysters, we must use an injection of oil, in which cumin or rue has been boiled, with the grease of a goose or hen; or of a decoction from the roots of wild cucumber, with a drachm of myrrh and some honey and oil; or from myrrh, honey, and Sicyonian oil. And often, when common oil is injected, the vitreous phlegm is discharged along with it, and instantly removes the pain. If, owing to the violence of the pain, the injection be retained, we must apply a suppository of honey, cumin, nitre, and the dried seeds of rue; or of a stalk of cabbage well shaven down and macerated in salt water; or of the ashes of cabbage mixed with honey; or of colocynth triturated with honey, nitre, and cumin. The suppositories should be six fingers’ breadth in length, so that they may extend beyond the sphincter muscle. The anus is to be anointed with the juice of sow-bread, with honey and nitre, or with centaury along with honey and nitre. When the pain is continued, in addition to the afore-mentioned, these injections are to be used: Of turpentine-rosin, oz. j; or of opopanax, dr. i; or of galbanum, dr. iv; of bitumen, an equal part, with, of nitre, dr. j; and of water, oz. j; of oil of rue, oz. v, or more. Embrocations are to be applied to the affected parts from the oil of cumin, of dill, or Sicyonian oil. Cataplasms are to be applied, composed of the medicine called trispermum with cumin, bay-berries, and parsley-seed. Epithemes are to be applied, namely, that from seeds, that from bay-berries, that from meliot, and the polyarchian. Let the patients sit in a hip-bath of the decoction of fenugreek, marshmallows, chamomile, mugwort, dill, bay, and the like. And they may be made to sit in a hip-bath of warm oil, or in oil and water. They should take potions containing wormwood and cumin, in equal parts, or panacea with water, or of castor, of anise, and of the peppers, dr. j, with oxymel. When the pain does not remit, we must give them a draught, containing the medicine from three peppers, or the theriac; and have recourse to a sinapism and dropax during the remissions, and to the natural baths; but they must abstain from bathing in drinkable water, unless compelled to have recourse to them by the urgency of the pain; when, having previously injected some of the afore-mentioned medicines, we must direct them to bathe, and be fomented within the heated walls of the bath, having been previously rubbed with some of the detergent ointments containing nitre. When the pain is violent, we must use those things which are moderately soothing, such as the trochisk of castor, either injected or taken by the mouth, and such like remedies. But powerful narcotics must be avoided, which allay the pain indeed for a short time, but render the affection more protracted by incrassating the offending matter, and occasioning obstruction of the pores of the intestine. When the phlegm is attenuated, we must purge them with hiera picra, or such pills as these: Of aloes, of euphorbium, of pure granum cnidium, of scammony, equal parts. The dose is two scruples. A heating and desiccant diet will suit with them. At first, indeed, they should abstain from food, but afterwards take acrid food. Wherefore we must give them leeks boiled with prepared wine and parsley, and marsh asparagus, raw garlic, more especially if they do not dislike these things; and they may drink of the prepared wine, and take some bread with it. Afterwards we must give them wholesome and digestible food, avoiding a surfeit and indigestion. If it is a flatulent spirit which causes the pain, after carminative injections and draughts, dry-cupping by means of large cupping-instruments, heated and fixed along the whole abdomen, often effects a cure. When the intestine is in a state of inflammation, we must bleed from the arm; but if dysuria prevails, we must likewise open the vein in the ankle, and use the remedies already mentioned, except those things which are acrid and powerfully cathartic; and we must rather use soothing injections, cataplasms, fomentations, placing the patient in a hip-bath of oil. We may also apply cupping-instruments to them, and lay a cerate upon the abdomen, containing, of wax, oz. v; of chamomile, oz. ij; of rose-oil, oz. ij; of the flour of beans, oz. ss; five yelks of eggs pounded with the juice of linseed. The diet should be light, and such as that applicable in fever, until the inflammation be resolved. But if the pain arise from acrid and sharp humours, we must administer injections of oil, in which has been boiled fenugreek or marshmallows, with plain fresh grease of a goose or hen, or the juice of ptisan with rose-oil, or the juice of linseed. They must take the antidote called picra from aloes in a draught, and use baths of sweet waters, and spoon-meats from chondrus or ptisan, and fishes caught among rocks; and, in a word, the whole regimen should be moistening and cooling. The patient must abstain from all acrid food and medicines, and from hot fomentations, by means of embrocations and cataplasms, and from drinking wine, more especially old. When the pain is strong, we may also use narcotics; for they prove less injurious in this case than in any of the others, incrassating and moderately cooling the thin and sharp humours. I am of opinion that the colic affection which now prevails is occasioned by such humours; the disease having taken its rise in the country of Italy, but raging also in many other regions of the Roman empire, like a pestilential contagion, which in many cases terminates in epilepsy, but in others in paralysis of the extremities, while the sensibility of them is preserved, and sometimes both these affections attacking together. And of those who fell into epilepsy the greater number died; but of the paralytics the most recovered, as their complaint proved a critical metastasis of the cause of the disorder. Those, therefore, who were thus affected, a certain physician in Italy cured, in an incredible way, by putting them boldly upon a refrigerant diet. For he gave them unboiled lettuces previously cooled, and succory, in like manner, to eat until they were more than sated; and also grapes, apples, fish which have hard flesh, and, in short, all the crustacea; also the feet of oxen, the bulbi, and the like, namely, things which were not only cold by their powers, but likewise to the touch. He seldom gave wine, and when he did, he mixed it with cold water. And he gave cold water for drink, or cold oxycrate, and prohibited all warm food and that of the middle kind; and, contrary to all expectation, he cured most people in this way, and even some who had begun to experience a conversion of the disease into epilepsy or paralysis.

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COMMENTARY. See Hippocrates (de Affect. xv); Galen (de Med. sec. loc. ix; de Loc. Affect. vi, 2); Aretæus (Morb. Acut. ii, 6; Chron. ii, 8); Alexander (ix, 1); Celsus (iv, 14); Oribasius (Loc. Affect. Curat. iv, 87); Leo (v, 13); Aëtius (ix, 29); Actuarius (Meth. Med. i, 45); Pliny (H. N. ix, 37); Nonnus (170); Scribonius Largus; Cælius Aurelianus (Tard. Pass. iv, 7); Marcellus (de Med. 29); Serapion (iii, 32); Avicenna (iii, 16, 4); Avenzoar (ii, 1); Haly Abbas (Pract. vii, 28); Alsaharavius (Pract. xvii, 2, 12); Rhases (Divis. 69; Contin. xxi.)

Hippocrates treats very sensibly of the colic pains which occur in summer, recommending for them emetics of tepid mulse and vinegar, warm clysters, the warm bath, fomentations, soporifics, and purgatives, according to circumstances. When the pains are seated in the lower part of the belly, he merely gives clysters and laxatives.

Galen gives a long list of preparations for colic. They consist principally of narcotics, such as opium, henbane, and mandragora, along with carminatives and aromatics, as anise, pepper, valerian, cinnamon, saffron, gentian, and the like.

Aretæus concludes his chapter on ileus with a short account of colic. He remarks that the colon being a larger and more fleshy intestine than the ileum, the pain is less acute, and the complaint in so far less dangerous. The pain, he says, sometimes extends to the side, resembling pleurisy; sometimes to the false ribs, resembling hepatitis or splenitis; and sometimes to the os sacrum, tops of the thighs, and testicles. The complaint is attended with unavailing vomiting; and what is vomited is thin, bilious, and oily. He also describes a more protracted species of colic among the chronic diseases. Among the symptoms he enumerates torpor, loathing of food, watchfulness, and swelling of the face. He says the pain sometimes shoots down to the testicles, whereby ignorant surgeons have been led into the mistake of supposing that the disease was seated there, and have made an incision into the cremasters. Does he allude to the operation for strangulated hernia? or does he mean to say that the disease is confounded with inflammation of the testicle? His treatment of ileus will be given in the next Section.

Alexander insists strongly on the absolute necessity of distinguishing colic from the diseases of the adjoining parts, which, he remarks, is sometimes difficult. He first treats of colic pain arising from a cold humour, and discusses fully the remedies for it. They are nearly such as our author recommends, namely, attenuant food, including white wines in cases of flatulence; avoiding the common bath, which does no good, but using the sulphureous bath if convenient; rubbing the affected parts with calefacient ointments, or applying heated bricks to them; purging with aloes, scammony, and the like; using the hip-bath made with the decoctions of parsley and anise, common oil, and the like; applying epithemes; administering clysters of hot oil, either alone or with some carminative, such as turpentine; giving narcotics, as opium and henbane, when the humours are thin and acrid, but not otherwise; applying sinapisms and calefacient plasters; sometimes giving emetics; and in protracted cases enjoining exercise. When the disease proceeds from flatulence, he applies dry fomentations of millet, calefacient oils, and a cupping-instrument to the belly. When it is occasioned by constipation, he directs us to remove the obstruction by giving water, oil, and mead, and administering the same in clysters. In obstinate cases he directs us to inflate the bowels with a bellows, and afterwards to inject a little nitre and oil and water. He also speaks of pills or pellets of lead. When it proceeds from hot and bilious humours, he gives for food fish, the testacea, the most indigestible parts of quadrupeds; and recommends the common bath, and purging with drastic cathartics, such as hellebore and scammony. When inflammation is the cause, he forbids purgatives, because they only increase the evil, but recommends general bleeding repeated at intervals; and, if the urine is suppressed, bleeding at the ankles; also emollient clysters, external applications of a soothing nature, and baths after venesection, but not before.

Celsus recommends principally dry fomentations, friction of the extremities, and dry cupping. He also mentions a medicine called the colic composition, consisting of poppy tears, pepper, anise, castor, spikenard, myrrh, &c.

The beginning of Cælius Aurelianus’s chapter on colic is unfortunately lost. He approves of venesection, fomentations of sweet oil, and injections of the same; but disapproves of adding rue, anise, or anything calefacient to them; speaks favorably of cupping and leeching, which are to be followed by hot fomentations with sponges squeezed out of warm water, or by the hip-bath. As to the calefacient and acrid things usually given, namely, parsley, cumin, and the like, he properly directs them to be avoided when inflammation is present. In this case he recommends the bath of oil. When the complaint is on the decline, he approves of gestation, of friction of the belly with rubefacients; and of sinapisms, calefacient plasters, and the like. He speaks favorably of a long sea-voyage, and of the use of medicinal springs, especially sulphureous, and directs indigestion and everything of a flatulent nature to be guarded against.

Several of the other Greek and Latin authorities, especially Aëtius, treat of colic with admirable precision; but, as their remedial measures are much the same as those already mentioned, we shall not attempt to give any account of them.

Serapion’s divisions and treatment are nearly the same as our author’s. Avicenna, however, treats of the complaint more fully and circumstantially than any other ancient author, but the length of his description prevents us from giving an abstract of it. We may mention, however, that when the pain is violent he approves of narcotics both by the mouth and in clysters. Among the causes of colic mentioned by Haly Abbas is debility of the intestine, so that it can neither digest the food nor evacuate it. Haly justly remarks that the inflammatory colic is the worst species of the disease, for that in it the patient experiences no relief from evacuations, and the danger is imminent. With regard to the treatment of it, he forbids purgatives, which do but increase the irritation; and recommends bleeding, emollient drinks, plasters, &c. In flatulent colic his remedies are purgatives and carminatives, such as hiera with anise, fenugreek, cucumber, mastich, &c. In all cases he approves much of clysters. Alsaharavius enumerates the following causes of colic: A hot intemperament, hernia, indurated fæces, cold humours impacted in the intestines, and the presence of some poisonous medicine. We dare scarcely venture upon an exposition of the minutiæ of his treatment. When the disease is occasioned by retention of hard fæces, he recommends oily injections, baths, and diluent draughts. When it arises from gross humours, he agrees with Galen in approving of strong wine, clysters of dill, chamomile, fenugreek, and the like, boiled in water. Rhases directs us to give emetics when the disease arises from indigestion. He probably alludes to duodenal disease. He mentions alvine calculi and worms among the causes of colic. He particularly recommends the warm bath and clysters.

Our author’s interesting account of the epidemical colic is copied by Avicenna; but neither he nor any other subsequent authority supplies the smallest additional information. Pliny seems to allude to an epidemical colic which prevailed in the reign of Tiberius, but gives no satisfactory account of it. (H.N. xxvi, 6.) The Jewish physician Moyses Alatinus gives the following description of a pestilential colic resembling that described by Paulus and Avicenna: “Colicam, iliacamque, hujus generis, contagiosas passiones, quas hoc in loco refert Avicenna, memini me olim vidisse in civitate Mantuæ anno 1560, mensibus nimirum Augusti et Septembris, quia publicè tunc temporis ejusmodi passiones contagiosæ per universam civitatem grassabantur, cum sævis symptomatibus, assiduo nempe, ac urgente vomitu bilis porraceæ in magna copia, nec non etiam æruginosæ, lipothymia, assiduâ febre malignitatis non experte, ac siti immensâ, ac in eâdem familiâ plurimi eo morbo oppressi inveniebantur,” &c. (Marciæ Prælect. 276.) See Book Second, Sect. XXXVI.

SECT. XLIV.—ON ILEUS.

Iliac passion, being a very acute and painful complaint, has a symptom more grievous even than dangerous; for those who are overpowered by the disease die a most piteous death, vomiting up fæces at last by the mouth. The affection arises from indigestion and obstruction, when the corrupted matters are retained, and from deleterious medicines, and from a falling down of the bowels into the scrotum, and from inflammation of the intestines, commonly supervening upon a colic affection. Wherefore children are to be cured by embrocations, cataplasms, clysters, suppositories, and fomentations, as described when treating of colic. But young persons and adults are to be bled without delay, and the operation repeated; and dry cupping is to be freely applied along the abdomen, and cupping even with scarifications to the affected parts. The extremities are to be rubbed and ligatures applied round them; and we must have recourse to the most drastic clysters and enemata, putting the patients into hip-baths of hot oil, giving antidotes, and purgatives; and simply all things, in short, which are applicable for colics, except when the affection of the colon proceeds from acrid and pungent humours. It has a wonderful effect in this complaint to drink the decoction of dill, even if it should be vomited up; but after drinking it, dip bread in warm water, and give the hot pieces of it to eat. For those who cannot retain their food, triturate sumach and cumin together, and give to drink in oxymel to the amount of six cupfuls. Those who are attacked with ileus from taking deleterious substances are to be compelled to vomit by drinking warm water (the symptoms arising from taking any of the deleterious substances are detailed in the Fifth Book); and then they are to be made to drink warm oil, or fat soups, that they may again vomit; but, after a certain number of days, they must drink the theriac. If the constipation continue, the belly is to be evacuated by curds and whey (schiston), with a little scammony, aloes, or some other purgative. If the complaint arise from the falling down of the intestine into the scrotum, we must put the patient into a reclining position with his feet elevated, and then we are to press the prolapsed intestine up to the groin, and retain it with a bandage.

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COMMENTARY. Consult the authors referred to in the preceding Section.

Among other remedies for ileus, Hippocrates recommends inflating the bowels by means of a bellows. (De Morb. iii, 15.)

Aretæus gives an excellent account of the disease, the causes of which, as enumerated by him, are protracted indigestion of multifarious and unwonted food, a blow, exposure to cold, cold drink, and prolapsus of the intestine into the scrotum, or intestinal hernia. Some, he says, die from the violence of the pain, some from the conversion of the disease into suppuration, and some from blackening and mortification of the bowels. The symptoms are most accurately described. There is at first vomiting of phlegm and bile, but latterly of fæces; the pulse at first is rare and small, but before death it becomes very small, very dense, and intermittent. When inflammation is the cause of the disease, he approves of immediate venesection, so as to induce deliquium animi, which, he says, will, at all events, bring some respite to the patient’s sufferings. If inflammation is not present, venesection may be omitted, and an emetic of oil and water may be given; and afterwards applications are to be used for promoting the discharge of flatus, consisting of sow-bread, nitre, salts, and turpentine, which last medicine is also to be administered in a clyster with oil, honey, hyssop, and colocynth; and afterwards another injection of hot oil and rue is to be given. Externally he applies various fomentations and dry cupping. He gives carminatives with anodynes and the theriac. When the bowels cannot be got opened otherwise, he recommends the purgative hiera. The food is to consist of soups made from domestic fowls, with cumin, nitre, &c.; and, when there is no fever, he permits the use of hot wine.

Celsus forbids wine, but his treatment otherwise is like that of Aretæus. He directs immediate venesection and cupping; and, if the pain be seated above the navel, he approves of emetics, but, if below, he agrees with Erasistratus in preferring purgatives, such as ptisan, with oil and honey. He directs us to apply cataplasms from the breast to the loins, to put the patient into a bath of oil, to inject hot oil per anum, and to use friction of the extremities.

Our author follows Aëtius and Oribasius closely, who, in their turn, are indebted to Galen.

Nonnus seems merely to abridge our author. The causes of ileus are said by him to be obstruction of the bowels, inflammation, indigestion, and colic affections. His remedies for children are embrocations, cataplasms, and fomentations; and for adults, also venesection, cupping, clysters, and the oily bath. When the food is rejected, he recommends sumach and cumin in oxymel, and also purgatives.

It appears from Cælius Aurelianus that Diocles had been in the practice of giving a leaden bullet to swallow in this disease, no doubt with the same intention that quicksilver is now sometimes administered. In the preceding Section, we have mentioned that Alexander gave pills of lead for colic. Cælius, however, disapproves of this practice. He finds fault with Hippocrates for recommending to inflate the bowels with smoke; for giving emetics; and for cooling the upper parts of the body. He himself approves of bleeding, oily clysters, baths of oil, and the like.

The Arabians, like the Greeks, treat ileus by venesection, clysters, and so forth. They mention cooling plasters as an external application; but we believe it was the practice of the ancients rather to use hot fomentations than cold in this disease. Haly Abbas in general approves of venesection, but, in certain cases arising from a cold cause, he joins Hippocrates in permitting the use of wine. When the disease is occasioned by obstruction, he recommends laxatives; when connected with descent of the gut, he directs us to return it, but says nothing of the operation for strangulated hernia. According to Rhases, the causes of ileus are inflammation of the bowels, debility of the expulsive faculty, and indurated fæces.

Vegetius, the veterinary surgeon, gives an excellent account of the symptoms and treatment of colic and ileus in cattle. (Mulomedicina, i, 41, 42.)

SECT. XLV.—ON AFFECTIONS OF THE KIDNEYS AND BLADDER; AND, FIRST, ON CALCULUS.

The alliance of these diseases obliges us to break through the order of instruction; for it is a common symptom of colic and of calculus in the kidney, that the belly is at first constipated, with violent pain, anorexia, indigestion, and tormina. But it is peculiar to colic affections to have all these symptoms more intense, whereas in nephritic they are less so; and in colics the pain is rather in the right loin, and ascends to the stomach, liver, and spleen; and the passage of the fæces is completely obstructed, so that not even flatus can pass; or, when with difficulty the fæces are evacuated, they are flatulent, and resemble the dung of oxen, or sometimes a vitreous phlegm is discharged, and the urine is voided freely, and is of a pituitous nature: whereas, in nephritic cases, there is a severe fixed pain in the kidneys, as if transfixed with a sharp-pointed instrument, and the corresponding testicle is pained, and there is torpor in the thigh of the same side. They also have sometimes, though rarely, spontaneous evacuations of the belly; but clysters always bring away flatus and bilious fæces; the urine is in small quantity and sandy, and the urinary passage is contracted. These are the symptoms of stones in the kidneys, which occur most frequently in adults, but the stones in the bladder form rather in boys. The symptoms of these are, unconcocted and whitish urine, with a sandy sediment; the patients rub constantly and handle the member, stretch it, and make incessant attempts to pass water, and are troubled with strangury. Wherefore the material cause of the formation of stones is a thick and terrene humour, but the efficient is a fiery heat of the kidneys or bladder. But with regard to the kidneys, we must use lithontriptics of a cutting nature, without being decidedly heating: such are the roots of the royal asparagus and of the bramble, burnt glass, the root of couch-grass, maiden-hair, bdellium, the rind of the root of the bay, the seeds of marshmallows, the black chick-pea, the stones of sponges, vinegar of squills, and valerian, spignel, asarabacca, carpesia, saxifrage, water-parsnip, when eaten or drank, the golden-thistle (scolymus), hedge-mustard, and prionitis. Let them use baths constantly; and after the bath take some of the afore-mentioned things; and have recourse to embrocations, cataplasms, fomentations, hip-baths of a soothing nature; in short, applying the remedies for colics. The following are compound draughts: Boil the roots of wild rue, wild mallows, and parsley, with wine; mix the expressed juice with water, and give to the amount of two cyathi. And this is a powder: Of the fruit of balsam, of the stone in sponges, of dried pennyroyal, of the seeds of wild mallows, equal parts. Give a spoonful with two cupfuls of diluted wine. Also, dried goat’s blood, dried cicadæ without the wings and feet, the Jew’s stone, in oxymel. Let these things be given in the warm bath, and the compound medicines prepared from them, the nephritic sour wine (posca), and the wines prepared for this intention. And the troglodytes (wren?) is a much-commended remedy. It is of all the sparrow tribe the least, except that called the regulus; for it is a little larger than this one alone, and resembles it in colour, which is intermediate between that of ashes and green. It has a slender bill, and lives mostly in walls and hedges. When, therefore, this bird is pickled whole, and frequently eaten in a raw state, it makes the stones which are already formed be passed with the urine, and prevents them from being formed again; and if it be burnt alive entire with its wings, and if the ashes by itself and along with pepper and a moderate quantity of Indian leaf, be drunk out of mulse, it will do the same thing. To relieve the acuteness of the pains and the want of sleep, the medicine called Sotira and that of Philo, are excellent remedies; and frequent venesection, if had recourse to, alleviates the pain, and produces a speedy discharge of the stone. The preservatives from the formation of stones are, first, wholesome and moderate food, exercise, abstinence from the frequent use of all kinds of pulse and food of grain, cheese, milk, and condiments prepared from dark-coloured wine, much flesh, and simply all things which contain thick juices; also from those things which are very hot and acrid, I mean hydrogarum, prepared wines, and the like. And the following things not only prevent stones from forming, but also break down or produce the discharge of those which are already formed. Let them drink oxymel with some of the simpler diuretics, the decoction of maiden-hair, parsley, and couch-grass; and, after the bath, let them drink tepid water before taking food or drinking wine; and in the midst of dinner, let them drink cold water if nothing prevent it. If they feel a collection of vitiated humours, let them evacuate by bleeding or purging. But the most effectual of all remedies is to drink water of a middling temperature after the bath, and before taking food or wine. The stones which form in the bladders of young persons you may destroy by the more powerful remedies, making choice from among the above mentioned. But when the stone gets too large, or becomes impacted at the neck of the bladder, we must have recourse to concussion, catheterism, or even lithotomy, as will be described in the Surgical part of the work.

On inflammation. If there be inflammation of the kidneys or bladder, it is to be recognized by the heat in the place, attended with heaviness and pain, fever, delirium, vomiting of pure bile, and inability to make water, more especially if the bladder is inflamed. Wherefore we must have recourse immediately to venesection, and use soothing fomentations and cataplasms from rue, dill, fenugreek, and the root of marshmallows; also emollient clysters and injections consisting of oil, poppies, and the grease of geese; and when the bladder is affected, we may push up the anus half an obolus of opium with myrrh, saffron, and oil. They may take a sweet draught of honied water, but must abstain from the strong diuretics and much drink, unless an acrid and bilious humour prevail, when they must take copious draughts, and plenty of the non-stimulant diuretics. Let them take in water a spoonful of a mixture consisting of two parts of linseed, and one of starch; and likewise let them take the seeds of cucumber and pompion. If there is a sensation of great heat about the kidneys, apply to these parts rags out of wine and rose-oil, water and rose-oil, or oil of apples; or a cerate composed of wax, rose-oil, oil of chamomile; or oil of apples, and the yelks of eggs, with a little vinegar, or the juice of knot-grass. Afterwards they may use the diachylon plaster with oil of chamomile; but must abstain from very hot applications, lest they occasion suppuration; and from very cold, for thereby the kidneys will readily become scirrhous. During the violence of the inflammation they must abstain from baths, and use the regimen called the febrile and anti-inflammatory.

On abscess and ulceration of the urinary organs. Pains in the loins, anomalous rigours, and irregular fevers indicate an aposteme in the kidneys; but when it is in the bladder, it is marked by pain in that part in addition to the symptoms we have now mentioned. You may ascertain which kidney is affected from this, that when the person lies upon the sound side he has pain in the opposite one, from the diseased kidney being suspended. In these cases we must place the patients in hip-baths of oil and water, apply cataplasms of fine flour, oil, and rosin, or the flour of tares with honey, or cardamom, or pigeon’s dung with dried figs. Pus freely discharged in the urine indicates a rupture of the abscess and ulceration in the part. But since the urinary organs are ulcerated without an aposteme, from the rupture of a vessel, erosion by acrid matter, or the irritation of a stone, we may distinguish ulceration in the kidneys from that in the bladder or urethra in this way: When the kidneys are ulcerated, the patient experiences a heavy pain in the loins, he makes water freely, and pus is found mixed with the urine, and particles of flesh floating in it. When the bladder is in a state of ulceration, the patient has violent pain in the region of the pubes and hypogastrium, and difficulty of making water; the pus, after the urine is voided, sinks to the bottom, and fetid scales, or else foliaceous ones float in it. Furfuraceous sediments indicate scabies of the bladder. When the ureters are ulcerated, the mixture of the pus is in an intermediate degree, and rather resembles hairs floating in the urine; and the situation of the pain is intermediate between the kidneys and bladder. If blood or pus be discharged without any evacuation of urine, it is to be understood that none of the afore-mentioned parts are ulcerated, but the member itself. Wherefore to those who have ulceration of the urinary organs we must give the sweet draughts of honied water, or of the decoction of fenugreek with honey, or from the seeds of cucumber with must. To those who void pus in their urine we are to give Armenian bole, or the ashes of burnt reeds, as much as can be taken up with three fingers, in must; and drinking milk is an excellent remedy for them. The following are compound remedies: Of linseed, of the seed of cucumber, of tragacanth, of each, dr. ij; form trochisks.—Another: Twenty pine-nuts; forty seeds of the garden cucumber; of starch, dr. j; add to two heminæ of the decoction of nard and parsley seed. But Archigenes, in his epistle to Atticus, says that “when the dysuria is urgent, we should take of the powdered seed of toasted poppy, dr. j, which is to be sprinkled upon the decoction of bog-rush, sweet-rush, or liquorice. This medicine removes the pains from ulceration: Of the seeds of purified cucumber, xxx in number; pine-nuts, xij in number; bitter almonds, whitened, xxxv in number; of saffron, what is sufficient to give it colour; give to the patient with an empty stomach every day, along with the wine protropum, or milk. It will be milder, if, instead of the pine-nuts, it receive an equal quantity of the seeds of mallows. The cyphi and the cyphoid antidotes are also said to cure ulcerations in the bladder. I, in the more protracted cases, by using this medicine, have not stood in need of more complex remedies: Of wall-germander, of ground pine, of each, dr. xxiv; of asarabacca, of white pepper, of each, dr. vij; of cinnamon, dr. j. Of this medicine, finely powdered, I give two spoonfuls in Cretan sweet wine; but if there is fever, in three cyathi of water; but when the ulceration is attended with pain, by adding two cyathi of starch, and fifteen seeds of cucumber, I accomplish my purpose.” These things are from the works of Archigenes. And the remedies formed from alkekengi, the antidote from the seed of wild mallows, and that from sweet-meats are excellent. We may apply to the perinæum and lower belly cerates made from washed hyssop and butter, and the grease of geese, and storax; and we may inject into the bladder, by means of a small syringe, honied water much diluted, or milk with some honey, or with cucumber seed, or the white of an egg with pompholyx, or some of the remedies formerly mentioned. When the ulcer is spreading, the trochisk from paper must be injected, or the Bithynian; and cataplasms are to be applied, made from dates, dried grapes, with galls, acacia, hypocistis, and alum.

On hemorrhage of the kidneys. The kidneys often getting into a relaxed state, cannot retain the urine, but, becoming dilated, they allow the blood and other thick matters to escape from the veins. The kidneys often discharge blood periodically like hemorrhoids; and when evacuated they are relieved, in which cases we must not rashly interfere, if the bleeding immediately stops; but, if it continue, we must bleed in the arm, and use for hemorrhage of the kidneys and bladder those remedies which are recommended for hemoptysis and other hemorrhages; and, more especially, we must give the root of comfrey and tragacanth macerated in wine, the juice of knotgrass and plantain with oxycrate, or bitter almonds with must; or this medicine: Of fissile alum, dr. j; of tragacanth, dr. ij; of gum, oboli, v; with must. And we must apply a cataplasm of raw barley-meal with oxycrate or rose-oil, or that from dates, and bread of siligo with acacia, or hypocistis boiled in an astringent wine or oxycrate. In hemorrhages from the bladder, we must apply cupping instruments to the loins and ischium; and we must ascertain the part from which the blood flows by the pain in the place, and whether the blood be mixed with the urine or no, as was said with regard to pus. If there be coagulated blood in the bladder (which you may know from the flow of urine being suddenly stopped after a discharge of bloody urine, and from certain clots or bloody fluids being probably passed), give the decoction of mugwort to drink, and the seed of shrubby-everlasting, of fleabane, or of radish, or the juice of laserwort, or the Cyrenaic juice, or the juice of parsley, each mixed with vinegar, or the rennet of a hare, or of a hind, or of a kid, in oxymel, or strained lye with oil, and externally sponges out of hot salt water, or strained lye, must be applied. But, if they are not dissolved, we must make an incision in the perineum, as in the cases of calculus; and having removed the clots of blood, accomplish the cure in a proper manner.

On hardness of the kidneys. When hardness occurs in the kidneys, it does not occasion pains, but they seem, as it were, to hang from the loins, and the haunches are torpid, and the limbs lose their strength, little urine is passed, and the whole habit resembles that of dropsical persons. Wherefore they are to be softened by cerates, emollient ointments, friction and fomentations; and we must administer diuretics, and clear out the bowels by clysters.

On diabetes. Diabetes is a rapid passage of the drink out of the body, liquids being voided by urine as they were drank; and hence it is attended with immoderate thirst; and therefore the affection has been called dipsacus, being occasioned by a weakness of the retentive faculty of the kidneys, while the attractive is increased in strength, and deprives the whole body of its moisture by its immoderate heat. Wherefore with this intention we will give more food, and that of difficult digestion and not humid, such as alica with rose-wine, or rhodomel, or hydromel, or some wine that is not old, or some of the hot wines. We must give of pot-herbs, succory, endive, and lettuces; of fishes, those that abide among rocks; the feet and womb of swine; pears, apples, and pomegranates; and give cold water to drink. They must get to drink propomata, from the juice of knotgrass, and elicampane, in dark-coloured wine, and from the decoction of dates and myrtles. We must apply a cataplasm to the hypochondrium and kidneys of polenta, in vinegar and rose-oil; and of the leaves of the vine and navelwort, pellitory of the wall, and purslain. We must promote sweats, and excite vomiting by drinking cold water; and make them abstain from all sorts of diuretics. There will be nothing improper in letting blood at the commencement.

On strangury and dysuria. When neither inflammation, nor a stone, nor any of the afore-mentioned complaints are present, if there is acrimony in the urine, and if the whole habit or the other symptoms indicate bile, the dysuria or strangury is formed by it, and we are to use medicines for altering and diluting it; the juice of ptisan, fishes, baths, and a corresponding diet; avoiding acrid things, wine, baths, anger, and long abstinence from food. If the thinness and whiteness of the urine, and the other symptoms indicate a cold intemperament, hot wine and prepared wines will be proper; also diuretic food and medicines, and hot hip-baths. When, in conjunction with the whiteness, the urine appears thicker than natural, we are to suspect a pituitous humour obstructing the neck of the bladder, and must use oxymel, and the compositions from hyssop and pennyroyal, or marjoram, or thyme, or laserwort, boiled in honied water, and the hotter embrocations. But, if a thick humour, a stone, a thrombus, or some such obstruction stop up the passage of the urine, we must apply the catheter to them, unless inflammation of the part be present. Dysuria in fevers is to be cured by an embrocation with oil of rue, of dill, or old oil. When the bowels are constipated, a decoction of fenugreek or mallows is to be injected, and the patient made to sit in oil and water, or in some of the afore-mentioned decoctions, with oil. And this cerate will be proper for them: The roots of wild mallows are to be boiled in Sicyonian oil, with a little water, until they are dried, and they are to be thrown away; and with the oil is to be mixed of the juice of rue a fourth part, and of wax and castor a sufficient quantity.

On paralysis of the bladder. This complaint, which is sometimes accompanied with dysuria, and sometimes with an involuntary discharge of water, has been formerly treated of under the head of Paralysis.

On incontinence of urine. Relaxation of the muscle at the neck of the bladder occasions this affection, and therefore it happens most frequently to children. Our general treatment ought to consist especially of tonics, such as hot wine and oil, and the like, abstaining from all things which are powerfully refrigerant, and rather as much as possible using calefacients; for cold produces a resemblance to paralysis. The following things are naturally efficacious: Burn the crop of a cock, and give to the patient to drink in tepid water, when fasting, or the flowers of the white ox-eye (chrysanthemum) in like manner; or, shave down the testicle of a hare into fragrant wine, and give to drink; or, give calamint and myrrh in a draught before supper; or, give the toasted seed of the wild rue to drink every third day. Let the privy member be anointed with Cimolian earth, mixed with the juice of perdicias (pellitory of the wall?)

* * * * *

COMMENTARY. On these diseases consult Hippocrates (Aphor. iv, 76; de Morb. Intern. 15, et alibi); Galen (de Med. sec. loc. x; de Affect. Renum; de Loc. Affect.; Isagoge); Celsus (iv, 10); Aretæus (Morb. Acut. ii, 9; Morb. Acut. Curat. ii, 8); Ruffus Ephesius (de Vesicæ Renumque Affectibus); Alexander (viii, 4); Aëtius (xi); Oribasius (de Loc. Affect. Curat. iv, 101); Actuarius (Meth. Med. iv, 8); Pseudo-Dioscor. (Euporist. ii, 112); Nonnus (173); Cælius Aurelianus (Morb. Chron. v, 4); Scribonius Largus (38); Marcellus (de Med. 24); Avicenna (iii, 19, 1); Avenzoar (ii, 2); Serapion (iv); Haly Abbas (Theor. ix, 34; Pract. vii, 12); Alsaharavius (Pract. xx); Rhases (Div. 70, and Contin. xxiii.)

Hippocrates describes four affections of the kidneys, beginning with calculus. According to his theory, stones are formed from phlegm which has been converted into sand. See his theory fully explained (de Morbis, iv, 28, and de Aer. &c. 53.) He states distinctly that the formation of stones is the product of a preternatural heat in the bladder, with a thick and turbid state of the urine. (l. c.) He recommends fomentations with the juice of scammony, purging the whole body, tepid baths, and the like. He intimates, however, that when a stone is fairly formed, the only hopes of recovery are founded upon the operation. It appears that in his days lithotomy was a separate branch of the profession; for in his Oath he inhibits his pupils from performing the operation, and binds them to leave it to those who make it their practice. Doubts, however, are entertained of the genuineness of this piece. He mentions that hairs are sometimes passed in the urine; and the same fact is attested by Galen (Loc. Affect. vi, 3), Cælius Aurelianus, Aëtius, Avicenna, and Alsaharavius, among the ancients, and by recent writers on pathology. Actuarius calls them substances resembling hairs, of a handbreadth or thereabout in length. (De Urinis, i, 16.) He held them to be connected with disease of the kidneys. (Ibid. iv, 20.)

Galen says that all lithontriptics are of a cutting and detergent nature, the most of them being bitters. He makes mention of pepper, galbanum, ammoniac, aphronitrum, asarabacca, spignel, St. John’s wort, &c. He does not hesitate, however, to declare it as his opinion that the only certain remedy for calculus is lithotomy. (Art. Med. 94.)

Aretæus gives an interesting account of the affections of the kidneys and bladder. His remedies are similar to those of our author. For stones in the bladder he recommends, among other things, some quicklime with honied water, and diuretics. When a stone obstructs the passage, he directs us to push it back, or cut the neck of the bladder. He states that navigation and living at sea are beneficial in all affections of the kidneys. We may mention that this accords well with the late statistics of calculous diseases.

Alexander, like our author, ascribes the formation of stones to viscid and thick humours which have been much heated or roasted. He says, in the language of the Peripatetic philosophy, that the material cause of calculus is a thick matter, but the efficient a fiery heat, in like manner as by heat and a suitable matter of such a nature tiles are formed which are insoluble in water. This theory is explained with great logical parade in the ‘Isagoge’ generally ascribed to Galen, but which Albertus Fabricius supposes to be a work of Demetrius Pepagomenos. Alexander’s remedies are mostly the same as our author’s. He speaks with surprising confidence of the efficacy of goats’ blood; and, by the way, there is no lithontriptic which, both in ancient and in modern times, has been so generally cried up as it. His general treatment, which consists of bleeding, baths, emollient and paregoric medicines, is very proper. He remarks that certain lithontriptics, if given unseasonably, increase the disposition to calculus. Like our author, he forbids thick food, and attributes the best effects to drinking water.

Those who wish to see a full exposition of the ancient views on this subject may consult Aëtius. Like all the others, he says that milk, with the exception of that of asses, contributes to the formation of stones. He also recommends goats’ blood. He gives very proper directions respecting the regimen after extraction of the stone, to prevent a recurrence of the complaint.

Cælius Aurelianus makes no mention of lithontriptics, but he describes very properly the treatment when pain and inflammation of the bladder supervene. It is altogether emollient and relaxant.

The nature and treatment of calculous diseases are treated of in a very practical manner by Palladius in his Commentary on the sixth ‘Epidem. Hippocrat.’ He depends principally upon a restricted diet and light food.

The Arabians treat of calculi at great length, but have the same ideas of the formation of them, and recommend the same remedies as the Greeks. We remark that Avicenna, Rhases, Serapion, and Alsaharavius mention among their lithontriptics barauch, or the nitrum of the Greeks and Romans, which was most probably an impure carbonate of soda. We need scarcely say that this alkali is now given upon chemical principles. Like our author, they make mention of glass as a lithontriptic. Rhases, Avicenna, and some of the others remark, and perhaps justly, that white urine is one of the earliest symptoms of calculus. For stone in the bladder Avenzoar recommends cubebs. Avicenna, Serapion, and Alsaharavius join the Greeks in commending the small sparrow (or, as some suppose it, the wren) as an efficacious remedy for calculus. It is said in the ‘Isagoge’ that its lithontriptic powers were discovered by dreams. We may mention that it has been ingeniously supposed that allusion is here made to magnetic somnambulism, which, it is maintained, was one of the remedial means practised in the ancient temples of health. Haly Abbas ascribes the formation of stones to the concurrence of a viscid humour with heat of the part. Old men, he says, are most subject to renal calculi; for in them the watery part of the urine passes down to the bladder, while the grosser part or sediment is detained in the kidneys, and is converted into stones. Children are said to be most liable to calculi in the bladder, owing to their eating much gross food, and taking exercise after meals, by which means the system is loaded with gross impurities. With regard to the treatment, he enjoins restricted diet, abstinence from gross food, and the use of medicines of an incisive and attenuant nature. The general treatment during a fit of gravel is well laid down by Alsaharavius, consisting of bleeding, cupping, the tepid bath, emollient clysters, &c. Rhases, upon the authority of Antyllus, states that stones are formed either from drinking turbid water or from imperfect digestion, whence the urine deposits a sediment, which is converted into a stony hardness by the heat of the part.

According to Theophilus, a thick and milky state of the urine is characteristic of calculous diathesis. (De Urin. 8.)

Vegetius mentions that cattle, especially young ones, are liable to stones in the bladder, which are apt to fall into the urethra and obstruct the urine. He states correctly that a stone will sometimes make its way into the rectum. (Mulom. i, 46.)

Alexander Aphrodisiensis states that young and old persons are most subject to calculus. (Prob. i.) From the late investigation of Dr. Prout, it appears that children until fourteen years of age are most liable to stone; then persons after forty; while those in the intermediate period are but little subject to the complaint.

With respect to the lithontriptics mentioned above, all we can venture to say is, that, having no experience of them, we do not think ourselves entitled to question or confirm their efficacy decidedly; but, as we repose little confidence in those now in repute, we cannot be supposed to have much in those which have fallen into disuse.

On inflammation, abscess, and ulceration of the urinary organs. Celsus recommends rest; a soft bed; opening the belly; sitting in hot water; avoiding cold food and drink; abstinence from everything that is saltish, acrid, and acid, and from apples; taking copious draughts; adding to the food or drink pepper, leeks, fennel-giant, and white poppy, to promote the urinary discharge, &c.

One may find in Galen many receipts for abscess and ulceration of the urinary passages, but they are similar to our author’s.

Aretæus makes mention of ulcers of the kidney occasioned by stones, which he pronounces to be incurable. He states also that ulcers of the kidneys give rise to consumption. Without doubt he alludes to the morbid condition of the kidneys now known by the name of Bright’s disease. Hippocrates has been supposed to refer to the same in the following Aphorism: “When bubbles appear on the surface of the urine, they indicate that the kidneys are affected, and that the disease will be protracted.” (Aph. vii, 34.) Upon which MM. Lallemand and Pappas remark that frothy urine and albuminous are identical; and it is well known that Bright, Rayer, and Martin Solon have decided that albuminous urine is generally connected with a very obstinate disease of the kidneys. (Littré’s Hippocrates, t. iv, 414.) It seems highly probable that Actuarius alludes to albuminous urine in the following passage: “When substances, the effect of melting, and resembling spiders’ webs, float in the urine, they indicate either that the kidneys are diseased, or that the system is in a state of atrophy from wasting.” (De Urinis, vi, 16.) On frothy urine, see, further ‘De Urin.’ (v, 4.)

Alexander lays down the rules of treatment very properly, recommending venesection, purging, and topical applications of a cooling nature, especially at the commencement. When the abscess forms, he prescribes a variety of things which are detergent without pungency.

When the bladder is ulcerated, Nonnus directs us to inject into it by a syringe honey much diluted with water, or the seed of cucumber with the same.

The treatment prescribed by Cælius Aurelianus scarcely differs at all from that of the others in this case.

One of the oldest writers on diseases of the kidneys is Ruffus, who lived, according to Suidas, in the days of Trajan; so that he was prior to Galen, and perhaps to Aretæus and Cælius Aurelianus. As we have seldom occasion to meet with him in our researches, we shall give a fuller abstract of his opinions on this subject than we would otherwise have done. The symptoms of inflammation of the kidneys, as detailed by him, are pains below the loins, so that the patient cannot stand erect nor walk, but is obliged to lie upon his back, which position affords him most relief; the pains extending to the bladder and testicles; the extremities cold, more especially the legs and feet; frequent and painful desire to make urine, which is at first thin and watery, but afterwards becomes redder. These symptoms are followed by emaciation of the thighs and hips, debility of the limbs, and sometimes suppuration. His treatment is as follows: The patient is to be laid on a soft couch, and must abstain from food for one day, but long abstinence is forbidden. If the bowels require to be opened, this is to be done by means of emollient clysters, such as injections of hot water, decoctions of mallows, of linseed, or of fenugreek, to which may be added some oil. Large injections, however, are forbidden, lest they press upon the kidneys and occasion irritation. When the bowels are evacuated, and yet the pain does not remit, the parts may be wrapped in wool which is smeared with hot oil having rue, marshmallows, dill, or mugwort boiled in it. When the pain is acute, a vein at the elbow is to be opened; after which emollient cataplasms and plasters are to be applied to the back when the kidneys are affected, and to the fore parts when the bladder. When these remedies fail to remove the pain, the loins and groins are to be cupped, and then sponges squeezed out of hot water are to be applied, and the patient put into a hip-bath of hot water in which poppies, chamomile, and the like have been boiled. Then, when the patient is laid in bed, let him be fomented with bladders half-filled with oil and water; and afterwards let cerates of the oil of privet, &c. or fragrant malagmata be applied. When the pain is excruciating, he directs us to give a decoction containing opium and the heads of poppies. In due time diuretics are to be administered, such as the root of acorus, ground-pine, cassia, spignel, parsley, sea urchins, radishes, carrots, and the like. When an abscess is formed, there is a discharge of tawny and more natural urine, there is swelling in the loins, strong heat in the kidneys, and the pain becomes duller with irregular fever. The abscess bursts either into the bladder or intestines. Praxagoras, he says, related a case in which there was pus voided by the anus for twelve years and probably longer. When it bursts into the bladder, pus is voided with the urine. Suppuration is to be promoted by frequent fomentations with sponges, by cataplasms of barley-meal with a decoction of figs in mead or wine, to which may be added pounded wormwood, spurge, &c. For promoting the rupture of the abscess, diuretics are prescribed, such as wild marjoram, mock dittany, and the like. When the abscess does not burst, acrid clysters containing black hellebore, radishes, garlic, and the pulp of colocynth are to be given. To these oil may be added, and when thus taken they will promote the rupture of the abscess. However, fomentations with sponges and plasters are to be applied to alienate the pain. When the ulcers are of a mild nature (which is shown by the abatement of the fever and pain, and from the substances which appear in the urine being white and inodorous), the milder diuretics are to be used for cleansing them, such as the seed of pompion, the decoction of dates, &c.; or, when stronger things are required, galbanum, opopanax, turpentine rosin, and the like may be added to mead or wine. When the ulcers are putrid, Æthiopian cumin with must, rue with honey and wine, and the like may be given internally; while cataplasms of bitter vetches boiled in wine and honey are to be applied externally. It is proper also, he says, to inject some of the medicines for dysentery; to give clysters of strained ptisan; and to place the patient in hot water. If the matter is thick, a decoction of fennel, parsley, or wormwood is to be given. With respect to food, he recommends milk, especially that of mares or asses, along with honey; also cucumbers, lettuces, the flesh of kids, lambs, and goats, almonds, and wine; but vinegar must be avoided. All motion is to be abstained from. When there are symptoms of repletion, emetics are to be given. When the abscess points outwardly, he seems to direct us to open it and apply the cautery; but here unfortunately the text is incomplete.

This account is so full and judicious that we think it unnecessary to give extracts from any more of the Greek and Latin authorities.

From the Arabians little or no additional information is to be derived. Haly Abbas recommends bleeding by opening the basilic vein, and then cataplasms of barley-flour, &c. He then gives a cooling draught containing the seeds of cucumbers, gourds, melons with purslain, mallows, and the syrup of violets. This part of his practice deserves consideration. When the abscess forms he directs us to apply cataplasms containing chamomile, fenugreek, melilot, &c. Alsaharavius, in like manner, recommends bleeding, cooling and demulcent draughts, the tepid bath, and discutient cataplasms. The same plan of treatment is fully laid down by Rhases. When pus is discharged from the bladder, owing to ulceration of it, he directs us to give astringent injections prepared from galls, sumach, purslain, pomegranate leaves, &c.

On hemorrhage of the kidneys. Our author’s treatment is so fully stated that it will be unnecessary to multiply extracts from the others. It is mostly condensed from Aëtius. (xi, 27.) The latter makes mention of injecting into the bladder some astringent infusion by means of an instrument like a catheter, having a bladder attached to one extremity. When the coagulated blood (and the urine generally does coagulate it) cannot be got otherwise discharged, he recommends, like our author, an incision to be made in the perinæum.

Cælius Aurelianus also recommends injecting into the bladder some astringent infusion, such as that of hypocistis, knot-grass, &c. In the case of women astringent pessaries may be used.

Avicenna recommends us to inject the rennet of a hare. Haly Abbas directs us to bleed by opening the basilic vein, and then to give draughts containing various vegetable astringents, such as wild pomegranate flowers, cucumbers, and purslain, with alum, Cyprian earth, &c. According to Rhases, the discharge of blood by urine is often connected with disease of the liver.

The veterinary surgeon Vegetius ascribes the bloody water of cattle to general plethora. This is a very plausible hypothesis.

On hardness of the kidneys. Nearly the same account is given by Aëtius, and also by Avicenna, Rhases, Serapion, and all the medical authorities who have treated of this subject. Haly Abbas and Alsaharavius particularly commend the diachylon plaster. Ruffus, as quoted by Rhases, recommends rest, emollient clysters, the application of cupping-instruments to the back, tepid baths, refrigerant and sedative medicines internally.

On diabetes. Aretæus remarks that diabetes is a wonderful affection, being a melting down of the flesh into urine, occasioned by a cold and humid cause like dropsy. The disease, he says, is of slow formation, but when completely formed speedily proves fatal. His description of the symptoms is very striking: a fiery thirst, a never-ending desire to make water, a parched skin, a dry mouth, and so forth. Diabetes, he justly remarks, is a species of dropsy, the water in the one case being determined to the peritoneum, and in the other to the urinary organs. We have, in fact, known these diseases reciprocate. He recommends by all means attention to the thirst, endeavouring to allay it by means of the medicines called Adipsa; rectifying the stomach by purging with hiera; and applying epithemes of spikenard, mastich, and the like. For drink he directs us to give water in which the autumnal fruits have been boiled; and for food recommends starch, milk, and cold astringent wines. He concludes by saying that the general remedies and regimen proper in dropsical cases will answer in diabetes, and particularly mentions the theriac and mithridate. Among the causes of diabetes he mentions poisoning by the sting of the African viper, called the dipsas. This subject will be found treated of in the Fifth Book.

Celsus recommends exercise, friction, purging, astringent food, and austere wine. Galen states that he only recollected having met with two cases of diabetes. He maintains that it is such an affection of the urinary organs as lientery is of the bowels. He is decidedly of opinion that the kidneys are primarily affected, and not the stomach, as some had supposed. He explains his views of the nature of the disease with great precision. (De Locis Affectis, vi, 3.)

Aëtius has given the fullest account of diabetes. Upon the authority of Archigenes, he recommends at the commencement bleeding and diuretics, the latter being given to clear away the vitiated urine from the kidneys; but if the disease be of long standing, he proscribes both those measures. He recommends also a cooling diet, ruddy wine diluted, cooling applications to the pubes and loins, and, in certain cases, narcotics, such as opium and mandragora.

Alexander’s theory respecting the nature of the disease is the same as our author’s, both having borrowed it from Galen. He recommends food of difficult digestion, such as the feet of oxen, the flesh of pompions, chesnuts, &c. He forbids all saltish, acrid, and diuretic articles. He says nothing of venesection.

Actuarius recommends purgatives, in order to determine to the intestines, and astringent and refrigerant remedies in general.

Avenzoar explains fully his views respecting the nature and treatment of diabetes, in which he follows Galen closely. But the fullest and most accurate of the Arabian authorities on this subject is Avicenna. In certain cases, he admits of venesection at the commencement. The remedies, however, in which he seems to place the greatest reliance, are emetics and sudorifics, which he gives until the intention of altering the determination of the fluids to the kidneys. He particularly directs the patient to avoid taking all diuretic articles, to use exercise on horseback, moderate friction, and, in the decline of the disease, the tepid bath with fragrant wine.

Serapion gives nearly the same account as Aëtius, only he says nothing of venesection. Haly Abbas states, with his usual precision, the theory of Galen and the other Greek authorities, namely, that the disease is occasioned by a preternatural increase of the attractive faculty of the kidneys, arising from heat of the viscus. Agreeably to this theory of the disease, his remedies are refrigerants and astringents. Alsaharavius advocates similar views of the nature and treatment of the disease. When the urine is thick, with some appearances of blood, he recommends venesection. According to Rhases, the affection is connected with preternatural heat of the kidneys and debility of their retentive faculty. He says it resembles lientery of the intestines.

To those who are conversant with the principles of ancient physiology, the theory advanced by Galen, and advocated by all subsequent authorities, will appear very plausible and ingenious. The ancients appear not to have known that the urine some times possesses saccharine properties.

Rogerius, like the ancient authorities, refers diabetes to a hot intemperament of the kidneys, whereby their attractive faculty is increased. (Tr. i, 54.) All the earlier writers on medicine appear to have held the same hypothesis.

On strangury and dysuria. As these diseases arise from a variety of causes, our author has properly treated of them accordingly. We do not find that the other authorities supply much additional information.

Hippocrates mentions that there are many varieties of strangury. His remedies are the tepid bath, diluent drinks, diuretics, and anodynes.

Aëtius states that the disease is called dysuria when the patient has a desire and passes his urine with difficulty, and strangury when it is passed in drops. It is occasioned, he says, by acrimony of the urine, ulceration, or debility of the bladder. It may also arise from affections of the kidneys and liver, or from an intemperament. The treatment is to be varied accordingly.

When dysuria is connected with weakness of the bladder Leo recommends that pressure should be made with the hands on the hypogastric region.

Avicenna is particularly full upon these affections. For ardor urinæ Haly Abbas recommends various emollient and cooling articles, such as mallows, the seeds of cucumbers, pompions, and the hot bath, &c. When it proceeds from an inflammatory cause, he recommends the treatment directed in the beginning of this Section. When these remedies prove ineffectual, the catheter is to be used. He says that one of the most common causes of the complaint is debility of the expulsive faculty of the bladder. Alsaharavius treats fully of these complaints in much the same terms. When dysuria is connected with inflammation, he recommends bleeding, diluent drinks, and the warm bath. When it proceeds from a clot of blood he directs us to inject into the bladder the water of ashes. (Aqua cinerum, perhaps it should be aqua cicerum.) Rhases states that the complaint generally arises in old men from heat or ulceration at the neck of the bladder. He justly remarks that when retention arises from inflammation, no urine at all is passed, and the pain is constant; and that, when connected with obstruction, the bladder gets distended.

For inflammation, pain, and ulceration of the bladder, Scribonius Largus recommends water into which a heated iron had been plunged. He adds that he had known the chalybeate waters of Tuscany do much good in diseases of the bladder. This may be said to be an anticipation of the modern practice, introduced, we believe, by the late Mr. Cline, of giving the tincture of muriated iron in such cases.

On incontinence of urine. Galen properly remarks that incontinence of urine is often occasioned by injury of the spinal marrow either through violence, or the application of cold. (De Loc. Affect. iv, 7.)

According to Avicenna it is occasioned by excessive cold, by relaxation of the muscles (sphincter vesicæ?) or weakness of the bladder, as happens at the end of certain diseases, or by the immoderate use of diuretics. Rhases says briefly, that the complaint is occasioned by excessive heat or coldness. When it proceeds from the former cause, he recommends a composition of coriander, vinegar, Armenian bole, acorns, &c. When from cold, he prescribes the following: Of dried acorns, of frankincense, q. s. to be rubbed into the pubes with oil of ben, or oil of rue. Haly Abbas attributes the complaint to enervation of the sphincter vesicæ and loss of the retentive faculty of the bladder. He also mentions its connexion with disease of the spine. Alsaharavius recommends various stimulant liniments externally, and galls, vinegar, and the like internally.

Ruffus briefly describes a disease of the urinary organs, by the name of scabies vesicæ, attended with furfuraceous sediments and pains in the hypogastric regions, and ending, for the most part, in ulcerations of the bladder. The disease is said to be of a very intractable nature. It is alluded to by Hippocrates. (Aph. iv, 77; where see the Comment. of Theophilus, ed. Dietz.) It is further stated in one of the aphorisms that blood, pus, and scales in the urine, accompanied with deep pain, indicate ulceration of the bladder. (Ed. Dietz., t. ii, 437.) Theophilus says, blood, pus, and scales in the urine, with a heavy smell, indicate ulceration of the kidneys or bladder. (De Urinis, 15.)

SECT. XLVI.—ON THE AFFECTIONS OF THE LIVER.

The affections of the liver being various (for it is subject to atony, inflammation, erysipelas, scirrhus, apostemes, ulcers, and obstructions), we shall treat first of atony of it, in which case, particularly those affected with it, are usually called hepatics. If, therefore, it evacuate the excrements in a state of chyle, but more liquid than natural, the distribution of the food to the liver being either diminished or altogether stopped, while the stomach is unaffected, it is to be inferred that the attractive power of the liver is in a weak state. But if they resemble the washings of newly-killed flesh, it is the alterative, and, as it has been called, the sanguificative power that is affected. But if the atony arise from a hot intemperament, in process of time it appears more feculent and very fetid, the bile being high-coloured and thick. Wherefore, the substance of the liver being already melted, the whole body also is melted down; and there is fever, anorexia, and vomiting of bile. When the intemperament is cold, the discharges are neither constant nor many, for the affection is a chronic one; and for several days the discharges from the belly will be more abundant, but less fetid, like the lees of thick blood, approaching to black bile. And many and various colours indicate a cold intemperament; for the fever is obscure, the face not collapsed, and there is rather a desire of food. Whichever of these intemperaments prevails, if complicated with the dry, the excrements appear drier and fewer in number, and there is more thirst; but, if the humid, they are more liquid and abundant, and the patients have less thirst. When the liver is inflamed, there is, in all cases, pain in the right hypochondrium, extending upwards as far as the clavicle, but downwards as far as the false ribs; an acute fever, dry cough, thirst, loathing of food, and difficulty of breathing; the tongue at first appears red, but afterwards black; there is vomiting of bile, and the belly is constipated. These symptoms being like to those of pleurisy, we have stated the difference under the head of pleurisy. When erysipelas is seated in the liver, the inflammatory heat is intense, there is ardent fever, and marasmus supervenes. In particular, when the concave parts of the liver are inflamed, there is nausea and vomitings, anorexia, intense inflammatory heat, deliquium animi; and the parts often become congealed, so that dropsical effusions derive their origin from hence. When the convex parts are inflamed, the other symptoms just now enumerated are present, with a visible swelling along its circumference, which swelling is manifest both to the sight and the touch. These are the symptoms of a strong and great inflammation; but if it is weak, we must order the patient to take in a large inspiration, and, if he says that he has pain in the right hypochondrium, we may conclude that there is moderate inflammation of the liver. But if an oblong tumour of a phlegmonous nature appear in the position of the muscles which lie over it, and none of the aforesaid symptoms be present, we know that the muscles themselves are inflamed. Weight with distension, and a sensation of pain in the right hypochondrium, without swelling or fever, indicate an obstruction of the veins, at the place where those of the porta and concave parts of the liver join those of its convex parts. When the inflammation is converted into an abscess, the pain and distension increase, inordinate rigors come on, and they cannot lie on the left side without increasing the pain in the liver. When the abscess bursts, the matter is discharged freely by the urine or bowels. If the tumour pass into a scirrhous state, the pain is diminished, but there is a manifest swelling, attended with hardness, and the surrounding parts become emaciated. But, in process of time, the diagnosis becomes difficult; for dropsy supervenes, and the whole hypochondrium is concealed by the water. For a hot intemperament of the Liver, we must use those things which have the properties of moderately cooling and strengthening the viscus, such as endive and succory, sometimes eaten raw and sometimes boiled with coriander; and the decoction and juice of them may be drunk; and not only thus, but the plant, when sprinkled dry upon honied water, relieves hot and cold intemperaments of the liver. And the species of those herbs called intybus, and troximus, and the sow-thistle, are possessed of similar properties. And a cupful of the juice of citron added to honied water has the same effect, and that of the brake in like manner. But if the intemperament is moderate and complicated with obstruction, these things may be given in some light wine, or some of the diuretics. And the following pill may be taken: Of succory, dr. iv; of the root of ground-pine, dr. iv; give in boiled honey to the size of a Pontic nut, and let the patient take some warm water, and then let him be made to drink the propomata from opium and the seed of hyoscyamus, and the antidote of Philo. In those cases in which the heat is intense, it may be very proper to give of the oil of roses, or of apples, in a draught. For food, let them take of the juice of ptisan, or chondrus, with hydrorosatum, and bread in like manner out of water, with some of the sweet potions; and, in a word, let them take such food as is moderately cooling without being obstruent; abstaining altogether from wine, unless they require it for some other cause, such as atony of the stomach, and in that case the kind which is given should be thin, weak, and watery. And erysipelas of the liver must be cured in like manner. When the intemperament is cold, we must proceed on the opposite mode; we must give them bread with wine, and cabbage which has been twice or three times boiled. Let them taste lightly of chesnuts, take what is sufficient of grapes, and of the flesh of fowls, and drink wine. Let them get a propoma from eupatorium, asarabacca, or the medicine from pepper; and a selection must be made for them from among the remedies formerly mentioned for colic and dysentery. The medicines called cyphoid do not suit entirely with the hot intemperaments, unless the heat be small and joined to much humidity; but they are excellent remedies for the cold, and more especially if complicated with humidity or obstruction of the liver. When the obstruction is occasioned by thick and viscid humours, we may give the myacantha (wild asparagus?), more especially the fruit of it, and the rind of the root of bay, agrimony in oxymel, or in the decoction of bitter lupines, with rue and pepper. And the flour of lupines in a draught; and of roots of cappers, p. ij; of costus, p. j, with wine; and the medicine from cacanus, are of use for obstructions occasioned by thick and viscid humours; also the iris, the fruit and rind of pistaches, horehound, and bitter almonds, and the trochisks from them, the root of dracunculus, and wakerobin, agaric, vinegar of squills, and oxymel. And the dried liver of a wolf, powdered and given with sweet wine to the amount of a spoonful, is applicable for all affections of the liver. And the antidote Theodoretus is one of the best remedies for obstructions of the liver, scirrhus, chronic inflammation, colics, and jaundice; and in like manner the picra with oxymel. The food which is given should be of a heating and deobstruent nature, such as leeks in oxymel, marsh asparagus, and capers in like manner; and the other articles of food should be boiled with some of the calefacient and deobstruent condiments. They should drink light old wine, avoiding such as are thicker, and also frequent baths, more especially after food. If the affection be protracted, we may have recourse to venesection and purging, if nothing prevent. When the liver is inflamed, we must bleed from the right arm without delay, and take away a great quantity, if the strength permit. And over the viscus we must apply externally a cataplasm made of the flour of barley, of fenugreek, and of linseed, with dates, or quinces and the flower of melilot, wormwood, and oil of chamomile; in a word, we must mix astringents with emollients. The epithemes to be applied are that of Nileus, the fragrant, the Philagrianum, that of Apollophanes, that made of melilots, and the one called Copton. For great inflammations, the following one is of tried efficacy: Of the flowers of wormwood, of Celtic nard, of asarabacca, of saffron, of each, oz. j; of iris, of myrrh, of storax, of bdellium, of ammoniac perfume, of each, oz. ij; of a calf’s marrow, oz. iv; of cerate of lentisk, lb. iv. Oxymel is also to be given to them, and the simple remedies, such as asarabacca, Celtic or Indian nard, bog-rush, and Macedonian parsley. We must stimulate the bowels by nettle, or the herb mercury eaten boiled; and during the decline of the complaint we must give of dodder of thyme (epithymum), and of polypody in honied water; and evacuate the bowels with a clyster, in the beginning by means of honied water with salts or nitre, but in the decline mix with hyssop, marjoram, or bastard saffron, or centaury and colocynth. In a word, the concave parts of the liver are to be purged by the belly, and the convex by the urine. For food, give them the juice of ptisan in which parsley has been boiled. We have already stated the cure of erysipelatous inflammation. When an aposteme is formed, we must promote its rupture, by applying a cataplasm of the composition called trispermus, with rosin, manna, pitch, the roots of marshmallows, pigeon’s dung, and goat’s dung. But let them take the propoma from the decoction of poley, that of the fumitory which grows in hedges, reduced to a third part, the decoction of treacle-mustard or of succory, and of the root of wall-germander. When the rupture takes place, honied water and the other things mentioned for ulcerated kidneys may be given; and externally the plaster of Mnasæus, and the other emollient plasters, and the Icesian, or that from willows may be applied. When the liver is in a scirrhous state, there is little hope of recovery, as the affection will pass into dropsy; and yet it may be attempted by mixing ammoniac, bdellium, marrow, grease, and things of similar properties, with emollients. The patients may take draughts of such things as will act as deobstruents and detergents of the viscus, such as diuretics and lithontriptics, along with those just now mentioned for obstruction of the liver; the diet being regulated accordingly.

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COMMENTARY. Consult Hippocrates (de Intern. Affect. 30); Galen (Meth. Med. xiii; Sec. Loc. vii); Aretæus (Morb. Acut. ii, 7; Morb. Chron. i, 13); Celsus (iv. 8); Alexander (vii, 19); Aëtius (x, i); Oribasius (Loc. Affec. iv, 96); Nonnus (182); Cælius Aurelianus (Pass. Tard. iii, 4); Octavius Horatianus (ii, 13); Marcellus (de Med. 22); Scribonius Largus (30); Avicenna (iii, 14, 1); Avenzoar (i, 13); Haly Abbas (Theor. ix, 30; Pract. vii, 31); Alsaharavius (Pract. xviii); Serapion (iv); Rhases (Divis. 62; ad Mansor. ix, 67; Contin. xvi.)

Hippocrates describes three varieties of hepatic disease, which appear to have been bilious fevers. It is not easy to define the principles upon which his practice is directed. He mentions, however, emollient applications, bleeding, purging, and vomiting; and, when the disease is protracted, recommends the side to be burned with spindles of box-wood smeared with oil. He directs abscesses of the liver to be opened by the cautery. (Coac. 457.) He states that abscesses of the liver are least dangerous when they open externally; more so when they open internally; and most of all when they open both internally and externally. (Prognost. 7.) He makes mention of hydatids, and says of them that when they burst into the cavity of the peritoneum, the case proves fatal. (vii, 54; where see the Comment. of Theophilus and Damascius, ed. Dietz, p. 540.)

Galen has laid down the principles upon which inflammation of the liver should be treated in the 13th book of his ‘Methodus Medendi.’ We can only afford room for his conclusions. He approves of venesection with the intention of producing revulsion. Such articles of food and medicine are to be given as will emulge the biliary ducts without occasioning irritation, and everything of the opposite kind is to be abstained from. Wherefore such things as are sweet and viscid are to be avoided, and only such as are detergent without pungency are to be allowed. Of this class are ptisan and oxymel much diluted. Astringents, such as pomegranates, are improper, because they occasion contraction of the vessels; and they are more especially to be avoided when the concave side of the liver is affected. When the convex is affected, these articles, being altered by the action of the liver before they reach the seat of the disease, prove less prejudicial. When the concave side is the seat of the disease, he directs us to evacuate by the bowels, which may be accomplished by mixing with the food cnicus (carthamus tinctorius?) the herb mercury, &c.; but, if stronger medicines are required, black hellebore, colocynth, the small centaury, and the like, may be given. When the convex side is affected, he directs us to give diuretics; at first parsley, but, after the inflammation has subsided, the stronger ones, such as Celtic nard, valerian, spignel, &c. He animadverts in strong terms upon the practice of the Thessalian Asses, so he calls the Methodists.

We regret that our limits prevent us from doing justice to the views of Aretæus. The liver, he states, is the grand seat of sanguification, being itself but a concretion of blood. Hence, he says, diseases of it prove speedily fatal. He accounts for the pain which is felt at the top of the shoulder or clavicle in this way: the liver, being enlarged and becoming heavier than natural, drags down the diaphragm to which it is attached, and thus stretches also the pleura from its upper adhesions, whereby pain in the part is produced. A crisis, he says, may take place by a hemorrhage, a copious discharge of bile, or of urine; or the disease may terminate in suppuration, or in dropsy. When pus is formed, it may be discharged by urine, by the bowels, or it may point outwardly. In this last case, he recommends us to open it with an instrument red hot. When it does not suppurate it is apt to end in scirrhus, which is marked by a dull pain in the part. His treatment of acute hepatitis consists of venesection, refrigerant and discutient applications externally, cupping or leeching the side affected, then applying cerates and emollient ointments, consisting of attenuants and diuretics, such as wormwood, cider, &c. The food is to be light, of easy distribution, and diuretic. His treatment of chronic disease is varied, according as the matter passes by the urine or the bowels; but the chapter on it is incomplete.

Celsus at the commencement recommends bleeding, purging even with black hellebore, cataplasms at first repellent and then calefacient. Diuretics are to be given, such as thyme, hyssop, &c.; and all cold things are to be avoided. When a vomica forms, it is to be opened and burnt.

Alexander’s account is full and judicious. He says that, in cases of obstruction of the liver, when deobstruents are given before the swelling is softened, the juices being overheated become like stones and cannot be discussed. He alludes, of course, to hepatic calculi, or gall-stones. He gives copious directions for emollient ointments to be rubbed into the side to dispel the enlargement of the liver.

In treating of scirrhus, Aëtius recommends the emollient ointments, cupping, leeching, calefacient plasters, sinapisms, burning by medicines or by the actual cautery.

The account given by Actuarius is in so far important, as it shows that the views of practice had not changed in his days. In inflammation, he recommends to bleed two or three times, and to unite emollients with deobstruents in the external applications.

For a full exposition of the doctrines of the Methodists, we must refer to Cælius Aurelianus, of whose opinions we can afford room only for a very brief outline. The symptoms of scirrhus of the liver, as stated by him, are a round circumscribed tumour felt below the ribs, the colour jaundiced, the urine muddy, pain extending to the throat of the affected side, difficulty of lying on the left side, as this posture suspends the enlarged viscus. (By the way, Cassius assigns the same reason why persons labouring under disease of the liver or spleen lie easiest on the affected side. Probl. vi.) At the commencement he recommends fomentations, cataplasms, laxative food, and then cupping, scarifications, and leeching. When the attack is violent, venesection is to be premised. Frequent changes, acrid food, and emetics with vinegar of squills or hellebore are also mentioned. He recommends a sea-voyage, vapour-baths, hot springs, the sand-bath, and various stimulant and rubefacient applications to the side. He delivers his strictures very freely upon the practice of the other sects. Thus he justly condemns as too bold and dangerous a measure the proposal of Erasistratus to lay bare the liver, and apply the remedies direct to the part affected. He thinks Asclepiades improperly rejected gestation, baths, cataplasms, and emollient ointments. He also condemns the free use of cauteries to the affected side.

Serapion, like Alexander, states strongly the danger of using discutients before emollients, lest the juices become indurated. No ancient author has treated of the diseases of the liver so fully as Avicenna. He is most minute in his distinctions of disease, and particular in his application of remedies. Among other diseased states of the viscus, he mentions diminution of bulk. Had not inspectiones cadaverum been common in ancient times, the existence of this state of diseased structure could not have been ascertained. In abscess, he and Serapion make mention of taraxacum or the dandelion, which was recommended by the late Dr. Pemberton in cases of diseased liver, and is still used occasionally. Haly Abbas directs us, when suppuration takes place, to determine to the kidneys by diuretics; and, when the abscess bursts into the cavity of the peritoneum, he advises us to open it. When it makes its way to the stomach or bowels, he recommends us to promote its discharge by purging. He remarks that sometimes an abscess will form externally to the liver and put on the appearance of hepatic abscess. He directs it to be opened with aperient medicines or the lancet. He takes notice of the pain at the top of the shoulder, which, like Aretæus, he attributes to the dragging down of the parts by the heavy liver. In the cold aposteme (chronic inflammation?) he recommends wormwood, fenugreek, hyssop, spikenard, fennel, and the like. One of his favourite remedies for hepatic disease is rhubarb. Alsaharavius gives a long account of these diseases. Inflammation he treats by bleeding, various laxative and cooling medicines, emollient plasters, &c. In obstruction he gives rhubarb, wormwood, fennel, endive, &c.; and bleeds, if there be a sanguineous plethora. He treats fully of a discharge of blood from the liver. When it arises from the bursting of a vein after excessive fatigue, he directs us to bleed; but when it proceeds from relaxation and debility, he recommends astringents externally and internally. The account of hepatic diseases given by Rhases in his ‘Continens’ is particularly excellent, but it is too lengthy for our limits. He explains the pain at the top of the shoulder in the same way as Aretæus. He mentions that gross food produces enlargement of the liver, and hence animals fed on figs have large livers. For inflammation he recommends at first depletion and afterwards refrigerants, such as camphor, fleawort, and even snow-water. He recommends aloes with wormwood as a deobstruent cathartic.

SECT. XLVII.—ON CACHEXIA.

We are accustomed to call the commencement of dropsical affections cachexia. Wherefore we must cure it by bleeding, if nothing prevent, at intervals, and continuing the abstraction until the third or fourth day. But, in an especial manner, we must evacuate those who have fallen into this affection from retention of the hemorrhoidal or menstrual discharge; as in those cases which arise from a copious evacuation, we must abstain from venesection, and by all means purge with the hiera from colocynth. The diet should be light and desiccative; and recourse must be had to natural baths, namely the aluminous, and more especially the nitrous, and then the sulphureous; but the other kind of baths may be taken at greater intervals. Let them be exercised in every way, more especially by those who are called jatraliptæ. At last they must be put under a course of hellebore. They are wonderfully remedied by a propoma of wormwood, and by sinapisms and dropaces. If the affection is converted into dropsy, we must have recourse to the treatment applicable for dropsical cases in the manner about to be explained.

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COMMENTARY. Almost all the authors referred to in the preceding Section may be consulted on cachexia and dropsy.

Aretæus gives an accurate account of this affection, which, he says, usually terminates in dropsy, phthisis, or wasting. He mentions many symptoms of it, such as œdema, difficulty of breathing, and so forth; and he correctly remarks that the alvine discharges are dry, white, crude, and without bile. His chapter on the treatment unfortunately is lost.

Cælius Aurelianus says that Themison was the first who explained the treatment of cachexia. He mentions as causes of the disease intemperance, the improper use of medicines, hardness of the liver or spleen, long-continued hemorrhoidal discharge, vomiting, protracted fevers, &c. His treatment is judiciously varied according to the cause of the disease, and is given at great length.

Aëtius gives a very interesting account of the views and practice of Archigenes. He says the disease is generally occasioned by scirrhus of the liver or spleen. Like our author, he recommends bleeding if not contra-indicated, and purging with drastic cathartics, such as the hiera from colocynth, friction, rubefacients, exercise, the bath, and thin white wines. Celsus admits of bleeding, but not until after purging, friction, unction, and exercise have failed to restore the health.

Serapion expresses himself in much the same terms as our author and Aëtius respecting venesection; but Avicenna recommends not to have recourse to it unless there be a sanguineous plethora. He also forbids baths of sweet water, but otherwise he adopts the treatment recommended by the Greeks.

SECT. XLVIII.—ON DROPSY.

When the liver is greatly congealed, sometimes primarily, as when it has been inflamed, indurated, or otherwise affected, or when from sympathy with other parts, the process of sanguification ceases, and the affection is called dropsy. When a great quantity of air is collected with a small quantity of fluid between the peritoneum and intestines, so that the abdomen when struck sounds like a drum, the dropsy in this case gets the name of tympanites, being formed by flatulence about the stomach, belly, and colon, and by chronic fevers. But sometimes from hardness of the peritoneum and of the uterus in women, or from scirrhus, on the contrary, a great collection of fluid with a very small proportion of air is formed in the same parts, being confined as it were in a bladder, when the dropsy is named ascites, and is occasioned by the afore-mentioned causes; but, for the most part, it arises from hardness and scirrhus about the spleen and liver, and from chronic defluxions about the intestines; whereby it happens that the belly is swelled, while the rest of the body is melted owing to its not being nourished. Sometimes throughout the whole body a colder and more pituitous blood is collected, either coming from the liver, or deriving its origin from a melting down of the flesh of the whole body, which is as it were converted into water, so that the whole body appears white and pituitous like a corpse, and then the affection is called leucophlegmatia, dropsy of the flesh, or anasarca, being occasioned by protracted fevers, cachexia of the stomach, suppression of long-continued hemorrhoidal discharges, the female flux, dyspnœa, inordinate insomnolency, and similar causes. In treating these complaints, we commence generally with evacuation; but in ascites and tympanites it is by administering hydrogogue medicines; and in anasarca by bloodletting, more especially when the affection is formed by retention of the hemorrhoidal or menstrual discharges, unless the patients had been previously bled for cachexia; and in this case, as in cachexia, the evacuation must be made at intervals. Then, having carefully triturated the dried dung of an ox of the herd, boil it in oxycrate or oxymel, and sprinkling on it a fourth part of sulphur, apply it over the whole belly; or, apply a cataplasm of goat’s dung with the urine of a child, made of the thickness of bath-sordes. These things purge strongly by the belly; and we may use cataplasms made of leaven, dried figs, calcined lime, nitre, iris, cardamom, native sulphur, ammoniac, bay-berries, stavesacre, the dung of wild pigeons, all or some of these may be used with oxymel. After which the epitheme, called spongium, made of goat’s dung, evacuates the fluids in a wonderful manner, both by the insensible pores and by the belly. Afterwards we must apply desiccative plasters, that from willows, the Icesian, the barber’s, that from bay-berries, the Polyarchium, and that from seeds. And the following one is wonderfully efficacious, for it fetches, as it were, the fluids from the deep-seated parts: Of the stone pyrites, dr. xij; of native sulphur, dr. xij; of ammoniac perfume, dr. xij; of cumin, dr. xvj; of nitre, dr. xij; add to a little wax and turpentine, and spreading it upon a piece of skin, apply to the whole belly. Let them take the propoma (liqueur) made by boiling the root of vervain-mallow in wine, or macerate the wild cucumber in austere wine, and give every three days, adding a cupful every day, until the dose amount to three cupfuls. The following is a very compound mixture: Of balsam, of nard, of cassia, of cumin, of liquorice, of St. John’s-wort, of bog-rush, of asarabacca, of carrot, of amomum, of myrrh, of Macedonian parsley, of sweet hay, of pepper, of hartwort, of cow-parsnip, equal parts. Each of these produces a good effect by itself, and in like manner all the diuretics. Squill baked and triturated with honey, and given as a linctus, provokes urine without trouble; or it may be boiled in the water which is drunk. And the following is an excellent remedy: Boil lb. ij of the inner part of squills in iij sextarii of austere wine until it be reduced to one third; give every day of this wine, beginning with a mystrum, until the dose amount to an ounce. The following is an excellent diuretic: Of moist alum, the size of a bean; dissolve in water; strain through a linen cloth; and give to drink every third day, or every alternate day. Picra given in oxymel, the theodoret, and the trochisk from bitter almonds also suit with them. There are many hydragogues, but the following are of approved efficacy: The seeds of the thymelæa (grana cnidia), xl or l; or lathyrides, xx or xxx; or of euphorbium, v or vj siliquæ; or of flakes of copper, dr. ij or iij; being mixed with crumbs of bread and formed into pills; or the juice of the rind of elder-root, drunk with prepared wine; or of the leaves of mezeron, of burnt copper, and of anise, equal parts; give in water at first to the amount of dr. j; and afterwards of dr. ij, or more. And the following are admirable pills: Of aloes, of euphorbium, of grana cnidia, of each, oz. j; of rhubarb, oz. ss; mix together with the juice of cabbage, and form into pills, and give to the amount of viij or ix siliquæ. And the antidote from cloves evacuates water in a wonderful manner. And we must try the effect of a hydragogue wine. The following makes an excellent one: Of squills, oz. iij; of parsley-seed, of the rind of the root of capers, of pepper, of each, dr. iv; of peeled grana cnidia, dr. j; of the Indian leaf, two balls; of best wine, xij heminæ; of raw honey, dr. xvj; beat together, sift, and macerate in the wine, but triturate the squill. The dose is three cyathi. After the evacuation of the water, we must use the theriac. And ox-dung dried and drunk to the amount of a spoonful every day is of mighty use. We must use the most stimulant clysters, unless the belly be spontaneously very loose, in which case we must rather use things for drying it up. When women are affected with dropsy we must use this pessary: Of anise, of cardamom, of cumin, of nitre, of birthwort, of fenugreek, of pennyroyal, of the inner part of figs, equal parts; mix together in the oil called Susinum, and apply per vaginam. Afterwards we may use the natural baths perseveringly, and the sand-bath, but we must abstain from the others; but if they do ever go into a bath, let them sprinkle the body with powders from nitre, salts, mustard, lime, and the like. These things even without bathing are useful, when rubbed into the belly in a dry state, or with oil. In anasarca they must exercise the other parts as much as possible, and use dry friction in the sun. And a desiccative diet should be taken. Let them, therefore, eat pickle, mustard, garlic, wild and dry fowls, asparagus, picktooth fennel, leeks, wild carrot, and the other wild pot-herbs; and the theriac salts, or those of Iamblichus may be mixed with condiments; and old light diuretic wine may be used, or if it is at hand, the wine prepared with salt water. But the patients must abstain from much drink of any kind, and from water altogether.

When the dropsy is attended with fever, the patient must abstain from the more heating and acrid food or remedies; but we may give them intermixed with other things in case of urgent necessity. In tympanites, purgatives and every medicine which wastes the body must be rejected, and also the more drastic diuretics; and we must use both externally and internally such things as can attenuate and dissipate the flatus; and dry-cupping may be frequently applied over the whole belly. When those who have ascites are not benefited by any of the remedies already described, we must have recourse to paracentesis, which does not apply to any of the other varieties of dropsy.

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COMMENTARY. See Hippocrates (de Intern. Affect. 25; de Ratione Victus in Morb. Acut.), and Galen’s Commentary on the same (Prognost.), with the Commentary of Stephanus (ed. Dietz), and almost all the authors who treat of hepatic diseases may be consulted.

Hippocrates gives a tolerably correct account of the causes and treatment of dropsy. The varieties of the disease described by him are dropsy from the drinking of cold water, from disease of the liver, and from disease of the spleen. He further states that it is frequently the consequence of protracted fevers, diarrhœa, dysentery, and quartan fevers (de Aer. &c.) He mentions a species of dropsy which he calls the dry (Aph. iv, 11), which has been generally referred to tympanitis. See Littré (t. iv, 416.) In certain cases attended with dyspnœa he recommends venesection; and Galen in his Commentary states that these cases are, when the disease is preceded by suppression of the hemorrhoidal or menstrual discharges, or is connected with plethora. But no one, he says, ventures to bleed in tympanites or ascites. Hence Avicenna and most of the ancient authorities forbid venesection in dropsy, except under the circumstances mentioned by Galen. Galen says, indeed, in his work (de Venesect. ad Erasistrat.) that he had sometimes cured dropsy by bleeding; but it is not to be understood that he approved of it as a common practice. In short, he was no Sangrado, but had anticipated Blackall. One of his hydragogue potions is composed of cantharides. (De Reg. in Morb. Acut.) Hippocrates recommends us to perform paracentesis thoracis in the side at the third rib from the last. He also approves of paracentesis abdominis in cases of ascites; and directs us to burn the region of the liver, when that viscus is affected. He further approves of free scarifications of the testicles and thighs. He has described hydrops uteri, or hydrometra, a case which, although of rare occurrence, is occasionally met with. See Van Swieten (Comment. 1224); Vesalius (de Fabrica Hum. v, 9); Monro (Works), and Dr. A. T. Thomson (Paper in the Med. Chir. Trans. xiii, 1.)

Galen gives a long list of external and internal remedies for dropsical complaints. (Sec. Loc. ix.) Ox-dung mentioned by our author was a common remedy in ancient times, according to Galen. Diogenes Laertius relates that the celebrated Heraclitus died lying in a bed of it. Upon the authority of Antonius Musa, Galen recommends a cataplasm containing elaterium, stavesacre, and hyssop. He recommends a vinous preparation of elder. Pliny particularly commends this medicine in dropsy, and most of the ancient authorities make mention of its diuretic properties. Galen says that the liver is affected in all cases of dropsy. (De Locis, v, 6.) In like manner Stephanus, the commentator on Hippocrates, states that in all cases of dropsy the liver is affected, either primarily or sympathetically. Hippocrates refers one species of dropsy to disease of the parts situated in the loins, by which Galen and Stephanus agree that he means the jejunum, mesaraic veins and kidneys. (Ed. Dietz. 139.)

Celsus describes three varieties of dropsy, namely, ascites, anasarca, and tympanites. He enjoins restriction as to food and drink, and recommends walking, friction, and sudorifics, such as heated sand and warm baths. He gives a long list of diuretics, as iris, valerian, saffron, cinnamon, &c. In tympanites he recommends emetics, cupping the belly, rubbing it with rubefacients, and applying sinapisms to it, or burning eschars on it with heated irons. In anasarca he recommends scarifications at the inner part of the leg, squills in a linctus, and the like. He approves of tapping in ascites.

Aretæus describes the symptoms of dropsy with great accuracy and elegance. He says it is a most unseemly disease, from which few recover, and those more by the aid of the gods than of art. He treats of the three varieties already mentioned, and also makes mention of hydatids. Hydatids, by the way, are described also by Galen (Comm. ad Aphor. vii, 55), and Rhases (Cont. vii). He remarks that it is wonderful how much the patient in dropsy flatters himself with hopes of recovery, more than in many other diseases far less dangerous. He states that there are partial dropsies, such as of the head, lungs, liver, spleen, and uterus. He mentions among the exciting causes of the disease the drinking of cold water, flatulent food, and the insect buprestis (meloe vesicatoria L.)

From a passage in Plutarch, it would appear that certain forms of dropsy had at one time been thought infectious. (De Serâ Num. Vind.)

Dioscorides and Ruffus praise elaterium as a hydragogue in dropsy. In the ‘Euporista,’ baked squills and oxymel are particularly commended, with various cataplasms externally.

Cælius Aurelianus states fully the causes of dropsy, such as cachexia, protracted fevers, hardness of the liver, spleen, peritoneum, or uterus; dyspnœa, cæliac affection, dysentery, retention of the hemorrhoidal or menstrual discharges, abstinence, an unseasonable draught of water, especially of salt water, the abuse of medicines, and so forth. He maintains, however, that the disease is the same, from whatever cause it arises. The common symptoms of all its varieties are said by him to be swelling, torpor, difficult breathing, disturbed sleep, thirst, diminished urine, and sometimes latent fever. He informs us that Erasistratus in his dissections generally found the liver indurated. His external applications are very similar to those of our author. He particularly commends a vinous tincture of squills as a hydragogue. He approves highly of paracentesis, and has answered all the objections which had been made to the operation. He mentions that Asclepiades practised scarifications at the ankles.

The ordinary cases of dropsy are well stated by Serenus Samonicus in the following lines:

“Corrupti jecoris vitio, vel splenis acervo, Crescit hydrops, aut cum siccatæ febre medullæ, Aut avidæ fauces gelidum hausere liquorem.”

Among his internal remedies he mentions broom-seeds, the wine of squills, elder, and hellebore.

Alexander states that a coldness of the liver is the cause of dropsy, in consequence of which it is no longer able to form blood, but converts the fluids into water, phlegm, or air. Hence the distinction of dropsy into ascites, anasarca, and tympanites. In certain cases of anasarca he permits venesection, in order to relieve the depression of the system. He adds afterwards that, if not only the liver, but also the spleen and stomach appear hard, and especially if combined with plethora of blood, venesection is to be had recourse to before all other remedies. But in ascites and tympanites he agrees with Galen in condemning venesection, and trusts principally to purging and friction. Like our author, he commends copper and the leaves of elder. Exercise, he says, is adapted in an especial manner to dropsical complaints, either by sea, on horseback, or in a couch. Horace, by the way, no doubt, alludes to the established practice of taking exercise for the cure of dropsy in the following passage:

“Atqui Si noles sanus, curres hydropicus.”

(Epist. i, 2.)

Alexander has stated correctly that the disease sometimes derives its origin from disease of the uterus, kidneys, spleen, liver, colon, heart, or other organ of the body. He remarks that dropsy is apt to come on in phthisical cases.

Our author has merely condensed the account given by Aëtius. His list of diuretics contains squills, spikenard, alum, spurge, burnt copper, &c. Like Hippocrates, he approves highly of scarifications at the inner ankle. Upon the authority of Antyllus, he recommends lying in heated salt. In like manner, Galen and some of the other authorities speak favorably of insolation while the patient lies on sand, wheat, or the like. The sand-bath is mentioned as a remedy for dropsy by the earlier modern writers on medicine. See Theodoricus (iii, 33).

Leo, like preceding authorities, refers all dropsies to a coldness of the liver, and says they are mostly incurable. We do not find that Avicenna, Rhases, Avenzoar, and Serapion make any material alteration on the practice of the Greeks. In certain cases of anasarca they permit venesection, but generally condemn it in ascites. They praise mezereon or the chamelæa strongly as a diuretic; and also make mention of colocynth and scammony. Haly Abbas treats separately of anasarca, ascites, tympanites, and dropsy from a hot cause. When anasarca is connected with an obstructed secretion, he approves of bleeding; and, in general, recommends abstinence from drink, exercise in the sun, friction with sand or hard towels, sulphureous baths and diuretics. He concludes with an advice not to persevere too long in the use of any one medicine. In the treatment of ascites, he recommends mezereon, colocynth, &c., but disapproves in general of paracentesis. For tympanitis he prescribes various carminatives, such as parsley, fennel, spikenard, mastich, southernwood, melilot, &c. Alsaharavius expresses himself strongly in favour of venesection for anasarca; and for all kinds of dropsy recommends the sand-bath, sudorifics, and the common remedies mentioned above. The general causes of dropsy upon which Rhases most insists are induration of the liver and debility of the kidneys, so that they no longer attract the aqueous superfluity of the blood. He approves of paracentesis and scarifications of the feet and testicles when they are much swelled. Among his hydragogues, the most powerful are white hellebore, elaterium, scammony, and euphorbium. He mentions that he had known several dropsical cases cured by a spontaneous diarrhœa, and hence he recommends us not to stop one when it comes on. When dropsy is connected with the retention of a natural evacuation, he approves of bleeding. He speaks favorably of the elder as a diuretic.

SECT. XLIX.—ON THE SPLEEN.

The use of the spleen being to attract from the liver the melancholic humour, which is, as it were, the lees of the blood, if its attractive power be weakened, or the passage obstructed by which this was formerly attracted, the black jaundice is formed, blood in an unpurified state being distributed over the whole body; and if there be weight and distension about the spleen, or if there be also pain, obstruction is indicated; but if there be none of these, it is weakness of the attractive power. But vomiting of black bile taking place without fever, or any other symptom of malignity, indicates a weakness of the retentive faculty of the spleen. A weakness of the expulsive faculty will bring on anorexia, the melancholic superfluity being no longer carried to the orifice of the stomach and exciting the appetite. When the melancholic humour is infarcted in the spleen, in the first place inflammation of it occurs, indicated by heat, pain, and tightness, but afterwards it passes into scirrhus, the heat and pain having ceased, while the swelling and hardness remain. Persons thus affected have fetor of the mouth, their gums are corroded, and ulcers in their legs are difficult to heal. When the liver sympathises, dropsy takes place, as formerly mentioned; wherefore intemperaments of it are to be cured like those of the liver. But when inflammation is present, we must bleed from the left arm at the elbow, or at the extremity of the hand, in order that revulsion may take place from as great a distance as possible, and also because of some natural alliance between these parts. Then we are to apply a cataplasm of attenuants which are not manifestly caleficient, intermixing some of the astringents with them. Such is that natural substance called the flower of salt. And this is an admirable cataplasm: Of fenugreek, oz. iv; of barley-flour, of cresses, of each, oz. j; of fat figs, lb. j; of the herb vervain dried, oz. j; macerate the figs in the most acrid vinegar, and boil with the other things already bruised together, and then boil again; or apply goat’s dung boiled with raw barley-meal in oxycrate; and, if you choose, it may receive also some flower of salt. But having first used a fomentation of oil of privet with a little vinegar, use the emollient ointments; and first the more simple, such as this: Of wax, lb. iss; of the fat of bulls, lb. j; of nitre, oz. iij; of turpentine, of the fruit of the chaste-tree, of the bark of the root of capers, of each, oz. v; having boiled the soluble ingredients, sprinkle the powders above. And the malagma of Nileus is an excellent one. If the inflammation is converted into scirrhus, we must use the most powerful applications so as to stimulate the skin, such as the one from goats’ dung, and that from citrons, also that of Macherion, the barber’s, the one from bay-berries, and that from willows. This one I have found to answer upon trial: Of arsenic, oz. ij; of sandarach, oz. ij; of wax, of turpentine, of each, lib. j; of dry pitch, lb. j; of galbanum, oz. j; of opopanax, oz. j; of the bark of the root of capers, of nut ben, of each, oz. iv; of ammoniac perfume, scr. vj; of the oil of nard, and of privet, oz. v. And ammoniac, when rubbed over the spleen with vinegar, is often of great use, and also, when drunk to the amount of three or four scr. with one scr. of castor, while sitting in the hip-bath, having previously chewed dried figs and spit them out. Or of ammoniac, p. j; of castor, p. j; give one drachm of these things, and it will be of great service for scirrhus; and, in like manner, the bark of capers, triturated with vinegar and applied. The same, when drunk with vinegar or oxymel, evacuates thick and viscid humours, and sometimes blood. And the bark of the willow is rubbed in similarly. And the ashes of the brazier’s shop, when applied with raw barley-meal in oxymel, is of use; and the juice of centaury, when applied externally, and when taken in a draught; and the decoction of bitter lupines, when drunk with rue and pepper; and its flour, when applied as a poultice; and the water in which heated iron has been often extinguished, when given to the amount of three cyathi to such as have fever; and to such as are free from fever, to the amount of one cyathus with wine and vinegar; or the root of the wild dock with squills, to the amount of three oboli; or of wall germander, and of wild thyme, an acetabulum; all these may be given with oxymel; or, give two oboli of the juice of the pimpernel having a blue flower (anagallis cærulea?) with oxycrate; or vinegar of squills, or oxymel. These are compound medicines: Of the root of panacea, of ammoniac perfume, of the rind of the root of capers, of fuller’s herb, of the inner part of baked squills, equal parts; give one drachm. It is also of use in asthmatic and dropsical cases.—Another: Of the fruit of tamarisk, dr. iv; of pepper, dr. iv; of spikenard, dr. ij; of ammoniac perfume, dr. ij; triturate with vinegar of squills, and give one drachm in oxymel.

For scirrhus of the spleen. Of sow-bread, dr. xx; of bryony, dr. iij; of dittany, dr. ij; of baked squills, dr. viij; of fuller’s herb, dr. vj; of the root of capers, dr. vj. Give a trochisk to the amount of three oboli in oxymel. And the trochisk from heath is also applicable. The food should be attenuant, acrid, and dry; little drink should be taken; but exercise, friction, and sinapisms should be had recourse to, and sometimes cupping with scarifications.

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COMMENTARY. Hippocrates describes several diseases of the spleen in his work, ‘de Internis Affectionibus.’ He states that in scirrhus the spleen is sometimes larger and sometimes smaller than natural. It is an affection which continues long, but is not fatal. Sometimes, he says, it terminates in dropsy, and sometimes in suppuration, when he approves of burning the side. He also recommends diuretics and purging with hellebore. The description which he gives of the symptoms of enlarged spleen, in his work ‘On Airs, &c.,’ is very curious. Dr. Coray considers that it applies to scurvy. (See Notes, &c. 29.)

Aretæus remarks correctly that the spleen is very subject to scirrhus, but little so to suppuration. Scirrhus, he says, is removed with difficulty.

For scirrhous enlargement of the spleen, Celsus recommends unction, friction, and sudorifics. He forbids all sweet things, milk and cheese. He approves of pickled and salted things, acids, the vinegar of squills, a decoction of wormwood, and water in which a red-hot iron has been extinguished. Emollient ointments are to be applied externally.

Cælius Aurelianus says that some had directed the spleen to be cut out when it is much diseased, but he holds the proposal as mere words of course, and believes that the operation had never been performed.

Octavius Horatianus recommends as general remedies for complaints of the spleen, bleeding, purging, and fomentations with wool soaked in equal parts of oil and vinegar. When it becomes indurated he approves of vinegar of squills, friction, gestation, dropaces, salt baths, &c.

Most of our author’s remedies are taken from Galen, who treats fully and scientifically of diseases of the spleen. He states, as a general principle of treatment, that the proper medicines in cases of indurated spleen are such as are of an incisive and attenuant nature. He, therefore, approves of the mixture of bitter with austere things.

Alexander forbids strong purging in the beginning of an inflammation either of the liver or spleen.

The Arabians treat of these affections similarly to the Greeks. Haly Abbas remarks that the spleen can bear much stronger medicines than the liver, and recommends in the indolent diseases of it various bitter and very acid medicines. In inflammation he very properly bleeds. These are his general principles of treatment, the detail of which he explains at great length. Avicenna and Alsaharavius treat of these diseases more minutely than any other of the ancient authorities. Rhases recommends camel’s milk in cases of indurated spleen. He joins Archigenes in directing the application of sinapisms and leeches to the side.

SECT. L.—ON JAUNDICE.

Jaundice is a diffusion of bile over the whole body, sometimes of black, as we stated when treating of diseases of the spleen, and sometimes of yellow. There are many varieties of this complaint, the causes and diagnosis of which are as follows: If jaundice occurring suddenly in a febrile complaint diminish the fever, it is critical, being occasioned by a metastasis of the matter from the deep-seated parts, and, therefore, stands in no need of medicines, but is soon removed by baths and friction. But if it is attended with fever and bilious evacuations from the bowels, and if there be a sense of weight in the right hypochondrium, a hot inflammation of the liver is indicated, by which the blood, being rendered bilious, is conveyed over the whole body. When there is heat in the part without a sense of weight, the affection is occasioned by a hot intemperament alone of the liver. If it is without fever, and the alvine discharges are white, an affection of the gall-bladder, or of its ducts, is indicated. When there is a sense of heaviness in the right hypochondrium, it indicates that the ducts are obstructed; but when without heaviness, weakness of some of its powers is indicated, either of the attractive, by which it attracts the bile from the liver, or of the expulsive, by which it propels the bile to the intestines. For when the blood is not purged of bile, it is diffused over the whole body (as we stated respecting the black jaundice); in which case the urine is voided very much mixed with bile. But jaundice is also occasioned by a hot intemperament of the solid parts, which convert into bile whatever is brought to them in place of food, in like manner as in anasarcous complaints a conversion to a pituitous fluid takes place. This variety of jaundice is recognized by its not occurring at once but by degrees, none of the afore-mentioned symptoms being present. Moreover jaundice is occasioned also by drinking certain deleterious medicines, and by the external application of poison from some venomous animal. The cure of a hot intemperament of the liver, and of inflammation of it, and of weakness of its powers, we have treated of under the head of the affections of it; and what we said there is to be applied here without alteration, that we may not be obliged to repeat the same thing. When both the ducts of the gall-bladder are obstructed, or either of them only, we must let blood from the right arm. But some, both in this case and in jaundice from inflammation of the liver, open the vessel near the middle finger of the right hand. And we must use anti-inflammatory cataplasms, and purge with hiera. But persons affected with jaundice must take the propomata from a decoction of parsley, maiden-hair, or dock, or of wild thyme, reduced to a third part; or sprinkle wormwood on the potion. Two cyathi of the juice of radish, drunk with a cyathus of wine, is also of great use; also two or three cyathi of succory alone, and with wine. In cases of jaundice from inflammation of the liver, give a draught of mulse, or of a decoction of slender birthwort, or of St. John’s wort, or of maiden-hair, or of fuller’s herb, or of madder, in like manner; or a drachm of the shavings of hartshorn with wine, or the decoction of carrot boiled in wine to one third; or they may take a drachm of native sulphur in eggs. These things are of great use also in obstruction. But viij scruples of the seed of orache, with Chrysattic, or any other must, if drunk when in the bath, effect a proper evacuation. But the picra may be properly given in powder, or with oxymel, and the one called Theodoret; likewise the trochisk from bitter almonds. Give also of cinnamon what can be lifted with three fingers in a cyathus of mulse, or in mixed water; or of myrrh, the bulk of a bean, with twenty seeds of pepper, and the same quantity of cinnamon. Those affected with jaundice, owing to a warm intemperament of the solid parts, are to be treated with gentle friction, moderate exercise, unction and baths, with a moistening and moderately cooling diet, the juice of ptisan, intybus, endive, succory, fish, and light watery wine. The treatment of those who are affected with jaundice from drinking some deleterious substance, or from the bite of some venomous animal, will be laid down in the Fifth Book. When bile is lodged in the vessels of the face and eyes, inject elaterium to the size of a vetch, with a woman’s milk, into the nose while in the bath, and then direct the person to descend immediately into it, but not to immerse his head; and after the bath, having given him a recruiting diet, again inject the errhine in the sun. The juices of sow-bread, of horehound, and of gith act in like manner. But let him draw into his nostrils, while seated in the bath, some acrid vinegar, and compress his nostrils for a short time, and it will produce a wonderful discharge.

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